Dr. Peter Antevy walks through an EMS protocol for pediatric sepsis using age-appropriate vital signs and the S/H/A/T screening tool. Early IV fluids, epinephrine for hypotension, and field antibiotics like ceftriaxone can cut treatment time from 120 minutes in the hospital to roughly 12 minutes in the field.
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Hey, everyone, it's Dr. Peter Antebe. Thanks for joining me. We're talking about pediatric sepsis today. If you remember, our last protocol, we only had adult sepsis. We're going to talk about pediatric sepsis because our new protocol dives into that with treatment, and it's very important. Why? It turns out that there was a study that showed 3% of children who came in via EMS with sepsis were treated with IV fluids. That's 97%, Ms. Rate. We're not going to do that here. So our new protocol looks just like the adult protocol. First you have to say, is there a suspicion of infection? Does a child have a known infection? Is a child a chronic patient? The child have a high fever and a cough that you suspect an infection? Yes. Okay, now we're going to move on to the hat criteria. Hypotension in kids. We know it's age appropriate. Go to the app, look at the systolic blood pressure. If it's below the lowest number, then that's hypotension for that age group. So we're having an issue with blood pressures. Here's what I want you to do. Put a. Put on a blood pressure cuff, blow it up until you lose the radial pulse. Leak out the air until you feel that first pulsation at the radial. That is your systolic blood pressure palpable. So 70 palp, 80 palp compared to the app. If it's lower than that number, you have an H A altered mental. And in children who have a high fever and if they have infection, they will be altered. Talk to the parents. They'll help you out with that as well. And the last one is T, which is tachypnea. The respiratory rate go to the highest respiratory rate in the APP for that age. If it's higher than that number, they qualify. Alternatively, look at the end title. End title of less than 25 millimeters of mercury, they qualify. Real quick. This is great physiology. Why does an end tidal of lower than 25 give you suspicion for sepsis? Is because sepsis is a metabolic acidosis. To compensate, your body wants to do a respiratory alkalosis so that respiratory alkalosis trying to breathe out that CO2 to compensate for that lactate level in the blood, that is the marker. That is the reason why an end tidal of less than 25 could equal sepsis. Now let's go into treatment. Most importantly, you're sizing up the child. You're doing your assessment. They look sick. You're going down the sepsis train. What are we going to do now? We're looking at the blood pressure. If that blood pressure is low and they're hypotensive, I want you to reach for that push presser. Epi, I want you to reach for that normal saline. Because sepsis is effectively a leaky pipe. All your capillaries are leaking. In order to stop the leak. That's push pressure. Fill the tank back up. That's normal saline. And then we're going to move towards antibiotics. We have rocephin, we have gentamicin. That's gonna stop the actual process from happening, the thing that caused the leak. We have to stop that as well. Now let me give you a situation where the child is not hypotensive yet, but they perhaps have two other criteria. And maybe you don't have to reach for the push pressure right away, but you should give that child fluids. All those children should get fluids no matter what. And you may still give that child antibiotics. So the protocol looks very similar to what we do in adults. The vital signs are all age appropriate and we've laid those out very clearly in the app. You now know what my expectation is for a palpable blood pressure at a minimum in these children. And we could save a lot of lives. Children who are septic, their mortality rate is sky high. If we can get them the treatment that they need before they get to the hospital. I don't care if we're a mile away from the hospital. We're doing everything for this child because we can get antibiotics in within 12 minutes, whereas the hospital, it may take them 120 minutes. So let's do the right thing for the kids. I'm really excited for this protocol. Thanks for listening today.
