Neutropaenic fever in kids
- Don’t be fooled. The patient with no immune system deserves significant respect and requires our vigilance.
- Be thorough.Where is the source? Look at the mucous membranes and consider necrotizing fasciitis (i.e., look in the perineum)!
- Be aggressive! If the child looks sick, throw all of the antibiotics at them. If the child looks well, monotherapy is recommended.
- High Risk vs Low Risk… don’t decide alone. Your physical exam and lab results will help determine whether a patient is high risk or low risk, but that determination should be made concurrently with the patient’s oncologist.
Vasopressors for Septic Shock
- Epinephrine and norepinephrine are both acceptable, evidence-based approaches to hemodynamic support in septic shock.
- Individual patient responsiveness to vasopressors is variable and unpredictable.
- Some patients respond better to epinephrine than norepinephrine.
- For patients who are not responding well to norepinephrine, it is reasonable to empirically trial a low dose of epinephrine (“epinephrine challenge”).