ICU Pathway for the Evaluation/Treatment of Infants > 28 Days and Children with Severe Sepsis/Septic Shock

History and Physical, Infection Source Control

Review of detailed H&P findings, imaging studies, and laboratory data may identify an infectious source. Prompt involvement of appropriate consultants for urgent definitive therapy (drainage, debridement, surgical intervention) may be warranted. Adjust antibiotic therapy based on suspected infectious source identified

Detailed H&P to Identify Potential Source of Infection

HPI
  • Presence of headache, neck pain or stiffness
  • Change in behavior, mental status
  • Cough, rhinorrhea, shortness of breath, sore throat, facial pain
  • Abdominal pain (location and quality), vomiting (bilious?), diarrhea
  • Dysuria, frequency, urgency, back pain
  • Vaginal discharge, recent sexual activity, LMP, use of tampons if adolescent female
  • Joint pain, myalgias, joint swelling or redness
  • Rash
  • Recent wounds, insect bites, breaks in skin integrity
  • Ill contacts, recent immunizations
  • Current or recent antibiotic use
  • Recent travel
  • History of IV drug use
PMH
  • Chronic illness
  • Immunodeficiency, immunosuppression, recent steroid use
  • Central line
  • Any  indwelling hardware (surgical rods/pins, PD catheter, VP shunt, etc)
  • Past surgical history, recent surgery
  • Birth history
  • Immunization history
  • History of UTI, neurogenic bladder
  • History of frequent pneumonia, sinusitis, prior cellulitis
  • History of drug resistant organisms (MRSA, VRE)
Full PE
(Attention to listed elements)
  • Rash,  other skin findings (surgical wounds, decubitus ulcer, ostomy sites)
  • HEENT exam including oropharynx,  meningeal signs
  • Focal neurologic symptoms
  • Respiratory distress, lung exam findings consistent with pneumonia or empyema
  • Abdominal distension, rigid abdomen, rebound tenderness, fluid wave
  • Joint and extremity exam, signs of fasciitis, myositis, compartment syndrome
  • Pelvic exam in adolescent female

Imaging Studies and Procedures to Identify Potential Source of Infection

The following studies may be indicated based upon H&P findings: