Sep 30, 2019
It it the end of Sepsis Awareness Month, but
there is a BONUS Monday (Sept. 30th), so why not a BONUS
episode! Join the EMGuideWire Team as
they explore the challenges the children bring to this clinical
condition. Let's review Pediatric Sepsis!
- Screening should be age adjusted. Identify severe sepsis. Treat
w/early antibiotics, balanced fluid administration, and EPI if
- SIRS in children must be age-adjusted. HR & RR > 2
standard deviations of nml; WBC age adjusted.
- Screen: high risk medical history + vital sign
abnormalities (age based SIRS) require check of cap refill, mental
status, and general appearance followed by a physician
- Identify: Severe sepsis = sepsis + organ
dysfunction (CV/resp/neuro/renal/hepatic dysfunction). Order a
lactate, CBC, CMP, and blood cultures, and consider CXR and UA. CRP
is helpful for inpatient team.
- Higher lactate has higher mortality and is associated with
- Treat: Start 20cc/kg bolus LR
and reassess. Those with heart disease can’t take anymore fluids
after this, so only add pressors if needed. Continue to 40cc/kg and
up to 60cc/kg total bolus prior to pressors for other
- If still hypotensive, start 0.1 mcg/kg/min of
EPI (peripheral or IO).
- Early antibiotics saves lives.
- LR is better than NS.
Summarized by: Travis Barlock, MD PGY-1
- Emrath ET, Fortenberry JD, Travers C, McCracken CE, Hebbar KB.
Resuscitation With Balanced Fluids Is Associated With Improved
Survival in Pediatric Severe Sepsis. Critical Care
Medicine. 2017 Jul;45(7):1177-1183
- Ventura et al. Double-Blind Prospective Randomized Controlled
Trial of Dopamine Versus Epinephrine as First-Line Vasoactive Drugs
in Pediatric Septic Shock. Critical Care Medicine. 2015;