Sepsis order

Sepsis order

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📄 Medical Orders: Suspected Sepsis / Septic Shock

I. General

• Admit to: Medical Ward / ICU (ตามความรุนแรงของผู้ป่วย)
• Diagnosis: Suspected sepsis / septic shock
• NPO / Sips / Regular diet as tolerated (ตามภาวะผู้ป่วย)
• Bed rest with bathroom privileges / Complete bed rest

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II. Monitoring

• Vital signs: q1hr until stable, then q4hr
• Strict input/output monitoring
• Monitor urine output ≥0.5 mL/kg/hr
• Monitor mental status, skin perfusion, capillary refill time
• Monitor SpO₂ continuously

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III. Investigations (Septic workup)

• CBC with differential
• Blood chemistry (BUN, Cr, Na, K, HCO₃, glucose)
• Liver function tests (AST, ALT, ALP, total/direct bilirubin, albumin)
• Coagulation profile (PT, aPTT, INR)
• Serum lactate
• Blood culture ×2 sites before antibiotics (aerobic & anaerobic bottles)
• Urinalysis + urine culture
• Chest X-ray (portable if unstable)
• Others: wound culture / sputum culture / stool culture (ตามดุลยพินิจ)
• ABG with lactate if hypoxemia / shock suspected
• ECG (baseline)

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IV. Fluid Resuscitation

• Start 0.9% NaCl or Ringer’s lactate 1,000 mL IV bolus over 30–60 min, then reassess
• Repeat bolus 500–1000 mL IV q30–60 min PRN if hypotension or lactate >2 mmol/L, up to 30 mL/kg within 3 hrs
• Target: MAP ≥65 mmHg, urine output ≥0.5 mL/kg/hr

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V. Empiric Antibiotics

(เลือกตาม site of infection และความเสี่ยงของเชื้อดื้อยา)

ตัวอย่าง A: ไม่เสี่ยง Pseudomonas หรือ MRSA

• Ceftriaxone 2 g IV q24hr

ตัวอย่าง B: มีความเสี่ยง MRSA

• Ceftriaxone 2 g IV q24hr
• Vancomycin IV load 25–30 mg/kg, then maintenance per trough level

ตัวอย่าง C: Sepsis from hospital-acquired infection / risk for Pseudomonas

• Meropenem 1 g IV q8hr
• Vancomycin IV load 25–30 mg/kg

(ให้ภายใน 1 ชม.แรก หลังเพาะเชื้อ)
(ปรับตาม CrCl / nephrotoxicity และตาม culture ภายหลัง)

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VI. Others

• Paracetamol 500–1000 mg PO/IV q6h PRN for T >38.5°C
• Oxygen via nasal cannula / mask to maintain SpO₂ ≥92%
• Foley catheter insertion for accurate UOP monitoring
• Consider central venous access / arterial line if persistent hypotension or need vasopressor

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VII. Consult

• ID consult for antibiotic guidance if no improvement
• ICU consult if hypotension refractory to fluids or concern for shock