Paediatric Sepsis

Question 1

What symptoms in children suggest SIRS (systemic inflammatory response)

Answer 1

At least 2 of:

• Temperature - high or low
• High heart rate
• High resp rate
• WCC - high or low

Question 2

What would suggest sepsis in in a child?

Answer 2

Symptoms of SIRS + suspected or proven infection

Question 3

What would suggest severe sepsis in a child?

Answer 3

Sepsis (SIRS + suspected infection) + organ dysfunction:

• Cardiovascular, or
• Respiratory, or
• Or 2 or more other organs

Question 4

What are the key steps that need to be achieved within an hour of a child being admitted with sepsis?

Answer 4

0 mins - Recognise, Begin Oxygen and estabilish IO/IV access

5 mins - Administer fluids, correct hypoglycaemia/ hypocalcaemia with glucose & calcium, administer antibiotics

15 mins - If in fluid refractory shock- give peripheral inotropes to supported heart function and improve BP, cold shock- give adrenaline, warm shock - give noradrenaline

60 mins -If inotropes not working - hydrocortisone

Question 5

What are some of the risk factors for developing sepsis?

Answer 5

• Age <1 year
• impaired immunity
• recent trauma/ surgery/ skin breach
• any indwelling lines / catheters/ devices

Question 6

What are the NICE sepsis ABCDE?

Answer 6

Appearance

Breathing - do they need help breathing, grunting, high resp rate?

Circulation - look at heart rate (BP in children doesn’t show much

Demeanor - Behaviour, GCS

Exposure - look for any rashes / breaks skin

Question 7

What is the significant of lactate levels in children?

Answer 7

Raised lactate indicates increased risk of mortality

(sign of bacteria anaerobic respiration)

Question 8

What is the role of capillary refill in diagnosing sepsis in children?

Answer 8

Has a low diagnostic value for serious infections

Question 9

What is the role of temperature in diagnosing sepsis?

Answer 9

Cannot rely on temperature - normal temperature can be misleading / falsly assuring

Question 10

What are the peadiatric sepsis 6?

Answer 10

1. Give high flow oxygen
2. Obtain IV/ IO and take bloods
3. Give IV or IO antibiotics
4. Consider fluid resuscitation (lactate)
5. Involve senior clinicians / specialists
6. Consider inotropic support early

Question 11

What antibiotics would be in a peadiatric sepsis box for a child <1 month

Answer 11

1. Gentamicin
2. Amoxicillin
3. Cefotaxime

Question 12

What antibiotoics would be in a peadiatric sepsis box for a child age 1-3 months?

Answer 12

1. Amoxicillin
2. Ceftriaxone

Question 13

What antibiotoics would be in a peadiatric sepsis box for a child age >3 months?

Answer 13

1. Ceftriaxone