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Infectious Disease > Pediatric Sepsis > Flashcards

Pediatric Sepsis Flashcards

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1
Q

Why is a tracheostomy a risk for sepsis?

A

Bypasses the airway defenses

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2
Q

What are the labs that should be obtained in a patient with a tracheostomy?

A

Get a tracheal aspirate

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3
Q

What is the definition of colonization?

A

to be carried on the skin or airway without causing disease

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4
Q

What is the definition of infection?

A

An inflammatory response to a pathogen in a normally sterile area

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5
Q

What are the five cardinal signs of inflammation?

A
  • calor
  • rubor
  • tumor
  • dolor
  • functio laeso
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6
Q

What is procalcitonin?

A

Nonspecific Inflammatory marker like CRP

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7
Q

What is a fever?

A

100.4 F or 38 C

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8
Q

What is the normal diurnal variation with temperature?

A

Lowest in the morning, highest in the evening

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9
Q

How does temperature vary with age?

A

Slightly higher in infants

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10
Q

What is the gold standard temperature measurement?

A

Rectal

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11
Q

What factors may affect TM temp measurement?

A

Affected by cerumen impaction, or OM

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12
Q

Why is the axilla an innacurate place to check temperature?

A

Sweat will decrease temp

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13
Q

What prostaglandin is the main contributor to fever?

A

PGE2

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14
Q

What is the definition of SIRS in children? (4)

A
  • Temp of more than 38 or less than 36
  • HR more than 90 or 2 SDs above for age
  • RR more than 30 or 2 SDs above for age OR PaCO2 less than 32
  • WBC more than 15k, less than 5k, or more than 10% bands
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15
Q

What are the temperatures that define SIRS?

A

More than 38 or less than 36

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16
Q

What are the heart rates that define SIRS?

A

More than 90 or 2 SD above the mean

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17
Q

What are the respiratory rates that define SIRS?

A

More than 30 or 2 SDs above for age

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18
Q

What is the PaCO2 that defines SIRS?

A

Less than 32

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19
Q

What are the ranges of WBCs that define SIRS? (3)

A

More than 15k
Less than 5k
More than 10% bands

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20
Q

What are the normal vital signs of 1 month old?

A

120-160 HR

40-60 breaths

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21
Q

SIRS + infection = ?

A

sepsis

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22
Q

What is bacteremia?

A

Viable bacteria in the blood

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23
Q

What defines severe sepsis?

A

Sepsis with associated organ dysfunction, hypoperfusion, or hypotension

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24
Q

What causes the lactic acidosis with sepsis?

A

Lack of perfusion of the muscles

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25
What is septic shock?
Sepsis that persists after adequate fluid resuscitation, along with the presence of perfusion abnormalities
26
What is multiple organ dysfunction syndrome?
The presence of altered organ function in an acutely ill patient such that physiologic homeostasis cannot be maintained without intervention
27
What is the general order of infection?
SIRS, Sepsis, septic shock, MODS
28
What is the definition of early onset sepsis?
At less than 6 hours of life
29
Most of the time, early onset sepsis occurs when?
Within 24 hours or life
30
What are the most common infectious agents that cause sepsis in the newborn?
GBS E.coli Listeria (GEL)
31
Rupture of membranes lasting longer than how many hours is a risk factor for sepsis?
More than 18 hours
32
Maternal temperature over how much is a risk factor for sepsis?
More than 100.4 (38) during labor
33
Maternal age less than what is a risk factor for sepsis?
20 years
34
True or false: low birth weight or prematurity is a risk factor for neonatal sepsis
True
35
What is maternal chorioamnionitis?
an inflammation of the fetal membranes (amnion and chorion) due to a bacterial infection. It typically results from bacteria ascending into the uterus from the vagina and is most often associated with prolonged labor.
36
True or false: having a previous infant that had a GBS infection is a risk factor for the development of neonatal sepsis
True
37
What are the ssx of maternal chorioamnionitis (5)?
Mother who has fever during labor, with two of the following: - Fetal tachycardia - uterine tenderness - Foul vaginal discharge - Maternal leukocytosis
38
What is the definition of late onset neonatal sepsis?
Occurs at greater than 7 days from birth to 90 days of age.
39
What is the most common infectious source of neonatal sepsis?
Organisms from the caregiving environment
40
Which more often presents as pneumonia, and which more often as meningitis: early and late neonatal sepsis
``` Early = pneumonia Late = meningitis ```
41
What is the treatment for early onset neonatal sepsis?
Ampicillin and an aminoglycoside OR 2nd gen cephalosporin
42
What is the treatment for late onset sepsis?
cephalosporin and vanco
43
What is occult bacteremia?
Condition in which bacteremia is identified in patients without clinical evidence of sepsis who have neither significant underlying chronic medical conditions, nor clear foci of infection on exam
44
What is the most common cause of occult bacteremia?
Strep pneumo
45
What is the most common infectious agent for fevers?
Viruses
46
What ages is occult bacteremia most common?
3 months to 3 years
47
Why is vaccination history important in the setting of occult bacteremia?
Have a vaccine for strep pneumo
48
What is the treatment for occult bacteremia caused by strep pneumo? When should this occur?
IM ceftriaxone If patient has WBC greater than 15k
49
True or false: if a patient suspected of occult bacteremia has a negative blood culture at 48 hours, and is well appearing, you may stop abx
True
50
What should you do if a pt has bacteremia + positive blood cultures?
Reassess by exam and finish out abx course
51
What is meningococcemia?
Presence of Neisseria meningitidis in the blood
52
How does meningococcemia present?
Occult bacteremia to severe sepsis fever Petechial rash or purpura
53
What is the gram stain and morphology of N Meningitidis?
Gram negative diplococcus
54
What serotypes of N. meningitidis most often cause sepsis?
A B C
55
Who is particularly susceptible to N. Meningitidis infections?
Complement deficiency (specifically in C5-C9)
56
How is N. Meningitis transmitted?
Respiratory route
57
Who most commonly gets infected with meningococcemia (ages and living environment)?
6 months to 1 year and in older adolescents Military bases and colleges
58
How do you diagnose meningococcemia?
Isolation of organism from the blood or CSF with rapid latex agglutination
59
90% mortality occurs with meningococcemia if what factors are present?
3 of any of the following: - Petechia for less than 12 hours - Hypotension - Absence of meningitis - peripheral WBC less than 10000 - ESR less than 10
60
Why is it a worse prognosis if you do not have meningitis with meningococcemia?
Body has not mounted an immune response
61
What is the treatment for N. Meningitidis infection?
PCN G

Infectious Disease (18 decks)

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