Critical Sepsis- Emergency Department - Arkansas Children's Hospital
Signs & Symptoms of Critical Sepsis
Hypotension (MAP 5th percentile for age)
Tachycardia Poor perfusion Reduced urine output Tachypnea/new oxygen
requirement Mental status changes
Critical Sepsis- Emergency Department
Inclusion Criteria: Any patient > 30 days old with clinical concern for critical sepsis/septic
shock OR Sepsis RED AND ED Attending/Fellow assessment with concern for critical sepsis/
septic shock Exclusion Criteria:
Burn patients
!
RN calls SEPSIS Triage Alert for SEPSIS REDs
Primary team huddle to evaluate for sepsis (RN/Team Leader, LIP, Surgeon when appropriate)
Notify Attending Deviation from pathway requires detailed documentation
SHOCK TIME GOALS
Time Zero = Patient flags sepsis red
Does patient meet Critical SEPSIS criteria?
NO
OFF PATHWAY Resume routine care
YES
5min
Activate Critical Sepsis Pathway/Order Set
Provide supplemental oxygen as needed (oral/nasal ETCO2 for perfusion deficits)
Reassess vital signs every 5 minutes
Order appropriate antibiotics
15min
Access
Place 2 large bore PIVs if no central line
Consider PIV in patients with central line
If 2 unsuccessful IV attempts: consider IO
Labs
Blood/urine cultures
iSTAT VBG POCT Glucose CBC + diff UA BMP CRP
!
Correct glucose and calcium
Procalcitonin
Consider Type & Screen
Lactate-order STAT
Magnesium
Phosphorus
Consider PT/PTT/d-dimer
Consider lumbar puncture ................
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