Protocol 4-500 - Chronic Sepsis Management

CMH EMS & MIH Protocols

Condition GREEN: All Clear Zone... This is the safety zone.
Indications:
  • None of the YELLOW or RED indications are present.
What you can do:
  • Take your medications as ordered.
  • Follow healthy eating habits.
  • Drink enough fluids to keep your urine light yellow in color.
  • Get plenty of rest while you are recovering. Try to get at least seven (7) to nine (9) hours of sleep each night.
  • Balance activity and rest periods.
  • Perform hand hygiene before and after eating, restroom activities, changing dressings, or changing catheters.
  • Keep wounds and surgical sites clean until healed.
  • Keep your living environment and home clean.
  • Keep all medical appointments.
What your CHW might do:
  • Review health history and PCP care plan prior to visit.
  • Answer any questions and address any concerns you have.
  • Review any discharge instructions from any hospital, emergency room, and/or doctor visits.
  • Review goals from previous visit:__________
  • Assess adherence to care plan, including diet, exercise, medications, and keeping appointments.
  • Review disease process and prevention measures with you including how and when to correctly take your medications.
  • Education on sepsis is to be expected for every encounter specific to your diagnosis(es).
  • Education on healthy eating and living habits is to be expected for every encounter.
  • Specific education on medications as they relates to your specific diagnosis will be provided.
  • Complete a History and Physical Exam.
  • A complete Medications Reconciliation is to be expected at every encounter.
  • Complete a Safety Assessment.
  • Complete a Social Assessment.
  • Facilitate a Telehealth visit, if scheduled.
  • Follow any verbal orders as obtained via telehealth, phone call, or electronic messaging.
  • Schedule follow-up appointment(s) as needed that might include, but not limited to: Primary Care Provider, Addiction Recovery, Behavioral Health, Dental Care, Dietician, Home Health, Home Medical Equipment, Hospice, Pharmacy Services, Therapy Services, Public Health, Wound Care
  • Establish goals for next visit:__________
What your CP might do:
  • Ensure completion of applicable CHW items above.
  • Perform venous blood draw.
Condition YELLOW: Warning Zone... This is the watch zone.
Indications:
  • None of the RED indications are present.
  • Fever higher than 100.5° F,
  • Chills or sweats,
  • New body aches,
  • Nausea or vomiting,
  • Decrease in appetite,
  • Decrease in your ability to do usual activities,
  • Fast heartbeat (above 100) while at rest,
  • New dizziness when you stand up,
  • Small amounts of new redness or swelling from any wound,
  • Easy bruising or bleeding,
  • Increased pain at site of infection or surgery,
  • Redness, swelling, or leaking around the area where an IV goes into your skin,
  • An uneasy feeling or you know something is not right,
  • Other indication set by your doctor:____________________
What you can do:
  • You may need an adjustment to your medications.
  • Improve your eating habits.
  • Increase your activity level.
  • Call your CHW or CP:____________________
  • Call your PCP:____________________
    • If outside business hours, 24-hour triage nurse screening is available by calling your PCP's number.
What your CHW might do:
  • Ensure completion of applicable items in the GREEN zone above.
What your CP might do:
  • Ensure completion of applicable CHW items above.
Condition RED: Medical Alert Zone... This is the danger zone.
Indications:
  • Altered mental status, confusion, or inability to think clearly,
  • Shortness of breath,
  • Clammy and sweaty skin,
  • Fever higher than 101.5° F,
  • Fast heartbeat (above 110) while at rest,
  • Fainting when you stand up or extreme dizziness,
  • Medium to large amounts of new redness or swelling from any wound,
  • Urinating less or not at all,
  • Drainage of pus from any wound,
  • Extreme pain or discomfort,
  • You have been in the YELLOW Zone for more than 24 hours without getting better,
  • Other indication set by your doctor:____________________
What you can do:
  • You need immediate evaluation by a medical professional.
  • Call your CHW or CP:____________________
  • Call your PCP:____________________
    • If outside business hours, 24-hour triage nurse screening is available by calling your PCP's number.
  • Call 9-1-1
What your CHW might do: What your CP might do:
  • Ensure completion of applicable CHW items above.
  • Assist you in the administration of your own prescribed medications.
  • Consult with your PCP to recommend antibiotic administration:
    • Bites (animal or human): Amoxicillin/Clavulanate 500 mg / 125 mg three times per day for seven to ten days.
    • Bronchitis:
      • Zithromax 250 mg two on the first day follwed by one per day for four more days OR
      • Amoxicillin/Clavulanate 500 mg / 125 mg three times per day for seven to ten days.
    • Cellulitis: Keflex 500 mg four times per day for five to ten days.
    • Cellulitis with MRSA:
      • Bactrim 160 mg / 800 mg two times per day for five to ten days OR
      • Clindamycin 300 mg four times per day for five to ten days.
    • Strep pharyngitis:
      • Penicillin 500 mg four times per day for seven to ten days OR
      • Keflex 500 mg four times per day for seven to ten days OR
      • Zithromax 250 mg two on the first day followed by one per day for four more days OR
      • Amoxicillin/Clavulanate 500 mg / 125 mg three times per day for seven to ten days.
    • Tooth infection:
      • Penicillin 500 mg four times per day for seven to ten days OR
      • Clindamycin 300 mg four times per day for five to ten days.
    • Urinary tract infection of pyelonephritis:
      • Keflex 500 mg three times per day for three to ten days OR
      • Bactrim 160 mg / 800 mg two times per day for three to ten days OR
      • Cipro 500 mg for three to ten days.

NEMSIS Protocol: 9914175 - General-Community Paramedicine / Mobile Integrated Healthcare

Citations:

Change Log:

DateLink to
previous
version		Description of change
03/16/23Created this section.
05/12/23pdfFirst draft with green, yellow, and red sections.
05/26/23pdfAdded review of discharge instructions. Changed antibiotic infusion to antibiotic administration.

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