Pediatric emergency medicine trisk 0280 0280

TABLE 10.5
EXAMPLE OF INITIAL ANTIMICROBIAL CHOICES IN SEPTIC
SHOCK
Patient history

Antibiotic choices

Previously healthy child Ceftriaxone and vancomycin
with communityacquired infection

Additional
considerations
Oseltamivir during
influenza season
Add clindamycin if
toxin-mediated
syndrome
suspected

Suspected intraabdominal source of
infection

Piperacillin/tazobactam and
vancomycin
OR
Ceftriaxone, metronidazole,
and vancomycin
Immunocompromised
Cefepime and vancomycin
Consider antifungal
patient, history of

coverage for those
Include gentamicin for
cancer, chronic
patients already on
patients with history of
medical conditions,
broad-spectrum
cancer/immunocompromise
recent hospitalization
antibiotics
or resides in a longterm care facility,
indwelling central line
present
Neonate
Ampicillin and gentamicin
Consider acyclovir

Airway Management
Supplemental oxygen should be provided to increase oxygen delivery while
rapidly obtaining IV access, administering fluid, and initiating vasoactive
infusions. Use of a 100% nonrebreather mask provides the highest amount of
noninvasive supplemental oxygen delivery. Indications for intubation and
mechanical ventilation are discussed below in the section on refractory shock. If
the patient has respiratory failure in addition to shock, extra caution needs to be
taken during intubation and the transition from negative pressure to positive