Time

critical conditions: SEPSIS

Use for:
Adult patients with suspected infection
This can be started at any time when SEPSIS is clinically suspected.

HOSPITAL LABEL
NAME

!Start / Complete this form if EWS 3

!If neutropenic sepsis suspected / considered manage as severe sepsis

DOB

and discuss with senior Doctor.

Hosp. No.
1. Are any 2 of the following present?

(SIRS)

YES

Clinician

Temperature > 38.3 C or < 36 C

Respiratory rate > 20 per minute
Heart rate > 90 per minute
Acute confusion/ reduced conscious level
Glucose > 7.7 mmol/l (unless DM)

Designation
Date/Time

EARLY RECOGNITION

2. Could this be an infection?

Consider likely source:

Pneumonia

Urinary Tract Infection

Abdominal pain or distension

Meningitis

Cellulitis/ septic arthritis/ infected wound

YES

Sepsis not present now.

Treat to standard
NO
protocols.
Review with WCC

Inform Senior Doctor in charge.
Begin regular observations (as per EWS).

Measure lactate (VBG)

Result
Time taken

Additional investigations:

FBC, U&E, LFT,CRP, clotting, BC x2

Consider sepsis mimics: e.g. acute pancreatitis;

anaphylaxis; PE; STEMI; hypovolemic shock;
cardiogenic shock; DKA; SLE flare; systemic
vasculitis; adrenal insufficiency

Perform a CXR and urinalysis

3. Is any red flag present?

YES

Uncomplicated Sepsis

SBP < 90 mmHg or MAP < 65 mmHg

Lactate > 2 mmol/l
Heart rate > 130 per minute
Respiratory rate > 25 per minute
Oxygen saturations < 91%
AVPU/ unresponsive; Purpuric rash

NO

Your patient may have

SEVERE SEPSIS

A documented decision to initiate sepsis 6 or

not
Investigate, treat and monitor closely
Review by senior doctor < 60min of diagnosis

TIME SEVERE SEPSIS CONSIDERED:

Complete sepsis 6 urgently

and WITHIN 1 hour

EARLY TREATMENT

(mortality rate ~35%)

1
2

100% O2
IV Fluid
bolus

Give 15L/minute via facemask with reservoir bag unless oxygen restriction necessary
Give a 500mL-1000ml bolus of Hartmanns.
Larger bolus may be required e.g. if systolic BP less than 90 or lactate greater than 4,
consider 15002000ml
Take blood cultures and consider infective source.
At least 1 set with 8-10mls blood/bottle, preferably prior to any antibiotic administration

time

sign

Blood
Cultures

IV
Antibiotics

Use trust antibiotic guidelines.

Prescribe first dose in the stat section of the chart with TIME specified. Prescribe
ongoing treatment as usual. Short intervals between stat dose and first regular
prescription are acceptable (except gentamicin).
Delay in administration increases mortality

Lactate &
bloods

Monitor
Urine
Output

Lactate on arterial or venous sample. (lactate should be repeated after 2 hours)

Also request FBC, U&E, LFT, clotting (INR and APTT) and glucose if not yet done.
Consider blood transfusion if Hb less than 7
Start a fluid balance chart. Monitor the output hourly. (Consider a urinary catheter.)
Dip urine and send MSU / CSU
Fluid balance chart yes no Catheter yes no

Bothma / Sampson May 2015 v7.3