Dr. Peter Antevy explains why pediatric sepsis is hard to catch: kids keep their blood pressure normal until they crash. Watch for sustained high heart rate, respiratory rate, and altered mental status. If you see those signs, push 20 cc/kg fluid boluses fast, up to three times in the first 30 minutes.
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Hey, everyone, this is Dr. Peter Anteve for another edition of the Hentavi Minute. Today I want to talk about pediatric sepsis. Very difficult to detect. I can tell you that after 20 years in the pediatric ER that there are many kids who came in looking okay. They have a fever like all the other kids in the emergency department. And then suddenly, after a couple of hours, the mom comes running out and says, my child's not looking so well. And it turns out that that one child out of the others was maintaining their blood pressure, but their heart rate was up. They were breathing a little faster. And then suddenly when the blood pressure goes down, we start ringing all the bells. Maybe that's too late by then. So pediatric sepsis is difficult to detect. So let's talk about the important numbers. And this came out in a study recently. It's heart rate, heart rate, heart rate. Now, if the kid's screaming their head off, well, every kid's heart rate is high. That may be kind of tough unless you can calm the kid down and see the sustained heart rate over time. What about blood pressure? Many agencies, it turns out, aren't even checking the blood pressure. But it's so important to check a blood pressure on a kid. Now, if they won't let the automated cuff continue to go on them, they keep screaming. Well, you do a palpable blood pressure. Basically, you inflate the cuff. You put your finger on the radial pulse, and you inflate, and then you lose the pulse. And then as soon as you leak it out, so you start feeling the pulse back. That's your systolic blood pressure. So once you're under the fifth percentile for blood pressure for that age range, then you're hypotensive. So if you look in the app that we've created under vital signs, you'll see a systolic blood pressure. If you're under that number, then you're below the fifth percentile. You're hypotensive. If you're hypotensive in your child, that's bad news, and that's elevated morbidity and mortality. You could also use the mean arterial pressure as well. So we've already talked about heart rate, we've talked about blood pressure. Respiratory rate's another big one. So get your end title on. Another great reason to use the end title, and not only will it give you a number, and if it's under 25, then that's suggestive of an acidosis. And you can also see, basically, if your respiratory rate is High. So putting an end tidal on gives you two important pieces of information. And then lastly, is the child's mental status. Are they altered, sleepy, not really responding to you, not looking at you as you're walking into the room? That's not a normal child. So many of you may have heard of QSofA, we've kind of transformed that into what we call the HAT criteria. A child who has a suspected infection. And then let's go one at a time. H, are they hypotensive? Below the fifth percent systolic blood pressure for their age. That's number one. A, are they altered? And altered mental status in an adult or kid is bad. And then T for tachypnea, are they breathing fast? Another marker for that, is there end tidal under the number 25? That would all suggest sepsis. And so if you have a child who's septic, you have to give fluids, start an IV if you can. If not, put in an IO. And then the last thing I'll challenge you with is how do you give 20cc's per kilo over 10 minutes, three times, which you're allowed to do in pals, right? 60cc's per kilo in the first 30 minutes. If you don't know how to do that, it's hard, right? So you can do push, pull, but please don't just put a pressure bag on or squeeze the bag because that's not going to get to a 24 gauge IV. And of course you've all heard, hopefully you've heard of Life Flow, which is created by an amazing Dr. Mark Peel, who created a device where you can get like 500cc's in within a minute. We use it at our hospital with great success. So however you do it, understand sepsis, know that it's hard to determine, right? You'll get fooled by it. But don't hesitate to give IV fluids, give them fast and give them frequently. Again, this has been Dr. Peter Antevi. Thank you for joining me on this edition of the Hentevy Minute.
