Welcome

I struggled to find PEM resources for my CT3 year, despite the variety of excellent resources out there. I hope this website will help point you in the right direction. I'm not a PEM expert, but am following the guidance CEM have issued (in the form of a syllabus) to put together this page. This page is not endorsed by CEM, and any mistakes are mine.

Please comment with corrections, additions and further suggestions.

All the information here is collected from the internet, and it might be out of date or inaccurate, so please use your judgement and adhere to your hospital's protocols. If you do notice any errors or omissions please comment so we can put them right!

To navigate, decide whether you want to start with a PMP or a PAP. You can then select which PMP or PAP you want to look at. You will then be taken to the summary page for that PMP, with links expanded topic collections. If you know what topic you want to look at already, click on the link on the right hand side.

Monday, 16 December 2013

Sepsis in Children

Sepsis in children is one of those areas that always frustrates me slightly. In adults, sepsis  care is improving and we have clear criteria for diagnosing sepsis. Diagnosing sepsis in children is a little bit harder - and it can be a fine line between a nasty infection, and sepsis. There are probably three important sections to consider under the "sepsis" banner:
  • Fever in children
  • Meningococcal septicaemia
  • Sepsis identification and treatment 
Mortality from paediatric sepsis ranges from 9% to 35%. Aggressive fluid resuscitation early in the course of SIRS results in decreased mortality. The risk of sepsis is inversely related to age. Neonates are at the highest risk, with bacterial sepsis occurring in 1-10 per 1000 live births in the United States.

Risk Factors
- Children with sickle cell have a 400-fold increased risk of sepsis due to pneumococcus and salmonella.  am
- Severe sepsis 15% more common in boys.

Pathogenesis
In children, shock is more likely to be associated with profound hypovolaemia. They often need more aggressive fluid resuscitation than adults.

Recognition of Sepsis

The NICE traffic light guidelines on feverish illness provide a useful structure for assessing children.
Colour - normal, pale, mottled, ashen or blue?
Activity - responds normally, not responding to social cues, appears ill to an HCP
Respiratory - any signs of respiratory distress?
Circulation - any signs of dehydration?
Other - any amber signs, fever for more than 5 days, swelling of a joint

The college has clear standards for managing sepsis and meningitis in children, and fever in children which will be looked at in more detail when we get to the "fever" section.

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