2.17P Sepsis-Pediatric

IDENTIFICATION OF POSSIBLE SEPTIC SHOCK

• Suspected infection – YES

• Evidence of sepsis criteria-YES (2 or more):

• Temperature less than 96.8° F or greater than 100.4° F

• Heart Rate greater than normal limit for age (heart rate may not be elevated in septic   

               hypothermic patients) AND at least one of the following indications of altered organ function                    

• Altered mental status (decreased, irritable, confused)

• Capillary refill time < 1 second(flash) or > 3 seconds

• Mottled cool extremities

• Decreased urine output

NOTE: Consider early consultation with Medical Control for suspected pediatric septic shock patients.

EMT STANDING ORDERS 

∙    1.0 Routine Patient Care

∙    Notify hospital of incoming Sepsis Alert prior to arrival if applicable. 

∙    Monitor and maintain airway and breathing as these may change precipitously.

∙    Administer oxygen and continue regardless of oxygen saturation levels.

∙    Obtain blood glucose reading if available.

∙    Do not delay transport.

ADVANCED EMT STANDING ORDERS 

∙    IV/IO fluids should be titrated to attain normal capillary refill, peripheral pulses,

     and level of consciousness.

∙    Administer fluid boluses of 20 mL/kg of 0.9% NaCl by syringe push method:

   o Reassess patient immediately after completion of bolus and repeat 2    

           times (max 60 mL/kg) if inadequate response to boluses.

NOTE: Reassessment of patient after boluses should include assessment of

improving clinical signs and signs of volume overload (rales, increased work 

of breathing, or increased oxygen requirements).

PARAMEDIC STANDING ORDER 

• If there is no response after 3 fluid boluses, contact Medical Control to consider:

     o Additional fluids     OR

∙    Epinephrine infusion: 0.1 mcg/kg/min IV/IO, titrate to maintain perfusion with a max dose of

       1 mcg/kg/min. 

       Recommended administration via infusion pump.

PEARLS:

• To stabilize blood pressure-titrate infusions to maintain perfusion.  

• Blood pressure can be assessed by using this formula: 70+(age in years times 2). 

• Sepsis is a systemic inflammatory response due to infection.  Frequent causes of septic shock include urinary, respiratory, or gastrointestinal infections and complications from catheters and feeding tubes.  Patient who are immuno-compromised are also susceptible to sepsis.

• Septic shock has a high mortality and is one of the leading causes of pediatric deaths.

• Aggressive IV therapy and early antibiotic significantly reduce death.