Inadequate Perfusion: Non-cardiogenic / Non-hypovolaemic (Adult)
 
Status
Suspected Sepsis
Other causes of non-cardiogenic, non-hypovolaemic shock
   
Assess
• Perfusion status
• Respiratory status
• Sepsis criteria
• Other possible causes
   
Inadequate or Extremely poor perfusion
• If sepsis is suspected and chest is clear and MICA is not immediately available:
  - Confirm request for MICA support
  - Normal Saline up to 20ml/kg IV over 30 minutes
  - Normal Saline up to 20ml/kg IV
   
Reassess
         
Adequate Perfusion
BLS
 
Inadequate or Extremely Poor Perfusion persists
Adrenaline Infusion (3mg/50ml Dextrose 5% / Normal Saline) commencing at 5mcg/min. (5ml/hr)
  - Increase by 5mcg/minute, 2 minutely until adequate perfusion/side effects
Inadequate or Extremely Poor Perfusion persists
  - Reassess Pt and delivery system prior to increasing rate beyond 50mcg/minute
If syringe pump unavailable/malfunction
  - Adrenaline 10mcg IV
  - repeat Adrenaline 10mcg, 2 minutely until adequate perfusion/side effects
If poor response
  - Adrenaline 50-100mcg IV as required
  - NB. Doses >100mcg may be required
If chest clear
Continue Normal Saline 20ml/kg IV boluses as per Hypovolaemia
 
Special Notes
Any infusions established under this Guideline must be clearly labelled with the name and dose of any additive drugs and their dilution.
Sepsis criteria are relevant in the presence of an infection or severe clinical insult such multi trauma leading to SIRS (Systemic Inflammatory Response Syndrome).
- 2 or more of:
- Temp >38˚C or <36˚C
- HR >90
- RR >20
- BP <90
If sepsis suspected and prolonged transport times exist (>1 hour) consider Ceftriaxone 1g IV (consult)
  - Do not consult if meningococcal septicaemia is suspected and manage as per Meningococcal Septicaemia
  -  Dexamethasone is no longer indicated in the management of the patient with sepsis
 
General Care
Adrenaline Infusion >50mcg/min. may be required to manage these Pts.
- Ensure delivery system is fully operational (e.g. tube not kinked, IV patent) prior to increasing dose.
Unstable Pts may require bolus Adrenaline concurrently with the infusion.
Adrenaline Infusion
- 3mg Adrenaline added to make 50ml with Dextrose 5% or Normal Saline.
- 1ml/hr = 1mcg/min.