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Sepsis Recognition and Treatment in the Emergency Department (ED)

1. Triage Screen Adult

When screening keep in mind:

When a patient is taking a beta or calcium channel blocker, they are often unable to elevate their heart rate.
If pyrexia was treated at home or by Emergency Health Services prior to arrival.
Elderly patients present more often with ‘atypical’ symptoms such as confusion, falls, malaise, incontinence, and immobility

A Positive Screen Requires:

Two of:	Must have:	And, one of:
Heart Rate greater than 90/min	Suspected infection	Look unwell
Resp. rate greater than 20/min		Age greater than 65 years
Temperature greater than 38°C or less than 36°C		Recent surgery
Altered level of consciousness		Immunocompromised
		Chronic illness

2. If + Screen, Implement Care Directive

CD-EC-095 Sepsis Recognition and Treatment in the Emergency Department (ED) - Care Directive

Dynamic Health Skills and Procedures

Recognizing and Treating Sepsis in the Emergency Department (ED)

To implement care directive:

Complete bloodwork and blood cultures x 2 sets
Obtain urinalysis
Apply oxygen if needed (SPO2 less than 90%)
Place patient on cardiac monitor
Insert IV and infuse NS / RL at 50 mL/hr
- If SBP < 90 mmHg or MAP < 65: Bolus with NS / R 10mL/kg
Initiate IV antibiotics as per table

Order Set

Form number	Form name
NS-OSEDSSS	OS: Emergency Department Sepsis/Septic Shock Initial Management – Adult
NS_STPA	Documentation Tool: Sepsis Treatment Protocol – Adult

To view the order sets, please select the electronic forms repository link for your zone below. Then search for the appropriate form.

Central Zone: https://healthforms.cdha.nshealth.ca/

Western Zone, Northern Zone, Eastern Zone: http://dc-sv-efrns/

Antibiotic Therapy

Sepsis Origin	Empiric Initial IV Antibiotics
Unknown	Piperacillin/Tazobactam 4.5 g IV x 1
Lung (suspected pneumonia) Community Acquired/Nursing Home	Ceftriaxone 1 g IV x 1 AND Azithromycin 500 mg IV X 1
Intra-Abdominal Community Acquired	Ceftriaxone 1 g IV x 1 AND Metronidazole 500 mg IV x 1
Urologic Community Acquired	Ceftriaxone 1 g IV x 1
Febrile Neutropenia (suspected as per criteria on yellow card)	Piperacillin/Tazobactam 4.5 g IV x1
Skin (rapidly progressing /necrotizing fasciitis)	Consult Emergency Physician/AP immediately
Central Nervous System	Consult Emergency Physician/AP immediately