Emergency Department, PICU, and Inpatient Clinical Pathway for Infants > 28 Days and Children with Suspected Sepsis, Sepsis and Septic Shock
Related Pathways
- Identification of Signs and Symptoms Concerning for Sepsis/Septic Shock by Physical Assessment
- or
- EHR Alert by Care Area
- Sepsis Huddle
- Focused H&P
- Identify Evidence of Shock or
- Sepsis-associated Organ Dysfunction
Signs and Symptoms
Concerning for Septic Shock
Concerning for Septic Shock
- Fever, Temp 36 °C, or concern for infection
- Tachycardia
- Altered Mental Status
- Lethargy, obtundation, agitation
- Hypotension or perfusion abnormality
- Diminished pulses, delayed/flash capillary refill, oliguria
- Tachypnea
- Skin
- Petechial and/or purpuric rash or erythroderma
Green Zone: Low Suspicion for Sepsis
Suspected infection or non-infectious syndrome, no clinical shock or concern for sepsis-associated organ dysfunction.
If antibiotics indicated, see antibiotic choices for suspected bacterial infections in the PICU
Evaluation |
|
---|---|
Treatment |
|
Reassessment |
|
Evaluation |
|
---|---|
Treatment |
|
Reassessment |
|
Clinical Goals Met
Consider care de-escalation
Consider care de-escalation
Adjuvant Therapies
IVIG, Plasma Exchange, Diuresis, RRT
IVIG, Plasma Exchange, Diuresis, RRT
Escalation
ICU, CAT or CODE
ICU, CAT or CODE
Correct
hypoglycemia, hypocalcemia
hypoglycemia, hypocalcemia
- Assess Cardiac Function if available
- Do not delay initiation of vasoactive therapy
- Initiate First-line Vasoactive
- Titrate epinephrine, norepinephrine
- Consider CVL, Arterial line, Foley
- Consider Stress Dose Hydrocortisone
- Evaluate for:
- Pericardial effusion
- Pneumothorax
- Intra-abdominal hypertension
- Primary cardiac dysfunction
- Consider ETT
- Consider ECMO
Evidence
- Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children
- International Pediatric Sepsis Consensus Conference: Definitions for Sepsis and Organ Dysfunction in Pediatrics
- Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock: 2017 Update from the American College of Critical Care Medicine
- Sepsis References
- Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2017
- Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2017
- World Federation of Pediatric Intensive & Critical Care Societies website
- Sepsis Alliance