Sepsis & Meningococcal Flashcards
Meningococcal disease - definition
A life threatening infection caused by meningocous bacteria where the bacteria enters the blood stream.
Can causes meningitis and/or sepsis
Meningococcal disease - signs & symptoms
- Fever
- Joint pain
- Headache
- Cold hands/feet
- Skin mottling and leg pain
- Altered conscious state
- Hypotension
- Tachycardia
- Purpuric rate (non-blanching)
Groups most at risk of meningoccocal
Babies up to 5 years old are at most risk due to under developed immune system.
Meningococcal disease - signs and symptoms specific for paedicatrics
- Fever, irritable, poor feeding, nausea/vomiting, drowsiness, petechiae
Criteria for Abx administration in Meningococcal Disease
Any one of the following:
- Altered conscious state
- stiff neck, photosphobia
- petechial (non blanching) rash
Meningococcal disease management
- ICP back up
- IV access
- Ceftriaxone (600mg/kg) or 2g max
- Sepsis management
How to draw up and administer ceftriaxone
- IV: Dilute each 1g of Ceftriaxone with 9.5 mLs of normal saline and administer over 2 min (e.g. 2g over 4 mins).
- If unable to obtain IV/IO access or not accredited in IO access, dilute each 1 g of ceftriaxone with 3.5mLs 1% Lignocaine HCl and administer into the upper lateral thigh or large muscle mass.
What is the ETAT criteria?
Emergency Triage Assessment and treatment for paediatric shock criteria
- Cold extremities
- Cap refill <3 secs
- Fast, rapid pulse (SV is unable to increase, therefore, usually first sign of distributive shock)
Sepsis management for paediatrics
Treatment is administered if ETAT criteria is met.
1. O2 if SpO2 <94%.
2. Fluid: 10mg/kg bolus repeated once after 15 mins.
3. Ceftriaxone 50mg/kg if transport time >60 mins.
4. Manage hypoglycaemia
How to prepare ceftriaxone for administration
IV administration: dilute 1g ceftriaxone with 9.5ml NaCl and administer over 2 mins.
IM Administration: dilute each 1 g of ceftriaxone with 3.5mLs 1% Lignocaine HCl and administer into the upper lateral thigh or large muscle mass.
Sepsis definition
Life-threatening organ dysfunction caused by dysregulated host response to infection
Septic shock definition
Sepsis + hypotension; subset of sepsis with profound circulatory, cellular and metabolic disregulation.
Generally required vasopressors to maintain MAP >65mmHg
Sepsis Pathophysiology
- Cytokines (immune cells) mitigate to antigen and elicit an immune response (complement system).
- Histamine and mast cell degranulation occurs to lyse foreign cells.
- Activated coagulation factors result coagulation cascade and sticky mesh preventing microbe spread. Bradykinin is released, facilitating vasodilation and increased capillary leakage = increased tissue swelling oedema.
- Systemic release of cortisone, adrenaline and prostaglandins which inhibit immune response systemically.
- In sepsis, there is low levels of activated protein C, an anticoagulation system that results in fibrin deposited widely and small clots forming throughout vasculature. This contributes to DIC which is widespread clot formation, impaired tissue perfusion and thrombosis.
qSOFA definition and uses
Quick Sequential Organ Failure Assessment. A risk stratification tool that is used to identify the adult who is at risk of deterioration from sepsis. DOES NOT DIAGNOSE.
qSOFA criteria
Hypotension <90mmHg
Altered conscious state
Tachypnoea >22
