paeds sepsis and meningitidis Flashcards
define sepsis
Sepsis: syndrome when an infection causes child to become systemically unwell
- Result of systemic inflam response
what is the pathphys of sepsis?
Pathophys: causative organisms macrophages, lymphocytes and mast cells
- Releasing cytokines (IL and TNF)
- Cytokines activate other parts of immune system
- Further release of chemicals eg NO causes vasodilation immune response causes inflame throughout body
- Cytokines + endothelial lining in blood vessels: more permeable 00> fluid leaking into extracellular space causing oedema and reduction in intravascular volume (less O2 to tissues)
- Activating coagulation system: deposition of fibrin throughout circulation – compromising organ and tissue perfusion = low platelets + increased clotting time
- DIC: thrombocytopenia, haemorrhages
- Blood lactate rises as a result of anaerobic respiration in hypo-perfused tissues with inadequate oxygen
what is septic shock?
Septic shock: sepsis leads to CVS dysfunction
- Drop in BP
- Organ hypo-perfusion
circulatory collapse and hypoperfusion of organs
why is there a rise in blood lactate in sepsis?
- Rise in blood lactate organs are anaerobically respirating
what are signs of sepsis?
- Deranged obs
- Prolonged CRT
- Fever/ hypothermia
- Poor feeding
- Inconsolable/ high pitched crying
- Reduced consciousness
- Reduced body tone (floppy)
- Skin colour changes – cyanosis, mottled pale, ashen
how do you diagnosis sepsis?
USE NICE TRAFFIC LIGHTS
- All infants <3mths with temp of 38+ = sepsis treatment
how do you manage sepsis?
sepsis 6
- Call early for senior help
- Give O2 if sats <94%
- Obtain IV access
- Bloods: FBC, U+E, clotting, blood gas for lactate/ acidosis
- Blood cultures (prior to broad spec antibiotics)
- Urine dip
- Antibiotics within 1hr of pres
- IV fluids
what are paeds IV fluids bolus?
20ml/kg IV bolus over 5 mins
check obs and do again if needed
what maintenance IV fluids for paeds?
Calculate routine
maintenance IV fluid rates for
children and young people
using the Holliday–Segar
formula:
100 ml/kg/day for the first
10 kg of weight
50 ml/kg/day for the
second 10 kg of weight
20 ml/kg/day for the
weight over 20 kg.
Be aware that over a
24-hour period, males
rarely need more than
2500 ml and females
rarely need more than 2000ml
what IV fluid solution should be used within paeds?
plasma lyte 148?
cystalloids
what further management? investigations is needed post sepsis 6?
- CXR: ?pneumonia
- Abdo/ pelvic US: intra-abdo infection
- Lumbar puncture if ? meningitis
- Meningococcal PCR
- Serum cortisol: ? adrenal crisis
what is most common cause of sepsis in menigitidis?
strep B – from mothers vagina
what is the most common cause of meningitidis in children?
Neisseria meningitidis and strep. Pneumoniae
how does meningitis present in paeds?
fever, neck stiffness, headache
- Vomiting
- Photophobia
- Altered consciousness
- Seizures
- Meningococcal septicaemia – non-blanching rash
how does meningitis present in neonates?
- Neonates: bulging fontanelle, hypotonia, poor feeding, lethargy, hypothermia
