FIELD REFERENCE
Full criteria & treatment guidance
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.
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
- 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.
- Establish IV access. If systolic BP is below 100 and lungs are clear without CHF, give 250 mL normal saline.
- Repeat only while lungs remain clear, up to 1 L, to improve perfusion.
- 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.
VISUAL FIELD REFERENCE
Infection + at least two findings
Adult / adolescent · ALS
Start with suspected or known infection
Infection is required
Suspected or known infection, plus at least TWO findings:
PLUS at least TWO of the following
- GCS < 13
Mental status
GCS below 13
- SBP < 100
Blood pressure
systolic BP below 100 mmHg
- RR > 22/min
Breathing
respiratory rate above 22/min
Temperature
reported/measured temperature above 100.4°F (38°C) or below 97°F (36°C).
- Fluid overload is a concern with CHF or renal disease. Absence of fever does not exclude infection, especially in older or immunosuppressed patients.
Selected checkpoints; read the complete guide for criteria, exclusions, doses, and ongoing care. SO-M-055 · PR-230
UNDERSTAND THE CARE
Why the infection history and the trend both matter
The local screen joins a suspected infectious process to abnormal physiology. Neither a fever alone nor an isolated low pressure establishes the pathway. Ask about the likely infection, recent symptoms and change from baseline while documenting which qualifying findings are actually present. The temperature finding can be either high or low; a reassuring temperature does not erase other signs of illness.
Applying the guidance
Fluid treatment is a repeated decision. Compare blood pressure, mental status, skin perfusion, respiratory effort and lung sounds before and after each permitted bolus. The maximum is a ceiling, not an instruction to finish a bag despite deterioration. If congestion develops, the clear-lung pathway no longer describes the patient. Keep the newer adult epinephrine procedure distinct from older sepsis wording and from the pediatric order.
Reassess after each fluid bolus
Putting it together
Teaching example: after an initial bolus, pressure improves but breathing worsens and new rales appear. Report both changes and stop treating the remaining fluid allowance as an automatic next step; use the escalation instructions and current medical direction.
Diagram text & teaching checkpoints
- Infection context
- Identify the suspected source and onset.
- Qualifying findings
- Record the actual local screening findings.
- Response to care
- Compare perfusion AND lung findings.
- Escalation
- Use the current condition and procedure requirements.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.
Look beyond a dramatic fever presentation
The treatment guideline specifically describes sepsis in patients dispatched as nonspecific illness, weakness or dizziness. Ask about a possible pulmonary, urinary, or skin/soft-tissue source and compare the current mental status with the usual baseline. A patient may not volunteer an infection history unless someone asks about recent symptoms or obtains information from a caregiver.
The source identifies immune suppression and conditions such as steroid use, organ transplantation, cancer, diabetes and renal failure as relevant context. Older patients and people with immune suppression may have infection without fever. These considerations prompt a careful assessment; they do not replace the guide’s requirement for a suspected or known source plus the qualifying findings.
For a weak patient from a care facility, report which findings actually meet the local screen, what the baseline was, and who supplied the history. If fluids are indicated, include heart-failure or renal history when describing the decision and response. An early sepsis notification is more useful when it includes the suspected source, abnormalities and trend than when it consists only of the word “sepsis.”
Sources: SO-M-055