image by: HWN

HWN Suggests

PEM Pearls: Pediatric Sepsis Management – Understanding the Basics

The definitions and guidelines are confusing, sparse, and changing.

• Begin fluid resuscitation quickly but do not force patients to have a “minimum” number of boluses...
• Initiate antibiotics as soon as possible, and do not agonize as much about stewardship...
• The best choice, first-line vasopressor is likely not dopamine. However, in practice, other vasopressors (especially norepinephrine) can take longer to get ready, so a reasonable approach is to start dopamine while preparing your other drugs.
• If the patient remains in shock despite IV fluids and vasopressors, consider adding steroids.
• Intubation can be deadly and is rarely needed…

read full article

Featured

 Pediatric Sepsis and the New Phoenix Criteria (Part 1)

The criteria are applicable to all pediatric patients, but further research is needed for the neonatal population.

 Pediatric Sepsis and the New Phoenix Criteria (Part 2)

The Phoenix sepsis criteria provide a new definition of sepsis based on a point system that evaluates respiratory, cardiovascular, coagulation, and neurologic systems. A score of two or more indicates sepsis, while a score of six or more indicates septic shock.

Articles of Interest

We Have New Sepsis Criteria for Children…Now What?

Sepsis in children continues to be a major public health problem, with millions of children affected by death and disability every year worldwide.1–5 Defining pediatric sepsis, however, has been problematic. The previous criteria developed by the International Pediatric Sepsis Consensus Conference in 20056 based on systemic inflammatory response syndrome (SIRS) criteria had low specificity and low sensitivity, did not allow for risk stratification in both lower- and higher-resource settings, and were discordant with clinician-based diagnosis of sepsis.

Balanced vs Unbalanced Fluids in Pediatric Severe Sepsis

Not surprisingly, it appears that the resuscitative fluid of choice in many children’s hospital’s around the US for pediatric severe sepsis and septic shock is normal saline.

Diagnosis and management of sepsis in the paediatric patient

Two changes from previous guidelines are the concern for fluid overload, implying the need for clinical re-assessment after administration of each fluid bolus, and the removal of dopamine as the initial vasoactive agent for use in hypotensive paediatric patients, with recommendations for the use of epinephrine or norepinephrine as dictated by the clinical context.

Improving Recognition of Pediatric Severe Sepsis in the Emergency Department: Contributions of a Vital Sign Based Electronic Alert and Bedside Clinician Identification

Recognition of pediatric sepsis is a key clinical challenge. We evaluated the performance of a sepsis recognition process including an electronic sepsis alert (ESA) and bedside assessment in a pediatric emergency department.

In Shock: The Approach to Pediatric Sepsis

Whether in a pediatric or adult patient, the physiologic process of sepsis remains the same. Sepsis is a systemic inflammatory host response to infection, which can progress to acute organ dysfunction and death.

Pediatric Office Emergencies – Pediatric Sepsis and Pediatric Septic Shock

Be very cautious in setting of tachycardia and DO NOT WAIT for hypotension to make diagnosis of septic shock. A pediatric patient with hypotension and sepsis is a pre-arrest patient.

Pediatric Sepsis and Septic Shock

Kids aren’t little adults. Pediatric sepsis and septic shock usually presents as ‘cold shock’ where as adult septic shock usually presents as ‘warm shock’...

Pediatric Sepsis Update

It is important to note that in children, tachypnea may be a warning sign of inadequate perfusion. Additionally, tachycardia may occur much later than adults and is a true sign of hemodynamic compromise. This underscores the importance of early, goal-directed treatment.

Sepsis and Septic Shock in the Pediatric Patient: Part 1

The first part of this two-part series should allow you to define and identify the criteria for sepsis and septic shock in children, and identify the investigations and management of the septic pediatric patient.

Sepsis can send a child to the brink of death within hours. A new coalition of hospitals is fighting back

It might start out looking like not much more than an ordinary childhood fever. But within days — within hours, sometimes — the complication known as sepsis can turn deadly. The patient’s blood pressure dives. Intense pain floods her body. Her organs begin to shut down. The toll is frightening: Sepsis hospitalizes some 75,000 children and teens each year in the United States.

Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children

A large cohort of international experts was able to achieve consensus regarding many recommendations for the best care of children with sepsis, acknowledging that most aspects of care had relatively low quality of evidence resulting in the frequent issuance of weak recommendations.

What EMS needs to know about new pediatric sepsis guidelines

In its first update in 15 years, SSC 2020 pediatric guidelines make six strong recommendations, 52 weak recommendations, nine best practice statements where little science exists, along with 49 priorities for future research. Their goal is to, “provide a foundation for consistent care to improve outcomes and inform future research”

Resources

Phoenix Sepsis Score

Sepsis requires a score ≥2 in children with a suspected infection. Septic shock requires a score ≥2 plus ≥1 cardiovascular point.