Emergency: Sepsis Flashcards
In neonates, early onset sepsis is most commonly caused by…
Group B streptococcus
E. coli
In neonates, late onset sepsis is most commonly caused by..
Coagulase negative staphylococcus - staphylococcus epidermis
Which causes of sepsis have declined since immunisation introduction?
Neisseria meningitidis
Haemophilius influenzae
Streptococcus pneumonia
What clinical features of sepsis are there (history)?
Fever
Poor feeding
Miserable, irritable, lethargy
History of focal infection: meningitis, osteomyelitis, gastroenteritis, cellulitis
Predisposing conditions: sickle cell disease, immunodeficiency
What examination findings can indicate sepsis?
Fever
Tachycardia
Tachypnoea
Low BP
Purpuric rash (meningococcal septicaemia)
Features that suggest source (e.g pneumonia, UTI, meningitis etc)
What does septic shock mean?
Persisting hypotension requiring treatment to maintain blood pressure despite fluid resuscitation
What must be started without delay?
Antibiotics
What is the sepsis 6 for paediatrics?
Oxygen: aim sats >94%
IV/IO access: blood culture, blood gas, FBC, CRP, U&E, coagulation, LP unless contraindicated
Fluids: 20ml/kg of 0.9% normal saline over 5-10 minutes (can repeat x3 depending on response)
IV/IO antibiotics (broad spectrum)
Escalation
Consider inotropic support early e.g adrenaline infusion
Why is significant hypovolaemia usually present?
Fluid maldistribution - due to release of vasoactive mediators by host immune response
What monitoring may be required to guide assessment of fluid balance?
Catheter
Central venous pressure
Why may inotropic support be required?
Due to myocardial dysfunction, which occurs as inflammatory cytokines and circulating toxins depress myocardial contractility
Can sepsis be cause by viral or fungal infections?
Yes but bacterial is by far most common cause
What are common causes of sepsis?
Respiratory tract infections UTIs Congenital infections Bloodstream infections Abdominal infections Infected wounds Indwelling lines and catheters Cellulitis
In children, sepsis is defined as a suspected or proven infection with a Systemic Inflammatory Response (SIRS). SIRS is the presence of…
At least 2 of the following, one of which must be abnormal temperature or WCC:
- core temp > 38.5 or <36
- tachycardia for age in absence of external stimulus
- tachypnoea for age or mechanical ventilation for an acute process
- WCC elevated or depressed
When should a paediatric sepsis screening and action tool be done?
PEWS or POPS scoring 3 or more
Healthcare professional concern
Parental concern of sepsis
What should any red flags on sepsis screening and action tool prompt?
Immediate review by clinician at ST4 or above
Paediatric sepsis 6 actions completed within one hour of time zero
What is time zero?
The booking in time for PED/CAU
For inpatients it is the time when red flag sepsis signs or observations noted
Infants with red flag signs should have observations increased to..
Every 15-30 minutes
Infants and children in amber flag category should have observations increased to every..
Hour with re assessment for red flag signs
On the age <5 years paediatric sepsis screening and action tool, what red flag sepsis signs are there?
Appearance: any - appears I’ll to healthcare professional, looks mottled/ashen, cyanosis of skin, lips or tongue, non blanching rash
Breathing: any- grunting/apnoea, SpO2 <90% OA or increased O2 requirements over baseline
<1 RR > or equal to 60
1-2 RR > or equal to 50
3-4 RR > or equal to 40
Circulation: any - HR < 60
<1 HR > or equal to 160
1-2 HR > or equal to 150
3-4 HR > or equal to 140
Demeanour: any- no response to social cues, does not wake, if roused does not stay awake, weak high pitched or continuous cry
Exposure: any - temp <36
< 3 months temp >38
What sepsis mimics are there?
Asthma, anaphylaxis, DKA, bronchiolitis
What urgent investigations should be done?
FBC, urea and electrolytes, LFTs, CRP EDTA bottle for PCR Blood sugar Clotting studies Blood gas Other microbiology samples - CSF, urine etc
What should a blood gas be done for?
Lactate and glucose
If lactate >2 mmol/L what fluids should be given?
20ml/kg of 0.9% sodium chloride max 500ml over 5-10 minutes and repeat if necessary
What inotropic support should be considered?
Adrenaline infusion via peripheral IV or IO access
If there is a moderate risk of sepsis, what should be done?
Paediatric amber flag sepsis tool
What antibiotics are given in children less than 1 month?
Gentamicin
Amoxicillin 50mg/kg/dose IV (12 hourly under 7 days old, 8 hourly over 7 days)
Cefotaxime 50mg/kg/dose IV
What antibiotics are prescribed in 1-3 month age?
Amoxicillin
Ceftriaxone
What antibiotic is prescribed in over 3 month age?
Ceftriaxone
What is prescribed for haematological /ontological sepsis?
Piperacillin-Tazobactam
What is the definition of sepsis?
Life threatening organ dysfunction due to a dysregulated host response to infection
Why can sepsis cause organ failure?
The cytokines produced as a result of the infection initiate thrombin production and inhibit fibrinolysis
The coagulation cascade leads to micro vascular thrombosis and hence organ ischaemia
In neonates, what is classified as early onset sepsis?
Less than 48 hours after birth
