ACS Sepsis Stroke Trauma GI bleed DKA Anaphylaxis Pregnancy trauma Child sepsis Status epilepticus APO HyperK

Sepsis and septic shock

Start this sheet when: Suspected infection with NEWS2 5 or more, any single red-flag sign (SBP 90 or less, new confusion, RR 25 or more, SpO2 below 92%, mottled skin), or lactate 2 or more. Time zero is the door, or the moment sepsis is recognised if that is later.

Hospital (remembered on this device)Patient ID / UHID (not saved)Age / SexFilled by

Door dateDoor time (clock starts here)

Time since door

Targets met --Breaches 0

1.Triage, sepsis screen positive
≤ 5 min from door · ED KPI: triage median 5 min
Enter door time
2.Doctor review at the bedside
≤ 15 min from door · Local target: red-flag sepsis seen at once
Enter door time
3.Lactate measured (venous gas is fine)
≤ 1 h from door · SSC hour-1 bundle
Enter door time
4.Blood cultures x2 drawn
≤ 1 h from door · SSC hour-1: before the antibiotic, never delaying it
Enter door time
5.First antibiotic dose running
≤ 1 h from door · SSC 2021: 1 h in shock or probable sepsis
Enter door time
6.30 mL/kg balanced crystalloid completed(Hypotension or lactate 4+)
≤ 3 h from door · SSC 2021: first 3 h
N/AEnter door time
7.Noradrenaline started for MAP below 65(MAP below 65 despite fluids)
≤ 1 h from door · SSC hour-1 bundle: during or after fluids
N/AEnter door time
8.Repeat lactate(First lactate 2 or more)
≤ 4 h from door · SSC 2021: repeat at 2-4 h if first was raised
N/AEnter door time
9.Disposition decided
Record · Admit / transfer / OT; for the length-of-stay audit
Enter door time
10.Patient left the ED
≤ 2 h from disposition decision · ED KPI: decision to departure 2 h or less
Enter door time

Bedside checklist

☐Reassess after every 250-500 mL: crackles, JVP, liver, SpO2, CRT
☐Dengue shock or capillary leak: smaller boluses, watch haematocrit
☐Source in 6 h: urine, chest X-ray, USG abdomen; drain or OT by 12 h
☐Ceftriaxone runs in 5 min: give it first, slower drugs after
☐Add doxycycline for scrub typhus; artesunate if malaria test positive
☐Catheter and hourly urine output, target 0.5 mL/kg/h
☐Hydrocortisone 200 mg/day if noradrenaline 0.25 mcg/kg/min or more for 4 h
☐ICU / HDU called at the first vasopressor, not after the second

References

Targets marked “local” are suggestions: agree your own with the quality committee before auditing against them.

Bedside checklist

☐Reassess after every 250-500 mL: crackles, JVP, liver, SpO2, CRT

☐Dengue shock or capillary leak: smaller boluses, watch haematocrit

☐Source in 6 h: urine, chest X-ray, USG abdomen; drain or OT by 12 h

☐Ceftriaxone runs in 5 min: give it first, slower drugs after

☐Add doxycycline for scrub typhus; artesunate if malaria test positive

☐Catheter and hourly urine output, target 0.5 mL/kg/h

☐Hydrocortisone 200 mg/day if noradrenaline 0.25 mcg/kg/min or more for 4 h

☐ICU / HDU called at the first vasopressor, not after the second