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    Pediatric Septic Shock Collaborative Triage Trigger Tool

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    sdamays
    This document presents a triage tool to identify pediatric patients presenting with sepsis or septic shock. It provides tables to assess vital signs, high-risk conditions, and exam abnormalities. The tool guides clinicians through an assessment of temperature, hypotension, tachycardia, tachypnea, capillary refill, mental status, pulses, skin, and whether the patient meets criteria to initiate septic shock protocols and mobilize resources. If criteria are not met, routine triage continues, but high-risk patients meeting two criteria should alert physicians.

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    Pediatric Septic Shock Collaborative Triage Trigger Tool

    Uploaded by

    sdamays
    31 views1 page
    This document presents a triage tool to identify pediatric patients presenting with sepsis or septic shock. It provides tables to assess vital signs, high-risk conditions, and exam abnormalities. The tool guides clinicians through an assessment of temperature, hypotension, tachycardia, tachypnea, capillary refill, mental status, pulses, skin, and whether the patient meets criteria to initiate septic shock protocols and mobilize resources. If criteria are not met, routine triage continues, but high-risk patients meeting two criteria should alert physicians.

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    pediatric ayok triger tool

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    pediatric syok

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    This document presents a triage tool to identify pediatric patients presenting with sepsis or septic shock. It provides tables to assess vital signs, high-risk conditions, and exam abnormalities. The tool guides clinicians through an assessment of temperature, hypotension, tachycardia, tachypnea, capillary refill, mental status, pulses, skin, and whether the patient meets criteria to initiate septic shock protocols and mobilize resources. If criteria are not met, routine triage continues, but high-risk patients meeting two criteria should alert physicians.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    31 views1 page

    Pediatric Septic Shock Collaborative Triage Trigger Tool

    Uploaded by

    sdamays
    This document presents a triage tool to identify pediatric patients presenting with sepsis or septic shock. It provides tables to assess vital signs, high-risk conditions, and exam abnormalities. The tool guides clinicians through an assessment of temperature, hypotension, tachycardia, tachypnea, capillary refill, mental status, pulses, skin, and whether the patient meets criteria to initiate septic shock protocols and mobilize resources. If criteria are not met, routine triage continues, but high-risk patients meeting two criteria should alert physicians.

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    of 1

    PEDIATRIC SEPTIC SHOCK COLLABORATIVE

    TRIAGE TRIGGER TOOL


    Patient presents to the ED with concern Exclude from shock
    NO
    for infection and/or temperature triage tool.
    abnormality (in the ED or within 4 hrs of Continue routine triage Table 1. High Risk Conditions
    presentation)? process • Malignancy
    • Asplenia (including SCD)
    YES • Bone marrow transplant
    Continue assessment at triage • Central or indwelling line/catheter
    • Solid organ transplant
    Transfer patient to a • Severe MR/CP
    YES
    General assessment: resuscitation room and • Immunodeficiency, immunocompromise or immunosuppression
    Is patient critically ill? immediately alert physician /
    NO resuscitation team
    Table 2. Vital Signs (PALS)
    Continue shock triage tool Heart Resp Temp
    • Obtain a full set of vital signs including blood pressure and temperature Age Rate Rate Systolic BP (°C)
    • Perform a brief history and physical exam assessing mental status, 0d– 1m > 205 > 60 < 60 <36 or >38
    skin, pulses and capillary refill/perfusion
    • Is the patient a high-risk patient? (see Table 1) 1m-3m > 205 > 60 < 70 <36 or >38
    Septic Shock Checklist
    3m-1r > 190 > 60 < 70 <36 or >38.5
     Temperature abnormality (Table 2) ____________°C
     Hypotension (Table 2) ___________________mmHg 1y-2y > 190 > 40 < 70 + (age in yr × 2) <36 or >38.5
     Tachycardia (Table 2) _____________________bpm
     Tachypnea (Table 2) _____________________bpm 2y-4y > 140 > 40 < 70 + (age in yr × 2) <36 or >38.5
     Capillary refill abnormality (Table 3) ______________ 4y-6y > 140 > 34 < 70 + (age in yr × 2) <36 or >38.5
     Mental status abnormality (Table 3) ______________
     Pulse abnormality (Table 3) _____________________ 6 y- 10 y > 140 > 30 < 70 + (age in yr × 2) <36 or >38.5
     Skin abnormality (Table 3) ______________________
     10 y - 13 y > 100 > 30 < 90 <36 or >38.5

    > 13 y > 100 >16 < 90 <36 or >38.5

    YES Initiate/continue the Septic Shock


    Is patient Table 3. Exam Abnormalities
    hypotensive? protocol /pathway using the Septic
    Shock Order Set, and mobilize Cold Shock Warm Shock Non-specific
    NO resources
    Pulses
    Decreased
    (central vs. Bounding
    Does patient meet 3 or more of the 8 or weak
    Continue peripheral)
    clinical criteria, NO routine
    OR
    triage
    Does high-risk patient meet 2 or more of Capillary refill
    process
    the 8 clinical criteria? (central vs.  3 sec Flash (< 1 sec)
    YES peripheral)

    Identify the patient as meeting septic Flushed, ruddy,


    shock triage criteria, transfer to a room Mottled, Petechiae below the nipple, any
    Skin erythroderma
    immediately and alert physician cool purpura
    (other than face)

    YES Decreased, irritability, confusion,


    Does physician assessment concur with
    triage assessment? inappropriate crying or drowsiness,
    Mental status poor interaction with parents,
    NO
    lethargy, diminished arousability,
    obtunded
    Continue routine care

    CONTACT INFORMATION: [email protected],[email protected] DATE: 3/14/2014 (Fall 2014 CQPI)

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