Prehospital Sepsis Screen of Robson et a

 

Patient selection: sick patient in the community, with emergency response team called

 

The protocol consists of 3 parts:

(1) screen for signs and symptoms of infection

(2) identification of an infection source

(3) recogntion of septic shock

 

Parameters for initial screen which should be new for the patient:

(1) body temperature in °C

(2) glucose in mmol/L

(3) respiratory rate in breaths per minute

(4) heart rate in beats per minute

(5) mental status

 

Parameter	Finding	Points
body temperature	< 36°C	1
	36 to 38.3°C	0
	> 38.3°C	1
glucose	<= 6.6 mmol/L	0
	> 6.6 mmol/L and diabetic	0
	> 6.6 mmol/L and not diabetic	1
respiratory rate	<= 20 breaths per minute	0
	> 20 breaths per minute	1
heart rate	<= 90 beats per minute	0
	> 90 beats per minute	1
mental status	not altered	0
	acutely altered	1

 

total score =

= SUM(points for all 5 parameters)

 

Interpretation:

• minimum score: 0

• maximum score: 5

• A score >= 2 indicates a patient who has signs and symptoms of sepsis.

 

The second step is to identify possible sources of infection:

(1) pneumonia

(2) urinary tract infection (UT)

(3) intra-abdominal

(4) meningitis

(5) cellulitis, wound infection, soft tissue infection, septic arthritis

(6) infected indwelling device

(7) other

 

If the patient has a source for infection, then sepsis is likely.

 

The third step is to identify evidence of septic shock with organ failure.

 

Findings associated with septic shock include any of the following:

(1) hypotension (systolic blood pressure < 90 mm Hg, mean arterial pressure < 65 mm Hg)

(2) oxygen saturation < 90%

(3) anuria or oliguar for > 8 hours (no urine passed)

(4) bleeding from minor cuts or gums

(5) elevated serum lactate > 2 mmol/L.

 

A patient with any of the findings is presumed to have severe sepsis and requires immediate resuscitation.