ED Pathway for Evaluation/Treatment of Infants > 28 Days
of Age and Children with Suspected Severe Sepsis
 
Infants and Children with Suspected Severe Sepsis
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Sepsis Watcher:
Order other pathway
as indicated

Sepsis pathway not indicated: Care/reassessment continues as clinically indicated
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Initiate Sepsis Pathway
MD/CRNP/RN Rapid Assessment
  • MS, ABCDE's
  • Monitors, VS
  • Administer high flow O2
  • Immediate IV access, Bring US to bedside for USGIV
  • IV Escalation Plan
  • Order labs, IVF, antibiotics
Assure 1st antibiotic given within 1st hour
Consider need for hydrocortisone
Correct Hypoglycemia, Hypocalcemia
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10 min
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0-20 min
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Rapid NS
20 mL/kg boluses
Repeat as needed
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0-40 min
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60 min
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Consider ordering epinephrine to the bedside if > 40-60mL/kg with inadequate clinical response
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Consider Observation
in ICU
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Titrate Epinephrine
Titrate Norepinephrine
*If norepinephrine is not immediately available, start with epinephrine infusion and convert to norepinephrine when available
Consider Hydrocortisone
for Catecholamine Resistant Shock
RAPID TRANSFER TO PICU WITHIN 1 HOUR
Tier 1 or 2
Notify PICU
Tier 1 or 2 as needed
Posted: July 2011
Revised: June 2015, May 2016, March 2017, July 2018
Authors: B. Ku, MD; F. Balamuth, MD; M.K. Funari, RN; J. Lavelle, MD; C. Jacobstein, MD; D. Davis, MD; J. Fitzgerald, MD J. Gerber, MD; T. Metjian, Pharm D; S. Fesnak, MD; L. Hutchins, CRNP; D. Potts, RN