IDENTIFICATION OF POSSIBLE SEPSIS:

• Suspected infection - YES
• Evidence of sepsis criteria - YES (2 or more):
  • Temperature < 36°C or > 38.3°C (< 96.8°F or > 101°F).
  • Heart rate > 90 bpm.
  • Respiratory rate > 20 bpm
  • Systolic blood pressure (SBP) < 90 mmHg OR Mean Arterial Pressure (MAP) < 65mmHg.
  • New onset altered mental status OR increasing mental status change with previously altered mental status.
  • Lactate ≥ 2 o ETCO2 < 25 mmHg.

IF POSITIVE SEPSIS SCREEN, NOTIFY RECEIVING FACILITY OF A “SEPSIS ALERT”.

EMT STANDING ORDERS:

• Routine Patient Care.
• Administer oxygen as appropriate with a target of achieving 94 - 98% saturation.
• Check finger stick glucose by glucometer.
• Do not delay transport.
• Call for AEMT/Paramedic intercept & assist them in patient care.

ADVANCED EMT STANDING ORDERS

• Establish IV/IO access. Do not delay transport to start IV/IO.
• If Suspected Septic Shock, administer 500 ml of normal saline bolus. Repeat a second bolus of 500 ml of normal saline if systolic BP remains less than 90-100 mmHg. Maximum 2 liters
• Consider Dopamine infusion 5-20mcg/kg/min titrated to maintain a systolic pressure of 90mmHg and above.
• Reassess the patient after each 500 mL administration, with special attention given to lung examination to ensure volume overload does not occur.

PARAMEDIC STANDING ORDERS

• Obtain serum lactate level (if available and trained)
• If Suspected Septic Shock, administer 500 ml of normal saline bolus. Repeat a second bolus of 500 ml of normal saline if systolic BP remains less than 90-100 mmHg. Maximum 2 liters
• Consider Dopamine infusion 5-20mcg/kg/min titrate to maintain a systolic pressure of 90mmHg and above if inadequate response
• Epinephrine infusion 2 - 10 mcg/min infusion IV/IO.
• Continue fluid administration concurrently with pressure administration. Titrate to MAP ≥ 65 (systolic bp ≥ 90).

PEARLS:

• Sepsis is a systemic inflammatory response due to infection, often resulting in significant morbidity and mortality. Septic shock is diagnosed if there is refractory hypotension that does not respond to fluid therapy.
• Severe septic shock has a 50% mortality rate and must be treated aggressively.
• Suspect infection in patients with cough, an indwelling catheter, open wounds, paralysis, recent antibiotic use, or bedridden or immuno-compromised individuals.
• IV fluid administration and early antibiotics reduce mortality in septic patients.
• Notifying Emergency Departments of patients with possible septic shock may improve outcomes.
• When administering vasopressors, monitor IV site for signs of extravasation.