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ICA > Paeds Sepsis > Flashcards

Paeds Sepsis Flashcards

1
Q

Risk factors for paediatric sepsis

(4)

A
  • Neonates
  • Immunodeficiency/supressed - onocology, asplenic
  • Central lines
  • Unvaccinated
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2
Q

What are the steps in sepsis occuring?

A
  1. Infection
  2. Systemic inflammatory response syndrome (SIRS)
  3. Sepsis
  4. Severe sepsis including septic shock
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3
Q

What does infection cause to occur?

A

Invasion and multiplication occurs = triggered inflammatory response

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4
Q

Common sources of infection for paeds

A
  • Urine
  • Chest
  • ENT
  • Skin
  • Lines - Hickmann, portacath
  • Blood
  • GI
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5
Q

What is SIRS - systemic inflammatory response syndrome that can occur following infection and pre sepsis?

A

Inflammatory cascade caused by inadequate recognition and/or elimination of trigger
With at least two of he following criteria:
* Temp >38.5 or <36
* Tachycardia (age specific)
* Tachypnoea (age specific)
* White cell count (raised or low)

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6
Q

Causes of SIRS

A
  • Infections - bacterial, viral fungal
  • Burns
  • Arrhythmias
  • Heart failure
  • Dehydration
  • Diabetes
  • Hypoglycaemia
  • Poisoning
  • Guillian Barre syndrome
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7
Q

What is definition of paediatric sepsis?

Different from adult!!!

A

Suspected or proven infection with an associated systemic inflammatory response syndrome (SIRS)

Infection + 2 SIRS criteria = sepsis

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8
Q

What is severe sepsis?

A

Sepsis + organ dysfunction which can be:
* CV
* Resp
* Renal
* Hepatic
* Neuro
* Haematological

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9
Q

What is septic shock?

A

Sepsis + cardiovascular organ dysfunction

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10
Q

What is the pathophysiology of sepsis?

A
  • Infection
  • Activates inflammatory cells and host defence
  • Acitvates complement system
  • Activates coagulation system
  • Inflammatory cytokines released
  • = increased thrombosis
  • = hypovolaemia, cardiac and vascular failure, capillary leak, DIC, acute respiratory distress dyndrome
  • = shock
  • = multiorgan dysfunction
  • = death
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11
Q

Challenges in identifying sepsis in children

A
  • SIRS criteria is not specific to sepsis - could be another cause eg burns
  • Evolving picture - may deteriorate quickly
  • Difficult to identify an unwell child - can be cheerful with isolated tachycardia at rest, severe sepsis can be mimicked by other things, takes experience
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12
Q

How to assess an unwell presenting child?

A

History - need to know how long had symptoms and how much eg urine out vs fluids in etc
Examination - A-E if acute
Investigations/management

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13
Q

What is fever temperature in paeds

A

Fever is temp 38 degrees or more
(38.5 is used for SIRS criteria)

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14
Q

How do we measure temperature in children?

A
  • Electronic thermometer in axilla - ANY AGE
  • Infrared tympanic thermometer - if older than 4 months
  • Chemical dot thermometer in axilla - if older than 4 months
  • Parental report of temp is also considered VALID
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15
Q

Paediatric sepsis 6 bundle

A

BUFALO completed within 1 hour
* Blood culture
* Urine output
* IV fluids
* IV antibiotics
* Lactate from blood gas
* Oxygen

Also escalate to senior and consider inotropes early

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16
Q

How does sepsis 6 bundle come in leicester hospitals?

A

Get sepsis 6 bundle box

17
Q

Why does sepsis bundle need to be completed within hour?

A

Mortality is lowered

18
Q

What O2 do we aim for in sepsis 6 bundle for paeds?

A

Give O2 via facemask and aim for more than 94% sats when stable

19
Q

Ways that you get get IV access to take bloods, give abx etc in children

A

Peripheral cannula - but this is difficult in children esp in sepsis
Intraosseous - drill into tibia

20
Q

What bloods do you want to get in sepsis scenario?

A

FBC
U&E
CRP
Clotting
Glucose
Blood gas for lactate
Blood culture

21
Q

What other samples may you want to get in child sepsis?

A

CSF via lumbar puncture
Urine - via in and out catheter or suprapubic aspiration
Swabs - eg if cellulitis

22
Q

Why do you want blood gas in sepsis?

A

See if metabolic acidosis - this will be due to raised lactate due to hypoperfusion of tissues resulting in anaerobic respiration

23
Q

What is raised lactate a sign of?

A
  • Not necessarily a direct marker of tissue perfusion
  • BUT is associated with adverse outcomes in septic shock
  • Normalising lactate ASAP reduces risk of persistant organ dysfunction
24
Q

What fluids do you give in child sepsis?

A
  • Bolus of crystalloids - esp if lactate is >2mmol/L
  • = 0.9% sodium chloride 10-20mls/kg over 5-10 mins
  • The re-evaluate BP, perfusion and lactate
  • Maximum is 40mls/kg
  • Then consider inotropes and PICU
  • Start maintenance fluids too and monitor fluids in and out to avoid overload
25
Q

What antimicrobials do we give to each age group?

A
  • If <1 month old - Cefotaxime, amoxicillin and gentamicin, +/- aciclovir if viral
  • 1-3 months - Ceftriaxone and amoxicillin
  • If >3 months - Ceftriaxone
26
Q

Why do we give these antimicrobials in children sepsis?

A

Aim to cover most common organisms - Group A and B Strep
Listeria
E-coli
Pneumococcal
Meningococcal
Psudomonas

27
Q

Warm vs cold shock

A

Warm -
* High/normal cardiac output
* Low systemic vascular resistance - dilated
* Warm peripheries, flushed, bounding pulse, reduced cap refill

Cold-
* Low cardiac output
* High systemic vascular resistance
* Cold peripheries, pale, mottled, increased cap refill

28
Q

Warm vs cold shock treatment

A

Treat the same - both associated with myocardial dysfunction even in warm

Fluid boluses up to 40-60mls/kg then adrenaline/noradrenaline

29
Q

Septic shock vs hypovolaemic shock

A

Septic shock:
* Distrubutive type of shock primarily
* Due to vasodilation with reduced systemic vascular resistance = low BP etc
* Be aware of myocardial dysfunction

Hypovolaemic:
* Insufficient intravascular volume
* Due to net fluid loss
* Increased systemic vascular resistance to compensate - vasoconstiction

ICA (13 decks)

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