infections Flashcards
(47 cards)
leading cause of death in children?
Sepsis
what is Sepsis?
SIRS + suspected or proven infection
what is sever sepsis?
Sepsis + organ dysfunction
what is septic shock?
Sepsis + CVS dysfunction
criteria to have SIRS?
Temperature
>38°C or <36°C
WCC
>15 x 109/L or <5 x 109/L
Tachycardia
>2SD above normal for age
Tachypnoea
>2SD above normal for age
How might sepsis look in a kid?
Fever/hypothermia
Chills & rigors
Cold hands/feet + Slow cap refill
Muscle weakness & muscle/joint ache
Rash
Low UO, vomiting & diarrhoea -- 5 Sepsis 6 in kids is a bit different, what criteria do we use to spot it? - Hypotension - Fever/Hypothermia - Tachycardia - Tachypnoea - Alt Mental Status - Slow cap refill / poor perfusion / mottled peripheries
Sepsis 6 in kids is a bit different, what criteria do we use to spot it?
Hypotension
- Fever/Hypothermia
- Tachycardia
- Tachypnoea
- Alt Mental Status
- Slow cap refill / poor perfusion / mottled peripheries
Sepsis 6 is a bit different in kids, what are the 6 actions?
Take Blood cultures
- Give IV resus
- Give IV Abx
- Give Inotropes
- Give O2
Get Senior Help
What organisms cause sepsis?
Neonates: (BEL)
- Group B Strep,
- E. Coli
- Listeria Monocytogenes
Children: (PANS) - Pneumococcus, -Neisseria meningitidis (meningoccoccal) -Group A strep -Staph Aureus
what are infants under 3 months more at risk
Increased risk bacterial infection
Increased risk sepsis
Increased risk meningitis
May have minimal signs & symptoms
Presentation often non-specific
May not mount a febrile response (~50%)
Deteriorate quickly
RF for sepsis in infants <3months (I think this is the slide?)
Prematurity (< 37/40) PROM Maternal pyrexia/chorioamnionitis Maternal GBS (this pregnancy) Previous child with GBS Maternal STI (Chlamydia, Gonorrhoea, Syphilis, HSV)
how many mls per kg do u give for sepsis?
20ml/kg fluid bolus
how much glucose to give in sepsis?
don’t ever forget glucose’
2ml/kg 10% dextrose
what abs to give in sepsis?
3rd generation cephalosporin (eg Cefotaxime/Ceftriaxone)!!
add IV Amoxicillin if <1m old
investigations to do in sepsis?
Bloods FBC (leukocytosis, thrombocytopaenia) CRP Coagulation screen (DIC) Blood gas (metabolic acidosis, raised lactate) Glucose Blood culture
Cultures Blood Urine CSF (including send to virology) \+/- stool (micro + virology)
Imaging
CXR
Pathogenesis of Sepsis
Secretion of pro and anti-inflammatory cytokines
Activation of complement
Activation and mobilisation of leukocytes
Activation of coagulation and inhibition of fibrinolysis
Increased apoptosis
what is meningitis?
A disease caused by inflammation of the meninges
what is meningism?
The clinical signs and symptoms suggestive of meningeal irritation
Meningitis signs and symptoms in older children
classic symptoms
Fever Headache Photophobia Neck stiffness (nuchal rigidity) Nausea & vomiting Reduced GCS Seizures Focal neurological deficits
Meningitis signs and symptoms in young infants
lethargic, irritable
bulging fontanelle & “Nappy Pain”
Fever or hypothermia Poor feeding Vomiting Lethargy Irritability Respiratory distress Apnoea Bulging fontanelle
3 clinical signs of meningitis
-Nuchal Rigidity (Neck Stiffness)
Palpable resistance to neck flexion
-Brudzinski’s sign
Hips and knees flex on passive flexion of the neck
-Kernig’s sign
Pain on passive extension of the knee
Meningitis in kids often comes secondary to sepsis, what organisms cause it?
Neonates: (Same as sepsis)
- Group B Strep
- E. Coli
- Listeria Monocytogenes
Children - Pneumococcus - Neisseria meningitidis (meningoccoccal) - H. Influenzae
Haemophilus influenzae- what type of bacteria?
where is it found?
Small, non-motile, gram-negative coccobacillus
Nasopharyngeal carriage
what are the 2 types of Haemophilus influenzae
Encapsulated
Non-encapsulated
