Lecture 8 - Paeds Sepsis Flashcards
What type of receptors are on pathogens?
What type of receptors are present on immune cells which detect the cells above?
PAMPs (Pathogen Associated Molecular Patterns)
TLRs (Toll Like Receptors) detect PAMPs
Toll Like receptors are a type of PRRs (Pathogen Recognition Receptor)
What happens in terms of cells when a PAMP binds to a TLR (PRR) on an immune cell?
Immune cells secrete pro-inflammatory cytokines which recruit more immune cells
These cells then make cytokines which lead to vasodilation, vascular permeability and recruit adaptive immune system
How does an inflammtory response remain localised/regulated in a normal repsonse to infection?
How is this different in sepsis?
There’s a balance between the pro-inflammatory repsonse to anti-inflammatory response
In sepsis the normal balance is lost and the pro-inflammatory response is exaggerated causing inflammation remote from the infection source
How do we broadly suspect sepsis?
Does the child have a source of infection? (Bacterial, viral, fungal)
Does the child have a systemic inflammatory repsonse? (Temp above 38.5 or below 36, tachycardia, white cell count high or low, tachypnoae)
What is considered severe sepsis?
Sepsis with organ dysfunction
What is coryza?
Inflamation of mucus membranes leading to runny nose, nasal congestion and sneezing
What is the problem with paediatric sepsis?
Non specific symptoms
Can deteriorate rapidly so must give SAFTEY NET advice
What would you ask in a Hx for a child when assesing for sepsis?
Pateint age <3monts
Duration of illness
Temperatures (high high how often)
Determine source of infection (cough, smelly urine, rash)
Behaviour
Unwell contacts
Vaccinations history
Why are kids under 3months with a. Fever immediately?
Children under 3 moths are immunocomprimsied due to mothers immunity from breast milk depleted
What are some signs or source of infection in paediatric sepsis?
Crackles in lungs
Cellulitis on skin
Non blanching rash suggestive of meningococcal disease
What are some signs of shock?
Hypotension
Tachycardia
Cool peripheries
Confusion
What is the paediatric sepsis six bundle?
Must all be done in an hour
Administer oxygen
IV and take bloods
Give antibiotics
Consider fluid resus
Escalate
Consider inotropic support early (adrenaline)
What oxygen saturation do we aim for in the sepsis 6 bundle?
Over 94%
How do we give a child IV access and to take bloods?
What happens if we can’t cannulate after 2 attempts?
Cannulation
The intraosseous gun to take and give substance into the bone marrow
Always tell lab blood is from an Intraosseous line
What antimicrobials are normally given in <1month olds with sepsis?
Cefotaxime (group B strep)
Amoxicillin (listeria)
Gentamicin (E.coli)
Acyclovir (herpes simplex)
