Recognition and initial actions

NHS Tayside ED Guidance
NHS Tayside

Presentation:

  • Patients may present with predominant septicaemia (with shock), meningitis (with raised ICP) or both.
  • Purpuric / petechial non-blanching rash is typical. 
  • Some may have neither shock not meningitis.
  • Rash may be atypical or absent in some cases.

Immediate actions:

  • Call consultant in emergency medicine, paediatrics, anaesthesia or intensive care
  • Initial assessment looking for shock/raised ICP
  • Do not perform lumbar puncture yet
  • Give IV ceftriaxone (80 mg/kg od) without delay (See note BM3)
  • Do not use ceftriaxone at the same time as calcium-containing solutions: in this situation use cefotaxime (50 mg/kg qds)

Observe HR, RR, BP, perfusion, conscious level:

  • Cardiac monitor and pulse oximetry
  • Conscious level:
    • alert
    • responds to voice
    • responds to pain
    • unresponsive

Normal levels:

Age RR/min HR/min Systolic BP
Birth 25-50 120-170 80-90
3 months 25-45 115-160 80-90
6 months 20-40 110-160 80-90
12 months 20-40 110-160 85-90
18 months 20-35 100-155 85-100
2 years 20-30 100-150 85-100
3 years 20-30 90-140 85-100
4 years 20-30 80-135 85-100
5 years 20-30 80-135 90-110
6 years 20-30 80-130 90-110
8 years 15-25 70-120 90-110
12 years 12-24 60-115 100-120
over 14 years 12-24 60-110 100-120

Are there any of the following signs of shock?

 

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