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Protocols ST Helens Adult Sepsis Management Pathway

1) This document outlines an adult sepsis management pathway for confirmed or suspected non-neutropenic sepsis. 2) It provides guidance on initial steps that should be completed within the first hour of diagnosis, including administering antibiotics and IV fluids, obtaining blood cultures and labs, and assessing vital signs. 3) It also provides criteria for severe sepsis and septic shock that should trigger escalation of care and referral to intensive care, including signs of end organ dysfunction like elevated lactate or decreased urine output.

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108 views1 page

Protocols ST Helens Adult Sepsis Management Pathway

1) This document outlines an adult sepsis management pathway for confirmed or suspected non-neutropenic sepsis. 2) It provides guidance on initial steps that should be completed within the first hour of diagnosis, including administering antibiotics and IV fluids, obtaining blood cultures and labs, and assessing vital signs. 3) It also provides criteria for severe sepsis and septic shock that should trigger escalation of care and referral to intensive care, including signs of end organ dysfunction like elevated lactate or decreased urine output.

Uploaded by

putra purnomo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Name

Adult Sepsis Management Pathway


Hospital No (Non Neutropenic Sepsis)
Complete and Insert in Patient Notes
DOB
Time (Zero) Now: Date: Bleep: Name:

Confirmed or Suspected Infection Within 1st Hour of Diagnosis

Chest Urinary CNS (Meningitis) Y


S E Lactate Stat Abx Time
Skin Abdomen Joint
E S
Unknown ________________________________ Antibiotic
P Iv Access Blood Gases CXR
S & Blood Cultures – 2 sets (Ideally Prior to antibiotic administration)
I At least 2 SIRS or General Variables Bloods: FBC / U&E / LFTs / CRP / INR / BMs
S BP: Aim for urine output (UOP) of > 0.5ml / kg / hr
HR>90 T° >38° or <36°C Acute Confusion Oxygen: Aim for SATS 88-92 in type 2 Respiratory failure or COPD and
RR>20 WBC>12 or <4 Raised CRP 94-98 in others Hourly MEWS
BMs: >7.7 mmol/L in Non Diabetic Now Check Below for any signs of Severe Sepsis

S Any Features of Severe Sepsis? (i.e. End Organ Dysfunction) Within 3 hrs of Diagnosis
E
V
Mortality 20 - 35% Ensure all above steps have been Completed And
Lactate > 2 YES Source Control
E
Creatinine > 177 µmol/L or
R Consider Urinary Catheterisation ! Infection Risk
Creatinine of > 45 µmol/L over baseline
E Fluid Resuscitate with either Saline or Hartmans.
Oliguria <0.5mls/kg/hr for >2hrs to be reviewed by SpR / Cons
Altered Mental State
Unless CCF / HF give 1st Litre as Stat and fluid boluses 30mls/kg/hr of
S Crystalloid or equivalent if Hypotensive or Lactate > 4mmol / L
E
Platelets<100
P BP Low<90 systolic NO Observe Hourly Repeat Lactate in 1hr Half Hourly MEWS
S Bilirubin>35 µmol/L Inform Senior
INR>1.5 if NOT improving
Refer to ITU / Critical Care if Lactate Not improving or deteriorating
I
S Hypoxia pO2<8.0 Now Check Below for any signs of Septic Shock

S Septic Shock Ensure all above steps have been Completed &
H Mortality Very High 40-60% Urgent referral to ITU / Critical Care
O Continue with aggressive Fluid Resuscitation
As above and Profound Hypotension (BP less than 90 Systolic) Consider Central Venous Access
C Hypotension Resistant to Fluid Challenges Urinary Catheterisation
K
15 min MEWS
CM - V-2 Oct 2013

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