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Severe Sepsis and Septic Shock

  • Criteria

    • SIRS
      • 2 of the following:
      • temp > 38 C or < 36 C
      • HR > 90
      • RR > 20 or PaCO2 < 32
      • WBC > 12 or < 4 or 10% bands
    • Sepsis: SIRS + documented infection
    • Severe sepsis: sepsis + hypotension, hypoperfusion or organ dysfunction
    • Septic shock: severe sepsis despite fluid resuscitation
  • Admission orders

    • Admit: ICU
    • Diagnosis: Severe Sepsis and Septic Shock
    • Condition: Critical
    • Vital Signs: q 15 minutes x 4, then hourly if initially stable
    • Allergies:
    • Nursing:
      • Foley catheter
      • Strict I/Os
      • Daily weight
      • Neurologic checks q 2 hours
      • SCDs
    • Diet: NPO
    • Activity: Bedrest
    • Labs:
      • Blood cultures x 3
      • CBC with diff and platelet qday
      • Chem, Ca, Mg qday
      • LFTs, amylase
      • Coags: PT, PTT qday
      • thrombin time, fibrinogen level
      • Lactate level
      • UA and culture
      • ABG
      • EKG, CXR
      • Cosyntropin stimulation test:
    • IV: NS 500 mL Every 30 Minutes Until JVP or CVP > 8 mmHg, then Continue NS at 150 mL/h
    • Special:
    • Medications:
      • Collect blood culture before antibiotics
      • Vancomycin 1 g IV q 12 hours
      • Imipenem 500 mg IV q 6 hours
      • Insulin drip per ICU protocol, to maintain blood glucose 80-150 mg/dL
      • Ranitidine 150 mg IV qd
      • Hydrocortisone 50 mg IV q 6 hours
      • Heparin 5000 units SQ q 8 hours
    • Call HO: BP < 90/60, HR > 120, worsening oxygenation, UO < 30 mL/h, worsening neurologic status

  • Print | Citations

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