Pediatric emergency medicine trisk 1449 1449
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (133.78 KB, 1 trang )
CHAPTER 73 ■ SEPTIC-APPEARING INFANT
STEVEN M. SELBST, BRENT D. ROGERS
INTRODUCTION
A young infant may be brought to the emergency department (ED) because he or
she “just doesn’t look right” to the parents. Inexperienced parents will notice
when their newborn is unusually sleepy, fussy, or not drinking well. To the
clinician, such an infant may appear quite ill with pallor, cyanosis, or ashen color,
and have noted irritability, lethargy, fever, or hypothermia. Tachypnea,
tachycardia, hypotension, or signs of poor perfusion may also be apparent.
Generally, an ill-appearing infant will be immediately thought to have sepsis
and managed reflexively. Although this is the correct approach, several other
conditions can produce a septic-appearing infant. This chapter establishes a
differential diagnosis for infants in the first 2 months of life who appear ill. An
approach to the evaluation of such infants is discussed.
DIFFERENTIAL DIAGNOSIS
Numerous disorders ( Table 73.1 ) may cause an infant to appear septic. The most
common of these diseases ( Table 73.2 ) include bacterial and viral infections.
The remaining disorders demand diagnostic consideration because although
uncommon, they are potentially life-threatening and treatable.
Sepsis
Sepsis should always be considered when managing an ill-appearing infant (see
Chapters 7 A General Approach to the Ill or Injured Child , 10 Shock , and 94
Infectious Disease Emergencies ). The signs and symptoms of sepsis may be
subtle, and include lethargy, irritability, diarrhea, vomiting, and anorexia. Fever is
often present, but some septic infants younger than 2 months will be hypothermic
instead. (See ED Clinical Pathway for Evaluation/Treatment of Febrile Young
Infants (0-56 Days Old); ). The history may vary, and some infants
are ill for several days whereas others deteriorate rapidly. On physical
examination, a septic infant may be pale, ashen, or cyanotic with cool and mottled
skin due to poor perfusion. The infant may be lethargic, obtunded, or irritable.
There is often marked tachycardia, (heart rate approaching 200 beats per minute)
and tachypnea (respiratory rate more than 60 breaths per minute). If disseminated
intravascular coagulopathy (DIC) has developed, scattered petechiae or purpura
