INDEX

Sepsis (Code Sepsis)

Sepsis Alert

  • If the Sepsis Alert fires, you are required to initiate the UED Sepsis PowerPlan regardless of whether sepsis is truly present. In the PowerPlan, you may indicate "Sepsis No" if the patient has an alternate diagnosis, otherwise proceed with ordering the sepsis bundle. You can also find the “Sepsis No” order on the ED quick orders.

  • Be on the lookout for sepsis even if the alert has not fired, and initiate the UED Sepsis PowerPlan early when sepsis is suspected.

 

Sepsis DART

Sepsis DART is an integrated application within FirstNet that helps detect and notify providers of potential sepsis. It also helps track bundle measures in real-time.

 

Sepsis Bundle

To be completed within 3 hours:

  • UED Sepsis PowerPlan initiated.

  • Lactate drawn and sent to lab.

  • Blood cultures drawn BEFORE antibiotics administered.

  • Broad-spectrum antibiotics given.

  • 30 mL/kg IV fluid bolus if SBP under 90 at anytime or lactate over 4.

To be completed within 6 hours:

  • Repeat lactate drawn and sent to lab.

  • Sepsis Reeval documented after initial fluids in the ED Physician Note.

Exempting a septic shock patient from the full 30 cc/kg:  In rare cases, a patient may meet criteria for Septic Shock but also be volume overloaded (CHF/ESRD). In the cases, you may have a discussion with the patient about the risks/benefits of the 30 mL/kg IV fluid bolus. If the patient declines the full bolus, there is a option to select in the Sepsis Reevaluation in the ED Physician Note that documents this and excludes them from the full bundle.

 

Documenting Sepsis Severity

Be sure to document the appropriate severity of sepsis in the final diagnosis and any associated specific source (eg. UTI, pneumonia, cellulitis).

  • "Sepsis" = 2 SIRS + Infection

  • "Severe Sepsis" = Sepsis + Organ Dysfunction (Lactate over 2, AKI)

  • "Septic Shock" = Severe + Persisent Hypotension or Lactate over 4.

 

KEYWORDS: sepsis, septic shock, infection, SIRS