Paediatri Sepsis Flashcards
Why can sepsis be hard to identify
Overlapping symptoms-
What os the new sepsis definition fo adults
-
What is the sofa score
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
What is sirs
At least 2 of: temp high or low, heart rate high, breathing rate high, wcc high or low. Indication of inflammation
What os the international sepsis consensus deefiniion for paediatric sepsis
SIRS+suspected/proven infection
What is the definition of severe sepsis in a child’s
Sepsis + organ dysfunction (CVS r resp or 2 or more other organs)
What proportion of sirs is due to infection
53%
What are the sirs criteria performance
SIRS - more likely to be younger, likely to triage higher, more often admitted
Describe the epidemiology for paediatric sepsis
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
How can sepsis be identified?
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?
What is ACCM-PALS
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,
-
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.
What are the 5 algorithmic time-specific goals for accs pals
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,
What is ncepod
Natural confucdntally inquiry into patient outcome and death
Showing that guidelines are not being follows. Children are receiving sub optimal care.
What are the nice guidelines for sepsis
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 ??
What are the risk factors for sepsis
Younger, impaired immunity eg chemo, steroids congenital. Recent trauma/surgery/skin breach, indwellign lines/catheters/devices
What is the nice sepsis risk stratification criteria
Ss
Whar is the nice sepsis abcde
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)
What happens if antibiotics are delayed in shock
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
When are fluids given
-based on lactate. Usuals for child to have lactate above 4.
Describe teh nice guidelines for capillary refill
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
What does temperature indicate for sepsis
Normal temp does not reassure
What is the impact of nice ng51
-
What is teh criteria paediatric sepsis 6 recognition
Looks unwell, clinical/parental concern, raised ess, (raised temp not required _. Treatment base on suspicion SS
What is the paediatric sepsis 6
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
What is the sepsis bo
< 1 month - gentamicin, amoxicillin,cefoTAXime
1-3 moths - amoycillin, ceftriaxone
>3 months - cefriaxone
