Patients with suspected sepsis or septic shock and National Early Warning System Score (NEWS2) indicating medium risk (score 5 to 6) or high risk (Score 7 or higher).
Refer to NEWS2 Scoring System Chart to calculate score.
Should not be used in patients under 16 years old or with pregnant women
Consider antibiotic history within the last 90 days and previous colonization or infections when selecting empiric therapy.
Blood cultures (aerobic and anaerobic) x 2 sets from 2 separate sites
Urinalysis and urine culture
Sputum for culture if respiratory source suspected
Consider additional test and analysis depending on the presenting syndrome:
If not already completed:
CBC, electrolytes, CO₂, urea, creatinine, glucose random, PTT, PT/INR, bilirubin, ALT, Alk Phos, LDH
Venous blood gas, lactate (repeat every 2 hours x 2)
Continuous cardiac monitoring
Vitals every 15 minutes for the first 6 hours
Consider additional imaging depending on the presenting syndrome
O₂ to keep SpO₂ greater than 88% (in patients with chronic respiratory conditions) or greater than 96%
Consider inserting urinary catheter with hourly urometer
Monitor intake and urinary output hourly
Goal: 30 mL/kg in first hour for hypotension (MAP < 65 mmHg) OR lactate greater than or equal to 4 mmol/L
Central line preferred for ALL vasopressors, but do NOT delay start of therapy. It is permissible to initiate therapy with a peripheral line until such time that central access can be established
Start Infusion if Mean Arterial Pressure (MAP) less than 65 mmHg after 2L crystalloid
norepinephrine 0.01 to 1 mcg per kg per min IV infusion, titrate to maintain MAP 65 to 70 mmHg.
Note: Usual maintenance dose: 0.03 to 0.06 mcg per kg per min