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SEVERE SEPSIS INITIAL
RESUSCITATION ORDERS – ADULT
ED AND IN-PATIENT
Nursing & Respiratory:
• STAT Establish intravenous access (at least one large bore) for IV fluid administration • If, after IV bolus, MAP is still < 65 mmHg or SBP < 90 and or CVP < 8 mmHg notify managing physician q FOR ED PATIENTS:
• STAT EKG. STAT portable CXR, ETCO2 evaluation.
• If ABG is ordered by ED M.D. perform POCT arterial lactate. If no ABG is ordered RT will do POCT CBC with differential, CMP, PT, PTT, type and screen, and blood cultures X 2 from different peripheral venipuncture sites. One set of blood cultures may be drawn from a pre-existing IV or central line only if
ordered by a physician.
q May obtain one set of the blood cultures from a pre-hospital IV or central line Draw cultures prior to administering antibiotics unless this would delay giving antibiotics > 1 hour
q FOR IN-PATIENTS:
• Draw blood and send to Laboratory Services for STAT: Serum arterial lactate, ABG, and blood cultures X 2 from different peripheral venipunture sites. One set of blood cultures may be drawn from a pre-existing IV or central line only if ordered by a physician.
q May obtain one set of the blood cultures from a pre-existing IV or central line Draw cultures prior to administering antibiotics unless this would delay giving antibiotics > 1 hour
q Serum random cortisol level
• If patient has an existing indwelling urinary catheter from transferring facility remove and insert a new indwelling urinary catheter BEFORE obtaining urine specimen.
• After initial resuscitation has been initiated consider obtaining other cultures ie: sputum or from existing • If not present, prepare for the insertion of a central venous pressure catheter: include all necessary supplies and equipment for insertion at the bedside.
Monitoring:
• Pulse oximetry. Initiate oxygen therapy if oxygen saturation is < 94% • If the patient gets intubated, monitor ETCO2 post intubation Consultation:
• Medical Critical Care for management of the patient • Surgical Critical Care for placement of central venous access line • _________________________________ for placement of central venous access line IV Fluids:
• 0.9% Normal Saline 2 liter bolus IV over 15-30 minutes • Repeat _______ mL 0.9% Normal Saline IV bolus rapidly if SBP is < 90, MAP < 65 mmHg; HR >110 bpm. _____________________________________________, M.D. I.D.#: __________ Date: ___________ Time: _________ FORM 5872-103765 Page 1 of 2 Rev. 10/09 {MR Tab #3} SEVERE SEPSIS INITIAL
RESUSCITATION ORDERS – ADULT
ED AND IN-PATIENT
Antibiotics/Antifungals:
Antimicrobials: (Pneumonia)
q Cefepime (Maxipime®) 2 Gm IV X 1 STAT [indication: severe sepsis] + Tobramycin (Nebcin®) 200 mg IV X 1 STAT [indication: severe sepsis] + Vancomycin (Vancocin®) 2 Gm IV X 1 STAT [indication: severe sepsis] q Piperacillin/Tazobactam (Zosyn®) 4.5 Gm IV X 1 STAT [indication: severe sepsis] + Tobramycin (Nebcin®) 200 mg IV X 1 STAT [indication: severe sepsis] + Vancomycin (Vancocin®) 2 Gm IV X 1 STAT [indication: severe sepsis] q Aztreonam (Azactam®) 2 Gm IV X 1 STAT [indication: severe sepsis] + Tobramycin (Nebcin®) 200 mg IV X 1 STAT [indication: severe sepsis] + Vancomycin (Vancocin®) 2 Gm IV X 1 STAT [indication: severe sepsis] Antimicrobials (Intra-Abdominal)
q Piperacillin/Tazobactam (Zosyn®) 4.5 Gm IV X 1 STAT [indication: severe sepsis] + Fluconazole (Diflucan®) 800 mg IV X 1 STAT [indication: severe sepsis q Ciprofloxacin (Cipro®) 400 mg IV X 1 STAT [indication: severe sepsis] + Metronidazole (Flagyl®) 500 mg IV X 1 STAT [indication: severe sepsis] + Fluconazole (Diflucan®) 800 mg IV X 1 STAT [indication: severe sepsis] q Cefepime (Maxipime®) 2 Gm IV X 1 STAT [indication: severe sepsis] + Metronidazole (Flagyl®) 500 mg IV X 1 STAT [indication: severe sepsis] + Fluconazole (Diflucan®) 800 mg IV X 1 STAT [indication: severe sepsis] Antimicrobials: (Urinary Tract Infection)
q Cefepime (Maxipime®) 2 Gm IV X 1 STAT [indication: severe sepsis] q Ciprofloxacin (Cipro®) 400 mg IV X 1 STAT [indication: severe sepsis] Vasopressor:
q Norepinephrine (Levophed®) 0.05 mcg/kg/min IV continuous infusion via central line preferred. Titrate to
keep MAP > 65 mmHg. (Do not exceed 1 mcg/kg/min without notifying physician). If after resuscitation the patient requires norepinephrine to maintain perfusion and/or mechanical
ventilation, transfer to ICU and begin Severe Sepsis Maintenance Order Set
_____________________________________________, M.D. I.D.#: __________ Date: ___________ Time: _________ FORM 5872-103765 Page 2 of 2 Rev. 10/09 {MR Tab #3}

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