Paediatric sepsis

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Definition

Sepsis is a whole-body inflammatory reaction due to infection, usually organic pathogens in the blood and generally bacteria. The layman's term is blood poisoning and a term now falling out of favour is septicaemia because it was an unclear mix of bacteraemia (bacteria in the blood) and sepsis.

Pathophysiology

Fairly simple really. Bacteria in the blood cause an inflammatory response throughout the body.

Clinical Features

Any infection (though meningitis especially) in its later stages often leads to the sepsis . This is bad. Sepsis is always bad. As such, you need to know what the signs of sepsis are. So here they are:

  • Negative change in vital signs
    • Temp ↑ OR ↓(<360 or >380)
    • BP↓
    • Tachycardia (>90bpm)
    • Tachypnoea (respiratory rate >20 breaths per min)
  • Limb pain
  • Change in behaviour (beware quiet children - unless they're asleep)
  • Rash (don't expect petechiae - these may not appear until the disease is untreatable)
  • Cyanosis

Investigations

The investigations for sepsis are called the septic screen and are done for all children with sepsis. It consists of:

  • FBC - WCC↑
  • Blood culture - find out what the bug is, especially in treatment resistant sepsis
  • C-reactive protein - raised
  • Urine for microscopy, sensitivity and culture
  • CSF (if not contraindicated) for microscopy, sensitivity and culture
  • Chest X-ray
  • Stool sample

Management