Makati Medical Center

MAKATI MEDICAL CENTER Physician’s Order Sheet Department: Medicine – Infectious Diseases Effective Date: February 11, 2008 Subject: Septic Shock Revision No. 0 Page No.

ADMITTING ORDERS

DIAGNOSIS: SEPSIS & SEPTIC SHOCK

Admit to: ______Diet: NPO temporarily

VS: Vital sign qi hourly

Nursing: I & 0 q 5hift; consider pulse oximeter; insert NGT, CVP; Foley catheter

IVF: Plain NSS 1 Liter x 8 hours; D5NSS 1 Liter x 8 hours

Diagnostics:  CBC with platelet count  PT, PTT, Fibrinogen degradation product  Chest X-ray  ECG  RBS  ABG  Na, K  Mg, Ca  BUN, Creatinine  Blood C/S 3X from different sites 1 hour apart  Urinalysis  Urine C/S  Sputum G/S and C/S  Culture of  Wound  IV catheters  ascitic fluid  decubitus ulcers  pleural fluid

Therapeutics:  Oxygen at 2-5 1pm by  nasal cannula  face mask

 Hemodynamic support: MAKATI MEDICAL CENTER Physician’s Order Sheet Department: Medicine – Infectious Diseases Effective Date: February 11, 2008 Subject: Septic Shock Revision No. 0 Page No.

 PNSS 1-2 L fast drip if hypotensive  Inotropic support: Dopamine Drip, Norepinephrine Drip

 Remove source of infection  Treat acidosis: Sodium bicarbonate for pH <7.2

 Treat disseminated intravascular coagulation  Heparin low-dose  Empiric Antibiotics

Note: Antibiotics may have to be changes depending on culture results after 2-3 days

 Non-immunocompromised Adults  Piperacillin-Tazobactam 4.5gm IV q4-6 hr or  Ceftazidime 1-2gm IV q8 hr or  Meropenem 500 mg—i gm IV q 6-8 hr or  Imipenem 500mg—i gm IV q6-8 hr o Gentamicin, Tobramycin or Amikacin IV o Clindamycin IV

 Nosocomial sepsis with IV catheter or IV drug abuse (S. aureus)  Vancomycin 1gm slow IV infusion in 1-2 hrs q 12 hr o Gentamicin orTobramycin IV o  Neutropenic patients (Neutrophiles <500/cu mm  Ceftazidime 1-2gm IV a 8 hr or  Meropenem or Imipenerri  Tobramycin or Amikacin (V  Vancomycin 1 gm slow IV infusion in 1-2 hrs q 12 hr (if with indwelling catheter)

 Candida Septicemia  Amphotericin B IV or Fluconazole IV infusion

 If pseudomonas aeruginosa is suspected fo for AIDS patients:  Ceftazidime 1-2 gm IV q 8 hr or  Meropenem or Imipenem o Amikacin or Tobramycin IV