Patient has received chemotherapy within past 6 weeks?

1. Management Of Suspected Febrile Neutropenia When indicated, antibiotics must be given within 60 minutes. Antibiotics must not be delayed by waiting for FBC results to confirm neutropenia No Patient has received chemotherapy within past 6 weeks? Normal triage and management of sepsis Yes 1. Intravenous fluid resuscitation 2. Critical care outreach team referral 3. Send urgent FBC, blood cultures, U&E LFT, CRP, G&S. Do not wait for results. 4. If no allergies: Piperacillin/tazobactam 4.5g IV and gentamicin 5mg/kg IV§ +/- vancomycin 1g IV§ (MRSA+ or CV line) 4. If penicillin allergy*: Meropenem 1g IV +/- vancomycin 1g IV§ (MRSA+ or CV line) 5. Send MSU Urgent observations CEWS scoring Record drug allergies HIGH RISK Clinical Early Warning Score Process FBC immediately using ISTAT Also send urgent U&E, LFT, CRP, group & save, blood cultures, MSU No Neutrophils <1.0 ? Patient is not neutropenic Oncology pt: contact acute oncology service Haematology pt: contact on-call haematologist Yes No Pyrexia >38°C (or fever at home)? or Patient Unwell Patient may not be septic Oncology pt: contact acute oncology service Haematology pt: contact on-call haematologist Yes Penicillin allergy* Weigh patient Review drug allergies Meropenem 1g IV +/- vancomycin 1g IV§ if suspect central line or MRSA infection No allergies Piperacillin / tazobactam 4.5g IV andgentamicin 5mg/kg IV§ +/- vancomycin 1g IV§ if suspect central line or MRSA infection Door to needle time = ______mins Contact Acute Oncology Service *This refers to previous skin reactions with penicillins. If previous anaphylaxis with penicillins, please contact on-call microbiologist for advice before giving meropenem. §Dose of gentamicin and vancomycin should be reduced if there is renal impairment. Gentamicin should be dosed on ideal body weight if >20% obese. Please refer to trust anti-microbial guidelines.