The Challenge We Face
The low frequency of pediatric patient encounters combined with increased fragility of septic patients creates a recipe for one of the biggest challenges any healthcare provider can face.
Complaints: What Was EMS Called For?
Common initial pediatric patient complaints for which EMS is called that cause an EMS provider to begin to think “sepsis” include infections, such as ear, respiratory or urinary tract.
History: What to Ask About
Although not every childhood infection leads to sepsis, the complaints above are an important reminder to search for special items in a pediatric patient’s medical history that will make them more susceptible to sepsis.
Assessment: What to Measure
When you assess the pediatric patient, it can be very easy to integrate sepsis-specific analysis. Begin, as always, with the pediatric assessment triangle to help you prioritize your patient assessment and care.
Red Flags: What to Check
The complexity of severe sepsis and septic shock can be overwhelming to healthcare providers of any level, in or out of the hospital. Although many treatment guidelines rely on criteria such as white blood cell count and arterial hypoxemia, the following can be red flags can be identified easily and rapidly by ED and EMS field personnel.
Treatment: What EMS Should Do
Treatment for sepsis in pediatric patients follows an ABCD format: airway, breathing, circulation, drugs.
Make the Difference
Not every infection a child gets will lead to sepsis, but when sepsis does occur it can be a complex and deadly mixture of inflammatory, immune, and coagulation responses resulting in a combination of distributive, hypovolemic and obstructive shock pathways.
Establish Responsiveness & Consent to Treat
As you approach the patient, introduce yourself and ask if you may help. You’re obtaining consent to treat, being polite, and finding out if the patient is responsive.
Assess for Verbal or Pain Response & Stabilize Spine
If there’s no response, say hello loudly. If this fails to arouse the patient, try a painful stimulus, such as pinching the shoulder or rubbing the breastbone. Permission to treat an unresponsive patient, or a patient with altered mental status, is given through the legal concept of implied consent.
D: Decision on Disability
Decide if further spine protection is needed. If there’s a mechanism of injury for spine injury, maintain manual stabilization.
Now What?
Your initial assessment is complete! Do you remember what comes next in the patient assessment system?
Tod Schimelpfenig
As a NOLS Instructor since 1973 and a WEMT, volunteer EMT on ambulance and search and rescue squads since the 70s, Tod Schimelpfenig has extensive experience with wilderness risk management.