1. Introducing ‘Sepsis 6’ at RACH

2. Important definitions SIRS Sepsis Severe sepsis Septic shock

3. SIRS Systemic Inflammatory Response Syndrome characterised by –Heart Rate greater than 2SD above normal for age in absence of stimuli or persistent elevation for 30min-4h. In infants depression of heart rate below 10 th centile in absence of stimuli –Temperature 38.5°C. Abnormal temperature has to be present in children to qualify as sepsis. –Resp rate greater than 2SD above normal for age or requirement for mechanical ventilation –WCC elevated or depressed for age not related to chemotherapy or >10%immature forms –Hyperglycaemia, altered mental status, hyperlactaemia, increased capillary refill time

4. Sepsis SIRS with a suspected or confirmed bacterial, viral, or fungal cause. Severe sepsis Sepsis and organ hypoperfusion (raised lactate, oliguria, prolonged CRT, reduced mental status) or dysfunction (disseminated intravascular coagulopathy, acute respiratory distress syndrome, acute renal failure). Septic shock Persistent hypotension despite adequate fluid resuscitation

5. Why does it matter? 1000 children admitted to UK PICUs with severe sepsis per year 20% with septic shock die (34 of 200 in audit published in 2009) Unknown number die of septic shock in ED before reaching PICU Biggest determinant of outcome is pre-PICU management and early reversal of shock

6. Why does it matter? 1000 children admitted to UK PICUs with severe sepsis per year 20% with septic shock die (34 of 200 in audit published in 2009) Unknown number die of septic shock in ED before reaching PICU Biggest determinant of outcome is pre-PICU management and early reversal of shock

7. The pitfalls Early recognition of sepsis –Raising awareness of many presentations of sepsis –Screening tool to identify new episodes Simplify initial management steps Raise awareness of the importance of aggressive treatment of shock

9. 1.Administer high flow oxygen. 2.Take blood cultures 3.Give broad spectrum antibiotics 4.Give intravenous fluid challenges 5.Measure serum lactate and haemoglobin 6.Measure accurate hourly urine output

10. Choice of empiric first line antibiotic: Broad-spectrum taking into account aetiology of paediatric sepsis –Strep, Staph, Meningococci, Haemophilus, E coli Easy to prepare and administer (minimise errors) Universal as much as is possible Possible meningitis should be treated as well

11. Antibiotic Cefotaxime 50 mg/kg 1 st dose (see emergency drug calculator) Add Amoxicilline 50 mg/kg 1 st dose if < 1 month of age (Listeria spp. coverage)