EXAM #2: PEDIATRIC SEPSIS

Question 1

How do you tell the difference between a colonized patient and an infected patient?

Answer 1

Infection= inflammatory response to organism

Question 2

What are the inflammatory signs?

Answer 2

1) Calor
2) Rubor
3) Tumor
4) Dolor
5) Functio laeso (loss of function)

Question 3

What are the lab markers for inflammation?

Answer 3

1) Increased WBC
2) ESR
3) CRP
4) Procalcitonin

Question 4

What is the definition of a fever?

Answer 4

Temperature greater than 100.4 F or 38.0 C

Question 5

When is the body temperature the lowest? Highest?

Answer 5

Low= 6-8am 
High= 4-6pm

Question 6

How does temperature vary with age?

Answer 6

Higher in infants

Question 7

Where is the gold standard site to take a temperature?

Answer 7

Rectal

Question 8

How old does a kid need to be for TM temp. and oral temp?

Answer 8

TM= 2 months
Oral= 5 years

Question 9

What is SIRS?

Answer 9

Systemic Inflammatory Response Syndrome

1) Temp. greater than 38
2) HR above 90 or 2SD above the mean for age
3) RR above 30 or 2SD above mean
4) PaCo2 less than 32
5) WBC greater than 15K or less than 5K
6) Bands greater than 10% WBC

Question 10

What is sepsis?

Answer 10

SIRS + infection

Question 11

What is bacteremia?

Answer 11

Viable bacteria in the blood

Note that viremia, fungemia, or parasitemia are all associated with sepsis

Question 12

What is severe sepsis? What are the indications of severe sepsis?

Answer 12

Sepsis associated with organ dysfunction

• Oliguira
• Mental status changes
• Lactic acidosis
• Hypotension

Question 13

What is septic shock?

Answer 13

Sepsis refractory to adequate fluid resuscitation

Question 14

What is MODS?

Answer 14

Septic shock with altered organ function in an acutely ill patient such that homeostasis cannot be maintained without intervention

Question 15

What is early onset newborn sepsis?

Answer 15

Sepsis that occurs in first 6 days of life

Question 16

What are the common organisms that cause early onset newborn sepsis?

Answer 16

GEL

Group B Strep
E. Coli
Listeria monocytogenes

Question 17

What are the risk factors for early onset newborn sepsis?

Answer 17

1) ROM greater than 18 hours
2) Maternal fever during labor/ chorioamionitis
3) Previous infant with GBS infection
4) Mom less than 20 y/o
5) Prematurity/low birth weight

Question 18

What is chroioamionitis?

Answer 18

Inflammation of fetal membranes diagnosed by:

1) Fever
2) Fetal tachycardia
3) Uterine tenderness
4) Foul vaginal discharge
5) Maternal leukocytosis

Question 19

What is late onset newborn sepsis?

Answer 19

Sepsis from 7-90 days

Question 20

What is the treatment for early onset newborn sepsis?

Answer 20

Ampicillin + aminoglycoside

2nd generation cephalosporin

Question 21

What is most likely to cause late onset newborn sepsis?

Answer 21

Meningitis

Question 22

How is late onset newborn sepsis treated?

Answer 22

2nd or 3rd generation cephalosporin

Vancomycin

Question 23

What is occult bacteremia?

Answer 23

Condition in which bacteremia is identified in a “well appearing kid” that may fit a couple sepsis criteria

Question 24

What is the most common cause of occult bacteremia?

Answer 24

S. pneumoniae

Question 25

What is the treatment for occult bacteremia?

Answer 25

1) Get WBC count
2) If high, get blood culture
3) Positive give IM ceftriaxone

Give instructions to return immediately if condition worsens

Question 26

What is meningococcemia?

Answer 26

Neisseria meningitidis in the bloodstream

Question 27

What are the symptoms of meningococcemia?

Answer 27

1) Fever
2) Petechia or purpura
3) Hypotension
4) Emesis
5) Lethargy
6) Irritability

Question 28

When are the highest attack rates of meningococcemia?

Answer 28

• 6 months to 1 year

- College dorm/ military recruit

Question 29

What is the drug of choice for meningococcemia?

Answer 29

PCN G