Emergency Department Clinical Pathway for
Evaluation/Treatment of Infants > 28 Days of Age
and Children with Suspected Severe Sepsis

Infants and Children with Suspected Severe Sepsis
Sepsis Watcher:
Order other pathway
as indicated

Sepsis pathway not indicated: Care/reassessment continues as clinically indicated
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
10 min
Correct Hypoglycemia, Hypocalcemia
0-20 min
Rapid NS
20 mL/kg boluses
Repeat as needed
0-40 min
60 min
Consider ordering epinephrine to the bedside if > 40-60mL/kg with inadequate clinical response
Consider Observation
in ICU
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
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