Announcements: 

1) The interactive Clinical Pathways have launched and they are available for free! 

2) 2023 E/M coding guidelines are in effect. See the summary here. 

___

In this episode, Sam Ashoo, MD, interviews Ara Festekjian, MD, one of the authors of the November 2022 Pediatric Emergency Medicine Practice article on Pediatric Septic Shock in the Emergency Department

Introduction: How common is sepsis in kids and what is the mortality rate in the US?

Definitions

• Septic shock
• Sepsis associated organ dysfunction
• Sepsis-3
• Compensated vs uncompensated shock

Etiology

• Neonate
• Central line and VP shunts
• Asplenia
• Immunocompromised children

Differential Diagnosis

Prehospital Care

ED Evaluation

• History
• Examination
• Septic shock + cardiogenic shock
• Warm vs cold shock
• Evolution of physical exam findings

Diagnostics

• Labs
• Imaging

Treatment

• IV/IO placement
• Fluid boluses
• Antibiotics 
• Pressors 
• Airway management 

Special Populations

• Febrile neutropenia
• Newborns with septic shock

Controversies

• Fluid volume
• Fluid type
• Antibiotic timing
• Corticosteroids