ED Pathway for Evaluation/Treatment of Infants > 28 Days of
Age and Children with Severe Sepsis
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CRITICAL - Activate Resuscitation Team
ACUTE - Patient to Room, Notify Team Attending
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10 min
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MD/CRNP/RN Rapid Assessment
Begin High Flow Oxygen
Immediate IV Access, IV Access Escalation Plan
Order Labs, IV Fluids, Antibiotics
Assure 1st Antibiotic Given within 1st Hour
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0-20 min
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Rapid Fluid Resuscitation
Order Dopamine to Bedside

Correct Hypoglycemia, Hypocalcemia
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Rapid NS
20 mL/kg boluses
Repeat as needed
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40 min
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Fluid Refractory Shock
Titrate Dopamine up to 10 mcg/min
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60 min
Consider Observation in ICU
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Epinephrine infusion
Norepinephrine
Consider Hydrocortisone
for Catecholamine Resistant Shock
RAPID TRANSFER TO PICU WITHIN 1 HOUR
Posted: July 2011
Revised: October 2011
Authors: J. Lavelle, MD, D. Davis MD, M. Mittal, MD, H. Scott, MD, C Jacobstein, MD, E. Alpern, MD, D. Davis, MD, J. Gerber, MD, T. Metjian, PharmD, J. Fitzgerald, MD, L. Hutchins, CRNP, D. Potts, RN