• Oral temp < 36°C (96.8°F) or ³ 38°C (100.4°F) • Heart rate > 110 beats per minute • Respiratory rate > 24 breaths per minute • WBCs > 15,000/mm3 or < 4,000/mm3 or > 10% bands Positive if any 2 of 4 criteria met
NOTE: Action: If suspected infection, start A MAP < 65 mm Hg source-directed antibiotics and (sustained for 15 minutes 1-2 L of IV fluids; increase after 30mL/kg fluid load) monitoring and surveillance. in setting of infection Move to confirmation evaluation. directly defines SEPTIC SHOCK
Step 2: Confirmation of Sepsis Evaluation
• Respiratory: New need for mechanical ventilation or PaO2/FiO2 < 300 • Coagulation: Platelets < 100 x 109/L or INR > 1.5 or PTT > 60 secs • Liver: Bilirubin > 2 mg/dL • Cardiovascular: SBP < 85 mm Hg or MAP < 65 mm Hg or > 40 mm Hg decrease in SBP (after fluids) • Renal: Creatinine ³ 1.2 mg/dL or doubling of creatinine or urine output < 0.5 mL/kg/hr x 2 hrs • Mental Status: Agitated, confused, or unresponsive • Lactic Acid: > 2 mmol/L in absence of labor Confirmed if 1 or more criteria met
Action: Start source-
directed antibiotics, All Criteria ≥ 1 Criterion broad spectrum NEGATIVE POSITIVE antibiotics if source Action: This group defines SEPSIS unclear; increase fluids remains at high risk to 30 mL/kg within 3 for sepsis and requires hours; collect blood close supervision and cultures if not already reevaluation. Elevated obtained, maintain close MAP < 65 mm Hg surveillance, e.g. RRT, lactate ONLY (sustained for 15 and repeat lactate. in Labor minutes) defines Escalate care as needed. Action: At a minimum, maintain close SEPTIC SHOCK surveillance; consider additional fluids to reduce lactic acid level; repeat lactate. (See Discussion Action: As above for Sepsis, admit to ICU. If of the Role of Lactic Acid in the Peripartum hypotension persists after 30 mL/kg fluid Period In the toolkit for more detail.) load, assess hemodynamic status and consider vasopressor use. Rev1: 4/2020
