Sepsis

Question 1

How high is the fatality rate of sepsis in children?

Answer 1

10%

Question 2

what is sepsis?

Answer 2

Systemic inflammatory response syndrome + proven infection.

Question 3

what is the criteria for SIRS?

Answer 3

at least 2 of:

• temp >38 or <36
• WCC >5x10^9 or <5x10^9
• tachycardia (depending on Childs age)
• Tachypnoea (depending on Childs age)

Question 4

What is severe sepsis?

Answer 4

Sepsis + organ dysfunction

Question 5

What is septic shock?

Answer 5

Sepsis + cardiovascular dysfunction.

Question 6

what is the pathophysiology of sepsis?

Answer 6

• The causative agent causes cells to release cytokines (TNF and interleukins).
• nitrous oxide is activated (vasodilation).
• endothelial lining becomes more permeable (oedema and reduced intravascular volume)
• activation of coagulopathy (leads to deposits of fibrin causing hypoxia and DIS)
• anaerobic respiration occurs (lactate levels rise and are acidic causing metabolic acidosis)

Question 7

What are the signs of sepsis?

Answer 7

Prolonged cap refill time
fever
hypothermia
confusion
poor feeding
high pitched cry
weak cry
reduced consciousness
reduced body tone
cyanosis
mottled skin
pale skin
ashen skin

Question 7

What are the signs of sepsis?

Answer 7

Prolonged cap refill time
fever
hypothermia
confusion
poor feeding
high pitched cry
weak cry
reduced consciousness
reduced body tone
cyanosis
mottled skin
pale skin
ashen skin

Question 8

What are the features that would indicate low risk of sepsis?

Answer 8

normal colour
responds to social cues
stays awake
moist mucus membranes

Question 9

What are the features that would suggest medium risk of sepsis?

Answer 9

pallor
not responding to social cues
no smile
wakes only after prolonged stimulation
decreased activity
increased respiratory effort (nasal flaring)
<95% O2 sats
crackles in chest
tachycardia
Cap refill time >3 secs
dry mucous membranes
poor feeding
reduced urine output
rever for >5 days
rigors
swelling of limb or joint

Question 10

What are the features that suggest a high risk of sepsis?

Answer 10

pale
mottled skin
ashen blue skin
no response to social cues
doesn't wake or stay awake
high pitched or weak cry
grunting
tachypnoea
chest indrawing
reduced skin turgor
<3 months with temperature
non blanching rash 
bulging fontanelle
neck stiffness 
status epilepticus
focal seizures

Question 11

what is usually a very late sign presenting ins sepsis in children?

Answer 11

Hypotension.

Question 12

what are the main things to look at when considering sepsis?

Answer 12

Temperature <3 or >38
capillary refill time
tachycardia
tachypnoea 
hypotension

Question 13

which neurological condition causes some children with sepsis to present differently?

Answer 13

cerebral palsy - often have very different normal ranges.

Question 14

Who is treated for sepsis until proven otherwise?

Answer 14

Baby < 3 months with a temp >38 degrees.

Question 15

What is the sepsis 6?

Answer 15

Give:
IV antibiotics
High flow Oxygen
IV fluid challenge

Take:
Blood lactate levels
Blood cultures
urine output

Question 16

When IV fluids don’t work in sepsis, what can be considered next?

Answer 16

Inotropes (nroadrenaline).

Question 17

what is important about children <3 months old?

Answer 17

50% of children <3 months old with sepsis DO NOT have a fever, so don’t be falsely reassured.

Question 18

what should always be added to the management of sepsis in children?

Answer 18

Glucose

Question 19

how much fluid should be given?

Answer 19

20mls per Kg.

Question 20

what antibiotics are used?

Answer 20

Cefotaxime or ceftriaxone

Question 21

what antibiotic should be added if the baby is <1 month?

Answer 21

amoxicillin

this covers listeria

Question 22

if the sepsis is caused by a bacteria how long should the antibiotics be continued for?

Answer 22

5-7 days