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Sepsis

Definition 

Inadequate tissue perfusion and oxygen delivery as a result of bacteremia and/or septicemia, leading to multi-organ system failure.

Clinical Presentation

Septic shock can be recognized before hypotension occurs by the clinical triad:

  • Hypothermia or hyperthermia
  • Altered mental status and low urine output
  • Peripheral vasodilation (warm shock)
  • Or cool extremities (cold shock)

Guidelines

  1. Early resuscitation of septic shock with fluid and inotropic therapies improves survival in a time-dependent manner.
  2. Maintain airway.
  3. Establish vascular access. DO NOT delay with multiple attempts. Consider IO (intraosseous line) if unsuccessful attempts in 90 seconds.
  4. Aggressive fluid resuscitation and inotropic support as per protocol. (Refer to Fluid Management protocol and Pediatric Vasoactive Drug Protocol.  Obtain blood cultures and start antibiotic therapy (consider Cefotaxime (Claforan) or Ceftriaxone (Rocephin). 
    1. NOTE: DO NOT DELAY ANTIBIOTICS pending obtaining cultures.
  5. Consider early mechanical ventilation to decrease work of breathing.
  6. Correct metabolic acidosis with Sodium bicarbonate boluses ONLY if evidence of impaired myocardial function due to extreme metabolic acidosis. 
    1. NOTE: Must have adequate ventilation and perfusion before administering.



Citations/References:

  1. (2013, February). Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock 2012. Critical Care Medicine, 41(2).
  2. Nguyen, H. B., Corbette, S., Steele, R., Banta, J., Clark, R., Hayes, S., Wittlake, W. (2007).Implementation of a bundle of quality indicators for the early management of severe sepsis and septic shock is associated with decreased mortality. Critical Care Medicine, 35(4), 1-7