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SEPSIS – A Matter of Seconds

Recognizing and treating an unstable patient as quickly as possible, even pre-hospital, can make a huge difference in the outcome for that patient. Most EMTs are taught to treat for the worst-case scenario and if you believe there is ANY possibility of sepsis, those seconds can make a life-saving difference. An initial injury with a bacterial infection can easily progress into sepsis as the body’s immune system over-reacts and can cause organ failure and/or cardiac collapse. Still, it may be difficult to differentiate sepsis from a simple infection.

"Sepsis is caused when the body’s immune system becomes overactive in response to an infection, causing inflammation which can affect how well other tissues and organs work. When sepsis is recognized early, people can be quickly given the right treatment. However, the signs and symptoms of sepsis can vary and may be subtle which can lead to it being missed if it is not considered early on." - National Institute for Health and Care Excellence (NICE) Guidelines

Sepsis presents itself in a myriad of ways, but the one consistency is HOW FAST it can progress (similar to the rapid progression of anaphylaxis and yet not as fast). By itself, untreated sepsis has an extremely high mortality rate and often the first medical attention a patient might get is in the field from responding EMS services. Recognizing sepsis, treating, transporting and alerting receiving hospitals are crucial steps to saving lives.

Some of the signs/symptoms of sepsis can include:
1. Above normal temperature
2. Chills
3. Abnormal sweating
4. Elevated heart rate
5. Increased respiratory rate
6. Decreased output of urine
7. Dizziness or faintness
8. A change in mental state
9. A skin rash
10. Gastrointestinal issues
11. Changes in personality
12. Cold, clammy skin
13. Fatigue and weakness
14. Difficulty breathing
There are three stages: Sepsis, Severe Sepsis, and Septic Shock.

Under NYS-BLS guidelines, sepsis protocol is activated for an adult patient with all three of the following:
1. Suspected infection
2. Hypotension (systolic BP < 90 mmHg) OR altered mental status
3. And at least two of the following:
• Heart rate > 90
• Respiratory rate > 20 or PaCO2 < 32 mmHg
• Temperature > 100.4° F (38° C), if available
During transport, advise the destination hospital that the patient has signs of sepsis/septic shock and obtain vital signs, including blood pressure, frequently.

Sepsis/septic shock is a life-threatening condition in children and must be recognized and treated as rapidly as possible. For pediatric patients with suspected infection who are abnormally hot or cold to touch, and/or have a fever over 100.4° F (38° C), or less than 96.8° F (36° C) and high heart rate (age dependent) and/or high respiratory rate (age dependent) look for:
• Vital sign criteria for defining sepsis:
< 1 mo. < 1 yr 1 yr-11 yr > 11 yr
~ Tachycardia >180 >180 > 140 >110
~ Tachypnea > 60 > 40 > 30 >20
~ Hypotension < 60 < 70 (< 70 + 2 x age) < 90
• Blood pressures may be difficult to obtain in infants – assure the respiratory rate and pulse are measured accurately
• Communication with the destination hospital is critical so that they can prepare to treat the child aggressively

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