16. Pediatric Sepsis

Question 1

infection suspected or proven plus SIRS criteria positive, infection is localized with inflammatory response, SIRS means there is a systemic response

Answer 1

sepsis definition

Question 2

occurs in sepsis but also in other settings such as trauma burns, pancreatitis, ischemia, SIRS represents dysregulation of the immune response, the flooding of pro and anti-inflammatory cyokines causes the clincal findings, two or more criteria, one must be temp or WBC count, core temp >38C or <36C, tachycardia or bradycardia for age, tachypnea or need for mechanical ventilation, elevated or decreased WBC count >15K or <5K, or >10% band formsco

Answer 2

systemic inflammatory response syndrome

Question 3

sepsis > severe sepsis > septic shock > refractory septic shock > multiple organ failure

Answer 3

continuum of sepsis

Question 4

age < 1 month, severe trauma/burns, children with special health care needs, immunosuppression like cancer, sickle cell, medications, devices, urinary tract anomalies

Answer 4

pediatric sepsis risk factors

Question 5

any microbe can cause sepsis, 30-75% of cases have no pathogen isolated, bacteria and viruses are most commonly identified, under 3 months old includes group B strep, e coli, listeria, herpes simplex virus can look like bacterial infection since they do not have vesicular lesions up to 40%, neutropenic patients gram + infections are coagulase negative staph aureus, s aureus, pneumococcus, gram - infection can be psuedomonas, e coli klebsiella, central line associated blood stream infections include coagulase negative staphyloccocus infection and other gram -

Answer 5

pediatric sepsis etiology

Question 6

begin treatment when sepsis is suspected, broad spectrum antimicrobials but think about causative pathogens, goal directed therapy is pursued as targeted efforts to reverse physiological abnormalities, usually meaning fluids and occasionally vasoactive drips, work on identifying etiology and/or alternate diagnosis, pediatric patients need relatively more fluid volume to reverse sepsis

Answer 6

pediatric sepsis treatment

Question 7

appearance, work of breathing, circulation

Answer 7

important to evaluate as pediatric patient comes in

Question 8

child abuse, congenital heart disease, myocarditis/cardiomyopathy, metabolic disease, dehydration, malrotation with volvulus, intussusception, toxins

Answer 8

pediatric sepsis differential diagnosis

Question 9

usually onset in the first 24 hours of life, can be up to a week, organisms from maternal GI tract include group B strep, e coli, listeria, causes temperature instability, lethargy, poor feeding, respiratory distress, grunting, tachypnea, retractions, abnormal heart rate, risk if membranes ruptured more than 18 hours prior to delivery, maternal GU infection, maternal fever, prematurity, group B strep

Answer 9

neonatal sepsis

Question 10

temperature >/= 38C 100.4

Answer 10

fever defintion

Question 11

well appearing patient without clinical risk for bacteremia, no lines/hardware/underlying illness, occult because you have to look for it to find it

Answer 11

occult bacteremia

Question 12

appearance, work of breathing, circulation

Answer 12

pediatric assessment triad