The podcast discusses pediatric sepsis and its management, including early recognition and treatment. They compare surge criteria for adults and children, highlighting the importance of mental status and poor perfusion in children. The management includes the use of ketamine, specific antibiotics, fluid resuscitation, vasopressors, and stress-dose hydrocortisone. Epinephrine is preferred over dopamine. The hosts also talk about Halloween costumes and request pictures.
Prompt diagnosis of pediatric sepsis requires a thorough evaluation, including glucose testing, CBC, blood culture, lactate levels, and potentially inflammatory biomarkers and chest x-ray.
Using bedside ultrasound is a valuable tool in assessing pediatric septic patients, helping to identify potential causes of shock and guide appropriate interventions.
Deep dives
Pediatric sepsis is a serious condition with high mortality rates. Timely recognition and treatment are crucial to reduce morbidity and mortality.
Pediatric sepsis is a significant cause of non-traumatic child mortality. Similar to adults, recognizing and treating pediatric sepsis early is essential to minimize complications and improve outcomes. The surge criteria for pediatric sepsis require the presence of fever or hypothermia, along with other signs such as tachycardia, tachypnea, leukocytosis or leukopenia, and bandemia. Mental status and perfusion indicators, such as pulse quality, capillary refill, and poor feeding, play a crucial role in determining the severity of sepsis in children. Prompt diagnosis requires thorough evaluation, including glucose testing, CBC, blood culture, lactate levels, and potentially inflammatory biomarkers and chest x-ray. Management includes fluid resuscitation, initiation of vasopressors such as epinephrine or norepinephrine, and administration of broad-spectrum antibiotics within the first hour.
Bedside ultrasound can assist in diagnosing and evaluating shock in pediatric sepsis.
Using bedside ultrasound is a valuable tool in assessing pediatric septic patients. An easy-to-perform ultrasound examination can help identify pericardial effusion and tamponade, assess cardiac function, detect free fluid in the abdomen, and evaluate for other causes of shock. In children, mental status and peripheral pulses are key indicators to monitor, as altered mental status and poor peripheral pulses are strongly associated with organ dysfunction. The ability to perform bedside ultrasound makes it easier for healthcare professionals to identify potential causes of shock and guide appropriate interventions.
Antibiotic selection, IV fluid administration, and vasopressor use require careful consideration in managing pediatric sepsis.
Antibiotic selection in pediatric sepsis depends on factors such as age and immune status, and there are different guidelines for specific age groups. Following appropriate guidelines, including broad-spectrum antibiotics, is essential in addressing potential sources of infection. IV fluid administration should focus on isotonic fluids with cautious monitoring in younger patients to avoid fluid overload. Initiating vasopressors promptly, like epinephrine or norepinephrine, is crucial if minimal response to fluid resuscitation occurs. Dopamine is not favored for pediatric sepsis. If septic shock remains refractory, stress-dose hydrocortisone can be considered. It is important to be aggressive in managing pediatric sepsis, with close monitoring, prompt interventions, and regular reassessment to improve outcomes and prevent complications.
Not many things are scarier than a sick child... In the Spirit of Halloween let's cover Pediatric Sepsis- the tricks of the trade and how to not miss infections, as well as what to know for the test.
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Cite this podcast as: Briggs, Blake. 199. Peds Sepsis: Nightmare on Epi Street. October 30th, 2023. Accessed [date].
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