Peds S- Sepsis and Serious Bacterial Infections
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 28 January 2018
⏱️ 7 minutes
🧾️ Download transcript
Summary
Pediatric “Sepsis”
* Consider in any toxic appearing child/neonate* Especially with fever (or hypothermia)* Treatment* Early antibiotics* Fluid bolus
“Serious Bacterial Infections” (SBI)
* Consider in any baby with fever* Three classic categories* Age <30 days* Introduction* Weak immune system* No immunizations* Very high risk for serious bacterial infections* Require a significant amount of testing* Urinalysis with Urine Culture* Blood Cultures* Lumbar Puncture with CSF Cultures* Chest X-Ray* Require admission and antibiotics* Age 30-60 days* ILL appearing* Treat same as fever in <30 day patient* WELL appearing* Testing and treatment differ by institution* Multiple criteria established to help in this age range* Rochester criteria* Philadelphia criteria* PECARN criteria* Choose one and use consistently* Age >60 days* (Assumes immunizations are up to date)* Workup is more targeted* Blood cultures, Urine cultures, Chest X-Rays still common
Additional Reading
* Rochester Criteria Febrile Infants (MDCalc)* PECARN Rule for Low Risk Febrile Infants (MDCalc)
Transcript
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| 0:00.0 | Hello, men students. |
| 0:03.1 | My name is Zach Olson, and thank you for downloading this week's episode of the EM Clerkship |
| 0:08.7 | Podcast. |
| 0:10.8 | Let's repeat our case. |
| 0:18.1 | Okay, everybody, this is Dakota. |
| 0:20.1 | He's a three-and-a-half-year-old male is awoken with diffuse abdominal pain. According to mom, this is Dakota. He's a three and a half year old male. |
| 0:21.5 | He's awoken with diffuse abdominal pain. According to mom, he vominated about five times. Some of that was productive. |
| 0:27.1 | Has a rash on the anterior chest. He was lethargic when we got there since we've been there with him and through the transport. |
| 0:34.1 | Now crying, as you can see. Lone sounds were clear as far as we can tell |
| 0:38.8 | we then noticed o2 sats dropping and had cyanosis around the lips so he put him on |
| 0:43.7 | o2 he's uh he had no previous fever now 102.3 rectal mom and extended family are out here so |
| 0:52.1 | just FYI GCS at 10 BP 100 overulse 1 20, 97% on the O2, and no allergies, no meds had not been sick for the past couple days. Any questions? Anybody, I know it was a lot. He's kind of crunking on us. Okay? Thank you. All right. |
| 1:15.0 | We're currently working our way through our very high yield. |
| 1:19.4 | Oh shit. |
| 1:20.2 | Grab the Braslow mnemonic. |
| 1:22.6 | We've talked about oxygen and respiratory disorders. |
| 1:25.3 | We know to check that finger stick glucose to look for hypoglycemia |
| 1:30.8 | and hyperglycemia. And this week we are moving on to a huge pediatric life threat. Pediatric |
| 1:39.6 | sepsis, serious bacterial infections, neonatal fever, all of that. |
| 1:45.8 | In the most important disclaimer I have for this episode is that if at any point the kid |
| 1:51.9 | looks really sick, you're going through your mnemonic and you feel that panic setting in, |
| 1:58.1 | you think it's possible that this kid has an infection? |
... |
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