Page 19 - Learnwell EVS
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A t the sam e tim e, ad m inister rap id ly Ringer lactate o r 0.9% sodium chloride: 1 litre in
ad ults (m axim um rate); 2 0 m l/ k g in child ren, to be rep eated if necessary .
I f there is no clinical im p ro vem ent, rep eat I M ep inep hrine every 5 to 1 5 m inutes.
I n sho ck p ersists after 3 IM injectio ns, ad m inistratio n o f IV ep inep hrine at a co nstant
rate by a sy ringe p um p is necessary :
U se a diluted so lutio n, i.e. ad d 1 m g ep inep h rine ( 1 :1 0 0 0 ) to 9 m l o f 0 .9 %
so d ium
chlo rid e to o btain a 0 .1 m g/ m l so lutio n (1 :1 0 0 0 0 ):
C hild ren: 0 .1 to 1 m icro gram / k g/ m inute
A d ults: 0 .0 5 to 0 .5 m icro gram / k g/ m inute
I f sy ringe p um p is no t available, see bo x p age 2 2 .
– C o rtico stero id s have no effect in the acute p hase. H o wever, they m ust be given o nce
thhyedrpocaotriteisnotnies hsetambisiluizcceidnattoe IpV reover nI tMrecurrence in the sho rt term :
C hild ren: 1 to 5 m g/ k g/ 2 4 ho urs in 2 o r 3 injectio ns
A d ults: 2 0 0 m g every 4 ho urs
– In p atients with bro ncho sp asm , ep inep hrine is usually effective. If the sp asm p ersists
give 1 0 p uffs o f inhaled salbutamol.
Septic shock
– V ascular fluid rep lacem ent w ith Ringer Lactate o r 0.9 % sodium chloride o r plasma
substitute.
– dUopsaemoinfevIaVsoactoa ncsotrnicsttoanrst :rate by sy ringe p um p (see bo x p age 2 2 ):
1 0 to 2 0 m icro gram s/ k g/ m inute
eoprin, eifpnhorinteaIvVailaabt lae co nstant rate by sy ringe p um p :
U se a diluted so lutio n, i.e. ad d 1 m g ep inep h rine ( 1 :1 0 0 0 ) to 9 m l o f 0 .9 %
so d ium
chlo rid e to o btain a 0 .1 m g/ m l so lutio n (1 :1 0 0 0 0 ). S tart with 0 .1
m icro gram / k g/ m inute.
Increase the d o se p ro gressively until a clinical im p ro vem ent is seen.
If sy ringe p um p is no t available, see bo x p age 2 2 .
– L o o k fo r th e o rig in o f th e infectio n ( abscess; E NT , p ulm o nary , d ig estive,
gy naeco lo gical o r uro lo gical infectio n etc.). A ntibio tic therap y acco rd ing to the o rigin
o f infectio n:
Origin Antibiotic therapy Alternative
Cutaneous clo xacillin + gentam icin co -am o xiclav o r ceftriaxo ne
stap hy lo co cci, strep to co cci + cip ro flo xacin
am p icillin o r ceftriaxo ne
Pulmonary + / - gentam icin
pneumococci, Haemophilus
influenzae
Intestinal or biliary co -am o xiclav + gentam icin ceftriaxo ne + gentam icin
entero bacteria, anaero bic
bacteria, entero co cci + m etro nid az o le
Gynaecological co -am o xiclav + gentam icin ceftriaxo ne + gentam icin
strep to co cci, go no co cci,
anaero bic bacteria, E. coli + m etro nid az o le
Urinary am p icillin + gentam icin ceftriaxo ne + cip ro flo xacin
entero bacteria, entero co cci am p icillin + gentam icin ceftriaxo ne + cip ro flo xacin
Other or undetermined
A t the sam e tim e, ad m inister rap id ly Ringer lactate o r 0.9% sodium chloride: 1 litre in
ad ults (m axim um rate); 2 0 m l/ k g in child ren, to be rep eated if necessary .
I f there is no clinical im p ro vem ent, rep eat I M ep inep hrine every 5 to 1 5 m inutes.
I n sho ck p ersists after 3 IM injectio ns, ad m inistratio n o f IV ep inep hrine at a co nstant
rate by a sy ringe p um p is necessary :
U se a diluted so lutio n, i.e. ad d 1 m g ep inep h rine ( 1 :1 0 0 0 ) to 9 m l o f 0 .9 %
so d ium
chlo rid e to o btain a 0 .1 m g/ m l so lutio n (1 :1 0 0 0 0 ):
C hild ren: 0 .1 to 1 m icro gram / k g/ m inute
A d ults: 0 .0 5 to 0 .5 m icro gram / k g/ m inute
I f sy ringe p um p is no t available, see bo x p age 2 2 .
– C o rtico stero id s have no effect in the acute p hase. H o wever, they m ust be given o nce
thhyedrpocaotriteisnotnies hsetambisiluizcceidnattoe IpV reover nI tMrecurrence in the sho rt term :
C hild ren: 1 to 5 m g/ k g/ 2 4 ho urs in 2 o r 3 injectio ns
A d ults: 2 0 0 m g every 4 ho urs
– In p atients with bro ncho sp asm , ep inep hrine is usually effective. If the sp asm p ersists
give 1 0 p uffs o f inhaled salbutamol.
Septic shock
– V ascular fluid rep lacem ent w ith Ringer Lactate o r 0.9 % sodium chloride o r plasma
substitute.
– dUopsaemoinfevIaVsoactoa ncsotrnicsttoanrst :rate by sy ringe p um p (see bo x p age 2 2 ):
1 0 to 2 0 m icro gram s/ k g/ m inute
eoprin, eifpnhorinteaIvVailaabt lae co nstant rate by sy ringe p um p :
U se a diluted so lutio n, i.e. ad d 1 m g ep inep h rine ( 1 :1 0 0 0 ) to 9 m l o f 0 .9 %
so d ium
chlo rid e to o btain a 0 .1 m g/ m l so lutio n (1 :1 0 0 0 0 ). S tart with 0 .1
m icro gram / k g/ m inute.
Increase the d o se p ro gressively until a clinical im p ro vem ent is seen.
If sy ringe p um p is no t available, see bo x p age 2 2 .
– L o o k fo r th e o rig in o f th e infectio n ( abscess; E NT , p ulm o nary , d ig estive,
gy naeco lo gical o r uro lo gical infectio n etc.). A ntibio tic therap y acco rd ing to the o rigin
o f infectio n:
Origin Antibiotic therapy Alternative
Cutaneous clo xacillin + gentam icin co -am o xiclav o r ceftriaxo ne
stap hy lo co cci, strep to co cci + cip ro flo xacin
am p icillin o r ceftriaxo ne
Pulmonary + / - gentam icin
pneumococci, Haemophilus
influenzae
Intestinal or biliary co -am o xiclav + gentam icin ceftriaxo ne + gentam icin
entero bacteria, anaero bic
bacteria, entero co cci + m etro nid az o le
Gynaecological co -am o xiclav + gentam icin ceftriaxo ne + gentam icin
strep to co cci, go no co cci,
anaero bic bacteria, E. coli + m etro nid az o le
Urinary am p icillin + gentam icin ceftriaxo ne + cip ro flo xacin
entero bacteria, entero co cci am p icillin + gentam icin ceftriaxo ne + cip ro flo xacin
Other or undetermined
