Sepsis Management

Diagnosis

Initial Management

Reassessment

Note: The BlueWater sepsis care quality bundle has the following components for care of patients with sepsis:
1. Blood culture drawn before antibiotics administered
2. Lactate drawn
3. Antibiotic(s) administered
4. 30mL/kg if hypotension present or Lactate >4 (use ideal body weight in obese patients) or reason why fluid bolus is not appropriate

SIRS Criteria (≥ 2 Required)

  • Temperature > 38°C or < 36°C
  • Heart rate > 90 bpm
  • Respiratory rate > 20 or PaCO₂ < 32 mmHg
  • WBC > 12,000, < 4,000, or > 10% bands

Sepsis

  • Suspected or confirmed infection AND
  • ≥ 2 SIRS criteria

Severe Sepsis

  • Sepsis AND evidence of acute organ dysfunction, such as:
    • Hypotension responsive to fluids
    • Lactate ≥ 2 mmol/L
    • Creatinine elevation or oliguria
    • Acute mental status change
    • Platelets < 100,000
    • Bilirubin > 2 mg/dL
    • Acute respiratory failure requiring supplemental O₂ or ventilation
    • INR > 1.5 (not on anticoagulation)

Septic Shock

  • Severe sepsis AND either:
    • Persistent hypotension despite adequate fluid resuscitation
    • Lactate ≥ 4 mmol/L even if blood pressure is normal

IBW Calculator: Ideal Body Weight