1. Sepsis

   1. Old criteria
      • SIRS
      • Proven or suspected infection
   2. Phoenix Criteria
      • Med Calc

2. Fever

   SIRS ≥2 of the following:

   • Hypotension
   • Tachycardia
   • Hyperthermia ≥38C or hypothermia ≤36C
   • Tachypnea
   • Leukocytosis ≥12 or leukopenia ≤5

   Proven or suspected infection: Go system by system [ROS]

Other (unofficial) criteria

• Compare to previous labs/readings — don’t rely on one reading, don’t treat a single number
• Increase in oxygen requirement [very significant]
• Low platelets — drop is platelets from baseline is also significant
• INR, PT, PTT
• Hypoglycemia is very important to check [esp in neonates and babies]
• Inflammatory markers

In a patient that meets 2 SIRS criteria + blood culture sent = start Abx

1. Septic Shock
   • Hypotension or ↓ MAP
   • On vasoactive medications to maintain blood pressure
   • Sign of poor perfusion
     1. CRT<2 seconds
     2. Oliguria 0.5ml/kg/hr
     3. Metabolic acidosis
     4. Lactate ≥2

Criteria met? Start broad spectrum antibiotics.

• Ceftriaxone
  • Does not cover atypical, anaerobes, MRSA, Pseudomonas
• Vancomycin
  • Cover MRSA
  • Ex. CLAPSI, central line
• Clindamycin / Tazocin
  • Anaerobes
  • Aspiration pneumonia
• Meropenem
  • ESBL
  • “Final gun”
• Tazocin, Ceftazidime, Meropenem
  • Pseudomonas
  • Prolonged hospital admission
  • Immunocompromised

Start within 1 hour — “Golden hour”

Fluids

• Start 3 fluid boluses of 20ml/kg
• Refractory to fluids (3x with no improvement)
  • Norepi is better due to peripheral vasoconstriction > cardiac effects
• Catecholamine resistant septic shock
  • Not maintaining blood pressure on one vasoactive agent alone