0000
Bullet items are automatically implemented with physician’s order. Boxed are optional.
Allergies:
Reaction:
Ht:
Wt:
Sepsis Standard of Care Protocol: implemented when patient presents with two or more of the following:
 Temp > 38.3 C (100.9F) or < 36.0 C (96.8F)
 Heart Rate > 90
 Respiratory Rate > 20 or PaCO2 < 32 mmHg
 WBC > 12K, < 4K or < 10% Bands
 Altered Mental Status (GCS < 15)
LABORATORY
 Blood cultures x 2 10 minutes apart ( 2 different sites) prior to IV antibiotic administration
 CBC
 Chem 20
 Lactate Level (gray top on ice) if > 4 mmo1/L, patient is high risk for severe sepsis
RESPIRTORY THERAPY
 Pulse Oximetry
 Oxygen therapy to keep Sp02 > 94%
ANTIBIOTIC THERAPY
As an initial choice, one of the following antibiotics are to be given IV with normal renal function, alone or in
combination depending on clinical diagnosis:







Piperacillin/Tazobactam (Zosyn ) 3.375 grams IV q 6 hours
Imipenem (Primaxin) 500 mg IV q 6 hours
Vancomycin 1 gram IV (Pharmacy to dose)
Fluconazole (Diflucan) 200 mg x 1 dose IV (100 mg IV once daily)
Levofloxacin (Levaquin) 500mg IV once daily
Amikacin 7.5 mg/kg/IV (pharmacy to dose)
Linezolid (Zyvox) 600mg IV q 12 hours
IV FLUIDS
If SBP < 90 administer:
 1 liter 0.9% NS IV – Repeat x1 if SBP remains < 90
 Albumin 50gm IV (if albumin < 2 g/dL)
SEPSIS PROTOCOL
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«AdmittingDoctorName» «Age» «Gender» PT: «PatientType»