Sepsis_Flashcards
What behavior indicates a high risk of severe illness or death from sepsis in children under 5 years?
No response to social cues, appears ill, does not wake or does not stay awake if roused, weak, high-pitched and continuous cry
What heart rate is concerning in sepsis for children?
Tachycardia (different at different ages) or < 60 bpm at any age
What respiratory signs indicate high risk in sepsis?
Tachypnoea (different at different ages), grunting, apnoea, SpO2 < 90% on air
What skin signs indicate a high risk of severe illness or death from sepsis?
Mottled or ashen appearance, cyanosis of the skin, lips, or tongue, non-blanching rash
What temperature signs indicate a high risk of severe illness or death from sepsis?
Aged < 3 months with temperature > 38 degrees, temperature < 36 degrees
What should be done if there are signs of severe illness or impaired immunity in a child with sepsis?
Transfer IMMEDIATELY to an acute hospital setting
What should be administered in the community if meningococcal disease is suspected?
IM benzylpenicillin
What investigations should be carried out to identify the source of infection in sepsis?
FBC, blood culture, CRP, urinalysis, LP, CXR
What are the contraindications for lumbar puncture (LP) in sepsis?
Signs of raised ICP, focal neurological signs, shock, purpura
In which children should lumbar puncture (LP) be performed in suspected sepsis?
< 1 month, 1-3 months who appear unwell, 1-3 months with WCC < 5 or > 15 x 10^9/L
What should be done for children with MODERATE to HIGH Risk of sepsis?
Carry out VBG for blood gas (including glucose and lactate), blood culture, FBC, CRP, urea and electrolytes, creatinine. Review venous lactate within 1 hour. Treat as HIGH RISK if lactate > 2 mmol/L. Repeat structured assessment at least hourly if lactate < 2 mmol/L. Ensure review by senior clinician within 3 hours of meeting 2 or more of the moderate to high-risk criteria
What should be done for children with HIGH Risk of sepsis?
Arrange immediate review by senior clinician. Carry out VBG for blood gas (including glucose and lactate), blood culture, FBC, CRP, urea and electrolytes, creatinine, clotting screen. Give broad spectrum antibiotics at the MAXIMUM dose without delay. Monitor continuously. Monitor mental state using GCS or AVPU. If lactate > 4 mmol/L, give IV fluid bolus without delay and refer to critical care. If lactate 2-4 mmol/L, give IV fluid bolus without delay. Consider IV fluids if lactate < 2 mmol/L
What antibiotics should be given for meningococcal sepsis in children?
IM benzylpenicillin in the community, IV ceftriaxone in hospital. Age up to 17 years old: IV ceftriaxone 80mg/kg OD (max 4g). Neonates <72h old: IV Benzylpenicillin and gentamicin. Children <3 months: give additional antibiotic to cover listeria, e.g., ampicillin or amoxicillin
What is included in the PAEDIATRIC SEPSIS 6?
Give high flow oxygen. Obtain IV/IO access and take bloods (blood gas and lactate, blood glucose, blood cultures). Give IV/IO antibiotics. Consider fluid resuscitation. Involve senior clinicians early. Consider inotropic support early if normal physiological parameters are not restored after > 40 ml/kg fluids
How should sepsis be explained to the parents or caregivers?
Explain that the child has an infection that may have crossed into the blood. It is important to monitor closely, identify the source of the infection and treat with antibiotics
