Scribd Logo
Upload

Welcome to Scribd!

  • Sepsis Telephone Triage Under 5 Version 1.2

    Uploaded by

    endy tovar
    12 views1 page
    This document provides a sepsis screening tool for telephone triage of patients under 5 years old. It outlines 4 steps to evaluate patients for sepsis based on reported symptoms and risk factors. Step 1 identifies red flag symptoms that indicate potential sepsis and require immediate emergency response. Step 2 determines if symptoms could be due to an infection. Step 3 evaluates for additional red flag symptoms. Step 4 checks for amber flag symptoms that require further review to determine the appropriate clinical response. The goal is to identify potential sepsis cases and determine the level of emergency response needed.

    Original Description:

    Neonatal

    Original Title

    Sepsis-Telephone-Triage-Under-5-Version-1.2

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    This document provides a sepsis screening tool for telephone triage of patients under 5 years old. It outlines 4 steps to evaluate patients for sepsis based on reported symptoms and risk factors. Step 1 identifies red flag symptoms that indicate potential sepsis and require immediate emergency response. Step 2 determines if symptoms could be due to an infection. Step 3 evaluates for additional red flag symptoms. Step 4 checks for amber flag symptoms that require further review to determine the appropriate clinical response. The goal is to identify potential sepsis cases and determine the level of emergency response needed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    12 views1 page

    Sepsis Telephone Triage Under 5 Version 1.2

    Uploaded by

    endy tovar
    This document provides a sepsis screening tool for telephone triage of patients under 5 years old. It outlines 4 steps to evaluate patients for sepsis based on reported symptoms and risk factors. Step 1 identifies red flag symptoms that indicate potential sepsis and require immediate emergency response. Step 2 determines if symptoms could be due to an infection. Step 3 evaluates for additional red flag symptoms. Step 4 checks for amber flag symptoms that require further review to determine the appropriate clinical response. The goal is to identify potential sepsis cases and determine the level of emergency response needed.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    SEPSIS SCREENING TOOL TELEPHONE TRIAGE UNDER 5

    01 START CHART IF ANY OF THE


    FOLLOWING ARE REPORTED:
    Abnormal temperature SEPSIS
    Appears to be breathing more quickly or slowly than normal UNLIKELY,
    Altered mental state – include sleepy, irritable, drowsy or floppy NO CONSIDER
    Abnormally pale / bluish skin or abnormally cold hands or feet OTHER
    Reduced wet nappies or reduced urine output DIAGNOSIS
    RISK FACTORS FOR SEPSIS INCLUDE:
    Impaired immunity (e.g. diabetes, steroids, chemotherapy) Indwelling lines / broken skin
    Recent trauma / surgery / invasive procedure

    02
    YES
    COULD THIS BE SEPSIS
    DUE TO AN INFECTION? NO
    UNLIKELY,
    CONSIDER
    LIKELY SOURCE: Brain Surgical Other OTHER
    Respiratory Urine Skin / joint / wound Indwelling device DIAGNOSIS

    03
    YES
    ANY RED
    FLAG PRESENT?
    No response to social cues RED FLAG
    SEPSIS
    Doesn’t wake when roused / won’t stay awake
    Weak, high-pitched or continuous cry
    Grunting or bleating noises with every breath YES
    Finding it much harder to breathe than normal
    Very fast breathing / ‘pauses’ in breathing
    Skin that’s very pale, mottled, ashen or blue
    Rash that doesn’t fade when pressed firmly
    Temperature <36°C (check 3 times in 10 min)
    START BUNDLE
    If under 3 months, temperature ≥ 38°C

    04
    NO
    ANY AMBER FURTHER INFORMATION AND
    REVIEW REQUIRED:
    FLAG PRESENT? - ARRANGE URGENT
    IF IMMUNITY IMPAIRED TREAT AS RED FLAG SEPSIS FACE-TO FACE
    Not responding normally / no smile Poor feeding in infants YES ASSESSMENT USING
    Parental concern Reduced urine output CLINICAL JUDGEMENT
    Wakes only with prolonged stimulation Leg pain TO DETERMINE
    Significantly decreased activity Cold feet or hands APPROPRIATE CLINICAL
    Having to work hard to breathe ENVIRONMENT

    NO AMBER FLAGS : GIVE


    NO AMBER FLAGS : ROUTINE CARE AND999GIVE
    CALL
    Is breathing very fast
    SAFETY NETTING ADVICE:
    Has a ‘fit’ or convulsion
    SAFETY-NETTING ADVICE: ANY
    IF Looks mottled, bluish or pale
    Has a rash that does not fade when you press it
    CALL 111 IF CONDITION CHANGES OR DETERIORATES. OF: Is very lethargic or difficult to wake
    SIGNPOST TO AVAILABLE RESOURCES AS APPROPRIATE Feels abnormally cold to touch

    TELEPHONE TRIAGE BUNDLE:


    DIAL 999
    THIS IS TIME-CRITICAL – IMMEDIATE ACTION REQUIRED:

    AND ARRANGE BLUE LIGHT TRANSFER UKST 2020 TT3.2 PAGE 1 OF 1

    COMMUNICATION: Ensure communication of ‘Red Flag Sepsis’ to crew


    Advise crew to pre-alert as ‘Red Flag Sepsis’
    The UK Sepsis Trust registered charity number (England & Wales) 1158843
    The controlled copy of this document is maintained by The UK Sepsis Trust. Any copies of this document held outside of that area, in (Scotland) SC050277. Company registration number 8644039.
    whatever format (e.g. paper, email attachment) are considered to have passed out of control and should be checked for currency and validity. Sepsis Enterprises Ltd. company number 9583335. VAT reg. number 293133408.

    You might also like