| What should be done if a child is not alert or not responding to voice? | Start Inj Adrenaline infusion @0.1 microgram/kg/min and refer to higher center | Give additional fluids if losses continue. Start maintenance fluid in case of other illness Antibiotics 1. >3 months Inj Ceftriaxone 100mg/kg/day ( 2 divided doses) 2. <3 month Inj Cefotaxime 200mg/kg (divided 6-8hrly), Inj Gentamicin 5-7.5 mg/kg single dose /day 3. If soft tissue infection: consider Inj Cloxacillin 200mg/kg divided 6 hourly or Inj Amoxicillin- Clavulanic acid 30 mg/kg/dose 8hrly) Inj Adrenaline- 0.3x body weight in mg in 50 ml NS or 5% dextrose at 1 ml/hr will give 0.1 microgram/kg/min Give 20 ml/kg of normal saline fluid bolus over 20- 30 minutes. Repeat bolus of 20 ml/kg over 30 minutes, with careful monitoring for hepatomegaly, oxygen saturation, crepitation’s in chest (if any of above appears then stop fluids) Start Inj Adrenaline infusion @0.1 microgram/kg/min and refer to higher center A Is the child Alert? If not; V Is the child responding to Voice? | 742 | summary | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952338_paediatrics_sepsis_and_septic_shock_in_children.pdf | Repeat bolus of 20 ml/kg over 30 minutes, with careful monitoring for hepatomegaly, oxygen saturation, crepitation’s in chest (if any of above appears then stop fluids) Start Inj Adrenaline infusion @0.1 microgram/kg/min and refer to higher center A Is the child Alert? If not; V Is the child responding to Voice? | 1 | page=1,block=11 | 0.700 | valid |
| What antibiotic is suggested for soft tissue infections? | Inj Cloxacillin 200mg/kg divided 6 hourly or Inj Amoxicillin- Clavulanic acid 30 mg/kg/dose 8hrly | Give additional fluids if losses continue. Start maintenance fluid in case of other illness Antibiotics 1. >3 months Inj Ceftriaxone 100mg/kg/day ( 2 divided doses) 2. <3 month Inj Cefotaxime 200mg/kg (divided 6-8hrly), Inj Gentamicin 5-7.5 mg/kg single dose /day 3. If soft tissue infection: consider Inj Cloxacillin 200mg/kg divided 6 hourly or Inj Amoxicillin- Clavulanic acid 30 mg/kg/dose 8hrly) Inj Adrenaline- 0.3x body weight in mg in 50 ml NS or 5% dextrose at 1 ml/hr will give 0.1 microgram/kg/min Give 20 ml/kg of normal saline fluid bolus over 20- 30 minutes. Repeat bolus of 20 ml/kg over 30 minutes, with careful monitoring for hepatomegaly, oxygen saturation, crepitation’s in chest (if any of above appears then stop fluids) Start Inj Adrenaline infusion @0.1 microgram/kg/min and refer to higher center A Is the child Alert? If not; V Is the child responding to Voice? | 302 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952338_paediatrics_sepsis_and_septic_shock_in_children.pdf | If soft tissue infection: consider Inj Cloxacillin 200mg/kg divided 6 hourly or Inj Amoxicillin- Clavulanic acid 30 mg/kg/dose 8hrly) Inj Adrenaline- 0.3x body weight in mg in 50 ml NS or 5% dextrose at 1 ml/hr will give 0.1 microgram/kg/min Give 20 ml/kg of normal saline fluid bolus over 20- 30 minutes. |
| What are the desirable diagnostic tests for specific illnesses like malaria or dengue? | Blood culture, blood gas, relevant cultures (based on symptoms), chest X-ray, specific illness- Malaria – rapid malarial antigen test, Dengue- dengue NS1, IgM, CSF study | Optional- PCT , USG to guide the fluids Desirable - Blood culture, blood gas, relevant cultures (based on symptoms), chest X-ray, specific illness- Malaria – rapid malarial antigen test, Dengue- dengue NS1, IgM, CSF study Essential – Complete blood counts, peripheral blood film, urine routine, blood sugar, CRP, serum electrolytes, renal function test, liver function test When to refer • Shock does not improve after 2nd fluid bolus • Signs of fluid overload • No facility for continuous monitoring. • Before referral counsel the parents and inform referring facility When to Suspect Cardiac Failure • History of underlying heart disease • History of forehead sweating/ suck rest suck cycle • Murmur • Hepatomegaly or basilar crept If it is suspected be careful in giving fluid bolus Complications • Respiratory failure ( excessive increase in the respiratory rates and inability to maintain saturation> 94% with oxygen) -non-invasive (CPAP/BIPAP) or invasive ventilation • Congestive heart failure- Dobutamine / Milrinone infusion and Furosemide • Infections on other sites- explore and treat accordingly #For severe acute malnutrition – consider SAM STW #For suspected Dengue follow Dengue Fever STW |
| What are the signs that indicate a need for referral? | Shock does not improve after 2nd fluid bolus • Signs of fluid overload • No facility for continuous monitoring | Optional- PCT , USG to guide the fluids Desirable - Blood culture, blood gas, relevant cultures (based on symptoms), chest X-ray, specific illness- Malaria – rapid malarial antigen test, Dengue- dengue NS1, IgM, CSF study Essential – Complete blood counts, peripheral blood film, urine routine, blood sugar, CRP, serum electrolytes, renal function test, liver function test When to refer • Shock does not improve after 2nd fluid bolus • Signs of fluid overload • No facility for continuous monitoring. • Before referral counsel the parents and inform referring facility When to Suspect Cardiac Failure • History of underlying heart disease • History of forehead sweating/ suck rest suck cycle • Murmur • Hepatomegaly or basilar crept If it is suspected be careful in giving fluid bolus Complications • Respiratory failure ( excessive increase in the respiratory rates and inability to maintain saturation> 94% with oxygen) -non-invasive (CPAP/BIPAP) or invasive ventilation • Congestive heart failure- Dobutamine / Milrinone infusion and Furosemide • Infections on other sites- explore and treat accordingly #For severe acute malnutrition – consider SAM STW #For suspected Dengue follow Dengue Fever STW | 390 | list | 0.820 |
| What are the signs to suspect cardiac failure in a patient? | History of underlying heart disease • History of forehead sweating/ suck rest suck cycle • Murmur • Hepatomegaly or basilar crept | Optional- PCT , USG to guide the fluids Desirable - Blood culture, blood gas, relevant cultures (based on symptoms), chest X-ray, specific illness- Malaria – rapid malarial antigen test, Dengue- dengue NS1, IgM, CSF study Essential – Complete blood counts, peripheral blood film, urine routine, blood sugar, CRP, serum electrolytes, renal function test, liver function test When to refer • Shock does not improve after 2nd fluid bolus • Signs of fluid overload • No facility for continuous monitoring. • Before referral counsel the parents and inform referring facility When to Suspect Cardiac Failure • History of underlying heart disease • History of forehead sweating/ suck rest suck cycle • Murmur • Hepatomegaly or basilar crept If it is suspected be careful in giving fluid bolus Complications • Respiratory failure ( excessive increase in the respiratory rates and inability to maintain saturation> 94% with oxygen) -non-invasive (CPAP/BIPAP) or invasive ventilation • Congestive heart failure- Dobutamine / Milrinone infusion and Furosemide • Infections on other sites- explore and treat accordingly #For severe acute malnutrition – consider SAM STW #For suspected Dengue follow Dengue Fever STW | 604 | list |
| What should be monitored during the administration of a fluid bolus? | hepatomegaly, oxygen saturation, crepitation’s in chest | Give additional fluids if losses continue. Start maintenance fluid in case of other illness Antibiotics 1. >3 months Inj Ceftriaxone 100mg/kg/day ( 2 divided doses) 2. <3 month Inj Cefotaxime 200mg/kg (divided 6-8hrly), Inj Gentamicin 5-7.5 mg/kg single dose /day 3. If soft tissue infection: consider Inj Cloxacillin 200mg/kg divided 6 hourly or Inj Amoxicillin- Clavulanic acid 30 mg/kg/dose 8hrly) Inj Adrenaline- 0.3x body weight in mg in 50 ml NS or 5% dextrose at 1 ml/hr will give 0.1 microgram/kg/min Give 20 ml/kg of normal saline fluid bolus over 20- 30 minutes. Repeat bolus of 20 ml/kg over 30 minutes, with careful monitoring for hepatomegaly, oxygen saturation, crepitation’s in chest (if any of above appears then stop fluids) Start Inj Adrenaline infusion @0.1 microgram/kg/min and refer to higher center A Is the child Alert? If not; V Is the child responding to Voice? | 643 | list | 0.820 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952338_paediatrics_sepsis_and_septic_shock_in_children.pdf | Repeat bolus of 20 ml/kg over 30 minutes, with careful monitoring for hepatomegaly, oxygen saturation, crepitation’s in chest (if any of above appears then stop fluids) Start Inj Adrenaline infusion @0.1 microgram/kg/min and refer to higher center A Is the child Alert? If not; V Is the child responding to Voice? |
| What antibiotic is recommended for children older than 3 months? | Inj Ceftriaxone 100mg/kg/day ( 2 divided doses) | Give additional fluids if losses continue. Start maintenance fluid in case of other illness Antibiotics 1. >3 months Inj Ceftriaxone 100mg/kg/day ( 2 divided doses) 2. <3 month Inj Cefotaxime 200mg/kg (divided 6-8hrly), Inj Gentamicin 5-7.5 mg/kg single dose /day 3. If soft tissue infection: consider Inj Cloxacillin 200mg/kg divided 6 hourly or Inj Amoxicillin- Clavulanic acid 30 mg/kg/dose 8hrly) Inj Adrenaline- 0.3x body weight in mg in 50 ml NS or 5% dextrose at 1 ml/hr will give 0.1 microgram/kg/min Give 20 ml/kg of normal saline fluid bolus over 20- 30 minutes. Repeat bolus of 20 ml/kg over 30 minutes, with careful monitoring for hepatomegaly, oxygen saturation, crepitation’s in chest (if any of above appears then stop fluids) Start Inj Adrenaline infusion @0.1 microgram/kg/min and refer to higher center A Is the child Alert? If not; V Is the child responding to Voice? | 117 | factual | 0.570 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725952338_paediatrics_sepsis_and_septic_shock_in_children.pdf | >3 months Inj Ceftriaxone 100mg/kg/day ( 2 divided doses) 2. | 1 | page=1,block=11 |