Definitions
Follow the clocks for an approximate time line after entering protocol at 12:00!
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Systemic inflammatory response may be present in animals with a consistent history and clinical characteristics, and with
any 3 or more of the following findings:
- resting HR > 140 (dog) or > 220 (cat) or < 160 (cat)
- resting respiratory rate > 30
- Injected or pale grey mucous membranes
- warm skin
- hypo- or hyperthermia
- leukocytosis or leucopenia
- thrombocytopenia
Sepsis syndrome is a systemic inflammatory response due to bacterial infection and is categorized, in order of increasing
severity, as:
- Sepsis: A systemic inflammatory response due to bacterial infection. Protocolized therapy not needed. Address underlying
infection and monitor response.
- Severe sepsis: Sepsis with hypotension (MAP < 70 mm Hg) that responds to supportive care and fluid therapy without vasopressors.
Enter protocol
- Septic Shock: Sepsis with hypotension unresponsive to fluid therapy and requiring vasopressors. Enter protocol
Acute Care Therapeutic Targets
Dogs
- HR < 140 BPM
- Temperature > 38o C
- Normal, bounding, or improved pulse
- Normal-to-injected mucus membrane color
- Warm skin
- CRT < 2 seconds
- Noninvasive arterial pressure systolic (SAP) > 140 mm Hg, mean (MAP) 80-90 mmHg
- Direct MAP 80-90 mm Hg, diastolic blood pressure (DBP) > 60 mm Hg
- Urine output > 1-2 ml/kg/hour
- Alert, oriented mentation
- Appropriate CVP response to fluid challenge
- Normoglycemia
- Arterial blood gas analysis: pO2 > 90 mm Hg, pCO2 25 – 35 mm Hg, lactate concentration < 2.5 mmol
Cats
- HR > 160 BPM
- Temperature > 38o C
- Palpable or improved pulse
- Normal-to-injected mucus membrane color
- Warm skin
- CRT < 2 seconds
- Noninvasive arterial pressure systolic (SAP) > 120 mm Hg, mean arterial pressure (MAP) 80-90
- Direct MAP 80-90 mm Hg, diastolic blood pressure (DBP) > 60 mm Hg
- Urine output > 1-2 ml/kg/hour
- Alert, oriented mentation
- Appropriate CVP response to fluid challenge
- Normoglycemia
- Arterial blood gas analysis: pO2 > 90 mm Hg, pCO2 25 – 35 mm Hg, lactate concentration < 2.5 mmol
Step 1: Characterize patient condition and begin instrumentation
Monitor with ECG, pulse oximetry
- Large-bore peripheral catheter
- Central venous catheter: Consider a double- or triple-lumen catheter
- Collect blood for:
o CBC
o chemistry profile
o Big 4 (PCV, TS, glucose, BUN)
o Arterial (or central venous) blood gas
o Coagulation profile and/or a baseline aPTT on the SCA 2000
- If SPO2 is < 90% or if increased respiratory effort is present: oxygen by face mask
