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ALERT
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| – Administer appropriate parenteral antibiotic within 1 h of sepsis recognition. The choice of antibiotics will depend on likelihood of specific infection, the patient immune status and allergies. |
| – Consider the following consults (if sepsis source known): |
| • Infectious Disease. |
| • General Surgery. |
| • Interventional Radiology. |
| – Activate Sepsis Response Team (if applicable to area) or appropriate resuscitation personnel is not available |
| Components of the order set checked by the provider: |
| 1. Organ Perfusion: |
| a. Obtain arterial blood gas every ____ hour(s) for ____ hours. |
| b. Obtain central venous saturations (ScvO2 or SvO2) every _ (1-2 h) place as guide under line___ hour(s) for __ 6 (pre-filled)__ hours. |
| c. Obtain Point Of Care serum lactate STAT. (should be a pre-checked box electronically). |
| d. Obtain serum lactate every _ (1-2 h) place as guide under line___ hour(s) for __ 6 (pre-filled)__ hours. (should be a pre-checked box electronically) |
| 2. Lab: Serum fasting glucose (not pre-checked). |
| 3. Blood type and screen. |
| 4. Vascular Access: |
| a. Insert central line (do not have pre-checked). |
| 5. Antibiotics |
| a. (Various choices of antibiotics are listed and appropriate check boxes are present to be clicked). |
| 6. Volume resuscitation: (At least 30ml/kg liters of fluid of one of the following). |
| a. Lactated Ringers 1000 mL IV PRN over 15 min up to a maximum of _____ mL until one of the following are achieved: |
| b. 0.9% NaCL 1000 mL IV PRN over 15 min up to a maximum of _______ mL or for 24 h until one of the following is achieved: |
| c. Albumin 5% 500 mL IV PRN over 15 min up to a maximum of _____ mL until one of the following is achieved: |
| i. To keep central venous pressure (CVP) at 12–15 mmHg (mechanically ventilated) or 8–12 mmHg (not mechanically ventilated). |
| ii. Central Venous Pressure (CVP) ≥ 8 (on Mechanical Ventilation ≥ 12) mmHg. |
| iii. MAP ≥ 65 mmHg and lactate <2.5 mmol/L and UO > 0.5 ml/kg/hr. |
| iv. Lack of fluid responsiveness based on dynamic or static variables assessment. |
| 7. Vasopressor infusion: Note: Recommend use only with central line, but in extreme emergency, vasopressors may be given for a brief period of time via peripheral site with constant monitoring for extravasation. Vasopressor should be administered for MAP <65 mmHg despite fluid challenge (30 ml/kg) (OR) MAP <50 mmHg for ≥ 15 min. |
| a. Norepinephrine infusion 0.05 mcg/kg/minute, titrate by 0.05 mcg/kg/minute every 5 min to keep MAP ≥ 65 60–80 mmHg. |
| b. Vasopressin 0.03 units/minute, do not titrate. |
| c. Phenylephrine infusion 0.5 mcg/kg/minute, titrate by 0.1 mcg/kg/minute every 5 min to keep MAP ≥ 65 60–80 mmHg. |
| d. Epinephrine infusion 0.05 mcg/kg/minute, titrate by 0.05 mcg/kg/minute every 5 min to keep MAP ≥ 65 60–80 mmHg. |
| 8. Target ScVO2 ≥ 70 (or SvO2 less than 65%) and downward trending Lactate towards normal values by considering (one or more of the following): |
| a. If ScvO2 less than 70% or SvO2 less than 65% (decreased oxygen delivery in spite of adequate volume replacement and preload): |
| i. Dobutamine infusion 5 mcg/kg/minute titrate by 2.5 mcg/kg/minute every 10 min up to a maximum of 15 mcg/kg/minute to keep ScvO2 greater than 70% or SvO2 greater than 65%. |
| ii. Milrinone 0.375 mcg/kg/minute titrate up to a maximum of 0.75 mcg/kg/minute to keep ScvO2 greater than 70% or SvO2 greater than 65%. |
| b. If anemia present, consider transfusing packed red blood cells for a hemoglobin level less than 710 mg/dL. |
