ED Pathway for Evaluation/Treatment of Infants > 28 Days of Age and Children with Severe Sepsis

Detailed H&P to Identify Source of Infection

HPI
  • Height and duration of fever
  • Oral intake / urine output in past 24 hours
  • Presence of headache, neck pain
  • Change in behavior/mental status
  • Cough, rhinorrhea, shortness of breath, sore throat
  • Abdominal pain /vomiting/diarrhea, fluid loss in past 24 hours
  • Dysuria frequency, urgency, back pain
  • Vaginal discharge, recent sexual activity, LMP if adolescent female
  • Joint or muscle pain, swelling or redness
  • Rash
  • Any recent wounds/breaks in skin integrity
  • Ill contacts, recent immunizations
  • Current or recent antibiotic use
PMH
  • Any underlying illness
  • Any immunosuppressive condition
  • Central line
  • Past surgical history
  • Allergies to medications, contrasts, blood products
  • Medication history (steroid treatment > 2 weeks)
  • Birth history
  • Immunization history
Physical Assessment
  • VS, weight
  • General appearance
  • Detailed exam including:
    • Rash, signs of meningitis/pneumonia/abdominal infection
  • Consider pelvic exam in an adolescent female if concern for PID or retained tampons as the source of sepsis