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Get NHS Adult Sepsis Management Pathway 2013-2021

Name Adult Sepsis Management Pathway Hospital No Non Neutropenic Sepsis Complete and Insert in Patient Notes DOB Time Zero Now Date Bleep Within 1st Hour of Diagnosis Confirmed or Suspected Infection S E P I V R H O C K Y Chest Urinary CNS Meningitis Skin Abdomen Joint Unknown At least 2 SIRS or General Variables Acute Confusion Raised CRP Stat Abx Time Antibiotic Now Check Below for any signs of Severe Sepsis Any Features of Severe Sepsis i.e. End Organ Dysfunction Mortality 20 - 35 Lactate 2 Creatinine 177 mol/L or Creatinine of 45 mol/L over baseline Oliguria 0. 5mls/kg/hr for 2hrs Altered Mental State Platelets 100 BP Low 90 systolic Bilirubin 35 mol/L INR 1. 5 Hypoxia pO2 8. 0 Iv Access Blood Gases CXR Blood Cultures 2 sets Ideally Prior to antibiotic administration Bloods FBC / U E / LFTs / CRP / INR / BMs BP Aim for urine output UOP of 0. 5ml / kg / hr Oxygen Aim for SATS 88-92 in type 2 Respiratory failure or COPD and 94-98 in others Hourly MEWS HR 90 T 38 or 36 C RR 20 WBC 12 or 4 BMs 7. 7 mmol/L in Non Diabetic YES to be reviewed by SpR / Cons NO Observe Hourly Inform Senior if NOT improving Septic Shock Within 3 hrs of Diagnosis Ensure all above steps have been Completed And Source Control Consider Urinary Catheterisation Infection Risk Fluid Resuscitate with either Saline or Hartmans. Unless CCF / HF give 1st Litre as Stat and fluid boluses 30mls/kg/hr of Crystalloid or equivalent if Hypotensive or Lactate 4mmol / L Refer to ITU / Critical Care if Lactate Not improving or deteriorating Repeat Lactate in 1hr Urgent referral to ITU / Critical Care Continue with aggressive Fluid Resuscitation Consider Central Venous Access Urinary Catheterisation Mortality Very High 40-60 As above and Profound Hypotension BP less than 90 Systolic Hypotension Resistant to Fluid Challenges 15 min MEWS CM - V-2 Oct 2013. 5mls/kg/hr for 2hrs Altered Mental State Platelets 100 BP Low 90 systolic Bilirubin 35 mol/L INR 1. 5 Hypoxia pO2 8. 0 Iv Access Blood Gases CXR Blood Cultures 2 sets Ideally Prior to antibiotic administration Bloods FBC / U E / LFTs / CRP / INR / BMs BP Aim for urine output UOP of 0. 5 Hypoxia pO2 8. 0 Iv Access Blood Gases CXR Blood Cultures 2 sets Ideally Prior to antibiotic administration Bloods FBC / U E / LFTs / CRP / INR / BMs BP Aim for urine output UOP of 0. 5ml / kg / hr Oxygen Aim for SATS 88-92 in type 2 Respiratory failure or COPD and 94-98 in others Hourly MEWS HR 90 T 38 or 36 C RR 20 WBC 12 or 4 BMs 7. 5ml / kg / hr Oxygen Aim for SATS 88-92 in type 2 Respiratory failure or COPD and 94-98 in others Hourly MEWS HR 90 T 38 or 36 C RR 20 WBC 12 or 4 BMs 7. 7 mmol/L in Non Diabetic YES to be reviewed by SpR / Cons NO Observe Hourly Inform Senior if NOT improving Septic Shock Within 3 hrs of Diagnosis Ensure all above steps have been Completed And Source Control Consider Urinary Catheterisation Infection Risk Fluid Resuscitate with either Saline or Hartmans. 7 mmol/L in Non Diabetic YES to be reviewed by SpR / Cons NO Observe Hourly Inform Senior if NOT improving Septic Shock Within 3 hrs of Diagnosis Ensure all above steps have been Completed And Source Control Consider Urinary Catheterisation Infection Risk Fluid Resuscitate with either Saline or Hartmans. Unless CCF / HF give 1st Litre as Stat and fluid boluses 30mls/kg/hr of Crystalloid or equivalent if Hypotensive or Lactate 4mmol / L Refer to ITU / Critical Care if Lactate Not improving or deteriorating Repeat Lactate in 1hr Urgent referral to ITU / Critical Care Continue with aggressive Fluid Resuscitation Consider Central Venous Access Urinary Catheterisation Mortality Very High 40-60 As above and Profound Hypotension BP less than 90 Systolic Hypotension Resistant to Fluid Challenges 15 min MEWS CM - V-2 Oct 2013. .

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