The NYPH Pediatric Sepsis protocol should be activated immediately when a patient is suspected of having sepsis. It emphasizes 7 key steps.
Establish reliable intravenous IV or IO access
Send a blood culture, culture other potential sources before giving antibiotics whenever possible and send other appropriate labs
Within the first golden hour, initiate the first 20 cc/kg bolus (ideally within the first 5 minutes), reassess and repeat up to and over 60 cc/kg of isotonic fluid, titrating to physiologic end-points.
Within 60 minutes, initiate broad spectrum antibiotics.
Treat hypoglycemia and hypocalcemia.
Treat fluid-refractory shock with vasopressors
Warm shock: norepinephrine
Cold shock: dopamine or epinephrine