Lecture 11- Sepsis in children

Question 1

new sepsis definitio in adults

Answer 1

• infection
• dysregulated host response
• life threatening organ dysfunction

Question 2

which score isnt hre best indicator

Answer 2

SOFA score (sequential organ failure assessment score)

Question 3

Sepsis definitions in children

Answer 3

• Systemic inflammatory response syndrome (SIRS)- may be remote to initial site of infection
• Sepsis= SIRS + suspected infection

Question 4

Septic shock=

Answer 4

Sepsis + organ dysfunction

• Cardiovascular or
• Resp or
• 2 or more other organs

Question 5

Spotting sepsis

Answer 5

• Really hard
• Most children have mild self-limiting illness which will get better without treatment
• Need to be able to recognise sepsis within that pattern
• Purpuric rash (wont blanch with glass test)- meningococcal septicaemia
  
  • Give subcut penicillin immediately
  • Rare now because of vaccine

Question 6

paediatric sepsis 6

Answer 6

1. give high flow oxygen
2. obtain IV/IO (intraosseous) access and take blood tests
3. give IV or IO antibitoics
4. consider fluid rescusitation (lactate) –> do not fluid overload
5. involve senior clinicals/specialists early
6. consider inotropic support early

Question 7

ACCM/PALS haemodynamic support guidelines for paediatric patients

Answer 7

not followed well

Fluid refractory shock

• Give peripheral inotropes
  
  • Cold shock adrenaline
  • Warm shock NorAd

Catecholamine- resistant shock

• Hydrocortisone
• Advanced monitor

Question 8

NICE management recommendations

Answer 8

• Red – high risk
• Yellow- moderate risk
• Green – low risk

Question 9

possible infection? Think ‘could this be sepsis’

Answer 9

Question 10

Risk factors

Answer 10

Lower threshold of suspicion for:

• age < 1 year
• Impaired immunity
• Recent trauma / surgery / skin breach
• Indwelling lines / catheters / devices

Question 11

NICE sepsis ABCDE

Answer 11

Question 12

Lactate

Answer 12

• Indicates increased risk of mortality
• Marker for circulatory shock

Question 13

IV fluid resuscitation

Answer 13

• Be careful how much you give
• Dont fluid overload

Question 14

Early senior review

Answer 14

• Within an hour of sepsis trigger
• Escalated from registrar to consultant level

Question 15

Capillary refill

Answer 15

• Low diagnostic value
• However most pedestrians will challenge this

Question 16

Normal temp should not reassure

Answer 16

• Does not mean that you don’t have sepsis
• Low temp can eb even more worrying – higher mortality rate

Question 17

Antibiotics

Answer 17

Delayed anti-microbial therapy increases mortality and organ dysfunction

Question 18

antibiotics for age <1 month

Answer 18

• Gentamicin
• Amoxicillin
• CefoTAXime

Question 19

antibiotics for age 1-3 months

Answer 19

• Amoxicillin
• CefTRIAXone

Question 20

antibiotics for age >3 months

Answer 20

• CefTRIAXone