Consider sepsis or septic shock if a child has a suspected or proven infection and has at least 2 of the following:
- Core temperature <36°C or >38.5°C
- Inappropriate tachycardia (according to local criteria or advanced paediatric life support guidance)
- Altered mental state (e.g., sleepiness, irritability, lethargy, floppiness, decreased conscious level)
- Reduced peripheral perfusion or prolonged capillary refill.
If in doubt, seek an experienced opinion!
Within 1 hour of presentation, sepsis should be treated with:
- Supplemental oxygen
- IV (or IO) access – within 5 minutes of presentation – and blood tests including blood cultures, blood glucose, and blood gas.
- FBC, serum lactate, and CRP should also be ordered for baseline assessment.
- Low blood glucose should be treated
- IV or IO antibiotics should be given with broad-spectrum cover as per local policies.
- Fluid resuscitation should be considered – aim to restore normal circulating volume and physiological parameters. Isotonic fluid (20 mL/kg) should be titrated over 5 minutes and repeated as necessary.
- Beware fluid overload – look for crepitations and hepatomegaly.
- Experienced senior clinicians or specialists should be involved and consulted early.
- Inotropes should be considered early if normal physiological parameters are not restored after giving ≥40 mL/kg of fluids. It is important to note that adrenaline (epinephrine) or dopamine may be given via peripheral IV or IO access.
UK Sepsis Trust have Red Flag screening & action tool –
Start Sepsis6 pathway if ONE red flag:
- objective change in behaviour or mental state
- Unrousable or won’t stay awake
- Looks very ill to HCP
- Sats under 90% or new need for oxygen
- Severe tachypnoea
- Severe tachycardia
- Not passed urine in last 18h
- Mottled, ashen or blue skin, lips or tongue
- Non-blanching rash
Otherwise, any amber flags:
- Behaving abnormally, not wanting to play
- Significantly decreased activity/parental concern
- Sats under 90^% or moderate tachypnoea
- Moderate tachycardia
- CRT >=3secs
- Reduced urine output
- leg pain
- Cold feet/hands
If 2 then do bloods, consider if just 1. Review by ST4 within 1 hour.
If lactate >2 then start Sepsis6