ID - Paediatric Sepsis Flashcards
What is sepsis?
Life threatening organ dysfunction due to dysregulated host response to infection
What is the response to pathogens in sepsis?
Pathogens recognised by macrophages, lymphocytes and mast cells
Large release of cytokines, interleukins and TNF to alert the immune system
What causes vasodilation in sepsis?
Cytokine release causes immune activation which leads to nitrous oxide release
Nitrous oxide causes vasodilation
Why do you get raised lactate in sepsis?
Cytokines increase endothelial permeability
This causes fluid to leak out from blood
Fluid accumulates and surrounds blood vessels decreasing oxygen delivery to tissues
Cells undergo anaerobic respiration and lactate builds up
What causes disseminated intravascular coagulopathy in sepsis?
Coagulation system activation
Fibrin deposition throughout circulation, decreases organ and tissue perfusion further
Consumption of platelets and clotting factors as used up to form blood clots
Leads to thrombocytopenia, haemorrhages and inability to form clots
What is septic shock?
Circulatory collapse and organ hypoperfusion
Arterial blood pressure falls causing organ hypo-perfusion
Leads to rise in blood lactate as anaerobic respiration starts
When is septic shock diagnosed?
When sepsis causes cardiovascular dysfunction
How is septic shock treated?
Aggressive IV fluids to improve blood pressure and tissue perfusion
If fluid boluses fail to improve blood pressure and lactate escalate to HDU or ITU
Inotropes e.g. NorAd can be given
What are the signs of sepsis?
Prolonged CRT
Fever or hypothermia
Deranged behaviour
Poor feeding
Incosolable
High pitched or weak cry
Reduced consciousness
Floppy (reduced body tone)
Mottled skin
Cyanosed
What is the most common feature of sepsis?
Fever or history of fever
what is a non-blanching rash most suggestive of?
Neisseria meningitidis
If an infant is under 3 months with a temperature over 38 what should be done?
Treat urgently for sepsis until proven otherwise
Learn
How is sepsis managed?
Give 3
High flow oxygen
IV fluids 20ml/kg if lactate over 2mmol/L
Iv antibiotics
Take 3
Blood cultures
Blood lactate
Monitor urine output, can use catheter
When giving fluids what should be considered for children?
Particularly prone to hypoglycaemia
Correct with 2ml/kg bolus of 10% dextrose if blood sugar under 3mmol/L
What further management should be used in suspected sepsis?
CXR - if pneumonia suspected
AXR and Pelvic USS - If intra-abdominal infection suspected
LP - meningitis
Meningococcal PCR
Serum cortisol - adrenal crisis
How long should antibiotics be continued for if bacterial infection suspected or confirmed?
5-7 days
When can you consider stopping antibiotics?
If patient is well
Blood cultures and two CRP results negative at 48 hours
What are the most common causative organisms of sepsis?
Neisseria meningitides
Streptococcus pneumoniae
Staphylococcus aureus
Group A and B streptococcus
Escherichia coli
Who is at increased risk of sepsis?
- Neonates and young babies under 3 months
- Premature babies
- History of intrapartum pyrexia or prolonged rupture of membranes (over 1 day)
- Maternal colonisation with Group B streptococcus
- Immunocompromised children
What are some differentials for sepsis in children?
- Uncomplicated infection e.g. vial URTI can mimic sepsis
- Leukaemia and aplastic anaemia
- Malignancies
- Juvenile idiopathic arthritis - can mimic infection, rashes and swollen joints, fever
- Kawasaki disease - rash, conjunctivitis, cervical lymphadenopathy
