Sepsis Flashcards
infection
Invasion of microorganisms not normally present in that part of the body
bateremia
bacteria in the bloodstream
Systemic inflammatory response syndrome (SIRS):
Exaggerated inflammatory reaction
Defined as two or more of the following: abnormal:
HR, RR, Temp, Leukocyte count (two must be included)
Sepsis
SIRS + a source of infection
Suspected or proven infection
Most common: Pneumonia, bacteremia, skin, UTI, meningitis
severe sepsis
Sepsis + organ dysfunction of one or more major systems
Kidney, lung (ARDS), heart, CNS (mental status alteration)
Hypotension, anuria, AMS
septic shock
Severe sepsis plus persistent hypotension despite aggressive fluid resuscitation
Think about giving vasopressors
Multiple Organ Dysfunction Syndrome (MODS)
Sepsis plus progressive dysfunction in 2 or more organs or organ systems
Mortality very high
SIRS criteria
Presence of 2 +:
core temp > 38.5C or < 36C
Tachycardia (age specific for peds)
Bradycardia if less than 1 y/o
Respiratory Rate: (age specific for peds)
tachypnea or mechanical ventilation
Leukocyte Count:
high or low for age or > 10 % bands (immature
neutrophils)
One of the criteria MUST be either abnormal temp or leukocyte count
SIRS presentation on pe
Inflammation, Vasodilation, Permeability (help WBC,
proteins to reach the damaged area), leukocyte
accumulation, platelet aggregation
Localized: on PE
Swelling, redness, warmth, pain
Widespread: on PE
Hypotension, widespread swelling, clotting disorders
(disseminated intracellular coagulopathy)
Leading cause of morbidity/mortality/healthcare costs in infants and children in the USA
sepsis
common sources of sepsis
Pneumonia, influenza, UTI
what does sepsis cause
hypotension increased cap permeability *translocaction of bacteria to systemic circulation AKI altered mental status
Disseminated intravascular coagulation
bleeding and clotting at the same time
condition in which small blood clots develop throughout the bloodstream blocking small blood vessels
The increased clotting depletes the platelets and clotting factors needed to control bleeding causing excessive bleeding
sepsis RF
Age < 1 month Serious injury/burn Chronic debilitating condition uncorrected congenital heart disease, DM Host Immunosuppression sickle cell, malignancy Large surgical incision/Recent Surgery Indwelling catheter Urinary tract abnormalities with frequent infections
neonatal sepsis bugs –> Bacteremia + systemic signs of infection in first 30 days of life
Early onset (< 7 days of life): GBS, E. Coli, Listeria Late Onset (> 7-30 days of life): GBS, E.Coli,
neonate MC bacteria pathogen
Group B strep (neonate)
E.Coli (neonate)
MC OVERALL peds pathogen for pneumonia
Streptococcus pneumoniae
PE for sepsis
“just not acting right” Changes in urine output Renal hypoperfusion, renal vasoconstrictor, dehydrated Ask how many diapers a day now vs normally Fever, cough Petechiae, purpura Hypoxemia Hypotension (late finding) Toxic, ill Dehydration AMS-1st sign, fatigue, listlelss, lethargy Seizure Respiratory depression Meningismus
1st sign of sepsis
altered mental staus
sepsis work up sequence
do NOT delay tx, give broad spectrum abx and get cultures (good if you can get before abx)
tx for sepsis Early onset/Late onset admitted from community
Ampicillin AND Gentamicin
Add acyclovir if suspect HSV
Vancomycin substitute for ampicillin if MRSA
tx for sepsis Late onset: hospitalized since birth
Gentamicin plus Vancomycin
Clindamycin/Metronidazole for GI source
lab work up for sepsis
CBC w/diff, CMP/BMP, fibrinogen/d-dimer, C-reactive protein, blood culture
when is LP done
Positive BC-blood cultures
Highly suspicious of sepsis with no identified cause
Suspected meningitis or encephalitis
Worsening clinical status while on antibiotics
tx bundle for sepsis
Airway, oxygenation, and ventilation
Circulation
Obtain vascular access
IV or intraosseous [IO]) within 5 minutes PUSH BOLUS
2 ports (fluids, antibiotics)
Start appropriate fluid resuscitation within 30 minutes
Replace electrolytes if needed
Begin broad-spectrum antibiotics within 60 minutes
For patients with fluid-refractory shock, initiate peripheral or central inotropic infusion within 60 minutes
Fever of unkown origin
Fever of unknown origin (FUO) refers to a prolonged febrile illness without an established etiology despite thorough evaluation
> 101 F / 38.3 C at least once/day for at least 8 days
> 106F/> 41.1 C hyperpyrexia (seizures, brain injury)
etiology of FUO
infectious, rheum, neoplastic, idiopathic
when to urgently go to hospital for FUO
Ill-appearance
Progressive symptoms or clinical deterioration
Concern for medical child
Munchausen syndrome by proxy
Need for observation of the child in a controlled setting
Need to perform studies or procedures best coordinated in the inpatient setting
benefits of fever
Hinders growth and replication of microorganisms
Kicks immune system into high gear
Further stimulates the immune system
Enhances phagocytosis
when do you tx fever
0-3 months seek medical advice (tx regardless)
3 month + treat 102 degrees or greater
hyperpyrexia
TEMPERATURE > 106 F/41.1 C
fever tx
alternate tylenol/ibuprofen
Community Acquired Pneumonia pathogen in neonates <3 wks
Group B strep, E.Coli
MC viral cause of pneumonia
RSV
CAP atypicals
Mycoplasma pneumoniae and Chlamydia pneumoniae (5+ yrs)
Macrolide- azithromycin 1st choice
Consider if not responding to amoxicillin (means it may be atypical use macrolide)
tx for pneumonia
Amoxicillin (high dose) 80-90 mg/kg/day (same dose as OM)
Alternative: Amoxicillin/Clavulanate or cefuroxime axetil
School age:
Azithromycin (or PCN allergy)
cover C. Pneum and M. Pneum
