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Sepsis Guidelines NICE PDF
Sepsis Guidelines NICE PDF
Young children
Think: High People with sepsis may Pay particular ?
temperature have non-specific, attention to concerns Different first language
Could this could be non-localising Take particular care if
be sepsis? expressed by the person
present presentations, such as and family/carer there are communication People with
or absent feeling very unwell barriers to overcome communication problems
In hospital
Detailed risk assessment H High risk M Moderate to high risk
Age (years) Under 1 1–2 3–4 5 6–7 8–11 12+ and adults
H Weak, high-pitched or continuous cry H Objective evidence of new mental state
In primary care
H Appears ill to a healthcare professional M History from patient,
friend or relative of altered
H M M
H Does not wake or, if roused, does not stay awake behaviour / mental state
M Parent or carer concern that child is behaving differently from usual M Deterioration of functional 1+ 2+ 1 No high or
M Decreased activity ability high risk moderate moderate moderate to
Behaviour M Not responding normally to social cues M Not behaving normally M Impaired immune system H M criteria
met
to high risk
criteria met
to high risk
criteria met
high risk
criteria met
and M No smile M Trauma, surgery or
history M Wakes only with prolonged stimulation
procedure in last 6 weeks
1+ 1+ No high or
moderate to
M Poor feeding high risk moderate
criteria to high risk high risk
criteria met Review by Clinical
Breaths per minute (resting rate) met criteria met Clinician
H 60+ senior clinical assessment
60 review and
H 50+ decision maker3
M 50–59 H 40+ consider
40 M 40–49 H 29+ H 27+ blood tests Manage
H 25+ H 25+ Give IV4
M 30–39 Age under 18 according
20 M 24–28 M 24–26 M 22–24 M 21–24 antibiotics Within
with immunity to clinical
H without 1 hour
Breathing
Grunting
H New requirement of oxygen compromised judgment
delay
H Moderate or severe chest indrawing 0.4+ FiO2 to maintain
saturation above 92%
H Oxygen saturation 90% or less in air
or 88% in known COPD1
M Oxygen saturation 92% or less in air
Pre-alert Can definitive
M Increased work of breathing Perform tests Escalate to high risk
M Nasal flaring secondary condition be Lactate
M Crackles in the chest care diagnosed and Blood culture
treated? Clinician and
Heart rate (beats per minute) Full blood count
170 H 160+ results review
Clotting screen
H 150+ No Yes
150 M 150–159 H 140+ C-reactive protein Within 1 hour
M 140–149 H 130+ H 130+ U/E and creatinine
130 M 130–139 H 120+ Blood gas
M 120–129 H 115+ Lactate
110 M 110–119 M 105–114 M 91–129
Send to Treat definitive <2 2+
90 emergency condition and/or Lactate (mmol/L)
Circulation H Less than 60 beats per minute H Systolic BP2 Under 90 mmHg department provide information
<2 2–4 4+ Assessed as having AKI5
M Capillary refill time 3+ seconds
or 40+ mmHg below normal to safety net
Consider Give IV4 fluid No Yes
M Cold hands / feet M Systolic BP2 91–100 mmHg IV4 fluids bolus injection
M Leg pain M Pregnant: 100–130 BPM
Discuss with consultant
M New onset arrythmia Only consider giving antibiotics if
Refer to Definitive condition identified?
transfer time will be greater than 1 hour critical
H Colour of skin / lips / tongue is mottled or ashen or blue care
No Yes
H Non-blanching rash
H Reduced skin turgor M Signs of infection
M Pale or flushed Increased redness Repeat structured Manage
Swelling or discharge
1
Chronic obstructive pulmonary disease Carry out assessment definitive
at surgical site
Blood pressure observations
Skin
2