Table 9.
Management of children with invasive bacterial infection (n = 6).
| Age | Gender | Triage codea | Vital signs | Initial working diagnosis | outcome | Comments | CRPb | PS6 interventions in the emergency department (time to intervention) | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Iv access | Blood lactate (mMol/L) | Blood culture | Iv antibiotics |
Iv fluid bolus |
Senior review |
Inotropes | |||||||||
| 1 | 11 years | Female | Unwell child, Recent problem, standard | HR 137; RR 24; T 39.0; CR 2 s or less; Sats 99%; AVPU alert | Fever without source | Admitted | Focus: bacterial gastro-enteritis Blood culture and feces culture: Salmonella paratyphi |
46 mg/L | Yes (176 min) |
No | Yes | No (iv antibiotics started on ward) |
No | Yes (136 min) |
No |
| 2 | 3 years | Female | Unwell child, Hot child, very urgent | HR 142 RR 26; T 39.5; CR 2 s or less; Sats 98%; AVPU alert | Septicaemia | Admitted | Focus: pneumonia, round consolidation on chest X Ray Leishmaniasis serology positive |
37 mg/L | Yes (time unknown) |
Yes 1.2 mMol/L (48 min) |
Yes | Yes (40 min) |
No | Yes (50 min) |
No |
| 3 | 2 months | Male | Unwell child, Hot child, very urgent | HR 165; RR 52; T 38; CR 2 s or less; Sats 100%; AVPU alert | Septicaemia | Admitted | Blood culture: Haemophilus influenza | 37 mg/L | Yes (124 min) |
Yes 2.5 mMol/L (84 min) |
Yes | Yes (time unknown) |
No | Yes (time unknown) |
No |
| 4 | 8 months | Female | Unwell child, Hot child, very urgent | HR 182; CR 2 s or less; Sats 100%; AVPU alert 2nd set of obs (66 min) HR 181; RR 30; T 38.0; Sats 100%; AVPU Alert |
Septicaemia | Admitted | Blood and CSF culture: Streptococcus pneumonia
CSF WBC: 816, polymorphs 73% |
69 mg/L | Yes (208 min) |
Yes 2.3 mMol/L (212 min) |
Yes | Yes (279 min) |
Yes (228 min) |
Yes (121 min) |
No |
| 5 | 4 years | Male | Shortness of breath in children, Increased work of breathing, very urgent | HR 134; RR 38; T 38.0; CR 2 s or less; Sats 98%; AVPU alert | Chest infection | Admitted | Focus: pneumonia, bilateral consolidation on chest X ray Blood culture: Streptococcus pneumoniae |
319 mg/L | Yes (72 min) |
Yes 3.8 mMol/L (392 min) |
Yes | Yes (72 min) |
No | Yes (492 min) |
No |
| 6* | 1 years | Male | Unwell child, Shock, emergent | In arrest | Meningococcal Septicaemia | RIP | Blood culture: group B meningococcus; meningococcal PCR positive | 25 mg/L | Yes (2* IO, at 31 min) |
Yes 8.9 mMol/L (40 min) |
Yes | Yes (31 min) |
Yes (31 min) |
Yes (0 min) |
Yes |
a
Manchester Triage flowchart, discriminator, and category;
b
CRP value as measured at presentation;
BP, blood pressure; CSF, cerebrospinal fluid; CR, capillary refill; HR heart rate; IO, intra-osseus; Iv, intravenous;PS6, pediatric sepsis 6 interventions; RR, respiratory rate; T, temperature; sats O2, saturations.
The colours in the Triage code column represent the assigned triage urgency: red for ‘emergent’, orange for ‘very urgent’, yellow for ‘urgent’, and green for ‘standard’.