Sepsis: Pediatric Sepsis (Nursing)

00:01 Hi, I'm Dr. Jackie Calhoun.

00:03 And today we're going to learn about pediatric sepsis.

00:07 Like always, we're going to cover all of these topics which include the definition, the epidemiology, or who gets sepsis, causes, the signs and symptoms, which are also known as the cues, the diagnosis, the prevention, and then finally treatment.

00:23 Let's start with the definition.

00:26 So sepsis is a serious and sometimes life threatening infection, in which a pathogen enters the body and is carried to the blood by different organs.

00:36 This pathogen can be a bacteria, can be a virus.

00:39 But either way, the body's immune system has an exaggerated, overreactive immune response to that infection.

00:48 Septic shock is progressed sepsis.

00:51 So it's an evolution of it.

00:52 sepsis starts and then it turns into a septic shock.

00:55 It's an even more serious illness in which there's a critical decrease in organ and tissue perfusion.

01:01 So blood is not getting into the organs as it should.

01:05 The blood vessels that carry that blood become injured and they leak, and blood clots can also develop.

01:09 and blood clots can also develop.

01:12 These leaky blood vessels and clots, like we said, they don't carry the blood properly.

01:17 So they lead to poor organ and tissue perfusion throughout the body.

01:20 And as a result, failure of multiple organ systems can occur.

01:25 So who gets sepsis? What's the epidemiology of this? And depending on the location in the world, sepsis can occur in 1 to 26% of hospitalized children.

01:38 This number is closer to 5% in hospitalized children in developed countries and up to 35% in children in developing nations.

01:47 Now, what are the risk factors for sepsis? Some of these risk factors include young age, especially infants younger than three months, absence of a spleen, or having more than one spleen, which is known as polysplenia.

02:02 Presence of an immune system disorder.

02:05 Patients who have sickle cell disease, cancer, or if they're under-or unimmunized.

02:13 Okay, so now let's talk about the signs and symptoms in pediatric sepsis.

02:18 Almost all of the symptoms of sepsis can be linked back to decrease organ perfusion.

02:21 can be linked back to decrease organ perfusion.

02:23 So if you remember that you're gonna think about what you need to look for.

02:26 So one symptom is decreased or absent urine output.

02:28 So one symptom is decreased or absent urine output.

02:29 So the kidneys just aren't getting enough blood to make urine.

02:32 Another is low blood pressure, which is also known as hypotension.

02:37 A patient's temperature can be either high so they can have a fever, or low which is called hypothermia.

02:44 They can have decreased blood flow to the brain, which can cause mental status changes such as excessive sleepiness or fuzziness.

02:52 Depending on the type of sepsis the patient may have either decrease or brisk pulses, so they may be hard to feel or they may be super easy to feel.

03:02 They can also either have flushed or cool skin.

03:05 Laboratory studies are very important in these patients.

03:09 If a patient has sepsis, they're definitely going to have labs drawn.

03:12 In those labs, the CBC might either show the either a high or low white blood count.

03:17 They might also have a high c-reactive protein, or CRP, which is a marker of inflammation, and high lactate level, which is an indicator of organ perfusion.

03:28 So now let's talk about how to diagnose sepsis.

03:31 Every patient who has sepsis needs to have cultures collected, and cultures as a reminder, our specific lab tests that helps us show if a certain virus or bacteria is growing in a sample.

03:45 So this can help determine what pathogen is causing the sepsis.

03:49 These cultures are going to be drawn from the blood.

03:52 Most commonly or most desirably, we want that blood to be drawn from a peripheral vein.

03:59 Respiratory culture, especially if that patient has a breathing tube or is intubated.

04:04 Urine cultures, cerebral spinal fluid cultures, especially if this patient is very young or has very significant mental status changes, or has very significant mental status changes, and possibly tissue samples in certain situations.

04:16 If a patient has a wound that could be infecting their entire body, you'd probably want to take a sample of that.

04:21 All patients with sepsis need to be hospitalized.

04:25 These are not kids that are going to go to their doctor's office or to the emergency room and be sent home.

04:30 In the hospital, your vital signs are going to be closely monitored sometimes as often as every hour.

04:36 The vital signs that we want to pay, especially close attention to include their temperature, their blood pressure, their heart rate.

04:43 So now let's talk about how serious sepsis is.

04:46 And we should also talk about how to prevent it.

04:50 One of the best ways is to get kids immunized with all of the recommended vaccines at the recommended times.

04:57 Another important part of prevention is frequent effective handwashing.

05:01 So now let's talk about how we treat sepsis.

05:04 First, it's important to note that many hospitals have treatment bundles for sepsis.

05:09 This has been a big push in a lot of different hospitals and health institutions because sepsis is such a serious disease.

05:16 They want to recognize it and treat it quickly.

05:19 And these bundles help to ensure that the right things happen at the right time for the sick patients.

05:27 The first step in these bundles is to obtain IV or intravenous access.

05:32 Next, we're going to start fluid resuscitation to help with those leaky blood vessels in that organ perfusion, and then we're going to obtain those blood cultures.

05:40 But what's important is that you don't want to delay antibiotics, to obtain those blood cultures.

05:45 So if it's taking a long time to draw them, you want to give the antibiotics first.

05:49 Which is the next step, like we just said, then we're going to measure lactate.

05:53 So we can have an indication of how sick that patient is and how their organ perfusion is doing.

05:59 And then if we started all those things, and a patient's blood pressure is still low, especially after we've given a lots of fluid, they may need to be started on continuous medications to help raise their blood pressure, which we call vasoactive medications.

06:15 Some of these that you may have heard about include epinephrine and norepinephrine.

06:20 So now let's evaluate our outcomes.

06:22 And this is an important part of sepsis treatment, And this is an important part of sepsis treatment, because he tells us how well we're doing.

06:27 The outcomes that need to be measured and re-measured and reevaluated until they are normalized include vital signs.

06:33 The patient's physical exam, their mental status, and their lab findings.

06:39 Okay, so let's put everything we learned into the clinical judgment model.

06:43 We'll start with layers two and three, which is where we'll focus on our hypotheses.

06:48 And first, we're going to recognize those cues of pediatric sepsis.

06:53 So when we recognize those cues are signs and symptoms, we're first going to look at those patient's vital signs.

06:59 So what's their temperature? Is it high or low? We want to look at their heart rate.

07:04 Do they have tachycardia, which is a high heart rate.

07:07 And then how is their blood pressure? Is it high or is it low as an hypotension? And then we're also going to look at their physical exam to help determine if they might have sepsis.

07:19 So some of those signs and symptoms or cues include mental status changes, either flushed to cool skin, delayed capillary refill, or brisk or decreased pulses.

07:30 Okay, now, let's analyze those cues.

07:33 So we recognize the cues with our signs and symptoms of our vital sign changes and our physical exam changes.

07:40 So now we had labs drawn, and let's look at those findings.

07:44 So in the complete blood count, we want to see if they have a high or a low white blood cell count.

07:49 We want to see how their CRP is.

07:52 Is it elevated? That can be a sign of inflammation.

07:55 And is their lactate acid level elevated.

07:58 That can be a sign of poor and organ perfusion.

08:02 So now we need to prioritize our findings or those hypotheses.

08:06 So what's causing this patient's sepsis? Do we think they have a bacterial infection? Do they have an open wound somewhere that's infecting their body? How sick is this child? How low is their blood pressure? Do they need stabilized? Do they need help with their breathing? If they do, how else are we going to help them? And then what medications and other treatments does this child need to help treat their sepsis? So antibiotics? Do we need to do more for their blood pressure than just giving them fluid? So let's develop our action plan.

08:40 We need to recognize those vital signs and physical exam findings of sepsis within 15 minutes, meeting the patient so this is where that bundle comes in that we talked about.

08:50 And then we want to implement that bundle within 30 minutes of meeting the patient.

08:54 Let's review those components.

08:56 So we want to implement the sepsis treatment bundle.

09:00 Starting with getting an IV access within the first 5 minutes of bundle implementation.

09:05 We want to start fluid resuscitation within 30 minutes.

09:09 We want to obtain blood cultures as soon as possible, but not at the expense of delaying antibiotics, which we want to administer within 60 minutes.

09:18 And then we're going to evaluate our outcomes.

09:22 So successful sepsis treatment results in normalization of a patient's vital signs, their physical exam, and their laboratory values.

09:30 So all of that needs to get back to where they were before they develop sepsis or septic shock.

09:36 So that's the end of our judgment model and the end of our video.

09:39 Thank you for watching. See you again next time.