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Paediatric sepsis and septic shock

Start this sheet when: Child with suspected infection and any of: fast heart rate or breathing for age, CRT over 3 s, cold or mottled skin, drowsy or floppy, low BP for age, lactate over 2, or a worried parent or nurse. Fever alone is enough in a neutropenic child or an infant under 3 months.

Hospital (remembered on this device)Patient ID / UHID (not saved)Age / SexFilled by

Door dateDoor time (clock starts here)

Time since door

Targets met --Breaches 0

1.Triage, sepsis screen positive
≤ 5 min from door · ED KPI: triage median 5 min
Enter door time
2.Doctor review at the bedside
≤ 15 min from door · Local target: shocked child seen at once
Enter door time
3.IV or IO access, bedside glucose checked
≤ 15 min from door · Local target: go IO after 2 failed IV attempts
Enter door time
4.Blood culture drawn (from the first line)
≤ 1 h from door · SSC Children 2020: before the antibiotic, never delaying it
Enter door time
5.Lactate measured
≤ 1 h from door · SSC Children 2020
Enter door time
6.First antibiotic dose given
≤ 1 h from door · SSC Children 2020: 1 h in shock (3 h if no shock)
Enter door time
7.First 10-20 mL/kg fluid bolus given(Signs of shock)
≤ 30 min from door · Local target; SSC Children 2020: reassess after each
N/AEnter door time
8.Adrenaline or noradrenaline infusion started(Shock not responding to fluid)
≤ 1 h from door · SSC Children 2020: after 40-60 mL/kg, peripheral or IO
N/AEnter door time
9.PICU / transfer centre called(Septic shock)
≤ 1 h from door · Local target: call with the first vasoactive
N/AEnter door time
10.Disposition decided
Record · Admit / transfer / OT; for the length-of-stay audit
Enter door time
11.Patient left the ED
≤ 2 h from disposition decision · ED KPI: decision to departure 2 h or less
Enter door time

Bedside checklist

☐Bolus 10-20 mL/kg over 5-10 min by push-pull; reassess after each
☐Stop fluid at a new liver edge, crackles or harder breathing
☐No ICU within reach: no bolus unless BP is low (FEAST)
☐Adrenaline for cold shock, noradrenaline for warm; IO line is fine
☐Glucose below 70 mg/dL: 2 mL/kg of 10% dextrose
☐Ceftriaxone 80-100 mg/kg (max 2 g); under 1 month: ampicillin + gentamicin or cefotaxime
☐Look for purpura, dengue, malaria and scrub typhus
☐Weigh or use a length tape; write every dose in mg and mL

References

Targets marked “local” are suggestions: agree your own with the quality committee before auditing against them.

Bedside checklist

☐Bolus 10-20 mL/kg over 5-10 min by push-pull; reassess after each

☐Stop fluid at a new liver edge, crackles or harder breathing

☐No ICU within reach: no bolus unless BP is low (FEAST)

☐Adrenaline for cold shock, noradrenaline for warm; IO line is fine

☐Glucose below 70 mg/dL: 2 mL/kg of 10% dextrose

☐Ceftriaxone 80-100 mg/kg (max 2 g); under 1 month: ampicillin + gentamicin or cefotaxime

☐Look for purpura, dengue, malaria and scrub typhus

☐Weigh or use a length tape; write every dose in mg and mL