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Peds > Sepsis > Flashcards

Sepsis Flashcards

1
Q

infection

A

Invasion of microorganisms not normally present in that part of the body

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2
Q

bateremia

A

bacteria in the bloodstream

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3
Q

Systemic inflammatory response syndrome (SIRS):

A

Exaggerated inflammatory reaction
Defined as two or more of the following: abnormal:
HR, RR, Temp, Leukocyte count (two must be included)

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4
Q

Sepsis

A

SIRS + a source of infection
Suspected or proven infection
Most common: Pneumonia, bacteremia, skin, UTI, meningitis

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5
Q

severe sepsis

A

Sepsis + organ dysfunction of one or more major systems
Kidney, lung (ARDS), heart, CNS (mental status alteration)
Hypotension, anuria, AMS

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6
Q

septic shock

A

Severe sepsis plus persistent hypotension despite aggressive fluid resuscitation
Think about giving vasopressors

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7
Q

Multiple Organ Dysfunction Syndrome (MODS)

A

Sepsis plus progressive dysfunction in 2 or more organs or organ systems
Mortality very high

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8
Q

SIRS criteria

A

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

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9
Q

SIRS presentation on pe

A

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)

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10
Q

Leading cause of morbidity/mortality/healthcare costs in infants and children in the USA

A

sepsis

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11
Q

common sources of sepsis

A

Pneumonia, influenza, UTI

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12
Q

what does sepsis cause

A 
hypotension
 increased cap permeability
*translocaction of bacteria to systemic circulation 
AKI
altered mental status
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13
Q

Disseminated intravascular coagulation

A

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

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14
Q

sepsis RF

A 
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
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15
Q

neonatal sepsis bugs –> Bacteremia + systemic signs of infection in first 30 days of life

A 
Early onset (< 7 days of life):  GBS, E. Coli, Listeria
Late Onset (> 7-30 days of life):  GBS, E.Coli,
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16
Q

neonate MC bacteria pathogen

A

Group B strep (neonate)

E.Coli (neonate)

17
Q

MC OVERALL peds pathogen for pneumonia

A

Streptococcus pneumoniae

18
Q

PE for sepsis

A 
“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
19
Q

1st sign of sepsis

A

altered mental staus

20
Q

sepsis work up sequence

A

do NOT delay tx, give broad spectrum abx and get cultures (good if you can get before abx)

21
Q

tx for sepsis Early onset/Late onset admitted from community

A

Ampicillin AND Gentamicin
Add acyclovir if suspect HSV
Vancomycin substitute for ampicillin if MRSA

22
Q

tx for sepsis Late onset: hospitalized since birth

A

Gentamicin plus Vancomycin

Clindamycin/Metronidazole for GI source

23
Q

lab work up for sepsis

A

CBC w/diff, CMP/BMP, fibrinogen/d-dimer, C-reactive protein, blood culture

24
Q

when is LP done

A

Positive BC-blood cultures
Highly suspicious of sepsis with no identified cause
Suspected meningitis or encephalitis
Worsening clinical status while on antibiotics

25
Q

tx bundle for sepsis

A

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

26
Q

Fever of unkown origin

A

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)

27
Q

etiology of FUO

A

infectious, rheum, neoplastic, idiopathic

28
Q

when to urgently go to hospital for FUO

A

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

29
Q

benefits of fever

A

Hinders growth and replication of microorganisms
Kicks immune system into high gear
Further stimulates the immune system
Enhances phagocytosis

30
Q

when do you tx fever

A

0-3 months seek medical advice (tx regardless)

3 month + treat 102 degrees or greater

31
Q

hyperpyrexia

A

TEMPERATURE > 106 F/41.1 C

32
Q

fever tx

A

alternate tylenol/ibuprofen

33
Q

Community Acquired Pneumonia pathogen in neonates <3 wks

A

Group B strep, E.Coli

34
Q

MC viral cause of pneumonia

A

RSV

35
Q

CAP atypicals

A

Mycoplasma pneumoniae and Chlamydia pneumoniae (5+ yrs)
Macrolide- azithromycin 1st choice
Consider if not responding to amoxicillin (means it may be atypical use macrolide)

36
Q

tx for pneumonia

A

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

Peds (5 decks)

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