SimFridays - Sepsis in under 3 months old

For our first month of SimFridays we’re looking at paediatrics, and if you couldn’t join us for the second session (11  September) this blog covers some of the learning points. We will be aiming to run simulations every Friday at 11am - go to derriforded.com/sim, particularly if you have suggestions of what we should cover!

​The simulated case: 
Tommy is a two month old infant who had been unwell for one day with high temperatures.

What are your initial thoughts about Tommy? How do you approach these patients?

What happened?
In this simulation, the nurse started with triage and a set of obs. They noted a prolonged capillary refill, tachycardia and a high temperature.They filled out sepsis bundle paperwork.
The nurse escalated early to doctors and conveyed their concerns. The patient was discussed with the paediatrics registrar.


What did we think? 
We talked through the scenario in debrief. Key points were: 

• Recognize early the possibility of sepsis
• Understand the importance of early antibiotics
• Utilize the sepsis boxes that are available in paeds ED with all the equipment needed for a partial septic screen 
• Know where the guideline is
• Early escalation

We discussed the importance of recognizing the possibility of sepsis and the need to communicate this clearly in handovers.

We discussed the importance of adopting an SBAR format in order to give a clear idea on worries and concerns.

We discussed that the paediatric team may be far away, both in time and in space! So it’s important to highlight sick people to seniors within ED too, and start management pending arrival of the paediatric team.

We discussed what a septic screen in an infant would include, i.e inflammatory markers, blood cultures, urine analysis, lumbar puncture.

We discussed how it is sometimes difficult to find a balance between the urgency of giving antibiotics within the ‘golden hour’ or waiting until a full septic screen can be done prior to starting antibiotics.

We acknowledged the difficulty given the sometimes long times for transfer and wondered whether a faster pathway could be developed to allow smoother transfers for paeds ED to CAU.


The guideline:
On the ED browser under paediatric guidelines scroll down to “assessing febrile children” and there are resources and proformas for each age group. The guideline for giving empirical antibiotics in children is also in this list near the top. 

It’s useful  to read the NICE guidance on sepsis - there are sections for each age group. Here is the risk stratification tool for children under 5 in hospital. 


To do:

• Familiarise yourself with the sepsis boxes available in ED  [  ]

 

• Look at the sepsis bundle paperwork and how the criteria are different for each age group, and know where to find our own ED guidelines (see above)  [  ]

 

• Know where to find the different antibiotic guidelines according to age group  [  ]

 

• Spottingthesickchild.com is an online resource for examining children. It features real-life videos of children displaying key symptoms/signs. You can register for free using your NHS email account. If you watch all the videos on the site (it’s a big site!!) then it provides a certificate. Take a look  [  ]

 

• If you took part in the sim, you can use this blog as a starter to reflect on your own experience of it    [  ]

Blog post by Dr Hana Bashir, paediatric sim fellow 
Ed: Dr James Keitley, ED sim fellow
Photos of this sim can be found on the ED Simulation Facebook page. 

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For clinical decisions please refer directly to appropriate guidance. This blog will not be updated.