knowing ‘what’ to do is easy, 'making it happen’ is hard.
YOU must make it happen
#paedsepsisEM #retrieval2014 @retrieval2014
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Hashtag
#paedsepsisEM
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Saline acceptable as early resus fluid, but balanced fluids such as plasmalyte arguably better
#paedsepsisEM #retrieval2014 @retrieval2014
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Don’t guess what to give. Use an online drug calculator.
I like this
http://www.crashcall.net
#paedsepsisEM #retrieval2014 @retrieval2014
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how many docs to get a paed IV?
2/limb cannulating + 1 at head (saying all is fine) = MADNESS
Use an IO!!
#paedsepsisEM #retrieval2014
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Neonates.
Admit for obs
If still in doubt admit.
If still in doubt admit and tx for sepsis.
#paedsepsisEM #retrieval2014 @retrieval2014
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IV access is tough in sick kids.
You’re not as good as you think.
2 IV tries then use an IO.
#paedsepsisEM #retrieval2014 @retrieval2014
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Great resource for learning how to spot sick kids
https://www.spottingthesickchild.com
#paedsepsisEM #retrieval2014 @retrieval2014
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We cannot absolve ourselves of responsibility to treat critically ill children through fear.
#paedsepsisEM #retrieval2014 @retrieval2014
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As generalists look for similarities between paed and adult care as well as differences
#paedsepsisEM #retrieval2014 @retrieval2014
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The dogma that ‘Children are not little adults’ can paralyse clinicians who fear children.
#paedsepsisEM #retrieval2014 @retrieval2014
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..but incidence of severe sepsis low so diff. to be ‘expert'
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3631515/
#paedsepsisEM #retrieval2014 @retrieval2014
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Most sick kids are in non-PICU hospitals - we must resuscitate
them.
www.thelancet.com/journals/lancet/article/...
#paedsepsisEM #retrieval2014 @retrieval2014
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Audit data shows that we miss resus targets in 60% of paeds sepsis cases.
http://adc.bmj.com/content/94/5/348
#paedsepsisEM #retrieval2014 @retrieval2014
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Easy to know ‘WHAT’ to do in 1st hour.
Making it happen is harder…why?
#paedsepsisEM #retrieval2014 @retrieval2014
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After 60ml/Kg fluids should be planning for inotropes +/- ventilation.
#paedsepsisEM #retrieval2014 @retrieval2014
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Early
1. recognition
2. O2 & IV/IO access
3. antibiotics
4. fluid resus
#paedsepsisEM #retrieval2014 @retrieval2014
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Lots of guidance exists for 1st hour management. All have 4 features.
#paedsepsisEM #retrieval2014 @retrieval2014
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Aggressive sepsis mx great for adults - kids too
#paedsepsisEM #retrieval2014 @retrieval2014
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A competent resuscitationist can, should & must be able to manage first hour of paeds sepsis.
#paedsepsisEM #retrieval2014 @retrieval2014
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Front door management of sepsis in kids talk starting now
#paedsepsisEM #retrieval2014 @retrieval2014
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