UMEM Educational Pearls

  • Much attention has been paid towards early goal-directed therapy for sepsis in adult ED patients, but there has not been as much consideration for the pediatric ED patient. 
  • R-C analyses and M&M reviews have consistently identified system difficulties  recognizing sepsis in children, especially cases of compensated shock, and subsequent management.
  • Protocols beginning in triage to recognize abnormal vital signs, followed by timely execution of interventions especially antibiotic and fluid administration are worthwhile to reduce overall morbidity and mortality.
  • Protocols should include 3 major goals:
  1. Triage vital signs adjusted for age, and corrected heart rate for pyrexia to recognize sepsis.
  2. Obtain vascular access within 5 minutes followed by a 20mL/kg bolus of IV fluids administered within 15 minutes in cases of volume depletion.
  3. Antibiotic administration within 30 minutes.


Cruz AT, Perry AM, Williams EA, et al. Implementaion of Goal-Directed Therapy for Children With Suspected Sepsis in the Emergency Department. Pediatrics 2011;127;e758.