Prehospital Sepsis
True or False?
We ask for VS and screen for sepsis on EVERY EMS call?
What is FALSE
We only ask for VS when pt meets criteria for screening: ALOC, GW, Resp distress, immunocompromised, FLS, from SNF, recent abx etc
True or False?
Our goal for antibiotic administration for patients arriving via lobby meeting sepsis criteria is <30 min from order.
What is TRUE
What is our goal for antibiotic administration on our sepsis patients who exhibit organ dysfunction?
What is <30 minutes from time of order.
How do you know what time is your “time zero” for sepsis?
What is The time the “sepsis management order” was placed
Your patient is receiving an IV NS bolus. Their pressure is now 70/50. What change do you anticipate with the IV bolus?
What is Notify the MD and ask for order to
Switch from NS to LR if not contraindicated.
What are the 2 most common CC that arrive via EMS who end up on sepsis pathway in our ED?
What is Respiratory distress/ SOB and ALOC
True or false?
We click “code emergent AND code sepsis” on a patient meets sepsis criteria with altered mental status.
What is TRUE! The brain is an organ and AMS counts as organ dysfunction.
True or False?
For every hour of delay in administering appropriate antibiotics to a septic patient, mortality increases by 7–10%, especially in cases of septic shock.
What is TRUE
List the 3 criteria for organ dysfunction that you can determine without labs
What is
Hypotensive sbp <90
Hypoxic spo2 <92
Altered from baseline
Your patient on sepsis pathway has finished their bolus and bp is now 80/65(62)
What do you do next?
What is
-Notify MD
-Notify Sepsis RN
-Document notifications
-Start 500ml bolus if not fluid contraindicated
True or False?
warm skins mean fever and be counted as a criteria for abnormal VS.
What is FALSE
HOT or cool skins meet criteria as abnormal VS. You can clarify with EMS by saying warm/ normal or hot?
You screened a patient from the lobby in triage as a + sepsis and documented appropriately, what do you do next?
What is Call the charge RN for immediate bed placement.
You have 3 antibiotics due: rocephin, azithromycin and vancomycin. Which abx should you give first?
What is Rocephin because it is broad spectrum
True or false?
1 IV is enough for my sepsis patient
What is False, sepsis patients need 2 IVs.
Halfway through their bolus, your sepsis patient develops crackles and respiratory distress with desat to 86%. What 2 things should you do?
What is
-stop the fluids
-notify the MD to add documentation regarding partial bolus. Document your notification.
Does this patient screen + for sepsis?
CC: Resp distress
VS:
BP 100/60
HR 89
RR 19
Skin: warm
Spo2: 70% RA
What is No.
This patient has concern for infection + ONE abnormal VS and organ dysfunction. Need at least 2 abnormal VS. This patient likely has incongruent VS on arrival but you will not be faulted for following the tool.
True or false?
we only care about our antibiotic times on our patients who arrive via EMS right now.
What is FALSE
all patients on sepsis regardless of how they arrive have a goal for antibiotics <30 min from order.
How many hours do you have to give your sepsis antibiotics?
What is 3 hours
How fast does the IV bolus need to infuse?
What is 90 minutes. Put it on a pump if its not going fast enough
What does an elevated lactic acid indicate?
What is Tissue hypoperfusion and increased mortality
Scenario: pt meets sepsis pathway with CC: Fever + 2 abnormal VS: HR 120 + HOT skins + BP 87/67
What needs to be documented in prehospital sepsis documentation?
1. Prehospital Chief Complaint: __________
2. EMS Report and vitals: ___________
3. Code Alert: ___________
4. RN notified: ___________
What is
1. Sepsis
2. CC: Fever + 2 abnormal VS: HR 120 + HOT skins + BP 87/67, no other VS given
3. Code Emergent, Code Sepsis
4. Charge RN name
True or false?
Its OK to skip the “infection likely” section of triage if you are busy.
What is FALSE
this section feeds information into the system so that the proper BPAs will fire when clinical criteria is met.
Your sepsis patient is a hard stick. You were able to gt a 22G but could not get blood cultures. Its been 20 min since abx order was placed. What should you do?
What is
Ask MD scribe to add (.sepsisbc) to note which says “Due to concern for severe infection, and in order to prevent rapid worsening of patient condition or deterioration in status, IV antibiotics were administered prior to drawing blood cultures. Blood culture collection would have resulted in a delay of 45 minutes or more and prompt treatment of patient's condition is priority.”
-Admin abx before bcx and continue to work on obtaining bcx
What does BOMBCLAP stand for?
What is
B: BP
O: oxygen
M: mental status
C: creatinine
LA: lactic acid
P: platelets
If antibiotics are delayed due to a critical situation, what should you do?
What is Document in quick note reason for delay. Example: “Abx delayed d/t pt being intubated. Pt also hypotensive and starting on pressors”