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Infectious Disease > Pediatric Sepsis > Flashcards

Pediatric Sepsis Flashcards

1
Q

Why is a tracheostomy a risk for sepsis?

A

Bypasses the airway defenses

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2
Q

What are the labs that should be obtained in a patient with a tracheostomy?

A

Get a tracheal aspirate

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3
Q

What is the definition of colonization?

A

to be carried on the skin or airway without causing disease

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4
Q

What is the definition of infection?

A

An inflammatory response to a pathogen in a normally sterile area

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5
Q

What are the five cardinal signs of inflammation?

A
  • calor
  • rubor
  • tumor
  • dolor
  • functio laeso
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6
Q

What is procalcitonin?

A

Nonspecific Inflammatory marker like CRP

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7
Q

What is a fever?

A

100.4 F or 38 C

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8
Q

What is the normal diurnal variation with temperature?

A

Lowest in the morning, highest in the evening

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9
Q

How does temperature vary with age?

A

Slightly higher in infants

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10
Q

What is the gold standard temperature measurement?

A

Rectal

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11
Q

What factors may affect TM temp measurement?

A

Affected by cerumen impaction, or OM

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12
Q

Why is the axilla an innacurate place to check temperature?

A

Sweat will decrease temp

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13
Q

What prostaglandin is the main contributor to fever?

A

PGE2

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14
Q

What is the definition of SIRS in children? (4)

A
  • Temp of more than 38 or less than 36
  • HR more than 90 or 2 SDs above for age
  • RR more than 30 or 2 SDs above for age OR PaCO2 less than 32
  • WBC more than 15k, less than 5k, or more than 10% bands
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15
Q

What are the temperatures that define SIRS?

A

More than 38 or less than 36

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16
Q

What are the heart rates that define SIRS?

A

More than 90 or 2 SD above the mean

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17
Q

What are the respiratory rates that define SIRS?

A

More than 30 or 2 SDs above for age

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18
Q

What is the PaCO2 that defines SIRS?

A

Less than 32

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19
Q

What are the ranges of WBCs that define SIRS? (3)

A

More than 15k
Less than 5k
More than 10% bands

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20
Q

What are the normal vital signs of 1 month old?

A

120-160 HR

40-60 breaths

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21
Q

SIRS + infection = ?

A

sepsis

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22
Q

What is bacteremia?

A

Viable bacteria in the blood

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23
Q

What defines severe sepsis?

A

Sepsis with associated organ dysfunction, hypoperfusion, or hypotension

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24
Q

What causes the lactic acidosis with sepsis?

A

Lack of perfusion of the muscles

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25
Q

What is septic shock?

A

Sepsis that persists after adequate fluid resuscitation, along with the presence of perfusion abnormalities

26
Q

What is multiple organ dysfunction syndrome?

A

The presence of altered organ function in an acutely ill patient such that physiologic homeostasis cannot be maintained without intervention

27
Q

What is the general order of infection?

A

SIRS, Sepsis, septic shock, MODS

28
Q

What is the definition of early onset sepsis?

A

At less than 6 hours of life

29
Q

Most of the time, early onset sepsis occurs when?

A

Within 24 hours or life

30
Q

What are the most common infectious agents that cause sepsis in the newborn?

A

GBS
E.coli
Listeria

(GEL)

31
Q

Rupture of membranes lasting longer than how many hours is a risk factor for sepsis?

A

More than 18 hours

32
Q

Maternal temperature over how much is a risk factor for sepsis?

A

More than 100.4 (38) during labor

33
Q

Maternal age less than what is a risk factor for sepsis?

A

20 years

34
Q

True or false: low birth weight or prematurity is a risk factor for neonatal sepsis

A

True

35
Q

What is maternal chorioamnionitis?

A

an inflammation of the fetal membranes (amnion and chorion) due to a bacterial infection. It typically results from bacteria ascending into the uterus from the vagina and is most often associated with prolonged labor.

36
Q

True or false: having a previous infant that had a GBS infection is a risk factor for the development of neonatal sepsis

A

True

37
Q

What are the ssx of maternal chorioamnionitis (5)?

A

Mother who has fever during labor, with two of the following:

  • Fetal tachycardia
  • uterine tenderness
  • Foul vaginal discharge
  • Maternal leukocytosis
38
Q

What is the definition of late onset neonatal sepsis?

A

Occurs at greater than 7 days from birth to 90 days of age.

39
Q

What is the most common infectious source of neonatal sepsis?

A

Organisms from the caregiving environment

40
Q

Which more often presents as pneumonia, and which more often as meningitis: early and late neonatal sepsis

A 
Early = pneumonia
Late = meningitis
41
Q

What is the treatment for early onset neonatal sepsis?

A

Ampicillin and an aminoglycoside

OR
2nd gen cephalosporin

42
Q

What is the treatment for late onset sepsis?

A

cephalosporin and vanco

43
Q

What is occult bacteremia?

A

Condition in which bacteremia is identified in patients without clinical evidence of sepsis who have neither significant underlying chronic medical conditions, nor clear foci of infection on exam

44
Q

What is the most common cause of occult bacteremia?

A

Strep pneumo

45
Q

What is the most common infectious agent for fevers?

A

Viruses

46
Q

What ages is occult bacteremia most common?

A

3 months to 3 years

47
Q

Why is vaccination history important in the setting of occult bacteremia?

A

Have a vaccine for strep pneumo

48
Q

What is the treatment for occult bacteremia caused by strep pneumo? When should this occur?

A

IM ceftriaxone

If patient has WBC greater than 15k

49
Q

True or false: if a patient suspected of occult bacteremia has a negative blood culture at 48 hours, and is well appearing, you may stop abx

A

True

50
Q

What should you do if a pt has bacteremia + positive blood cultures?

A

Reassess by exam and finish out abx course

51
Q

What is meningococcemia?

A

Presence of Neisseria meningitidis in the blood

52
Q

How does meningococcemia present?

A

Occult bacteremia to severe sepsis

fever
Petechial rash or purpura

53
Q

What is the gram stain and morphology of N Meningitidis?

A

Gram negative diplococcus

54
Q

What serotypes of N. meningitidis most often cause sepsis?

A

A
B
C

55
Q

Who is particularly susceptible to N. Meningitidis infections?

A

Complement deficiency (specifically in C5-C9)

56
Q

How is N. Meningitis transmitted?

A

Respiratory route

57
Q

Who most commonly gets infected with meningococcemia (ages and living environment)?

A

6 months to 1 year and in older adolescents

Military bases and colleges

58
Q

How do you diagnose meningococcemia?

A

Isolation of organism from the blood or CSF with rapid latex agglutination

59
Q

90% mortality occurs with meningococcemia if what factors are present?

A

3 of any of the following:

  • Petechia for less than 12 hours
  • Hypotension
  • Absence of meningitis
  • peripheral WBC less than 10000
  • ESR less than 10
60
Q

Why is it a worse prognosis if you do not have meningitis with meningococcemia?

A

Body has not mounted an immune response

61
Q

What is the treatment for N. Meningitidis infection?

A

PCN G

Infectious Disease (18 decks)

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