Paediatric sepsis Flashcards
When is the traffic light system used in children?
Used for risk stratification of children under age of 5 years presenting with fever etc.
Only apply until clinical diagnosis of underlying condition has been made
What are 5 things that must be recorded in all febrile children?
- Temperature
- Heart rate
- Respiratory rate
- Capillary refill time
- Any signs of dehydration: reduced skin turgor, extremities
How should temperature be measured in children?
With an electronic thermometer in the axilla if child is <4 weeks or with an electronic/ chemical dot thermometer in the axilla, or an intra-red tympanic thermometer
If a child falls under the green category of the traffic light system, what is the appropriate management?
Child can be managed at home with appropriate care advice, including when to seek further help
If a child falls under the amber category of the traffic light system, what is the appropriate management?
- provide parents with safety net OR refer to paediatric specialist for further assessment
- safety net includes written or verbal info on warning symptoms and how to access further healthcare, follow up appt, liaison with other healthcare professions e.g. OOH for further follow up
If a child falls under the red category of the traffic light system, what is the appropriate management?
Refer child urgently to a paediatric specialist
When shouldn’t you prescribe antibiotics to a child with a fever?
If it is a fever without apparent source
Should you perform an x-ray if pneumonia is suspected but the child isn’t going to be referred to hospital?
No, not routinely performed
What are 2 key questions to ask in the history if you suspect a risk of paediatric sepsis?
- Behaviour: are they drinking, playing, smiling
- Urine output: are they wetting nappies
What are 6 key parts of examination/ observation of a child in whom you suspect sepsis?
- Behaviour
- Heart rate
- Respiratory rate and effort
- Hydration
- Skin
- Temperature
What are 4 elements of behaviour that could put a child in the red category?
- no response to social cues
- appears ill to a healthcare professional
- does not wake, or if roused does not stay awake
- weak high-pitched or continuous cry
What heart rates would put a child in the red category for the following ages:
- <1 year
- 1-2 y
- 3-4y
- any age?
- >160
- >150
- >140
- <60
What respiratory rates would put a child in the red category for the following ages:
- <1 year
- 1-2 y
- 3-4y
- 4 features of breathing at any age?
- >60
- >50
- >40
- grunting, apnoea, sats<90 or >oxygen requirement over baseline
What skin features would put a child in the red sepsis risk category? 3 key points
- Mottled or ashen appearance
- Cyanosis of skin, lips or tongue
- Non-blanching rash of skin
What temperature would put a child in the red risk of sepsis category?
Under 3 months: >38
any age: <36
What are 5 more specific signs that would put a child in the red category?
- Bulging fontanelle
- Neck stiffness
- Status epilepticus
- Focal neurological signs
- Focal seizures
How many symptoms would put a child in the red category?
only need one from this category
What are 5 features of behaviour that would put a child in the amber category?
- not responding normally to social cues
- no smile
- wakes only with prolonged stimulation
- decreased activity
- parent or carer concern that child is behaving differently from normal
What heart rate ranges would put a child in the amber category for the following ages?
- <1y
- 1-2y
- 3-4y
- 150-159
- 140-149
- 130-139
What heart rate ranges would put a child in the amber category for the following ages?
- <1y
- 1-2
- 3-4
- 150-159
- 140-149
- 130-139
What heart rate ranges would put a child in the amber category for the following ages?
- <1y
- 1-2
- 3-4
- 3 further conditions for any age?
- 50-59
- 40-49
- 30-39
- Oxygen sats <92% in air, increased O2 requirement above baseline, nasal flaring
In addition to behavioural changes, heart rate and respiratory rate ranges, what are 6 further factors that could put a child in the amber category?
- Cap refill >3
- Reduced urine output, or for catheterised patient <1ml/kg per hour
- Pallor of skin, lips or tongue
- Temperature age 3-6 months: 39 degrees or more
- Leg pain
- Cold hands or feel
When would you admit a child with 1 amber risk factor?
If compromised immunity + 1 risk factor
What should you do if treating a child within the amber category in the community?
clear safety netting and follow up plans in place. Give written advice
Why must you be very careful about following up children with amber risk factors?
Could be a sign of early sepsis/ about to become sepsis
What are 6 factors that would put a child in the green category?
- Responds normally to social cues
- Content or smiles
- Stays awake or awakens quickly
- Strong normal cry or not crying
- No high risk or moderate high risk criteria met
- Normal colour
What are 7 additional things to consider in the history for a child in the amber or green category?
- Carer ICE
- How are carers coping
- Immunisation history
- Immunosuppression
- Medications
- Allergies
- Travel history
What is a good approach to paeds examination?
Start by listening with stethoscope, then when start crying can look in throat
What are 4 signs of respiratory illness in children e.g. LRTI?
- Raised RR
- Tracheal tug
- Cough
- Chest recession
What are 2 common causes of respiratory illness in children/babies?
Bronchiolitis and croup
What is the commonest cause of bronchiolitis?
Respiratory syncytial virus (RSV)
