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Paeds > Sepsis & Meningitis > Flashcards

Sepsis & Meningitis Flashcards

1
Q

Define Sepsis

A

life-threatening organ dysfunction caused by a dysregulated host response to infection

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2
Q

What organisms cause sepsis?

State 3 each for neonates and children

A

Neonates:
- Group B Strep, E. Coli & Listeria Monocytogenes

Children:

  • Streptococcus pneumoniae
  • Neisseria meningitides
  • haemophilus influenza type B
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3
Q

At what age is sepsis most common?

A

In neonates, gets progressively less from there

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4
Q

Sepsis in children
Symptoms [4]
Signs [4]

A

Fever/hypothermia
Chills & rigors
Muscle weakness, aches, limb pain
D + V

Cold and mottled hands/feet
Slow cap refill
Reduced urine output
Hypotension, tachycardia, tachypnoea

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5
Q

Sepsis 6 in kids is a bit different, what criteria do we use to spot it? [6]

A
  • Hypotension
  • Fever/Hypothermia
  • Tachycardia
  • Tachypnoea
  • Alt Mental Status
  • Slow cap refill / poor perfusion / mottled peripheries
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6
Q

SEPSIS 7 in children

A

High flow oxygen
IV/IO fluid resus
IV/IO ceftriaxone 50mg/kg
Give inotropes

Blood cultures
Monitor urine output
Blood lactate

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7
Q

Describe the classic appearance of meningococcal rash

A

Non-blanching purpuric or petechial rash

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8
Q

How would meningitis present in a kid?
Children [6]
Neonates [3]

A

Children:

  • Nuchal rigidity
  • Headache
  • Photophobia
  • Reduced GCS
  • Seizures
  • Focal neurological signs

Neonates:

  • Lethargy, irritability
  • Bulging fontanelle
  • Nappy pain
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9
Q

What blood tests would you do in a septic/meningeal child? [7]

A 
FBC (leucocytosis, thrombocytopenia)
CRP
Coagulation factors (DIC)
PCR (meningococcus)
Blood gas (metabolic acidosis)
Glc (hypo)
U&Es + Creatinine (renal failure)
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10
Q

What non-blood tests would you do for septicaemia/meningitis? [4]

A

LP with antigen testing & PCR

Culture blood, CSF, Urine & skin

Urinalysis

Head CT

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11
Q

Investigations for:

  1. Meningitis
  2. Meningococcal septicemia
A

Meningitis: LP

Meningococcal septicemia: no LP, only cultures and meningococcal PCR

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12
Q

Subsequent management [4]

What antibiotics to use for listeria?

A
  • IV dexamethasone (in suspected/confirmed bacterial meningitis in children >3m)
  • Ceftriaxone for 7-14d
  • Public health notification
  • Prophylaxis of contacts: ciprofloxacin within 24h dx for close contacts over 7d

Listeria: amoxicillin + gentamicin

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13
Q

Immediate management of: (in the community)

  1. Suspected bacterial meningitis without non-blanching rash
  2. Meningococcal rash [2]
A

o Suspected bacterial meningitis without non-blanching rash: ambulance to hospital
o Meningococcal rash: IV or IM BENZYLPENICILLIN then ambulance to hospital

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14
Q

List 3 major complications of pneumococcal meningitis?

A

Brain damage hearing loss & hydrocephalus

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15
Q

Where can pneumococcal infections occur in the body and what is likely to precede them?

A

Viral inf tends to predispose to invasive pneumococcal disease.

Can be found:

  • Pneumonia
  • Meningitis
  • Septicaemia
  • Otitis Media
  • Sinusitis
  • Arthritis
  • OM
  • Peritonitis
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16
Q

Are pneumococcus & H influenzae Gram -ve or +ve?

A

Pneumoccous is gram +ve

Haemophilus is Gram -ve

17
Q

Other than the brain where might you find H influenzae infection?

A

Septicaemia
Pneumonia
Epiglottitis

18
Q

What’s special about meningococcal infection?

A

Its very very fast. Once it hits the blood stream you get:

  • Septic shock within 12hrs
  • Meningitis within 18-36hrs

Also can cause meningococcal rash

Pre-hospital treatment is IM benzylpenicillin before transfer to secondary care and NO LP just do blood cultures and PCR

19
Q

List 5 major complications of meningococcal infection?

A

Skin Scarring
Amputation

Cognitive impairment
Epilepsy
Hearing Loss

20
Q

What LP results would you expect from meningitis?

A

CSF - Pleocytosis, high protein & low Glc

21
Q

Initial empirical antibiotic treatment for neonatal meningitis <3m and >50 yo (while awaiting investigations and culture & sensitivities)

A

Cefotaxime + amoxicillin

22
Q

Kernig’s sign vs Brudzinskis sign

A

Kernig’s sign, which is positive when there is pain and resistance on passive knee extension when hips are flexed
Brudzinski’s sign, which is positive if the hips flex when the neck is bent forward

23
Q

Difference in presentation between viral and bacterial meningitis

A

Viral infections (with enteroviruses, EBV, adenoviruses e.t.c.) are more common and usually have a less severe presentation than bacterial meningitis.

Paeds (33 decks)

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