Sepsis: Pediatric First Response

In the United States, more than 75,000 children develop sepsis each year. Sepsis accounts for 100,000 pediatric emergency department visits each year, with nearly 20% of children treated for septic shock arriving in the emergency department via ambulance.

First responders are on the frontlines of sepsis recognition and early treatment and need to know the signs and symptoms of sepsis and how to initiate treatment in pediatric patients.

Share this video with your colleagues, patients, and loved ones to ensure they know the signs and symptoms of pediatric sepsis. This video includes a reenactment of an EMS response to a pediatric sepsis case and expert commentary on sepsis in pediatric patients.

To learn more about sepsis, visit www.sepsis.org.
To share your sepsis story, visit www.facesofsepsis.org

This is the school nurse at Maplewood Middle school and I've got a student Showing signs of sepsis including Altered Mental Status rescue 37 respond Seven pronounced recess number 7 from s3 Maplewood middle school it was done in This location with these appear thank You For eleven year old male 3 Sun I'm Sun To receive a grant rescue 37 was found In a windows There was a case with an 11 year old boy Went on a camping trip with his family I wound up getting poison ivy it was Itching and bothering him he kept Scratching it his mom saw it and said it Didn't look too bad he could go to School he winds up going to school and It's still bothering him he's a little Distracted not able to concentrate on Class and he asked to go to the nurse's Office I just don't feel really well and I accidentally stepped in some poison Ivy and my leg like itches okay when did You start not feeling well like first Period I just couldn't focus on the Teacher what she was saying it was like Really hard so you couldn't focus that's I as you know for you okay all right let Me take your temperature She really begins to pick up on some Subtle signs and symptoms so one of the Next thing she does is take a look at This kid's past medical record and she

Sees that because of a prior injury he's Had a splinter it's an injury to his Spleen means that he's immunocompromised But it really takes a sharp clinical Provider like this school nurse to pick On the subtle signs and symptoms that This kid isn't acting quite right so When she cut off the bandage she was Looking at what might be more than just A simple case of poison ivy she Suspected that this might be something Like a staph infection now we're putting Together an infection and altered Mental Status we've raised the possibility of Sepsis anyone can get an infection and Almost any infection can lead to sepsis Pediatric sepsis is the number one Killer of children globally even in the United States there are more than 72,000 Cases per year and more than 6,800 Children die from sepsis [Music] Sepsis is the body's overwhelming and Life-threatening response to an Infection that can lead to tissue damage Organ failure and death at its most Basic sepsis is identifying that the Patient has an infection and altered Vital signs first responders and Pre-hospital caregivers are often the First to encounter sepsis patients so It's critical that they recognize the Signs and symptoms of sepsis and are Able to carry forward a care plan when

We're looking for signs and symptoms We're looking for changes in heart rate Oxygen levels changes in respiratory Rate changes in Mental Status blood Pressure that is hypotensive so low That's a very late stage of sepsis when We reach those levels that we have Multiple organs dysfunctioning there are Things that manifest individually that Map to those organs so for example I can See very low urine output and changes That are indicating I have kidney damage A common misconception is that every Child with sepsis or even every child With an infection is going to have a High temperature not every infection Produces fever so when you take the Patient's temperature and it's normal or Cold it doesn't mean that they don't Have an infection it doesn't mean that They don't have sepsis in fact the Particularly cold child can mean that This child has septic shock and it's Getting even worse unfortunately there's No one single set of criteria or one Single test that could tell you what the Patient has sepsis or not that makes it A real challenge in being able to Diagnose it so I may have to really Undergo a period of observation in that Hospital because the risk is there and That kind of observation happens often With neonates especially it's so Important to watch how they're

Progressing over time look you need Immediate medical attention so I'm gonna Call an ambulance Then I'm gonna call your mom all right And we'll make sure that you get what You need right away this is the school Nurse at Maplewood middle school and I've got a student showing signs of Sepsis when first responders find a Child where they suspect sepsis it's Really quite simple they have to say I Suspect sepsis he's got an increased Pulse a fever increased respiratory rate Substance is a medical emergency that Begins outside of the hospital in 80% of Cases we're talking about powers making The difference with life and death hi I Just want to let you know Luke's feeling Really ill his poison ivy looks really Infected it looks infected I have called EMS we do need him to have An immediate medical attention right What happened The school nurse contacts the mom to let Her know what's going on and to let her Know that it's something that's going to Require her son to go to the emergency Department and receive some emergency Care okay what hospital would you like Me to go to Maplewood memorial you're Just gonna meet the ambulance there the First responder to arrive as a police Today hi fine thanks I'm glad you're Here what's going on we've got Luke

Miller over here her showing signs of Sepsis okay he starts getting together The key information to be able to share With the EMTs and the paramedics hey Just hang tight okay okay do you have His information as far as information Right there okay great There are certain populations of Children who are higher risk for Infection Those include kids who are born Prematurely kids with chronic medical Conditions such as cancer or congenital Heart disease kids with medical devices And kids with immune deficiency also Newborns are at higher risk for Infections that can lead to sepsis Parents with children of special health Care needs really need to understand the Vulnerability of their children to Sepsis the American Academy of Pediatrics has an emergency information Form and being able to document it can Really mean make shorten the time to Ultimate interventions being a Pre-hospital provider gives you these Challenges when you're dealing with any Kind of sick patient but especially with The child who you must advocate for who You must understand all these nuances You alone are going to have the First opportunity to intervene to Communicate and to make sure you have Triggered the resources necessary to

Rescue that child This is medic 256 calling in a sepsis Alert when we're dealing with a newborn Patient you have to keep in mind the Possibility that this patient picked up Congenital infections possible Infections that they got from maybe even During the birthing process even when a Child's a little bit older up to three Months old every baby's immune system is Still developing so basically any child Under ninety days old is considered Immunocompromised There are children with chronic Illnesses that also remain vulnerable Such as them being on chemotherapy or Having acquired immune deficiency Syndrome or AIDS some children with Pediatric asthma may be on Corticosteroids and those steroids Anti-inflammatory medications can also Suppress their immune response that can Certainly make it more likely that They're going to get infections Especially respiratory infections which Cause approximately 50% of the cases of Sepsis the real challenge is with the Otherwise healthy population we know That mortality rates can exist somewhere And one to four percent in otherwise Completely healthy children so we need To be as attentive to those children That don't have a history of chronic Illnesses and don't already fall into

Those categories as we are those that do Because it could be very very subtle the Way that they present their signs and Symptoms and what we want to do is be Able to focus on how they're Compensating how they're trying to keep Their organs working while the septic Reaction slowly eats away at their Ability to frankly stay alive When the auntie's in the paramedic Arrived their goal is to gather the Information as quickly as possible to Get a patient picture and understand Basically what's going on and he's Getting worse while we're here here is 11 years old who's showing signs of Sepsis you want to make sure that that's The first thing that you say when you're Giving a radio report or a face-to-face Report this is a sepsis alert altered Mental state are able to work with the Police officer and the school nurse to Identify the key information to get them An accurate patient picture this is Going to allow them to begin focusing The rest of their assessment and to Begin treatment as soon as possible all Right we're gonna get your vital signs Real quick and get you ready to go it Was important for them to obtain initial Vital signs including pulse blood Pressure respirations pulse oximetry and More this way they're going to be able To identify trends and see whether the

Patient is getting better or worse one Really important thing that you should Know two years ago it's really important That we start with the patient's Complaint we really drill down with Their medical history especially when We're taking the patient in from family Members caregivers school nurses Pediatricians office Family Medical Center's is we're really getting all of The information that we can children of Any age are going to not be able to tell You as well what exactly is going on With them when you're dealing with Infants they're going to be able to tell You even less and you're really going to Need to rely on a rock-solid assessment And a really good patient history Medications they're on how they were Born when they were born if any problems Were encountered from the time they were Born up till now We can't let those bits of information Go unnoticed now not everything is going To be sepsis but we want to make sure That that is top of our list when we're Assessing this patient if the first Responder can accurately identify risk There's no greater control of the Destiny of that childhood being able to Say we got them the most rapid accurate Care of us on the way to the hospital The boy's condition started to Deteriorate the paramedic needed to

Continue treatment but needed to be very Careful in each step of the treatment Not to slow anything down but to make Sure that each step was being evaluated To see if he was slowing the Deterioration balancing off or maybe Even improve it well we want to be Aggressive with our treatment we want to Make sure that we don't go too far this Is a very delicate balance and a lot of Patients especially those with Underlying conditions could be Particularly fragile too much treatment Can be just as bad as not enough Pressure 70 over 40 heart rate is 160 The paramedic was administering fluids Rapidly and deciding that if this Patient didn't turn around they were Going to need to move on to the pressure Medications hey Doc this is medic – five Six calling and acceptance alert the Paramedic called a sepsis alert and this Let the emergency department physician Know that she and her team we're going To have to be ready to meet this patient As soon as they arrived at the hospital Reassessing the vital signs is crucial To be able to determine what the trend Is in the patient's overall condition Especially with pediatric patients going Into shock they can decompensate they Can deteriorate very very quickly blood Pressure 70 over 40 heart rate is once These patients try and sustain their

Blood pressure and their cardiovascular Status for as long as they can but when They run out of reserves their vital Signs can drop immediately when these Altered vital signs begin to become so Severe that indicates cardiovascular Collapse this patient is starting to Spiral down then that Shock some of the most common Misconceptions about sepsis is that Sepsis can only occur with heavily Heavily bacterially infected people but It's really the body's response gone Haywire that's doing that in the old Days a lot of times sepsis was referred To as blood infection the problem with That definition is it makes us think That the problem is isolated to the Blood for out-of-hospital providers the Other issue is that if it's a blood Problem you're not really thinking about The organ dysfunction and the things That you can actually do something about We want to make sure that when we hand Off the patient and the information at The hospital that we're doing it as Efficiently as possible we want to make Sure that we're giving them the key Information that they're going to need To keep up that momentum of care because Time is absolutely critical with these Patients this is the 11 year old now From school a sepsis alert the paramedic Delivers his face-to-face report to the

Emergency department physician and her Team allowing them to continue the care That's already begun in the field plus Any additional care that might be needed Such as blood cultures antibiotics or Any correction of electrolytes for other Problems that the patient might have ok Guys let's get the fluids hung let's Draw some labs including the lactate Level and the blood culture and let's Get the Vanco and there was Stefan Started stat the school nurse was able To put together some very subtle signs And symptoms in the beginning and knew That this was a child who needed a 911 Call this was a child who needed to go To the emergency department not back to Class the police officer began to gather The key information the EMTs and the Paramedic began their assessment early On suspecting sepsis beginning their Treatment for sepsis and coordinating it Right away with a sepsis alert with the Emergency department the emergency Department staff was ready to receive That sepsis alert and pick up the ball Continue that momentum of care and do Everything possible to make this a Positive outcome if everyone wasn't Working on the same page If anyone wasn't as sharp as they needed To be this might not have been Positive outcome at all prevention of Infection rapid recognition students

Showing signs of sepsis and effective Treatment remain the keys to sepsis Prevention and sepsis survival people Don't really understand the word sepsis It doesn't carry the same emotional Impact then when we hear about a child With cancer that evokes a completely Different emotional response we have to Be able as healthcare providers to say I'm going to overcome that reluctance to Say I believe this child has sepsis and This is what we need to do it is Concerning that sepsis cases are not Decreasing the way we would like them to And clearly much work remains to be done So when we think about the strategies That have really made the biggest Difference over the last two decades it Has all been about minimizing variation In practice and we have protocols in Place that are going to allow us to Rapidly and identify this child with Sepsis the second piece of that protocol Is having the right teams having a Pediatric readiness with the equipment That's number three use of pediatric Sepsis care guidelines by pre-hospital Providers has shown to reduce mortality By forty to forty seven percent we're Changing our infrastructures so that They're more responsive there's a Greater team effort there's a greater Communication there's a greater Standardization to minimize unwanted

Variation in the way that we approach These children now if we can get that to Spread we'll have really made a Difference across the nation [Music] [Music] [Music] [Music] [Music]