Lecture 11- Sepsis in children Flashcards
new sepsis definitio in adults
- infection
- dysregulated host response
- life threatening organ dysfunction
which score isnt hre best indicator
SOFA score (sequential organ failure assessment score)
Sepsis definitions in children
- Systemic inflammatory response syndrome (SIRS)- may be remote to initial site of infection
- Sepsis= SIRS + suspected infection
Septic shock=
Sepsis + organ dysfunction
- Cardiovascular or
- Resp or
- 2 or more other organs
Spotting sepsis
- 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
paediatric sepsis 6
- give high flow oxygen
- obtain IV/IO (intraosseous) access and take blood tests
- give IV or IO antibitoics
- consider fluid rescusitation (lactate) –> do not fluid overload
- involve senior clinicals/specialists early
- consider inotropic support early
ACCM/PALS haemodynamic support guidelines for paediatric patients
not followed well
Fluid refractory shock
-
Give peripheral inotropes
- Cold shock adrenaline
- Warm shock NorAd
Catecholamine- resistant shock
- Hydrocortisone
- Advanced monitor
NICE management recommendations
- Red – high risk
- Yellow- moderate risk
- Green – low risk
possible infection? Think ‘could this be sepsis’
Risk factors
Lower threshold of suspicion for:
- age < 1 year
- Impaired immunity
- Recent trauma / surgery / skin breach
- Indwelling lines / catheters / devices
NICE sepsis ABCDE
Lactate
- Indicates increased risk of mortality
- Marker for circulatory shock
IV fluid resuscitation
- Be careful how much you give
- Dont fluid overload
Early senior review
- Within an hour of sepsis trigger
- Escalated from registrar to consultant level
Capillary refill
- Low diagnostic value
- However most pedestrians will challenge this
Normal temp should not reassure
- Does not mean that you don’t have sepsis
- Low temp can eb even more worrying – higher mortality rate
Antibiotics
Delayed anti-microbial therapy increases mortality and organ dysfunction
antibiotics for age <1 month
- Gentamicin
- Amoxicillin
- CefoTAXime
antibiotics for age 1-3 months
- Amoxicillin
- CefTRIAXone
antibiotics for age >3 months
- CefTRIAXone
