Septicaemia (1*)

Question 1

What are the common causes in neonates?

What are the common causes in children?

What occurs in Septic Shock?

Answer 1

➊ Group B strep, and Listeria

➋ S.pneumoniae, N.meningitidis, and S.aureus

➌ Cardiovascular dysfunction - BP drops → Hypoperfusion → Raised Lactate

Question 2

How does it present?

What is found O/E?

Answer 2

➊ • Poor feeding
• Inconsolable crying
• Altered mental state – e.g. sleepiness, irritability, lethargy, floppiness
• Pale or mottled skin

➋ Increased WOB, Tachycardia, Fever or hypothermia, Prolonged CRT, Non-blanching rash (very worrying sign, and puts the child at high risk)

Question 3

How is it investigated and managed?

Answer 3

SEPSIS 6:
1. High-flow O2
2. Get IV/IO access and take:
‣ Blood Culture
‣ Bloods – Glucose, FBC, U&E, CRP, INR
‣ Blood Gas – Lactate, Acidosis
3. Give IV/IO Abx – Broad-spectrum
4. IVF – 20ml/kg IV bolus of 0.9% Saline over 5-10 mins if Lactate > 2mmol/L or Shock
‣ Repeat if necessary and aim for normal physiological parameters
5. Involve seniors early
6. Consider Inotropic support early if normal physiological parameters aren’t reached after >40ml/kg of Fluids