Child Sepsis and Immunisation

Question 1

What is sepsis?

Answer 1

Multi-system organ dysfunction due to a dysregulated host response to an infection

Question 2

What are the components of an ABG that indicate the severity of sepsis?

Answer 2

Lactate levels correlate with severity

There’d be metabolic acidosis - low pH, low HCO3 and type 1 respiratory failure - low oxygen

Question 3

What is hypovolaemic shock?

Answer 3

Hypotension due to reduced blood volume

Question 4

What is septic shock?

Answer 4

Hypotension due to vasodilation and infection and inflammatory responses

Question 5

What is the definition of sepsis in a child?

Answer 5

At least 2 of high or low temp, high HR, high RR and high or low WCC (system inflammatory response syndrome) + a suspected or proven infection (sepsis)

And if it’s severe - organ dysfunction - shock, respiratory or two or more other organs

Question 6

What is SEPSIS 6 in a paediatric setting?

Answer 6

1. Give high flow oxygen
2. Obtain IV/IO access and take bloods
3. Give IV/IO antibiotics
4. Consider fluid resus - dependent on lactate levels
5. Involve senior clinicians/specialists early
6. Consider inotropic support early

Question 7

What is inotropic support in sepsis?

Answer 7

Adrenaline/NA to reverse cold/warm shock

Question 8

What antibiotics are used in paediatric sepsis?

Answer 8

Under 1 month old - gentamicin, amoxicillin or cefotaxime
1-3 months old - amoxicillin, ceftriaxone
over 3 months - ceftraixone

Question 9

What are the common causative organisms of sepsis in children?

Answer 9

• Neisseria meningitides
• Haemophilus influenzae
• Streptococcus pneumoniae

Question 10

What is the possible presentation of children with sepsis?

Answer 10

• Fever or low temp - but normal temp doesn’t rule out sepsis
• fast HR
• fast RR
• low oxygen
• pale
• unresponsive or confused
• non-blanching rash
• ABCDE - appearance, breathing, circulation, demeanour, exposure
• after having a recent infection e.g. “bad cold”

Question 11

What are the benefits of vaccines?

Answer 11

Broad - prevent illness and reduces burden of healthcare, if kids are ill less, their cognitive skills improve quicker, same with physical strength

Specific - save on medical expenditures, reduces stress on family/parents as children ill less often, reduced disease in population

Question 12

What is vaccine hesitancy?

Answer 12

A delay in acceptance of or refusal of vaccines despite available vaccination services - involves complacency, convenience and confidence

Question 13

What are common obstacles to achieving good vaccination rates?

Answer 13

• vaccine hesitancy
• lay opinions
• media
• lack of time
• fear of needles
• scary big pharmaceutical companies

Question 14

What is the UK standard childhood immunisation schedule and where can it be found?

Answer 14

A schedule to help doctors and caregivers know which vaccines a child should be having and when

WHO
NICE

Question 15

How do childhood vaccinations work?

Answer 15

Given vaccines at young age with live/inactive parts of a microbe that allow the body to have a host response, so when the child comes into contact with the actual microbe, their immune system is already prepared to fight it