Professional Documents
Culture Documents
Aitaneet, Lebanon
Carson Bruner
4 year old male diagnosed and
treated for strep toxic shock in the
PICU in January of 2008.
Carson Bruner
playing soccer in April 2009
Tolerated PO
Given zofran
d/c vitals: 38
38.9
9 R / 140/ 36
Sent home with instructions
d/c diagnosis: Acute Febrile Illness with
most likely viral etiology
10
120
31
17B 13S 67L 3M
2.2
NEISSERIA MENINGITIDIS
Objectives
Define sepsis and the sepsis spectrum as
it relates to the pediatric population
Understand the role of inflammation and
inflammatory mediators in sepsis
Review the management strategy for
sepsis
Understand the endpoints of resuscitation
Review recent advances and research in
the management of pediatrics sepsis
Review brain death criteria
Sepsis Epidemiology
1990
CDC
estimated
450,000
cases off
sepsis/yr
Adults and
children1
1.
2.
CDC.JAMA 1990.
Martin. NEJM.2003.
Sepsis Epidemiology
Sepsis Epidemiology
Half of all children
with underlying comorbidity
Mean length
g of
stay 31days
Survivors
reduced quality of
life
Sepsis Epidemiology
Sepsis Definitions
Sepsis Definitions
Sepsis Definitions
Genetic
Risk
Factors
SEPSIS
Patient
Risk
Factors
Microvascular Circulation
Complement Activation
IL-10
IL-6
Pro-Inflammatory
Responses
Anti-Inflammatory
Responses
Anti-Inflammatory
Anti
Inflammatory
Responses
Pro-Inflammatory
Responses
Sepsis
SIRS
Sepsis
Coagulation
Endothelial
Injury
Inflammation
Severe
Sepsis
Fibrinolysis
Septic Shock
Organ
Failure
Death
SIRS
Sepsis
Severe Sepsis
SIRS in
presence of
suspected
or proven
infection
Tachycardia Bradycardia
RR
WBC Count
SBP
Septic Shock
0-7 days
>180
<100
>34
>34
<65
SEVERITY
7-30 days
>180
<100
>40
>19.5 or <5
<75
1 mo- 1 yr
>180
<90
>34
>17.5 OR <5
<100
2-5 years
>140
NA
>22
>15.5 OR <5
<94
6-12 years
>130
NA
>18
>13.5 OR
<4.5
<105
13-18 years
>110
NA
>14
>11 OR <4.5
<117
Sepsis + one
of the
following:
CV organ
dysfunction
ARDS
2 organ
dysfunctions
Sepsis + CV
dysfunction
(despite fluid
resuscitation)
P
Poor
Oxygen
O
Delivery
D li
Oxygen Delivery
= PUMP x
blood O2 content
Cardiac Output
Heart Rate x Stroke Volume
Preload
Cardiac Output
(volume)
Hypovolemic or Hemorrhagic Shock
HR x SV
preload
contractility
afterload
NS
LR
Blood
Albumin
FFP
Afterload
Contractility
(resistance)
Distributive Shock
Cardiogenic Shock
Dopamine
Epinephrine
Norepinephrine
Phenylephrine
Vasopressin
Inotropic agents
Dopamine
D b t i
Dobutamine
Milrinone
Epinephrine
Calcium
Septic Shock
a dysfunction of preload,
afterload and contractility
y
It
-confusion
-Warm extremities
Physiologic Parameters
Wide pulse pressure, increased CO
decreased SVR
Management
GOAL:
Management
oxygen delivery
oxygen demand
ABC
Fluid
Temperature control
Broad spectrum antibiotics after
cultures sent
Correct metabolic abnormalities
Inotropes
Management
Volume Expansion
Optimize preload
NS or LR
Use 10-20
10 20 cc/kg q 2
2-10
10 minutes
At 40-60 cc/kg reassess and consider
ongoing losses
adrenal insufficiency
intestinal ischemia
Therapeutic Endpoints
;