The term shock describes inadequate tissue oxygen delivery due to a reduction in tissue perfusion. Hypoxia within the cell forces it into adopting anaerobic metabolism leading to the production of lactic acid.
The work by the Surviving Sepsis Campaign clearly shows that early and aggressive fluid resuscitation along with administration of antibiotics and goal directed therapy can significantly reduce adverse outcomes.
Despite this, evidence suggests that in both children and adult patients these targets are often not met. It is essential as Emergency physicians that we rapidly identify and manage patients with sepsis to ensure the best possible outcomes.
LEARNING OUTCOMES FROM COMPLETING THE TASKS
Understand local guidelines for DKA in children and be able to prescribe insulin and fluids accordingly.
Recognise the features of cerebral oedema and institute initial management.
Know the causes of both upper and lower GI bleeding in children.
Be able to formulate a differential diagnosis for the shocked child.
Understand the pathophysiology, classification and management of septic shock in children.
LEARNING OUTCOMES FROM FACE-TO-FACE TEACHING
Have a structured approach to the shocked child.
Assess and initiate immediate management of a septic child.
Be able to stabilise a child who is haemodynamically compromised.
Understand the different options available to secure vascular access in a child with haemodynamic compromise e.g. IO & EZ-IO, peripheral cannulae, scalp cannulae, central access options.
Complete the following before the face to face session:
TASK 1: Shock, sirs and Sepsis
Duration: 60 mins
Damian's Video is A guide the Leicester Royal Infirmary Children's Emergency Department Sepsis pro forma.
A previous video on sepsis is available with a more generic overview.
TASK 2: Gastrointestinal bleeding in children
Duration: 45 mins
TASK 3: Button Battery Ingestion
Duration: 35 mins
Hopefully you will all be aware of the danger of button battery ingestion, however the following cover important points for anyone who sees children in the ED.
Task 4: Diabetic ketoacidosis
Duration: 20 mins
Read this document covering treatment of DKA in patients under 18 years of age. It is based on the NICE guideline from August 2015.
We have written a series of interactive cases (wikis) with short answer questions to be answered by trainees prior to the face to face teaching sessions. Currently this is only available to East Midlands Trainees.
Answer one or two questions before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. We will also provide tutor comments. If you find good resources that answer a question why not include links in your comment.
Part of the face-to-face teaching will be spent discussing the case(s) below:
Here are some extra resources to review if you want more information:
This module has been written by two of the senior gastroenterology trainees in Leicester and can be accessed through your eUHL account.
Guideline for the management of upper GI Bleeding
An excellent summary of the causes and management of upper GI bleeding in children. The podcast is 45 mins long.
Diabetes (type 1 and type 2) in children and young people: diagnosis and management.
An enlightening look at the evidence on PPI's in UGI bleeds – should we be using them at all?
A nice easy to read document that covers the important points of Surviving Sepsis Guidance.
A good overview of intussusception in paediatric patients.
A useful one page aide-memoire to use if treating a patient with DKA.
Once you have worked through the exercises, discussed the example cases and attended the face-to-face teaching, please complete the following form: