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Y5 Paediatrics > Sepsis > Flashcards

Sepsis Flashcards

1
Q

what are risk factors for early onset infection (<48h)

A

maternal pyrexia, chorioamninitis
maternal GBS +
Prior child with GBS
PROM

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2
Q

How does bacterial spread in early onset infection occuyr

A

foetal lungs are in direct contact with infected amniotic fluid, causing pneumonia and septicaemia/bacteraemia

OR

foetus is infected via placenta following maternal infection (viral/listeria)

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3
Q

How does early onset infection present in the newborn

A

resp distrss
apnoea
temp instavbility

vopmiting, poor feeeding, abdo distension, jaundice
neutropoenia
shock, irritability, seizures

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4
Q

What are investigations for sepsis - to identify source of infection

A 
Urine dip, MC&S 
FBC (neutropoenia), CRP
Blood culture 
CXR 
LP
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5
Q

What antibiotics do you give for early onset infection

A

BENZYLPEN + GENT

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6
Q

what antibiotic do you give for GBS

A

Benzylpen / ampicillin

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7
Q

what are common causes of late onset infection > 48h

A

coag neg staph - Staph epidermidis
Gram +ve: S aureus, E faecalis
Gram -ve: Klebsiella, pseudomonas

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8
Q

What is a suitable regimen for late onset infection

A

ampicillin + gent

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9
Q

what antibiotics work against listeria

A

amoxicillin
co-trimoxazole

DO NOT GIVE TRIMETHOPRIM in pregnancy

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10
Q

what is the most common cause of sepsis in children in UK

A

COAG NEG Staphylococci

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11
Q

What are 4 key things to give in neonatal sepsis

A
  1. Antibiotics, without delay
  2. Fluids (as hypovolaemia likely, with circulating fluid lost in interstitium)
  3. Inotropic support
  4. If in DIC > give FFPor CPP or platelet transfusion
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12
Q

What is the first thing you must assess if suspecting sepsis

A

Assess the HIGH RISK of severe illneess /death from sepsis:

  • BEHAVIOOUR (no response to social cues, appears ioll, does not wake / cannot staya awake, weak high pitched cryting)
  • HR: tachycardic OR <60bpm
  • RR: tachpynoea, grunting, apnoea, O2<90
  • mottled/ashen appearance
  • central cyanotis s
  • non blanching rash
  • ages <3m with temp >38
  • temp <36
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13
Q

What shoouyld you do in community if signs of meningococcal disease

A

IM benzylpenicillin

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14
Q

What are contraindications for an LP in a childl

A

signs of raised ICP (nausea, vomiting, papilloedema, bradycardia, raised BP)

  • focal neurological signss
  • shock
  • purpura (indicates bleeding)
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15
Q

what is Cushing’s reflex

A 
Irregular, decreased respirations (caused by impaired brainstem function) > periods of apnoea
slow HR
Systolic HTN (widening pulse pressure)
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16
Q

How does Cushings reflex occur

A
  1. ICP begins to increase, it eventually becomes greater than the mean arterial pressure, which typically must be greater than the ICP in order for the brain tissue to be adequately oxygenated.
  2. This difference in pressure causes a decrease in the cerebral perfusion pressure (CPP), or the amount of blood and oxygen the brain is receiving
  3. This leads to the brain not receiving enough oxygen (also known as a brain ischemia).
  4. To compensate for the lack of oxygen, the sympathetic nervous system is activated, causing an increase in systemic blood pressure and an initial increase in heart rate.
  5. The increased blood pressure then signals the carotid and aortic baroreceptors to activate the parasympathetic nervous system, causing the heart rate to decrease.
  6. As the pressure in the brain continues to rise, the brain stem may start to dysfunction, resulting in irregular respirations followed by periods where breathing ceases completely.

This progression is indicative of a worsening prognosis.

17
Q

What investigations must you do for sepsis, and with what aims in mind?

A
  1. IDENTIFY SOURCE OF INFECTION
Urine dip, MC&S 
FBC (neutropoenia), CRP
Blood culture 
CXR 
LP
  1. ASSESS PATIENT STATUS

VBG:

  • blood glas (incl glucose and LACTATE)
  • blood culture
  • FBC, CRP
  • urea and electrolytes
  • creat
18
Q

what must you review wihtin 1h in sepsis

19
Q

what do different levels of lactate indicate in terms of risk

A

lactate >2mmol/L or AKI: HIGH RISK

lactate <2mmol/L : repeat assessment hourly and ensure clinician review

20
Q

How do you manage high risk sepsis

A

BROAD SPECTRUM ANTIBIOTICS at MAX DOSE without delay (according to trust guidelines)

Monitor child continously
Monitor mental stat with GCS/AVPU

21
Q

What do you do in sepsis if lactate >4mmol/L

A

immediate IV fluid bolus,

Refer for critical care review for central access and initiation of inotropes

22
Q

What do you do in sepsis if lactate 2-4

A

Immediate IV fluid bolus

23
Q

What do you do in sepsis if lactate <2

A

consider IV fluid

24
Q

What antibiotic do you give for meningococcal sepsis

A

IM benzylpen in community
IV ceftriaxone in hospital

( if <1m do NOT give ceftriaxone - cefotaxime instead)

Y5 Paediatrics (30 decks)

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