# Suspected sepsis

Recognize suspected sepsis, support perfusion, and know when to contact base.

Population: Adult / adolescent. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: Revised July 30, 2024 · Implemented October 1, 2024.
Canonical page: https://www.ocmedic.com/guides/sepsis/
Official source: [SO-M-055 — Suspected Sepsis](https://www.ochealthinfo.com/sites/healthcare/files/2024-10/SO-M-55%20Sepsis%209-2024.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Escalation & the April 2026 update

- SO-M-055 still describes contacting base for persistent systolic BP below 90 after 1 L, or CHF developing before 1 L with BP still below 90. The newer PR-230, implemented April 2026, explicitly removes the adult push-dose epinephrine base-contact/order requirement. Other required contact and destination rules still apply.
- Fluid overload is a concern with CHF or renal disease. Absence of fever does not exclude infection, especially in older or immunosuppressed patients.

## Source documents

- [SO-M-055 — Suspected Sepsis](https://www.ochealthinfo.com/sites/healthcare/files/2024-10/SO-M-55%20Sepsis%209-2024.pdf)
- [PR-230 — Preparation and Dosing of Push Dose Epinephrine - Adult/Adolescent](https://www.ochealthinfo.com/sites/healthcare/files/2026-01/PR-230%20Push%20Dose%20Epi%201-2026.pdf)

## 1. Check the criteria

- Suspected or known infection, plus at least TWO findings:
- GCS below 13; systolic BP below 100 mmHg; respiratory rate above 22/min; or reported/measured temperature above 100.4°F (38°C) or below 97°F (36°C).

## 2. Start care

1. Monitor cardiac rhythm and oxygen saturation. If SpO₂ is below 95%, give high-flow oxygen by mask or nasal cannula at 6 L/min, as tolerated.
2. Establish IV access. If systolic BP is below 100 and lungs are clear without CHF, give 250 mL normal saline.
3. Repeat only while lungs remain clear, up to 1 L, to improve perfusion.
4. Provide ALS transport to the nearest emergency receiving center. Notify the receiving team early of suspected sepsis.

## 3. Escalation after fluids

- For eligible shock under PR-230, use epinephrine diluted to 10 mcg/mL: 1 mL (10 mcg) IV/IO every 3 minutes, titrated to systolic BP above 90. Use the linked medication guide for preparation and the complete PR-230 exclusions.
- Do not treat hemorrhage/dehydration with push-dose epinephrine before volume replacement. PR-230 also excludes a perfusing non-shock state and suspected stimulant intoxication.

## 4. Reassessment & handoff

- Reassess pressure, perfusion, respiratory status, and lung sounds after each intervention. Stop repeating the clear-lung fluid pathway if congestion develops.
- Communicate the suspected infection, qualifying findings, BP trend, fluid amount, treatment response, and early sepsis concern to the receiving team.