Cookeville Regional Medical Center Septic Shock Clinical Pathway
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2PLeaSe COMPLete tHe fOLLOWING:
COOKeVILLe reGIONaL MeDICaL CeNter
• Septic shock* diagnosis (Time Zero): Date: _____________________________ Time: __________________
SePtIC SHOCK CLINICaL PatHWaY
• Patient transferred from (unit or hospital): q ER
q Other In-house Transfer _______ floor
q Outside Facility / Direct Admit
• Patient was identified as having septic shock: q ED q Floor____________ q CVICU
q ICU
Room #: _______CVICU/ICU Admission Date:_________Time:________
• Hospital Discharge status: q Alive
q Expired
Goal directed
Date: ________________________
Date: ________________________
Date: ________________________
Date: _______________________
therapy to achieve
______________ to ____________
______________ to ____________
______________ to ____________
______________ to ___________
increased 0
2
0-1 Hours
1-6 Hours
6-24 Hours
24-72 Hours
delivery:
ED Provider ___________________________
Refer to Severe Sepsis Resuscitation Algorithm
Yes No
Is patient on vasopressor at greater than 6 hours (if no, skip to
_______ Confirm Infectious Source
Blood Glucose section)
• CVP 8-12mmHg
________ Initial Labs: serum lactate, additional
Yes No
Was initial lactate greater
_______
Re-assess need for broad
(non-vented),
labs as ordered by physician
than or equal to 4mmol/L?
Yes No
Considered Hydrocortisone if vasopressor unresponsive
_______
spectrum antibiotics based on
12-15 (vented)
Yes No
Was patient hypotensive after
_______
culture reports.
_______
If hydrocortisone administered, (50mg every 6 hours)
Yes No Serum lactate drawn
initial fluid bolus?
• MAP greater
Start Time: _________________
within 3 hours?
Yes No
Central Line placed
Yes No
Was the organism that
than or equal to
Type: q PreSep q PICC q Jug/SC TL q Fem TL
Yes No
Was Vasopressin considered for refractory septic shock?
NA
was identified sensitive to
65mmHg
Yes No Blood Cultures (BC) X 2
the initial antibiotic?
Date_______Time_______
Blood Glucose - chart all bgm’s between hours 6-24 (If patients glucose
Date_______Time_______
• Scv0
greater
greater than 180 obtain orders for an insulin drip) Goal <180mg/dL
2
Date_______Time_______
If no, why? __________________________________
_______
Discontinue Vancomycin
than or equal to
if appropriate
70%
CVAD >48 hrs BC Date_____Time_____
Provider Name:______________________________
Time_____ Value_____ Time_____ Value_____
Record the first time the following
Yes No Other Cultures:
_______
D/C or taper steroids if
• Blood Glucose
q Sputum
Time_____ Value_____ Time_____ Value_____
DATE
TIME
is achieved:
q Urine
vasopressors off
less than 180
Time_____ Value_____ Time_____ Value_____
q Wound
Yes No Establish IV access
mg/dl
CVP 8-12 mmHg
q __________
(non-vented)
_______
Re-evaluate need for
12-15 mmHg
In patients with acute lung injury or ARDS;
(vented)
________ Patient weight in kg
• Urine output
invasive lines and tubes
Is tidal volume 6ml/kg of ideal body weight in first 24 hours?
MAP greater than or equal to 65
greater than
TIME
DATE
Amount Infused
q Yes q No
0.5 ml/kg/hour
_______
Nutrition Therapy Support
Scv0
greater than or equal to 70% or
All Mechanically Ventilated Patients
2
Scv0
greater than or equal to 65%
Are the static or plateau inspiratory pressures less than 30cmH20 in first 24
2
(if PreSep not inserted and you have
hours?
a non-femoral central line draw an 0
2
q Yes q No
HGB from the distal port Stat. If not to
_______ Volume patient received
APRV
q Yes q No
goal draw one in 3 hours, then 6 hr until
(Goal 30mL/kg)
goal of 70.)
Oscillator Vent
q Yes q No
Yes No Confirm Infectious Source (actual
Initials: ______________________________
Initials: ______________________________
Yes No
Broad Spectrum Antibiotic-start
reports confirming ie, labs, ct report)
Signature: ___________________________
Signature: ___________________________
after obtaining blood culture?
Severe Sepsis defined as:
Baseline time ____________
Scv0
__________
Known or suspected infection, 2 or more signs of SIRS, and organ dysfunction.
2
Date_____Time_____antibiotic hung
3 hour time _____________
Scv0
__________
*Septic Shock defined as:
2
Known or suspected infection with 2 or more signs of SIRS, organ dysfunction, and hypotension which is defined as systolic B/P less than
_______
Source Control
90mmHg or MAP less than 65 or 40mmHg decrease in B/P from baseline after a30mL/Kg fluid bolus or known or suspected infection with 2 or
6 hour time _____________
Scv0
__________
(Testing Suspicious Signs of Sepsis)
2
more signs of SIRS, organ dysfunction, and hypoperfusion evidenced by a lactic acid level greater than or equal to 4.
TIME ZERO = ED Arrival Time OR Direct Admit Arrival to Critical Care
Initials: ________________________________
Initials: __________________________________
Signature: _____________________________
Signature: _______________________________
OR
Patient identified on inpatient unit - follow below algorithm
Date/Time of Initial Assessment: _________________
ä
Suspected/Known Infection
Suspected / Known Infection: ___________________
PATIENT ID STICKER
Ë
SIRS: T_____
HR_____
RR_____
WBC_____
2 or more SIRS
(may be less if immunocompromised or on beta blockers)
Ë
Hypotension 1 hour after fluid bolus started OR lactic acid > or = to 4 (whichever comes first)
(if no fluid given time zero = 1 hour after onset of hypotension, if on pressors - this counts for hypotension)
Form 1112-PRN (Rev. 1/29/15)
*
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1
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P
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WHITE COPY - CHART
YELLOW COPY - ICU CNS
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