Sepsis

Question 1

What are the four categories of shock?

Answer 1

Hypovolaemic, distributive, cardiogenic, obstructive.

Question 2

What are the causes of early onset neonatal sepsis?

Answer 2

Commonly Group B strep then E. coli

Question 3

What are the causes of later onset neonatal sepsis?

Answer 3

Coagulase-negative staphylococcus due to CVP lines or catheters

Question 4

What are the causes of sepsis in infants and young children?

Answer 4

Streptococcus pneumonia and Neisseria meningitidis (bimodal)

Question 5

What are the risk factors for developing sepsis?

Answer 5

1. immunodeficiencies, younger ages
2. if neonate - maternal infection/chorioamnionitis/PROM
3. Healthcare associated factors

Question 6

What are the features of the patient history in sepsis?

Answer 6

Altered mental state, recent trauma/surgery/invasive procedure.

Question 7

What are the features of the patients behaviour in sepsis?

Answer 7

Decreased activity, sleepy or unable to wake, non responsive to social cues, weak high-pitched or continuous cry.

Question 8

What are the respiratory features of a patient in sepsis?

Answer 8

Apnoea, grunting, nasal flaring, raised respiratory rate, need for oxygen to maintain saturation.

Question 9

What are the circulation features of a patient in sepsis?

Answer 9

Reduced BP, raised HR, reduced CRT, reduced urine output, dry nappies.

Question 10

What are the skin features of a patient in sepsis?

Answer 10

Mottled, cyanosis of skin or lips, non blanching rash.

Question 11

How is sepsis investigated in a child?

Answer 11

1. FBC, U&Es, LFTs, glucose, blood cultures, lactate, CRP.

2. CXR, urine MCS, ABG, LP

Question 12

What is the management of a child with sepsis?

Answer 12

1. ABCDE
2. IV or IO access
3. fluid bolus of 20 m/kg over 5 to 10 minutes
4. maintenance fluids hourly rate
5. empirical antibiotics, consider cover for viral and fungal sepsis
6. consider inotropes for fluid refractory shock (after two failed fluid boluses)

Question 13

What should you start in any neonate with signs of cardiogenic shock?

Answer 13

Alprostadil until duct dependent cyanotic defect can be ruled out