What’s Your Diagnosis? Pediatric Septic Shock: Recognition and Management in the Emergency Department

Welcome to this month’s What’s Your Diagnosis Challenge! But before we begin, check to see if you got last month’s case on Pediatric Ocular Trauma: Recognition and Management right.

Case Presentation: Pediatric Septic Shock: Recognition and Management in the Emergency Department 

An 8-year-old boy is brought in by his parents for fever, redness to his left shin, vomiting, and diarrhea… 

The boy’s parents tell you he scraped his shin 5 days earlier while playing at a park. His shin became progressively red and hot. He has had fever with vomiting and diarrhea for 3 days. He started to seem unusually tired, prompting their visit to the ED.  On examination, the boy is lethargic, with shallow respirations. His vital signs are: temperature, 38.9°C; heart rate, 176 beats/min; respiratory rate, 35 breaths/min; and blood pressure, 80/57 mm Hg. After an initial response to bag-valve mask ventilation, the patient’s mental status again deteriorated. If the patent needs an advanced airway, what medications should you choose to secure his airway? What are the possible consequences of initiating rapid sequence induction? 

Case Conclusion

The boy presented in uncompensated septic shock. After receiving bag-valve mask ventilation and fluid administration, his lethargy and blood pressure improved. He received broad-spectrum antibiotics within 24 minutes of arrival. Though his blood pressure and mental status initially improved, he developed hypotension again following IV ceftriaxone administration. He was started on an epinephrine infusion of 0.2 mcg/ kg/min and a decision was made to secure his airway.

He was given IV ketamine and an IV paralytic agent. He developed poor lung compliance, and fluid was seen returning into the endotracheal tube. With persistent hypotension, a norepinephrine infusion was started at 0.15 mcg/kg/min along with blood products, including packed red blood cells and FFP for DIC. He was transferred to a critical care setting where he later succumbed to his illness. Blood cultures grew Staphylococcal aureus

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Last Updated on November 22, 2022

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