Sepsis Flashcards
What are the four categories of shock?
Hypovolaemic, distributive, cardiogenic, obstructive.
What are the causes of early onset neonatal sepsis?
Commonly Group B strep then E. coli
What are the causes of later onset neonatal sepsis?
Coagulase-negative staphylococcus due to CVP lines or catheters
What are the causes of sepsis in infants and young children?
Streptococcus pneumonia and Neisseria meningitidis (bimodal)
What are the risk factors for developing sepsis?
- immunodeficiencies, younger ages
- if neonate - maternal infection/chorioamnionitis/PROM
- Healthcare associated factors
What are the features of the patient history in sepsis?
Altered mental state, recent trauma/surgery/invasive procedure.
What are the features of the patients behaviour in sepsis?
Decreased activity, sleepy or unable to wake, non responsive to social cues, weak high-pitched or continuous cry.
What are the respiratory features of a patient in sepsis?
Apnoea, grunting, nasal flaring, raised respiratory rate, need for oxygen to maintain saturation.
What are the circulation features of a patient in sepsis?
Reduced BP, raised HR, reduced CRT, reduced urine output, dry nappies.
What are the skin features of a patient in sepsis?
Mottled, cyanosis of skin or lips, non blanching rash.
How is sepsis investigated in a child?
- FBC, U&Es, LFTs, glucose, blood cultures, lactate, CRP.
2. CXR, urine MCS, ABG, LP
What is the management of a child with sepsis?
- ABCDE
- IV or IO access
- fluid bolus of 20 m/kg over 5 to 10 minutes
- maintenance fluids hourly rate
- empirical antibiotics, consider cover for viral and fungal sepsis
- consider inotropes for fluid refractory shock (after two failed fluid boluses)
What should you start in any neonate with signs of cardiogenic shock?
Alprostadil until duct dependent cyanotic defect can be ruled out
