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Key learning points:
• Abnormal age-based vital signs should prompt further admission or observation. Sepsis can be subtle in children.
• Divide your initial assessment into Appearance, Breathing, Circulation using the Paediatric Assessment Triangle.
• Fever in a young baby under three months of age requires admission and consideration of additional investigations (e.g. lumbar puncture)
This video is for educational use only. It is produced by doctors for doctors, pharmacists and other health professionals. Most of my videos are reviewed by multiple senior doctors for quality control prior to publication, but this still represents my personal take on this topic. This video is not medical advice.
References:
Dieckmann, R.A., Brownstein, D. and Gausche-Hill, M., 2010. The pediatric assessment triangle: a novel approach for the rapid evaluation of children. Pediatric emergency care, 26(4), pp.312-315.
Gausche-Hill, M., Eckstein, M., Horeczko, T., McGrath, N., Kurobe, A., Ullum, L., Kaji, A.H. and Lewis, R.J., 2014. Paramedics accurately apply the pediatric assessment triangle to drive management. Prehospital Emergency Care, 18(4), pp.520-530.
Goldstein B, Giroir B, Randolph A, et al. International pediatric spesis consensus conference: Definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005; 6:2. Correction published in: Gebara BM. Values for systolic blood pressure. Pediatr Crit Care Med 2005; 6:500.
Harley A, Schlapbach LJ, Johnston ANB, Massey D. Challenges in the recognition and management of paediatric sepsis - The journey. Australas Emerg Care. 2022 Mar;25(1):23-29. doi: 10.1016/j.auec.2021.03.006. Epub 2021 Apr 15. PMID: 33865753.
Horeczko T, Gausche-Hill M. The paediatric assessment triangle: a powerful tool for the prehospital provider. Journal of Paramedic Practice. 2011 Jan 13;3(1):20-5.
Horeczko T, Enriquez B, McGrath NE, Gausche-Hill M, Lewis RJ. The Pediatric Assessment Triangle: accuracy of its application by nurses in the triage of children. Journal of Emergency Nursing. 2013 Mar 1;39(2):182-9.
NICE guideline: Fever in under 5s: [ Ссылка ]
Queensland Health sepsis guidelines. [ Ссылка ]
RCH febrile child guideline: [ Ссылка ]
RCH sepsis guidelines: [ Ссылка ]
Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med 2017; 45:486.
Sydney Childrens Hospital Network policy: Fever. Published 30/1/2020. Accessed 22/4/22 at [ Ссылка ]
Tagg, A. Spotting severe sepsis sooner, Don't Forget the Bubbles, 2017. Available at: [ Ссылка ]
UpToDate: Septic shock in children: Rapid recognition and initial resuscitation (first hour)
Weiss SL, Fitzgerald JC, Balamuth F, et al. Delayed antimicrobial therapy increases mortality and organ dysfunction duration in pediatric sepsis. Crit Care Med 2014; 42:2409.
