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SEPSIS KILLS program Paediatric Inpatients

SEPSIS KILLS program Paediatric Inpatients. Learning Objectives. Recognise that sepsis i s a medical emergency Identify the risk factors, signs and symptoms Outline the escalation of the septic patient Define the initial A-G management actions

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SEPSIS KILLS program Paediatric Inpatients

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  1. SEPSIS KILLS programPaediatric Inpatients

  2. Learning Objectives • Recognise that sepsis is a medical emergency • Identify the risk factors, signs and symptoms • Outline the escalation of the septic patient • Define the initial A-G management actions • Discuss the requirements for 48 hour sepsis management including referral • Apply the pathway to a case study

  3. Paediatric Sepsis • Many paediatric sepsis related deaths are preventable • Sepsis is one of the leading causes of death in children • Mortality rates are as high as 10%

  4. Sepsis continuum Severe Sepsis Infection Systemic Inflammatory Response Syndrome Sepsis Septic Shock Increasing Mortality

  5. Sepsis recognition & management …..is there a problem in your facility?

  6. Sepsis program linkages with other paediatricresources

  7. Surviving Sepsis Campaign • Infuse 20ml/kg 0.9% sodium chloride bolus over no more than 10 minutes • Rapid administration of antibiotic therapy • BP is not a reliable target. Treatment should be titrated to clinical signs of adequate cardiac output -Heart rate in normal range -Improved capillary refill time -Improved LOC -Urine output ≥ 1ml/kg/hr • Early intubation recommended

  8. Pitfalls……. • Sepsis is a difficult diagnosis to make • Often under appreciate the mortality • Do not see sepsis as time critical

  9. Sepsis is a medical emergency You can make a difference for patients in this hospital

  10. Sepsis Pathway aims to: Provide clear guidelines regarding sepsis notification escalation and initial management Early involvement of senior clinicians in diagnosis and management of sepsis Prompt administration of resuscitation fluids Prompt administration of antibiotics (goal is within one hour of recognition) Timely referral, clinical supervision and escalation

  12. Case Study

  13. Transferred to the ward 7 year old girl Admitted via the Emergency Department with 3day history of flu-like symptoms Preliminary diagnosis of asthma

  14. 21 21 A FD RA Bloods VBG: pH 7.31; BE -5.3mmol/L Lactate 3.4mmol/L; CO2 48mmHg FD

  15. Arrive on ward Observations stable C/O “tummy pain” Reviewed by RMO Given analgesia + ventolin 2/24 Oral antibiotics ordered

  16. 21 22 2340  21 22 2340         Sepsis pathway activated with obs in Yellow Zone and deterioration despite treatment    RARA RA   

  17. 2nd Clinical Review Obs in Yellow Zone and “looks tired” Bloods 01:46 Repeat VBG pH 7. 35; CO2 52mmHg; BE -7.1mmol/L; Lactate 5.6mmol/L; SPO2 drop to 91% with NP O2 3rd review by RMO Ordered IV antibiotics

  18. 21 22 2340130 21 22 2340130                 RARA RA6LH    

  19. Bloods 02:30 Repeat VBG pH 7.19 CO2 57mmHg; BE -7.1mmol, Lactate 6.3mmol/L IVAB administered Refusing to keep Hudson mask on SPO2 91% with NP oxygen Becomes irritable Now grunting as Hudson mask held on by RN Administered ventolin nebuliser and IV hydrocortisone

  20. 10ml/kg 0.9% sodium chloride bolus and IV ceftriaxone and fluclox Nil improvement Paediatrician contacted Reviewed by paediatrician Requested repeat CXR Contacts NETS requesting transfer to tertiary hospital

  21. 21 22 2340130 03 21 22 2340130 03                       RARA RA6L 6L      

  22. Rapid Response call made Decision to intubate NETS arrive Adrenaline infusion commenced Arrested while transferring on to equipment Significant deterioration Difficulty keeping SPO2>88% (NRB)

  23. What is the evidence for urgent delivery of first dose antibiotics and aggressive fluid resuscitation?

  24. Antibiotics For each hour of delay to administration of antibiotics, after the onset of hypotension, there is a 7.6% increase in mortality (in adults) Kumar Crit Care Med 2006

  25. Time - and Fluid - Sensitive Resuscitation for Hemodynamic Support of Children in Septic Shock Oliveira et al Time-and fluid- sensitive resuscitation for haemodynamic support of children in septic shock. Pediatr Emerg Care 2008

  26. 91 children retrieved to Pittsburgh 1993-2001 for “septic shock” “For every hour a child remains in shock their mortality rate doubles”

  27. Points to remember • Senior clinician review is crucial • Beware of a lactate over 2mmol/L • Not all children with sepsis will be febrile • Persistent tachycardia is often consistent with sepsis • For every hour a child remains in shock their mortality rate doubles • Sepsis is an emergency • Rapid antibiotic therapy and early aggressive fluid resuscitation improves survival

  28. SEPSIS KILLS TIME IS LIFE RecogniseResuscitateRefer

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