Emergency Department Clinical Pathway for
Evaluation/Treatment of Infants > 28 Days of Age
and Children with Suspected Severe Sepsis
Quality Story
Reducing Time to Antibiotics for Children with Sepsis
Reducing Time to Antibiotics for Children with Sepsis
Infants and Children with Suspected Severe Sepsis
Sepsis Watcher:
Order other pathway
as indicated
Sepsis pathway not indicated: Care/reassessment continues as clinically indicated
Order other pathway
as indicated
Sepsis pathway not indicated: Care/reassessment continues as clinically indicated
Initiate Sepsis Pathway
MD/CRNP/RN Rapid Assessment
Assure 1st antibiotic given within 1st hour
Consider need for hydrocortisone
- MS, ABCDE's
- Monitors, VS
- Administer high flow O2
- Immediate IV access, Bring US to bedside for USGIV
- IV Escalation Plan
- Order labs, IVF, antibiotics
Consider need for hydrocortisone
10 min
Correct Hypoglycemia, Hypocalcemia
0-20 min
Rapid NS
20 mL/kg boluses
Repeat as needed
20 mL/kg boluses
Repeat as needed
0-40 min
60 min
Consider ordering epinephrine to the bedside if > 40-60mL/kg with inadequate clinical response
Consider Observation
in ICU
in ICU
Titrate Epinephrine
Titrate Norepinephrine
*If norepinephrine is not immediately available, start with epinephrine infusion and convert to norepinephrine when available
Consider Hydrocortisone
for Catecholamine Resistant Shock
for Catecholamine Resistant Shock
RAPID TRANSFER TO PICU WITHIN 1 HOUR
Tier 1 or 2
Notify PICU
Tier 1 or 2 as needed
Tier 1 or 2 as needed
Posted: July 2011
Revised: June 2015, May 2016, March 2017, July 2018
Authors: B. Ku, MD; F. Balamuth, MD; M.K. Funari, RN; J. Lavelle, MD; C. Jacobstein, MD; D. Davis, MD; J. Fitzgerald, MD J. Gerber, MD; T. Metjian, Pharm D; S. Fesnak, MD; L. Hutchins, CRNP; D. Potts, RN
Revised: June 2015, May 2016, March 2017, July 2018
Authors: B. Ku, MD; F. Balamuth, MD; M.K. Funari, RN; J. Lavelle, MD; C. Jacobstein, MD; D. Davis, MD; J. Fitzgerald, MD J. Gerber, MD; T. Metjian, Pharm D; S. Fesnak, MD; L. Hutchins, CRNP; D. Potts, RN
Learn More
- 2007 American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock
- Implementation of Goal-directed Therapy for Children with Suspected Sepsis in the Emergency Department
- An Emergency Department Septic Shock Protocol and Care Guideline for Children Initiated at Triage
- International Pediatric Sepsis Consensus Conference: Definitions for Sepsis and Organ Dysfunction in Pediatrics
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