Journeying through Sepsis: Facts about early stages of admission

Transcript

Amy Wilkinson: I had never heard about sepsis before Mia got ill. We, you know, we knew she was sick, but obviously not critically sick. And then it just escalated extremely quickly from that Sunday, evening. And she was rushed into ICU within a matter of hours that she presented that evening and was on life support. So it just happened so fast from diagnosis of flu or gastro to on life support.

Dr. Paula Lister: It can be very quick. So it's often what parents tell you is that they just can't believe how quickly it's happened. It can be a matter of hours from a child being relatively well at home, probably taking some fluid to being in intensive care on a ventilator literally four or five hours later.

A child will come to ICU in order for us to, to support their failing organs in order to, to help them to recover. The most common organ involvement is often the lungs and the cardiovascular system. So the lungs often we will need to pop a child off to sleep with an anaesthetic, put a breathing tube down through their mouth into their lungs, and then we attach them to a ventilator, and the ventilator does all the hard work for them.

We use pain relief and sedation, to make sure that the child has no knowledge of it or recollection of what's happening and also doesn't feel any pain while it's happening. So comfort is right up there and very important to us. So all of the therapies that we do in intensive care are supporting the lungs to get oxygen travelling around the body, supporting the cardiovascular system to keep that blood pressure going, taking oxygen to the brain, preventing brain injury, helping the kidneys, watching the kidneys. If the kidneys are injured, using another machine to do their job in the meantime. And watching some of the other organs like the liver and so on. So these are all interventions that the teams do to try and keep everything steady and stable. And whilst we're supporting all those organs, as they start to recover, we can start reducing our support. And the baby starts, or the child starts to do more of its own work, and we reduce our support, and they do more. So we can see that corner when it comes. You know, we'll be able to tell the parents that actually we're now in a slightly better position than we were a bit earlier.

So if a child falls ill in Queensland, there are really only a very few ICUs that they can be treated in. So it very often requires a retrieval team to move them to the intensive care unit. But as soon as that referral is made, the local team is in contact with the intensive care team and they're getting advice the whole way through and we have standardised the way we give out medications and the way our nurses work so that we can support those local teams to deliver the intensive care that is needed at the time. That's not always something that the parents see because that kind of happens away from them on a on a phone call that they don't necessarily see that communication. So when they're at the bedside, they can be sitting there thinking, why am I waiting so long?

Cindy Martin: A conference call, and then that's when they said they had to fly to Brisbane. And I went, okay, no problems. They told me, yep, you can go with him, you can go with him. And then as soon as the helicopter landed, because there was an emergency somewhere else, they only had a, small helicopter and I couldn't go with him.

So he left at six o'clock at night. I ran to the airport here. They shut, because they had no one on the flight. So... Yeah, he had to go in the helicopter by himself to Brisbane, and I met him there at nine o'clock in the morning. But I knew that we had to have doctors there. I knew we had to have the paediatricians in there.

We, that's just how it was, but it wasn't easy. They did the lump of puncture on him, they had to wait till I got there, of course, and that come back straight away that he had. The strep nasal cochlea meningitis. I think it was B that he had. But that morning, within hours, he just went from a happy little boy, it's like he went into a coma kind of state.

Amanda Harley: Pathways streamlines care, so whether you're in Brisbane, you're in Mackay, you're in Roma, this has been developed and distributed throughout the state of Queensland, so we're all following the same playbook. We all obviously know we need to tailor care to the individual patient, but we've got these key steps and these key criteria that will really increase the ability for clinicians to recognise and manage early.

Dr. Paula Lister: I think it's, it's really important to remember that the team that are working in the hospital are experts in sepsis. They know what to do for children who have sepsis, but they're not an expert in your child. So that's important that you bring us all the knowledge and expertise you have in your child. It's really important that we work together.

Amanda Harley: So just like sepsis affecting your child and it versus another child very, very differently. Parents responses to sepsis and having this diagnosis for their child definitely varies as well. And that's completely normal. As humans, we all respond to things very differently.

You may have heard of sepsis before, but didn't know it affected children. You may not have heard of sepsis before. So we are really here to support you through this process. We understand that it can be challenging and difficult. And we understand that you might not remember anything that's happened in the last 24 hours.

That is completely okay. So please ask us for any information that you may require, any resources, and we can definitely point you in the direction to get as much knowledge as you can.

Dr. Paula Lister: I've learned over the years that no two parents will react in the same way. So some parents want all the information, keep a note of all the monitors and all over it, whereas other parents are crying and can't take in any information at all. Some parents don't even talk. They don't respond at all. They're completely numb. I've had other parents that can't come in. They just stay out the room because they can't bear to see it. And that's all normal. That's all within the range of an absolute stress response to what for the parents is catastrophic, and we need to, as clinicians, support them with that.