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PedsSpring2020 > Sepsis > Flashcards

Sepsis Flashcards

1
Q

Signs of sepsis in a neonate (COMPENSATED)

  • Plan for next 5 min
  • plan for next few hours
A

“warm shock”

Hx of poor feeding, vomiting / diarrhea, fever

Tachycardic
Sunken fontanelle
Lethargic
Bounding pulses
increased WOB = subcostal retractions, nasal flaring, head bobbing

1) 2 large bore IV ==> 20mL/kg NS over 5 min x3 as needed.
2) place on CRM, pulse O2, q5min BP
3) non-rebreather O2 (HFNC +/- CPAP)
4) Labs - STAT glucose, BMP, CBC, coags, VBG, iCa/Mg/Phos, Blood/urine Cx
5) start empiric Abx with ceftriaxone
6) dose of rectal acetaminophen (NO NSAIDS for 5mo)
7) Prep for intubation / central acess
8) lumbar puncture (when heme stable)
9) PICU == ionotropes

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2
Q

what is the best fluid for resuscitation

A

NS

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3
Q

What is the age cutoff for NSAIDS

A

none for kids <6mo.

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4
Q

Define: shock

A

Insufficient oxygen perfusion to tissues +/- end-tissue damage.

O2 delivery < metabolic demands

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5
Q

Define delivery of oxygen

A

DO2 = CO * O2 carrying capacity

CO = SV*HR

SV = preload, contractility, afterload

O2 carrying capacity = bound to Hgb (1.36HgbSpO2) + unbound to Hgb (0.003*PaO2)

MAP = CO*SVR

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6
Q

difference between compensated v. uncompensated shock

A

compensated ==> might just look dehydrated & volume down

uncompensated ==> CRASHING

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7
Q

Define SIRS

A

presence of 2+

  • temp instability
  • tachycardia/bradycardia
  • tachypnea
  • leukocytosis/leukopenia
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8
Q

define sepsis

A

SIRS + infection

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9
Q

define septic shock

A

Sepsis + CV dysfunction not responsive to 40mL/kg fluids

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10
Q

Sepsis / MODS

A

at least 2 organ system failures

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11
Q

Define: severe sepsis

A

sepsis + organ dysfunction

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12
Q

what kind of shock do you get when your heart gives out first , and then the peripheral system is holding it together

A

COLD

~cardiogenic shock = COLD shock = uncompensated

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13
Q

how do kids experience sepsis differently compared to adults

A

sxs = head bobbing

1) different erelative head size == different upper airway anatomy (smaller distal & medium airways)
2) softer, more compliant chest walls

heart gives out first , and then the peripheral system is holding it together (low CO, high SVR) ==> ~ cardiogenic

v. adults = high CO, low SVR

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14
Q

what is the relationship between neonate and severe sepsis?

what is the importance of this?

A

neonates == 1/3 of all cases of sepsis
kids <1yo == 1/2 of all cases

==> neuro, cardiac, pulm & immune comorbidities greately increase risk of sepsis and death

tx = SPEED

1) isotonic fluids
2) abx

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15
Q

what kinds of bugs cause sepsis?

A
  • staph aureus, CoNS
  • Strep pneumo
  • strep pyogenes
  • GBS (Neonates)
  • pseudomonas
  • E coli (younger kids)
  • enterococcus
  • klebsiella
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16
Q

in what popualation is GBS more likely to cause sepsis?

A

neonates

17
Q

in what popualation is E. coli more likely to cause sepsis?

A

younger kids

18
Q

how do you manage fluid refractory shock

A

1) ionotrope IV/IO (dopamine or Epi)

2) atropine/ketamine

19
Q

what is the one most important thing that has lead to the survival of more neonates with sepsis

A

RAPID and AGGRESSIVE resuscitation and IV Abx

20
Q

how to reverse cold shock

A

titrate central dopamine

or if resistant- titrate central epinephrine

21
Q

how to reverse warm shock

A

titrate central NorE

22
Q

define: warm shock

tx

A

hypovolemic

compensated

tx = norE

23
Q

define: cold shock

tx

A

cardiogenic

uncompensated

tx = Epi

24
Q

for a patient that we are trying to resuscitate, what are the end goals that we are monitoring?

A
  • Cap refill <2 secs
  • Warm extremities, -central pulses=peripheral
  • Urine output >1 ml/kg/hr
  • Normal mental status
  • Normal blood pressure for age
  • Cardiac Index > 3.3, venous sat >70%
25
Q

Signs of sepsis in a neonate (UNCOMPENSATED)

- plan

A

Sxs

  • lethargic, moans to painful stimiulation
  • increased WOB
  • pulses weak, cool to thighs

tx

  • Continue with fluid resuscitation -Start dopamine 5 mcg/kg/min through PIV
  • Proceed with intubation – cautious sedation with fentanyl/rocuronium
  • Obtain central access and arterial line
  • Start epinephrine infusion at 0.1-1 mcg/kg/min
  • Obtain SvO2 to determine tissue perfusion
26
Q

when should you start vasopressors and what should you use for each situation?

A

==> once 2nd line access is obtained

#1 == dopamine
warm shock == norE
col dshock = Epi
27
Q

Mgmt:

15 y/o male, “not acting right”

Family on vacation, got a bug bite at camp, not it’s gotten worse.
Family now at home, mom calls and says he’s “lethargic”
What questions do you want to ask?

Just returned from camp, no known sick contacts
Previously healthy, unimmunized
No diarrhea
Complaining of headache, pain with bright lights
Mom thinks he is difficult to wake up, when he does wake up he just groans and goes back to sleep
What is your recommendation?

T 39.8
HR 145
RR 6
Sat 97% (RA)
BP 90/60

Gen: Ill-appearing, listless. Eyes closed, groans but no full sentences
HEENT: NCAT. Dry mucous membranes. OP clear. Scattered petechiae across nasal bridge, conjunctival hemorrhage
CV: Tachycardic, no murmur. Distal CR ~5 s.
Resp: Lungs CTAB, no increased WOB
Abdomen: Soft, NTND, NABS, no HSM
Leg: red, indurated, cratered lesion in the leg with surrounding redness
Extremities: Cool to touch, scattered petechiae throughout
Neuro: Somnolent, moves extremities weakly when asked, not cooperative with CN exam. Reflexes 2+ and equal bilaterally. GCS…?

A

Major concern: SEPSIS
==> inadequate perfusion - not enough oxygen to tissue; signs of end organ dysfunction
- classic for MRSA infection

Immediate = FLUIDS, ABx (3-4 boluses)

28
Q

physical findings of sepsis due to bug bite

A 
Fever
Tachycardia or Bradycardia
Decreased peripheral pulses OR bounding pulses
Mottled or cool extremities
Delayed cap refill
Dry mucous membranes, sunken eyes, decreased UOP 
Tachypnea, bradypnea, apnea
Hypotension
Hypothermia (neonates)
Altered mental status
29
Q

lab findings of sepsis due to bug bite

A 
Acidosis
Elevated Lactate == GI ischemia
Hyperglycemia
Hypocalcemia
Coag derangements
Elevated LFTs == liver ischemia
Elevated BUN and Creatinine == kidney ischemia
Leukocytosis
Elevated inflammatory markers

PedsSpring2020 (37 decks)

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