[72] Sepsis Flashcards
What is sepsis?
A life-threatening condition that arises when the body’s response to infection causes injury to it’s own tissues and organs
What causes sepsis?
Bacterial proliferation in the blood stream leading to over reactive host response
What parts of the immune response can lead to sepsis?
Release of inflammatory cytokines and activation of endothelial cells
What are the most common causative organisms of sepsis in children in the UK?
- Coagulase negative Staph
- Staph aureus
- Non-pyogenic streptococci
- Streptococci pneumoniae
Why are infections with H. Influenzae, meningococcus and pneumococcus becoming less common?
Due to immunisation against these organisms
What is the most common cause of earl onset sepsis in neonates?
Group B strep and E. coli
What is the most common cause of late-onset sepsis in neonates?
Coagulase negative staphylococcus
What are the risk factors for developing sepsis?
- Sickle cell disease
- Immunodeficiency
What are the general symptoms of sepsis in children?
- Poor feeding
- Miserable
- Lethargy
- Irritable
What are the signs of sepsis?
- Fever
- Tachycardia
- Tachypnoea
- Low BP
- Signs of shock and multi-organ failure
What may be an important indicator of sepsis?
History or signs of an ongoing infection
What is a common sign of meningococcal septicaemia?
Purpuric, non-blanching rash
What pathway is important to follow in Sepsis management?
Sepsis 6
What is the sepsis 6?
- Antibiotics
- Oxygen
- Fluids
- Measure urine output
- Blood cultures
- Serum lactate
What blood tests should be performed in suspected sepsis?
- Blood gas, lactate and glucose
- Blood culture
- FBC
- CRP
- Urea and electrolytes
- Creatinine
- Clotting screen (in high risk patients)
How should examination and further investigations be influenced?
By possible sources of infection
What further investigations could be considered?
- Urinalysis
- CXR
- Abdo and pelvis imaging
What influences the antibiotic of choice?
- Child’s age
- Predisposition to infection
What should be given in suspected meningococcal disease?
IV ceftriaxone
For community acquired sepsis what antibiotic should be used?
Ceftriaxone 80mg/kg/day (maximum dose 4g daily)
For hospital acquired sepsis (except neonates) what antibiotic should be used?
Check local guidelines
What additional antibiotic should be given in children under 3 months?
Amoxicillin
Why is amoxicillin also given in children under 3 months?
To have activity against listeria
How should fluids be administered in sepsis?
IV bolus
What should be done after administering initial IV fluid bolus?
Assess need for second bolus
What should you do if no response to second IV bolus?
Get senior help
What may be needed to asses the fluid balance?
- Central venous pressure monitoring
- Urinary cathaterisation
When should oxygen be given to children with sepsis?
- Sats < 92% when breathing air
- Signs of shock
