Additional treatment for the patient with sepsis or septic shock includes maintaining body temperature. Recall that patients with sepsis can present hyper- or hypothermic. Regardless of presenting core temperature, patients with sepsis are susceptible to heat loss. Protect them by employing warming measures such as blankets and turning up the heat in the patient compartment.
Monitor the blood sugar of patients with suspected sepsis closely. During the cascade of events that occurs systemically during severe sepsis, profound hyperglycemia becomes common—even in patients without prior histories of diabetes. Most hospitals use insulin to keep blood sugars below 180 mg/dL during sepsis.
The prehospital administration of antibiotics is beyond the scope of paramedics in essentially all EMS systems. However, it is well documented that the earlier sepsis is recognized and managed, the lower its mortality. Intravenous antibiotics may be appropriate to consider in some paramedic systems where lactate levels can be used to confirm the presence of sepsis and ED transport times are greater than 30 minutes.
The administration of intravenous antibiotics is common during interfacility transport of sepsis patients. Typically, once sepsis is confirmed, two different antibiotics are initiated simultaneously. A broad-spectrum antibiotic is given, as well as one specific to the local infection source. Vancomycin and Zosyn are commonly given as first-line antibiotics for sepsis. If you work in an environment where transport times are long (greater than 30 minutes), consider working with your medical director to implement a sepsis recognition and management plan.
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Scott R. Snyder, BS, NREMT-P, is EMT program director for the San Francisco Paramedic Association. Contact him at email@example.com.
Sean M. Kivlehan, MD, MPH, NREMT-P, is an emergency medicine resident at the University of California, San Francisco and a former New York City paramedic. Contact him at firstname.lastname@example.org.
Kevin T. Collopy, BA, FP-C, CCEMT-P, NREMT-P, WEMT, is the performance improvement coordinator for Vitalink/Airlink in Wilmington, NC, and a lead instructor for Wilderness Medical Associates. Contact him at email@example.com.