The Septic Child
OVERVIEW
Infection causing MODS, capillary leak and hypoperfusion
CLINICAL FEATURES
- Fever
- Tachycardia
- Hypotension
- Tachypnoea
- Confusion
- High WCC
INVESTIGATIONS
- Bloods
- CSF
- Urine
- ECHO
- Toxicology screen (ingestion)
- Metabolic screen
MANAGEMENT
General
- weight = age + 4 x 2
- need filling
- need sinus rhythm
- need glucose
- need to warm
Specific
A – airway (resus before induction and watch haemodynamics – fentanyl/ketamine) & antibiotics
B – FiO2 1.0
C – fluid boluses 20mL/kg -> once 60mL/kg give blood products, inotropes (dopamine, noradrenaline, adrenaline), albumin 4%
D – hypoglycaemia -> 10-20% glucose
Acidosis
- NaHCO3 (full correction = weight (kg) x 0.3 x BE) -> give half and then repeat ABG
Antibiotics:
- Cefotaxime 50mg/kg IV Q6hrly (children), Ampicillin + Gentamicin (neonates) – consider vancomycin if concerned about resistant pneumococcus.
Early ECHO
Contact nearest regional centre
If meningitis with raised ICP -> normocapnia, head up, mannitol 0.5g/kg, dexamethasone 0.15mg/kg, CT Head
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC