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in the prehospital environment, these same advances will 15. Mecham N. Early recognition and treatment of shock in the pediatric
translate to care standards in an austere environment. While patient. J Trauma Nurs. 2006;13(1):17–21.
data-driven guidelines for detecting sepsis in children remain 16. Walther FJ, Siassi B, Ramadan NA, Wu PY. Cardiac output in
newborn infants with transient myocardial dysfunction. J Pediatr.
mostly unchanged in recent years, new clinical evidence in 1985;107(5):781–785.
adults and children has created better clinical guidelines and 17. Crepaz R, Cemin R, Pedron C, et al. Age-related variations of left ven-
considerations for prehospital providers to use when treating tricular endocardial and midwall function in healthy infants, children,
and adolescents. Ital Heart J. 2005;6(8):634–639.
these patients. Ultimately septic children in the austere envi- 18. Ceneviva G, Paschall JA, Maffei F, Carcillo JA. Hemodynamic support
ronment will continue to present a series of unique challenges in fluid-refractory pediatric septic shock. Pediatrics. 1998;102(2):e19.
that require a wide array of clinical skills, expertise, and con- 19. Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign
fidence to navigate. With time, these areas of the world will international guidelines for the management of septic shock and sep-
become more accessible, allowing further intensive care re- sis-associated organ dysfunction in children. Intensive Care Med.
2020;46(Suppl 1):10–67.
sources to be brought to patients through medical advances 20. Makris K, Spanou L. Acute kidney injury: definition, pathophysiology
and better clinical guidelines. and clinical phenotypes. Clin Biochem Rev. 2016;37(2):85–98.
21. Wan L, Bagshaw SM, Langenberg C, et al. Pathophysiology of sep-
tic acute kidney injury: what do we really know? Crit Care Med.
Acknowledgments 2008;36(4 Suppl):S198–S203.
I would like to thank Andrew D. Fisher, MD, for his time and 22. Langenberg C, Bagshaw SM, May CN, Bellomo R. The histopa-
mentorship in this publication process, as well as Jonathan thology of septic acute kidney injury: a systematic review. Crit Care.
Friedman, RN, for his support and experience. Additional spe- 2008;12(2):R38.
cial thanks to my friend Kelly Ehrlich for setting me on my 23. English M, Muambi B, Mithwani S, Marsh K. Lactic acidosis and ox-
ygen debt in African children with severe anaemia. QJM. 1997;90(9):
path in health care, which has led to endeavors such as this. 563–569.
24. Raimer PL, Han YY, Weber MS, Annich GM, Custer JR. A normal
capillary refill time of ≤ 2 seconds is associated with superior vena
Disclosures cava oxygen saturations of ≥ 70%. J Pediatr. 2011;158(6):968–972.
I have no disclosures or conflicts of interest. 25. Evans JA, May J, Ansong D, et al. Capillary refill time as an indepen-
dent prognostic indicator in severe and complicated malaria. J Pedi-
Disclaimer atr. 2006;149(5):676–681.
Opinions or assertions contained herein are the private views 26. Orimadegun AE, Ogunbosi BO, Carson SS. Prevalence and predictors
of hypoxaemia in respiratory and non-respiratory primary diagnoses
of the author and are not to be construed as official or as among emergently ill children at a tertiary hospital in south western
reflecting the views of the University of Virginia or the Univer- Nigeria. Trans R Soc Trop Med Hyg. 2013;107(11):699–705.
sity of Virginia Health System. 27. Khilnani P, Singhi S, Lodha R, et al. Pediatric sepsis guidelines: sum-
mary for resource-limited countries. Indian J Crit Care Med. 2010;14
(1):41–52.
References 28. Dünser MW, Festic E, Dondorp A, et al. Recommendations for sep-
1. Wiens MO, Kumbakumba E, Kissoon N, et al. Pediatric sepsis in the sis management in resource-limited settings [published correction
developing world: challenges in defining sepsis and issues in post-dis- appears in Intensive Care Med. 2012 Apr;38(4):575–576]. Intensive
charge mortality. Clin Epidemiol. 2012;4:319–325. Care Med. 2012;38(4):557–574.
2. Mathias B, Mira JC, Larson SD. Pediatric sepsis. Curr Opin Pediatr. 29. Barbi E, Marzuillo P, Neri E, et al. Fever in children: pearls and pit-
2016;28(3):380–387. falls. Children (Basel). 2017;4(9):81.
3. Randolph AG, McCulloh RJ. Pediatric sepsis: important consider- 30. Jeena PM, Adhikari M, Carlin JB, et al. Clinical profile and predictors
ations for diagnosing and managing severe infections in infants, chil- of severe illness in young South African infants (<60 days). S Afr Med
dren, and adolescents. Virulence. 2014;5(1):179–189. J. 2008;98(11):883–888.
4. Wheeler DS, Wong HR, Zingarelli B. Pediatric sepsis – Part I: “Chil- 31. Haque IU, Zaritsky AL. Analysis of the evidence for the lower limit of
dren are not small adults!” Open Inflamm J. 2011;4:4–15. systolic and mean arterial pressure in children. Pediatr Crit Care Med.
5. Goldstein B, Giroir B, Randolph A; International Consensus Con- 2007;8(2):138–144.
ference on Pediatric Sepsis. International Pediatric Sepsis Consensus 32. George EC, Walker AS, Kiguli S, et al. Predicting mortality in sick Af-
Conference: definitions for sepsis and organ dysfunction in pediatrics. rican children: the FEAST Paediatric Emergency Triage (PET) Score.
Pediatr Crit Care Med. 2005;6(1):2–8. BMC Med. 2015;13:174.
6. Weiss SL, Fitzgerald JC, Pappachan J, et al. Global epidemiology of 33. Maitland K, Berkley JA, Shebbe M, et al. Children with severe malnu-
pediatric severe sepsis: the sepsis prevalence, outcomes, and therapies trition: can those at highest risk of death be identified with the WHO
study [published correction appears in Am J Respir Crit Care Med. protocol? PLoS Med. 2006;3(12):e500.
2016 Jan 15;193(2):223–224]. Am J Respir Crit Care Med. 2015;191 34. Biban P, Gaffuri M, Spaggiari S, et al. Early recognition and manage-
(10):1147–1157. ment of septic shock in children. Pediatr Rep. 2012;4(1):e13.
7. Singer M, Deutschman CS, Seymour CW, et al. The Third Interna- 35. World Health Organization. Guideline: Updates on paediatric emer-
tional Consensus definitions for sepsis and septic shock (Sepsis-3). gency triage, assessment and treatment: care of critically-ill children;
JAMA. 2016;315(8):801–810. 2016.
8. van Nassau SC, van Beek RH, Driessen GJ, et al. Translating Sepsis-3 36. Luck RP, Haines C, Mull CC. Intraosseous access. J Emerg Med.
criteria in children: prognostic accuracy of age-adjusted quick SOFA 2010;39(4):468–475.
score in children visiting the emergency department with suspected 37. Maitland K, George EC, Evans JA, et al. Exploring mechanisms of ex-
bacterial infection. Front Pediatr. 2018;6:266. cess mortality with early fluid resuscitation: insights from the FEAST
9. Shilkofski N, Agueh M, Fonseka M, et al. Pediatric emergency care in trial. BMC Med. 2013;11:68.
disaster-affected areas: a firsthand perspective after Typhoons Bopha 38. Weymouth W, Thaut L, Olson N. Point of view telemedicine at point
and Haiyan in the Philippines. J Pediatr Intensive Care. 2017;6(1): of care. Cureus. 2018;10(11):e3662.
19–27. 39. Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical practice guide-
10. Dondorp AM, Dünser MW, Schultz MJ, eds. Sepsis Management in line for screening and management of high blood pressure in children
Resource-limited Settings. Cham (CH): Springer; 2019. and adolescents [published correction appears in Pediatrics. 2017 Nov
11. Perkin RM, Levin DL. Shock in the pediatric patient. Part I. J Pediatr. 30] [published correction appears in Pediatrics. 2018 Sep;142(3)]. Pe-
1982;101(2):163–169. diatrics. 2017;140(3):e20171904.
12. Czaczkes JW, Abrahamov A. Plasma volume as an index of total fluid 40. Butterworth JF, Mackey DC, Wasnick JD. Pediatric anesthesia.
loss. A study of 75 dehydrated infants. Am J Dis Child. 1961;102: In: Morgan & Mikhail’s Clinical Anesthesiology. New York, NY:
190–193. McGraw-Hill Education; 2018.
13. Prusakowski MK, Chen AP. Pediatric sepsis [published correction ap- 41. University of Iowa Healthcare. Iowa Head and Neck Protocols.
pears in Emerg Med Clin North Am. 2019 Feb;37(1):xv]. Emerg Med https://medicine.uiowa.edu/iowaprotocols/pediatric-vital-signs-
Clin North Am. 2017;35(1):123–138. normal-ranges. 20 May 2020. Accessed 1 May 2022.
14. Friis-Hansen BJ, Holiday M, Stapleton T, Wallace WM. Total body
water in children. Pediatrics. 1951;7(3):321–327.
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