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PAEDIATRIC ALTERED
CONSCIOUS LEVEL GUIDELINE |
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Round three
9. Sepsis
A child with a clinical diagnosis of sepsis should be considered for the following additional investigations:
Coagulation studies (activated partial thromboplastin time, prothrombin time, fibrinogen, fibrinogen degradation products) if clotting abnormality suspected
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Position |
Comment |
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Micro |
This should certainly be done before lumbar puncture |
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paed |
Our lab would generally only do the fibrinogen and FDPs if PT/APTT abnormal, which seems perfectly reasonable. |
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Paed |
This should be part of the Routine initial tests in septic children |
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Metab |
Classical Reye syndrome (RS) also consistently show a prolonged Prothrombin time? Is there any consensus for a similar statement earlier up the guideline? This should have occurred to me sooner; but RS is now rare… |
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neuro s |
From my limited grasp of haematology it seems that if these problems are not detected early , then a cascade of increasingly serious and hard to treat further problems develop. |
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ED |
The evidence on added information from leucocyte / nitrite strips is not good. [ed - presumably this comment is related to urinalysis?] |
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metab |
Tend to agree. However this test seems traditional now in all cases of meningitis, and I think has come by “extension” from severe cases of meningococcal sepsis. How it influences treatment and outcome in the less serious cases I don’t know. What do you mean by “clotting abnormality suspected”? : bleeding from venepunctures?, obvious purpura? petechial rash? liver dysfunction on LFTs.? Is it just an indicator of how sick the child is? What do we do with the result? |
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paed |
It is difficult to do the FDP and fibrinogen in a DGH situation, when we are dealing commonly with meningococcal infection and the patient is then transferred out to a Regional PICU. |
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Paed ED |
Useful baseline anyway in sepsis |
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Paed ED |
I think you should take out “if clotting abnormality suspected” as you may not clinically suspect but the clotting may still be abnormal |
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Agreed |
Neither agree nor disagree |
Disagreed |
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92% |
8% |
0% |