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Integration for Clinical Application > 6.2 Paediatric Sepsis > Flashcards

6.2 Paediatric Sepsis Flashcards

1
Q

What are the risk factors of paediatric sepsis?

A
  • Neonates
  • Immunodefiency/supressed e.g. oncology or asplenic patients
  • Central lines
  • Unvaccinated
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2
Q

What does infection cause?

A

Invasion and multiplications triggers an inflammatory response

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3
Q

What are the common causes of infection in paediatrics?

A

Urine
Chest
ENT
Skin
Lines
Blood
GI

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4
Q

What is systemic inflammatory response syndrome (SIRS)?

A

Inflammatory cascade
- Caused by inadequate recognition and/or elimination of trigger

With at least 2 of the following:
- Temperature >38.5 or < 36
- Tachycardia
- Tachypnoea
- Raised or lowered white cell count

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5
Q

What causes SIRS?

A
  • Infections
  • Burns
  • Arrhythmia
  • Heart failure
  • Dehydration
  • Diabetes
  • Hypoglycaemia
  • Poisoning
  • Guillain-Barre syndrome
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6
Q

What is the paediatric definition of sepsis?

A

Suspected or provgen infection associated with a systemic inflammatory response

Infection + 2 of SIRS criteria = sepsis

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7
Q

What is severe sepsis?

A

Sepsis + organ dysfunction e.g. cardiovascular or respiratory

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8
Q

What is septic shock?

A

Sepsis + cardiovascular organ dysfunction

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9
Q

What is the pathophysiology of septic shock leading to death?

A

Infection causes release of toxins

Activation of inflammatory cells causing host defence activation

Inflammatory cytokines are released
Activation of complement and coagualation systems

Activation of endothelium leading to decreased thrombomodulin

Hypovolaemia

Shock

Multiorgan dysfunction syndrome

Death

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10
Q

What are the challenges of identifying sepsis in paediatrics?

A

SIRS criteria not sepsis specific

Deterioration can occur very quickly

May be difficult to identify unwell child e.g.
- Cheerful, playful, tachycardic at rest
- Several sepsis mimics

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11
Q

What temperature indicates fever?

A

38 degrees
38.5 is more specific for sepsis

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12
Q

What thermometers are used for paediatrics?

A

Electric thermometer in axilla- any age

Infared tympanic >4months

Chemical dot thermometer in axilla >4months

Parental temperature report is valid

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13
Q

What is sepsis 6?

A

BUFALO

Take bloods
Measure urine output
Give IV fluids
Give broad spectrum antibiotics
Take lactate levels
Give oxygen

Escalate to senior, consider inotropes early on

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14
Q

How quickly does the sepsis 6 bundle need to be completed?

A

Within 1 hour, mortality is lowered

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15
Q

How is oxygen given in the sepsis 6 bundle?

A

Facemask
Aim for more than 94%

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16
Q

How do you get IV access?

A

Peripheral cannula- difficult in children especially those with sepsis

Intraosseous

17
Q

What bloods are taken in sepsis?

A

FBC
U&Es
CRP
Clotting
Glucose
Lactate
Blood culture

18
Q

What other samples may be taken in sepsis?

A

CSF
Urine
Swabs

19
Q

Why is blood gas relevant in sepsis?

A

If ABG is acidotic, this is due to hypoperfusion, anaerobic respiration is taking place

20
Q

What does raised lactate mean?

A
  • Not direct marker of tissue perfusion
  • Associated with adverse outcomes in septic shock
  • Normalising lactate reduces risk of persistent organ dysfunction
21
Q

What fluids are given?

A

Bolus of crystalloids
- Especially if lactate >2mmol/l
- 0.9% NaCL
- Start with 10-20ml/kg over 5-10 minutes
- Re-evaluate perfusion, BP, lactate
- Maximum of 40ml/kg
- Then PICU and inotropes

Maintenance fluids

Monitor input and output

22
Q

What antibiotics are given at each age group?

A

CAG

< 1 month
- Ceftriaxon, Amoxicillin, Gentamicin
- Consider aciclovir

1-3 months
- Ceftriaxone, Amoxicillin

>3months
- Ceftriaxone

23
Q

What is the aim of antimicrobials?

A

Cover most common organisms

Group A strep
Group B strep
Listeria monocytogenes
Eshchericia Coli
Pneumococcal
Meningococcal
Pseudomonas Aeuriginosa

24
Q

Compare Warm and Cold shock

For treatment this is what should be considered not actual treatment

A
25
Q

Warm shock vs cold shock treatment

A

Treat the same

Fluid boluses up to 40-60ml/kg then adrenaline

26
Q

Compare septic shock and hypovolaemic shock

A

Septic
- Distributive
- Vasodilation with reduced systemic vascular resistance
- Myocardial dysfunction

Hypovolaemic
- Insufficient intravascular volume
- Fluid loss
- Increased systemic vascular resistance

Integration for Clinical Application (16 decks)

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