Paediatric emergencies Flashcards

1
Q

Name the most common micro-organisms causing sepsis

A

Bacteria:

  • coagulase-negative Staphylococcus
  • Staph. aureus
  • non-pyogenic streptococci
  • Strep. pneumoniae
  • Neissseria meningitidis
  • E. coli
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2
Q

Suggest examples of sepsis red flags.

A
  1. Appearance
    - appears ill to healthcare professional
    - looks mottled/ashen
    - cyanosis of skin, lips or tongue
    - non-blanching rash
  2. Breathing
    - grunting/apnoea
    - SpO2 <90% in air or increased O2 requirement over baseline
    - RR >60/min for <1 yo, >50/min for 1-2 yo, >40/min for 3-4 yo
  3. Circulation
    - HR <60/min
    - HR >160/min for <1 yo, >150/min for 1-2 yo, >140/min for 3-4 yo
  4. Demeanor
    - no response to social cues
    - does not wake
    - if roused does not stay awake
    - weak high-pitched or continuous cry
  5. Exposure
    - temp <36 C
    - temp >38 C in <3 mths old
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3
Q

How would you manage a child presenting with sepsis?

A
  1. Administer high O2 - titrate aiming for SpO2 >94%
  2. Obtain IV/IO access and take bloods
    - blood culture
    - blood gas for glucose and lactate
    - FBC, CRP, coagulation and U/Es
  3. LP unless contraindicated if <1 mth old or 1-3 mth old + looks unwell or has WBC <5 or >15, and consider urine, CSF or line cultures and meningococcal PCR
  4. Give broad spectrum IV or IO antibiotics
  5. Consider fluid resuscitation: 20 ml/kg (10 ml/kg if <28 days) 0.9% NaCl over 5-10 mins, repeat if necessary
  6. Escalation - review by senior clinician St4+, discuss with consultant paed/PICU if lactate >4 mmol/l or no clinical improvement following second fluid bolus
  7. consider inotropic support (adrenaline infusion IV/IO) if normal physiological parameters not restored after 40 ml/kg fluids
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4
Q

Which broad spectrum antibiotics would you prescribe a child presenting with sepsis (according to age group)?

A
  1. <28 days: IV gentamicin + amoxicillin (listeria cover) + cefotaxime
  2. 1-3 mths: IV amoxicillin + ceftriaxone
  3. > 3 mths: IV ceftriaxone
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5
Q

Why is cefotaxime preferred in neonates compared to ceftriaxone?

A

Less likely to cause cholestasis/jaundice and can be given alongside Ca2+. But has to be given QDS.

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6
Q

Describe the most common organisms causing meningitis in different age groups.

A

Viral infections most common cause:

  • enteroviruses (Coxsackie or Echovirus)
  • Herpes viruses (HSV or VZV)
  • mumps or measles

Bacterial causes:

  • neonates: group B strep., Listeria monocytogenes, E. coli
  • <4 yrs: H. influenzae type B, N. meningitidis, Strep. pneumoniae
  • > 4 yrs: N. meningitidis, Strep. pneumoniae
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7
Q

Suggest possible risk factors for neonatal meningitis

A
  • low birth weight
  • premature delivery
  • PROM
  • traumatic delivery
  • foetal hypoxia
  • maternal peripartum infection
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8
Q

Which investigations would you perform on a child presenting with suspected meningitis?

A
  1. Bloods
    - blood culture
    - blood gas - for lactate, bicarb and glucose
    - FBC, CRP, U/Es, bone profile, clotting
    - meningococcal and pneumococcal PCR
  2. urine MC+S, throat swab
  3. LP - send for
    - microscopy
    - culture + sensitivities
    - gram stain
    - HSV, VZV + enterovirus PCR
    - chemistry: glucose + protein
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9
Q

Describe your initial management of a child presenting with meningitis

A
  1. A-E assessment and management as required, e.g. O2, IV fluids
  2. Broad-spectrum antibiotics
    - neonate: IV gentamicin + amoxicillin + cefotaxime
    - 1-3 mths: IV amoxicillin + ceftriaxone
    - >3 mths: IV ceftriaxone
  3. Steroids (IV dexamethasone) within 12 hrs since 1st Abx dose to decrease risk of cerebral oedema caused by bacterial cell lysis if: >3 mths + LP shows: frank purulent CSF, CSF protein >1 g/L or bacteria on gram stain
  4. Notify Public Health England
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10
Q

which CSF findings would increase likelihood of a bacterial meningitis? a viral meningitis?

A

Bacterial

  • raised neutrophils (WCC>5 in >28 days or >20 in <28 days)
  • raised protein (>1 g/L)
  • low glucose (<50% serum Glu)

Viral

  • raised lymphocytes
  • normal glucose (>50% serum Glu)
  • normal or high protein
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11
Q

how would you treat a child with viral meningitis?

A
  • supportive treatment only for most

- IV acyclovir if herpes meningitis

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12
Q

Suggest possible acute and long-term complications of bacterial meningitis

A

Acute

  • cerebral abscess
  • subdural empyema
  • RICP and death

Long-term

  • cerebral palsy
  • general learning disability (cerebral infarction)
  • seizures/epilepsy (neuronal foci don’t develop properly)
  • microcephaly
  • visual impairment
  • hearing loss
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