Name

Adult Sepsis Management Pathway

Hospital No (Non Neutropenic Sepsis)
Complete and Insert in Patient Notes
DOB
Time (Zero) Now: Date: Bleep: Name:

Confirmed or Suspected Infection Within 1st Hour of Diagnosis

Chest Urinary CNS (Meningitis) Y

S E Lactate Stat Abx Time
Skin Abdomen Joint
E S
Unknown ________________________________ Antibiotic
P Iv Access Blood Gases CXR
S & Blood Cultures – 2 sets (Ideally Prior to antibiotic administration)
I At least 2 SIRS or General Variables Bloods: FBC / U&E / LFTs / CRP / INR / BMs
S BP: Aim for urine output (UOP) of > 0.5ml / kg / hr
HR>90 T° >38° or <36°C Acute Confusion Oxygen: Aim for SATS 88-92 in type 2 Respiratory failure or COPD and
RR>20 WBC>12 or <4 Raised CRP 94-98 in others Hourly MEWS
BMs: >7.7 mmol/L in Non Diabetic Now Check Below for any signs of Severe Sepsis

S Any Features of Severe Sepsis? (i.e. End Organ Dysfunction) Within 3 hrs of Diagnosis
E
V
Mortality 20 - 35% Ensure all above steps have been Completed And
Lactate > 2 YES Source Control
E
Creatinine > 177 µmol/L or
R Consider Urinary Catheterisation ! Infection Risk
Creatinine of > 45 µmol/L over baseline
E Fluid Resuscitate with either Saline or Hartmans.
Oliguria <0.5mls/kg/hr for >2hrs to be reviewed by SpR / Cons
Altered Mental State
Unless CCF / HF give 1st Litre as Stat and fluid boluses 30mls/kg/hr of
S Crystalloid or equivalent if Hypotensive or Lactate > 4mmol / L
E
Platelets<100
P BP Low<90 systolic NO Observe Hourly Repeat Lactate in 1hr Half Hourly MEWS
S Bilirubin>35 µmol/L Inform Senior
INR>1.5 if NOT improving
Refer to ITU / Critical Care if Lactate Not improving or deteriorating
I
S Hypoxia pO2<8.0 Now Check Below for any signs of Septic Shock

S Septic Shock Ensure all above steps have been Completed &
H Mortality Very High 40-60% Urgent referral to ITU / Critical Care
O Continue with aggressive Fluid Resuscitation
As above and Profound Hypotension (BP less than 90 Systolic) Consider Central Venous Access
C Hypotension Resistant to Fluid Challenges Urinary Catheterisation
K
15 min MEWS
CM - V-2 Oct 2013