Emergency Department, PICU, and Inpatient Clinical Pathway for Infants > 28 Days and Children with Suspected Sepsis, Sepsis and Septic Shock

  • Sepsis Huddle
  • Focused H&P
  • Identify Evidence of Shock or
  • Sepsis-associated Organ Dysfunction
Signs and Symptoms
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

Yellow Zone: Sepsis Watcher
Suspected Infection, No Shock
Evaluation
Treatment
  • Initial IVF
    • NS or LR 10-20 mL/kg as indicated
  • Antibiotic Recommendations — Yellow Zone
    • Aim to administer antibiotics within 180 min of sepsis alert if concern for infection persists
  • For children with SCD or oncologic diagnoses:
    • Aim to administer antibiotics within 60 min of arrival or sepsis alert
Reassessment
Red Zone:
Septic Shock or Sepsis Associated Organ Dysfunction
Evaluation
Treatment
Reassessment
Clinical Goals Met
Consider care de-escalation
Adjuvant Therapies
IVIG, Plasma Exchange, Diuresis, RRT
Escalation
ICU, CAT or CODE
Correct
hypoglycemia, hypocalcemia
Posted: May 2022
Authors: MKF Abbadessa, ACCNS-P; H. Stinson, MD; J. Fitzgerald, MD; K. Chiotos, MD; F. Balamuth, MD; S. Weiss, MD; B. Ku, MD; J. Lavelle, MD; B. Pagliaro, RN; H. Dashefsky, RN; J. Jacob-freese, RN; E. Shelov, MD; C. Moore, MSN; B. Blowey, PharmD; L. Goldstein, MD; J. Hemberger, MD; E. Vorel, MD