›Critical patient pathway
›Monitoring
›Cardiac monitor
›Pulse oximetry
›Frequent blood pressure checks
›IV access
›Two large bore IV for shock concern
›Intraosseous access if unable
›Oxygen strategy
›Supplemental oxygen if saturation less than 92 percent
›Escalation for rising work of breathing
›Early sepsis bundle triggers
›Lactate
›Blood cultures before antibiotics when feasible
›Broad spectrum antibiotics within 1 hour for shock concern
Antibiotics by syndrome and severity
›Empiric antimicrobial strategy
›Mild non purulent cellulitis
›Cephalexin PO 500 mg every 6 hours
›Duration 5 days with extension if slow response
›Mild purulent infection after drainage
›TMP SMX DS 1 tablet PO every 12 hours
›Doxycycline PO 100 mg every 12 hours
›Moderate to severe cellulitis needing IV
›Cefazolin IV 2 g every 8 hours
›Clindamycin IV 600 mg every 8 hours if severe beta lactam allergy
›Severe infection with MRSA concern
›Vancomycin IV weight based local protocol dependent
›Alternative linezolid IV 600 mg every 12 hours when appropriate
›Necrotizing infection concern
›Piperacillin tazobactam IV 4.5 g every 6 hours
›Vancomycin IV weight based local protocol dependent
›Clindamycin IV 900 mg every 8 hours toxin suppression
Source control and procedures
›Drainage and debridement strategy
›Abscess management
›Incision and drainage
›Packing selective for large cavity
›Necrotizing infection concern
›Immediate surgical consult
›Do not delay for imaging if unstable
›Foreign body consideration
›Removal if accessible
›Imaging guided localization if needed
Supportive care and symptom control
›Adjunctive management
›Fluids for hypoperfusion
›Crystalloid 30 mL per kg for shock physiology local protocol dependent
›Reassess after each bolus
›Analgesia
›Acetaminophen PO 1000 mg every 6 hours as needed
›Ibuprofen PO 400 mg every 6 hours as needed if no contraindication
›Limb care
›Elevation
›Mark borders for progression tracking
›Ongoing reassessment
›Repeat vitals within 30 to 60 minutes for systemic signs
›Pain trajectory monitoring
›Erythema spread reassessment after 2 to 4 hours in ED observation
›Repeat lactate within 2 to 4 hours if initial elevated
›Specialist involvement
›Surgery
›Necrotizing concern
›Large or complex abscess
›Orthopedics
›Septic arthritis concern
›Hardware infection
›Infectious diseases
›Immunocompromised host
›Recurrent infection and unusual exposures
›Wound care
›Diabetic foot ulcers
›Chronic wounds