MedBugs: SAQ #433

Case: Paediatric septic shock

A 2-year-old 15 kg child presents in the care of their parent. They have been febrile, and unwell for the last 24 hours. They are listless, irritable, and floppy at triage with the following observations:

HR 185 bpm

CR 4 sec

RR 42 bpm
SpO2 90% RA

Fever 39 degrees Celsius

GCS 14

Your registrar obtains IV access and provides you with a VBG: pH 6.90 CO2 20 mmHg HCO3 5 mmol/L Lactate 3 mmol/L K 3.3 mmol/L Na 138 mmol/L Cl 103 mmol/L Glucose 2.8 mmol/L

1. Describe 6 key findings on the VBG 6 marks

2. Detail your antimicrobial choice and the organism covered for this child. (8 marks) 8 marks

The child has had a sepsis screen and two 10ml/kg fluid boluses. HR 190 BP 80/30 CR 4 SpO2 95% RR 46 BSL 4.5

3. What inotrope would you start in this child? (2 marks) 2 marks

4. What are the indications for steroids in paediatric septic shock? (2 marks) 2 marks

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Case: Paediatric septic shock

1. Describe 6 key findings on the VBG 6 marks

2. Detail your antimicrobial choice and the organism covered for this child. (8 marks) 8 marks

3. What inotrope would you start in this child? (2 marks) 2 marks

4. What are the indications for steroids in paediatric septic shock? (2 marks) 2 marks

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