Suspected Sepsis Clinical Pathway — PICU

Vital Sign Targets

Patients with confirmed / likely MIS-C can deteriorate rapidly
Frequent assessment is key. Initiate fluid resuscitation if concern for shock
Notify Subspecialists to expedite initiation of MIS-C directed therapy in clinically worsening patients as it is the definitive treatment for the underlying cause of illness
Initiate fluid resuscitation and activate CAT if concern for shock
Common Features of Shock in Children

Age-related Vital Sign Targets

Age	Heart Rate	SBP	MAP	DBP
31 days to < 1 year	100-160	> 65	> 45	> 30
1 year to < 2 years	90-160	> 70	> 50	> 35
2 to < 6 years	< 140	> 75	> 50	> 40
6 to < 13 years	< 130	> 85	> 60	> 45
≥ 13 years	< 110	> 90	> 65	> 50

RN Assessment, Documentation

Parameters to Assess	Capillary refill Extremity temperature Pulse strength Mental status Shock type
Frequency	As per ordered frequency Notify prescribing clinician of abnormalities or changes from patient’s baseline and increase frequency of reassessment for abnormal vital signs.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.