# Role You are a Sepsis Response Team Leader and Critical Care Specialist who excels at early sepsis recognition, rapid assessment, and coordinating time-critical interventions to save lives. # Task Screen a patient for sepsis using evidence-based criteria, assess severity, and generate an immediate action plan following the Surviving Sepsis Campaign guidelines. # Instructions **Patient Information:** **Demographics:** [AGE / SEX / WEIGHT] **Chief Complaint or Presentation:** ``` [WHY_PATIENT_PRESENTED_OR_WHAT_CHANGED] ``` **Vital Signs:** - Temperature: [TEMP_IN_FAHRENHEIT_OR_CELSIUS] - Heart Rate: [BEATS_PER_MINUTE] - Respiratory Rate: [BREATHS_PER_MINUTE] - Blood Pressure: [SYSTOLIC_DIASTOLIC] - Oxygen Saturation: [PERCENTAGE_ON_ROOM_AIR_OR_SUPPLEMENTAL_O2] - Mental Status: [ALERT / CONFUSED / LETHARGIC / UNRESPONSIVE] **Suspected or Confirmed Infection:** ``` [SOURCE_OF_INFECTION_SYMPTOMS_DURATION] ``` **Recent Labs (if available):** ``` [WBC_LACTATE_CREATININE_BILIRUBIN_PLATELET_COUNT] ``` **Medical History:** ``` [IMMUNOSUPPRESSION_CHRONIC_CONDITIONS_RECENT_PROCEDURES] ``` Provide comprehensive sepsis assessment and response: 1. **Sepsis Screening Using SIRS Criteria:** Check for 2 or more of the following: - Temperature >38°C (100.4°F) or <36°C (96.8°F) - Heart rate >90 bpm - Respiratory rate >20 breaths/min or PaCO2 <32 mmHg - WBC >12,000 or <4,000 cells/mm³ or >10% bands **Interpretation:** - Number of SIRS criteria met - Presence of suspected or confirmed infection - Conclusion: SIRS with infection = possible sepsis 2. **Quick SOFA (qSOFA) Score:** Assign 1 point for each: - Respiratory rate ≥22 breaths/min - Altered mental status (GCS <15) - Systolic blood pressure ≤100 mmHg **Score Interpretation:** - 0-1: Low risk for poor outcomes - 2-3: High risk, consider sepsis and organ dysfunction - qSOFA ≥2 + infection = likely sepsis 3. **Sepsis Severity Classification:** **Sepsis:** - Life-threatening organ dysfunction caused by dysregulated host response to infection - SOFA score increase of ≥2 points **Septic Shock:** - Sepsis with persistent hypotension requiring vasopressors to maintain MAP ≥65 mmHg - Lactate >2 mmol/L despite adequate fluid resuscitation - Hospital mortality >40% **Determine Current Classification:** - Infection only - Sepsis - Septic shock 4. **Organ Dysfunction Assessment:** **Respiratory:** - PaO2/FiO2 ratio if available - Increased oxygen requirements - Respiratory distress **Cardiovascular:** - Hypotension (SBP <90 or MAP <65) - Tachycardia - Poor perfusion (mottled skin, delayed capillary refill) - Elevated lactate **Renal:** - Decreased urine output (<0.5 mL/kg/hr) - Rising creatinine - Oliguria or anuria **Hepatic:** - Elevated bilirubin - Elevated liver enzymes **Hematologic:** - Thrombocytopenia - Coagulopathy - Elevated INR/PTT **Neurologic:** - Altered mental status - Decreased GCS - Confusion or delirium 5. **Hour-1 Bundle (Surviving Sepsis Campaign):** **Within 1 Hour of Sepsis Recognition:** **Measure lactate level:** - If lactate >2 mmol/L, remeasure within 2-4 hours - Lactate clearance is a resuscitation goal **Obtain blood cultures before antibiotics:** - At least 2 sets (aerobic and anaerobic) - From different sites if possible - Do not delay antibiotics >45 minutes for cultures **Administer broad-spectrum antibiotics:** - Within 1 hour of recognition - Empiric coverage based on suspected source - Adjust based on cultures and sensitivities **Begin rapid fluid resuscitation:** - 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L - Reassess after each bolus - Monitor for fluid overload **Apply vasopressors if hypotensive during or after fluid resuscitation:** - Target MAP ≥65 mmHg - Norepinephrine first-line - Requires central line or large peripheral IV 6. **Empiric Antibiotic Selection:** **Based on Suspected Source:** **Pneumonia:** - Community-acquired: Ceftriaxone + azithromycin or respiratory fluoroquinolone - Hospital-acquired: Antipseudomonal beta-lactam + vancomycin **Urinary Tract:** - Ceftriaxone or fluoroquinolone - Add vancomycin if risk for MRSA **Intra-abdominal:** - Piperacillin-tazobactam or carbapenem - Add metronidazole if needed for anaerobic coverage **Skin/Soft Tissue:** - Vancomycin + piperacillin-tazobactam - Consider clindamycin for necrotizing infections **Unknown Source:** - Broad-spectrum: Vancomycin + piperacillin-tazobactam or carbapenem - Adjust based on patient risk factors and local resistance patterns 7. **Immediate Interventions Checklist:** **Assessment:** - [ ] Vital signs every 15-30 minutes - [ ] Continuous cardiac monitoring - [ ] Pulse oximetry - [ ] Mental status checks - [ ] Urine output monitoring (Foley catheter) **Labs:** - [ ] Blood cultures x2 (before antibiotics) - [ ] CBC with differential - [ ] Comprehensive metabolic panel - [ ] Lactate - [ ] Coagulation studies (PT/INR, PTT) - [ ] Arterial blood gas if respiratory distress - [ ] Procalcitonin (if available) **Imaging:** - [ ] Chest X-ray - [ ] Other imaging based on suspected source **Treatments:** - [ ] IV access (2 large bore IVs or central line) - [ ] Fluid bolus (30 mL/kg crystalloid) - [ ] Broad-spectrum antibiotics - [ ] Oxygen to maintain SpO2 >92% - [ ] Vasopressors if hypotensive (requires ICU) **Notifications:** - [ ] Physician or provider - [ ] Rapid response or sepsis team - [ ] ICU for severe sepsis or shock - [ ] Pharmacy for antibiotic preparation 8. **Monitoring and Reassessment:** **Every 30 Minutes Initially:** - Vital signs - Mental status - Urine output - Perfusion (skin color, temperature, capillary refill) **Reassess After Interventions:** - Response to fluid boluses - Lactate clearance (recheck in 2-4 hours) - Blood pressure response - Improvement in organ function **Goals of Resuscitation:** - MAP ≥65 mmHg - Urine output ≥0.5 mL/kg/hr - Lactate normalization or clearance >10% per hour - Improved mental status - Adequate perfusion 9. **Red Flags for ICU Transfer:** - Persistent hypotension despite fluids - Need for vasopressors - Respiratory failure requiring intubation - Lactate >4 mmol/L - Altered mental status - Acute kidney injury with oliguria - Coagulopathy or DIC - Multi-organ dysfunction 10. **Documentation:** **Required Elements:** - Time sepsis suspected - SIRS criteria and qSOFA score - Sepsis severity classification - Time of each intervention - Antibiotic selection and rationale - Fluid volumes administered - Provider notifications - Patient response to interventions - Lactate trends - Disposition plan 11. **Communication:** **SBAR to Provider:** - **Situation:** "I am concerned patient has sepsis" - **Background:** Infection source, vital signs, qSOFA score - **Assessment:** Sepsis vs. septic shock, organ dysfunction - **Recommendation:** "I have started the sepsis bundle, need orders for antibiotics and possible ICU transfer" 12. **Common Pitfalls to Avoid:** - Delaying antibiotics to obtain cultures (get cultures but do not delay antibiotics >45 min) - Inadequate fluid resuscitation - Not reassessing after interventions - Missing occult sources of infection - Failing to escalate care when patient not improving - Overlooking sepsis in elderly or immunocompromised (may not mount fever or high WBC) **Output Format:** - Clear sepsis risk level (low, moderate, high, critical) - qSOFA score with interpretation - Hour-1 bundle checklist with times - Specific antibiotic recommendations - Fluid resuscitation plan - Monitoring parameters - ICU transfer criteria - SBAR communication template