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Sepsis in the paediatric emergency department: Pearls and Pitfalls

If you enjoyed this video, please consider subscribing and you'll see the next topics when they come out. Pearls and pitfalls: • Forgetting to adjust vital sign expectations for age (e.g. a respiratory rate of 20 and heart rate of 70 are both severely abnormal in a one-year-old) • Discharging children without clear safety net advice to the parents/carers about what to look for and when to return- if appropriate, make definite follow up with a GP or paediatric review clinic • If a child looks unwell or a parent is worried, take this seriously even if the observations are within normal limits. • As with adults, sepsis is time critical and early initiation of a care bundle including antibiotics improves outcomes. • Antibiotics should ideally follow blood cultures but should not be delayed in patients with septic shock. Antibiotics should not be delayed longer than three hours even without septic shock. • Antibiotics should be broad spectrum (e.g. cefotaxime or cefepime) but the choice of agent varies by age and indication. Follow hospital protocols. (Either local or a tertiary hospital like Sydney Children’s Hospital) • Fluid should be dosed by weight (e.g. a 10 ml/kg crystalloid bolus for shock) • Blood sugar levels are more important than in adults as children are more prone to hypoglycaemia, which can be an indicator of adrenal insufficiency or refractory septic shock. • Acute fever as a solitary sign in a generally well child does not necessarily require treatment. This video is for educational use only. It is produced by doctors for doctors, pharmacists and other health professionals. Most of my videos are reviewed by multiple senior doctors for quality control prior to publication, but this still represents my personal take on this topic. This video is not medical advice. References: Dieckmann, R.A., Brownstein, D. and Gausche-Hill, M., 2010. The pediatric assessment triangle: a novel approach for the rapid evaluation of children. Pediatric emergency care, 26(4), pp.312-315. Gausche-Hill, M., Eckstein, M., Horeczko, T., McGrath, N., Kurobe, A., Ullum, L., Kaji, A.H. and Lewis, R.J., 2014. Paramedics accurately apply the pediatric assessment triangle to drive management. Prehospital Emergency Care, 18(4), pp.520-530. Goldstein B, Giroir B, Randolph A, et al. International pediatric spesis consensus conference: Definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005; 6:2. Correction published in: Gebara BM. Values for systolic blood pressure. Pediatr Crit Care Med 2005; 6:500. Harley A, Schlapbach LJ, Johnston ANB, Massey D. Challenges in the recognition and management of paediatric sepsis - The journey. Australas Emerg Care. 2022 Mar;25(1):23-29. doi: 10.1016/j.auec.2021.03.006. Epub 2021 Apr 15. PMID: 33865753. Horeczko T, Gausche-Hill M. The paediatric assessment triangle: a powerful tool for the prehospital provider. Journal of Paramedic Practice. 2011 Jan 13;3(1):20-5. Horeczko T, Enriquez B, McGrath NE, Gausche-Hill M, Lewis RJ. The Pediatric Assessment Triangle: accuracy of its application by nurses in the triage of children. Journal of Emergency Nursing. 2013 Mar 1;39(2):182-9. NICE guideline: Fever in under 5s: https://www.nice.org.uk/guidance/NG143 Queensland Health sepsis guidelines. https://www.childrens.health.qld.gov.... RCH febrile child guideline: https://www.rch.org.au/clinicalguide/... RCH sepsis guidelines: https://www.rch.org.au/clinicalguide/... Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med 2017; 45:486. Sydney Childrens Hospital Network policy: Fever. Published 30/1/2020. Accessed 22/4/22 at https://www.schn.health.nsw.gov.au/_p... Tagg, A. Spotting severe sepsis sooner, Don't Forget the Bubbles, 2017. Available at: https://doi.org/10.31440/DFTB.11512 UpToDate: Septic shock in children: Rapid recognition and initial resuscitation (first hour) Weiss SL, Fitzgerald JC, Balamuth F, et al. Delayed antimicrobial therapy increases mortality and organ dysfunction duration in pediatric sepsis. Crit Care Med 2014; 42:2409.