Paediatri Sepsis

Question 1

Why can sepsis be hard to identify

Answer 1

Overlapping symptoms-

Question 2

What os the new sepsis definition fo adults

Answer 2

-

Question 3

What is the sofa score

Answer 3

RR, BP, GCS - any can increase in context of infection. Increase mortality. If you have 2 if these factors increased -10% increase in mortality. This is a significant number

Question 4

What is sirs

Answer 4

At least 2 of: temp high or low, heart rate high, breathing rate high, wcc high or low. Indication of inflammation

Question 5

What os the international sepsis consensus deefiniion for paediatric sepsis

Answer 5

SIRS+suspected/proven infection

Question 6

What is the definition of severe sepsis in a child’s

Answer 6

Sepsis + organ dysfunction (CVS r resp or 2 or more other organs)

Question 7

What proportion of sirs is due to infection

Answer 7

53%

Question 8

What are the sirs criteria performance

Answer 8

SIRS - more likely to be younger, likely to triage higher, more often admitted

Question 9

Describe the epidemiology for paediatric sepsis

Answer 9

Episodes: 34% neonates, 32% previously well, 32% children with co morbidity.

Mortality: 11% neonates, 3% previously well, 7% children with co-morbiditied

Children and neonates - much more likely to die. Children showing signs of organ dysfunction - much high mortality rate - need to identify these. Need to imporve their care

Question 10

How can sepsis be identified?

Answer 10

Majority of children presenting to ED have viral illness.
Just 1 a year will develop sepsis.
How to identify them out of all the others who have the same symptoms but self limiting?

Question 11

What is ACCM-PALS

Answer 11

Recognise child unwell, give o2, iv or intraosseus access - needle into BM in long bone - used a lot in children
Think abt giving fluid bolus. Repeat this reassess to give right amaount. Correct glucose and calcium. Give antibiotics
If the fluids havent done it. Still in shock. Think abt giving inotropes. IO or peripheral cannula. Give NA. If thats not working think abt giving steroids - IV hydrocortisone. Monitor with advanced techniques. Expected to do al of that withi an hour. By 15 min - should have given fluid bolus and antibiotics,

Question 12

-

Answer 12

Some studies showing giving A Ot of fluid migh not be good - if fluid overload.- higher morbidity/mortality? Need to give just the right amount of fluid overall.

Question 13

What are the 5 algorithmic time-specific goals for accs pals

Answer 13

1) early recognition of severe sepsis. 2) vascular access 3) antibiotic administration 4) administrating iv fluids 5) vasopessors for fluid refractory shock
If you can follow the 5 things - hospital length halved, mortality rate close to half,

Question 14

What is ncepod

Answer 14

Natural confucdntally inquiry into patient outcome and death
Showing that guidelines are not being follows. Children are receiving sub optimal care.

Question 15

What are the nice guidelines for sepsis

Answer 15

Think if a patient could have sepsis if there is a possible infection. Asssess risk factors. Look at physiology, stratify the risk factors.
If risk factor
Then lower threshold for treatment
Lactate - surrogate for ??

Question 16

What are the risk factors for sepsis

Answer 16

Younger, impaired immunity eg chemo, steroids congenital. Recent trauma/surgery/skin breach, indwellign lines/catheters/devices

Question 17

What is the nice sepsis risk stratification criteria

Answer 17

Ss

Question 18

Whar is the nice sepsis abcde

Answer 18

Appearance, breathing, circulation (bp, low bc in young child very very bad sign - too late. But lactate is a surrogate), demeanour (how they look, are they responding), exposure (looking for surgical scares, wounds, foreign material evinces)

Question 19

What happens if antibiotics are delayed in shock

Answer 19

Early antibiotics - for every hour delayed, mortality goes up by 7.6% every hour for adults.
If delayed by 3 hours - significantly increased mortality - in child
Antibiotic early if you have an infecton

Question 20

When are fluids given

Answer 20

-based on lactate. Usuals for child to have lactate above 4.

Question 21

Describe teh nice guidelines for capillary refill

Answer 21

Less interested in capillary refill time- if it isnt really indicative of sirs bacterial infections. Gives useful clinical info tho. Interpret with care
Abnormal peripheral CRT or central CRTY have low diagnostic value FOR SERIOSU INFECTIONS in febrile children at ED

Question 22

What does temperature indicate for sepsis

Answer 22

Normal temp does not reassure

Question 23

What is the impact of nice ng51

Answer 23

-

Question 24

What is teh criteria paediatric sepsis 6 recognition

Answer 24

Looks unwell, clinical/parental concern, raised ess, (raised temp not required _. Treatment base on suspicion SS

Question 25

What is the paediatric sepsis 6

Answer 25

10 give high flow oxygen
2 obtain IV/IO access and take blood tests
3 give IV or IO antibiotics
4 consider fluid resuscitatio (look at the lactate)
5 involve serious clinicians/specialist early
6 consider inotropic support early
THINK - does this child have sepsis? If in doubt, consult a senior clinician
Deliver sepsis 6 in a timely manner

Question 26

What is the sepsis bo

Answer 26

< 1 month - gentamicin, amoxicillin,cefoTAXime
1-3 moths - amoycillin, ceftriaxone
>3 months - cefriaxone