Sepsis is leading cause of death in children. septic shock and multi organ dysfunction is final common pathway for death in various infections. We discuss here evidence based management of sepsis and septic shock in children.

1. Management of Sepsis and Septic Shock
Lokesh Tiwari
Associate Professor of Pediatrics, Incharge PICU
All India Institute of Medical Sciences Patna
17th March 2019

2. Sepsis

3. Organ dysfunction
Final common pathway of death

4. Under five mortality

7. Septic Shock
• Sepsis: life-threatening organ dysfunction caused by a
dysregulated host response to infection.
• Shock: Inability of circulation to meet the metabolic
demands of the body.
• Septic shock is a subset of sepsis with circulatory and
cellular/ metabolic dysfunction associated with a higher risk
of mortality
Final common pathway of death

8. Management of shock
3 phases of rapid recognition, stabilization / resuscitation and further critical care
management in ICU
1. Early detection of signs of septic shock: crucial and based on quick primary
assessment. Low blood pressure (systolic or diastolic) is not essential to level it as
septic shock.
2. Initial stabilization and resuscitation:
• First 10-15 minutes of detection of sign of shock, airway, oxygenation, ventilation and monitoring
of heart rate / rhythm and pulse oximetry should be taken care of and vascular access should be
established.
• Within first hour: first dose of broad-spectrum antibiotic and fluid resuscitation, appropriate
vasoactive drug infusion if there is no response to fluid therapy.
3. Further critical care management and ongoing care: hemodynamic monitoring,
continue and titrate vasoactive drugs and add newer agent, stress dose
hydrocortisone if there is no response to fluid therapy and vasoactive agents or there
is risk for adrenal insufficiency.

9. Early detection of signs of septic shock
Five components of circulatory assessment.
1.Heart rate and rhythm High HR
2.Central and peripheral pulses Poor
3.Capillary re-fill time flush or prolong
4.Skin color and temperature warm or cool
5.Blood pressure Low, normal or high

10. Early detection of signs of septic shock
Age Formula for 5th centile of BP
Neonate (<1 month) < 70 mm of Hg
Infant (1 month – 1 year) 70 + (age in years x 2) mm of Hg
Toddler (1-3 years) At least 90 mm of Hg
Definition of shock does not require the presence of hypotension. Shock can be
present with a normal, increased, or decreased systolic blood pressure.

11. Type of Shock
Severity Compensated shock
Hypotensive Shock
Type 1.Hypovolemic shock
2.Distributive shock
3.Cardiogenic Shock
4.Obstructive shock

12. Management of shock
3 phases of rapid recognition, stabilization / resuscitation and further critical care
management in ICU
1. Early detection of signs of septic shock: crucial and based on quick primary
assessment. Low blood pressure (systolic or diastolic) is not essential to level it as
septic shock.
2. Initial stabilization and resuscitation:
• First 10-15 minutes of detection of sign of shock, airway, oxygenation, ventilation and monitoring
of heart rate / rhythm and pulse oximetry should be taken care of and vascular access should be
established.
• Within first hour: first dose of broad-spectrum antibiotic and fluid resuscitation, appropriate
vasoactive drug infusion if there is no response to fluid therapy.
3. Further critical care management and ongoing care: hemodynamic monitoring,
continue and titrate vasoactive drugs and add newer agent, stress dose
hydrocortisone if there is no response to fluid therapy and vasoactive agents or there
is risk for adrenal insufficiency.

13. Initial stabilization and resuscitation
• Positioning:
• supine position or most comfortable position for responsive child.
• Support airway and breathing:
• Ensure effective oxygenation and ventilation.
• Start high concentration of oxygen preferably by high flow device (NRM).
• Respiratory Failure: non-invasive or invasive ventilation (CPAP or mechanical
ventilation)
• SpO2 monitoring, ABG and ScVO2
• Vascular access:
• Large bore, preferably 2
• Interosseous needle if IV cannulation is not possible.
• Start fluid therapy with in first five minutes of identification of shock
• Central venous access is desirable but not mandatory for fluid therapy and inotropic
support in emergency.

14. Initial stabilization and resuscitation:
Fluid Bolus
• Rapid administration of isotonic crystalloid solution as 20 ml/kg bolus
over 5-10 min
• Reassessment after every bolus
• Repeat fluid boluses if needed to restore BP and perfusion.
• In septic shock, children may need 60 ml/kg or more during first hour
and up to 200 ml/kg in first 8 hours of management.
• Rapid push technique
• Standard infusion pumps or syringe pumps cannot deliver rapid bolus
at desired rate

15. Initial stabilization and resuscitation:
Fluid Bolus
• If cardiogenic shock is suspected or history of ingestion of calcium
channel blockers or beta adrenergic blockers, consider small fluid
bolus (5-10 ml/kg) over 10-20 minutes.
• Caution for pulmonary edema specially in case of anemia and severe
febrile illness, especially in settings where further inotropic support,
mechanical ventilation and ongoing assessment in PICU is not
possible.

16. Initial stabilization and resuscitation:
Fluid Bolus
• Standard resuscitation fluid is Isotonic crystalloids (0.9 % saline or RL)
• Consider albumin and other colloids only in case of albumin
deficiency or large third spacing
• Blood products in case of visible or occult blood loss
• Hydroxyethyl starches should NOT be used.

17. Ongoing Assessment of Shock
Warm shock Warm shock Cold shock
Airway Usually open unless there is altered sensorium
Breathing Quite tachypnoea unless there is associated pneumonia or cardiogenic pulmonary edema
Circulation Tachycardia, bradycardia (sometime)
Bounding peripheral pulses
Flash capillary refill time
Warm peripheries
Hypotension or normo tension
Wide pulse pressure
Altered sensorium or restlessness
Oliguria
Tachycardia, sometime bradycardia
Poor peripheral pulses
Prolong capillary refill time
Cold peripheries
Hypotension or normo tension
Narrow pulse pressure
Altered sensorium or restlessness
Oliguria
Disability Altered GCS or AVPU scale
Exposure Fever or warm extremities
Normal, Petechial or purpuric rash
Pale or ashen grey skin, Fever, Increased
difference between core and peripheral
temperature > 2°C

18. Initial stabilization and resuscitation
Within first hour:
• First dose of broad-spectrum antibiotic
• Vasoactive agent if there is no response to fluid therapy
• Epinephrine for shock with cold extremities
• Nor epinephrine for shock with warm extremities;
• Dopamine as alternative in both conditions) infusion.

20. New Predictive Score for PICU: Pediatric
quick SOFA Score - AIIMS Patna Model
Age <1 year 1-5 year >5 year Score
Respiratory Rate >53 >37 >25 1
Systolic BP <70 <80 <90 1
Altered Mentation
(Modified GCS)
<15 <15 <15 1
SIRS qSOFA P AIIMS Patna
1. Sensitivity % (95 % CI) 72.7 ( 49.8- 89.3) 90.9 (70.8, 98.9)
2 Specificity % (95 % CI) 36.7 ( 29.0 - 44.9) 76.7 (69.1, 83.2)
3 Positive predictive value 14.4 ( 85.0 - 22.4) 36.4 (23.8, 50.4)
4 Negative predictive value 90.2 (79.8 – 96.3) 98.3 (94, 99.8 )
5 Positive likelihood ratio 1.148 (0.865 - 1.525) 3.896 (2.833, 5.359)
6 Negative likelihood ratio 0.744 (0.364 - 1.519) 0.119 (0.032, 0.446)
7 Odds Ratio 1.544 (0.571 - 4.177) 32.857 (7.317, 147.548)
8 Diagnostic accuracy 41.3% 78.4%
Aims & Objectives: Quick Sequential Organ Failure Assessment (qSOFA) score (respiratory
rate ≥22 breaths/min, systolic blood pressure ≤100 mm Hg, and altered mental status) may
predict complications in adult patients with infection.1 There is no such score for children.
We propose a new score named “Pediatric quick SOFA score- AIIMS Patna Model” to
predict poor outcome in children at the time of admission.
Methods
In this single center observational cohort study, proposed Pediatric quick SOFA Score was
calculated during first hour of PICU admission based on age specific respiratory rate2,
systolic blood pressure and modified Glasgow coma scale cut offs for children as described
in table 1. All patients were also screened for SIRS, sepsis and septic shock during first 24
hours of admission. Sensitivity, specificity and ROC to predict mortality were calculated for
SIRS and PqSOFA score ≥ 2.
Table 1. Pediatric quick SOFA Score
Results
consecutive 172 patients were analyzed. Mean age of patients admitted was 5.30 years
(range 2 months to 17 years) and male: Female ratio was 1.23: 1. Total 150 children
survived and 22 died in this cohort with all cause mortality rate of 12.79%.
Sensitivity of PqSOFA Score ≥ 2 to predict death was 90.91% (95% CI 70.8-98.8) as
compared to 72.73 % (95% CI 49.78-89.27) that of SIRS. Specificity was 76.0% (95% CI 68.3-
82.6) vs 36.67 (95% CI 28.9-44.9) respectively. Odds Ratio was 31.66 (95% CI 7.05-142; P<
0.001) for PqSOFA as compared to 1.544 (95% CI 0.57-4.17; p = 0.39) for SIRS. Diagnostic
accuracy of PqSOFA Score was 78.4% as compared to 41.3% for SIRS.
The AUC of PqSOFA score for hospital mortality was significantly higher than SIRS (AUC 0.87 vs
0.55 P = 0.001).
0
20
40
60
80
100
0 20 40 60 80 100
100-Specificity
Sensitivity
SIRS
QSOFA__2
AUC 0.87
P 0.001
AUC 0.54
Variable AUC SE a 95% CI b
SIRS 0.55 0.052 0.47 to 0.62
qSOFA_2 0.87 0.038 0.81 to 0.92
SIRS vs PqSOFA ≥ 2
Difference between areas 0.323
SE 0.0716
95% CI 0.182 to 0.463
z statistic 4.506
Significance level P < 0.0001
Conclusions
1. We proposed “Pediatric quick SOFA score- AIIMS Patna Model” for prediction of
survival outcome in children within first hour of PICU admission.
2. Proposed score has significantly better predictive value and diagnostic accuracy than
conventional SIRS criteria.
L. Tiwari1, C. Anand1, G. Kumar1, J. Chaturvedi2, N.R. Mishra3
1All India Institute of Medical Sciences Patna, Pediatrics, Patna, India, 2Mahavir Cancer Hospital and Research Institute Patna, Anaesthesiology,
Patna, India; 3Veer Surendra Sai Institute of Medical Sciences and Research, Pediatrics, Burla, India

21. Important Formulae useful in management of
septic shock
Cardiac Output (CO) Heart Rate (HR) × Stroke Volume (SV)
Cardiac Index (CI) Cardiac Output (CO) / Body Surface Area (BSA) = (HR X SV) / BSA
(L/min/m2). Target CI for management of septic shock is between 3.3
and 6.0 L/min/m2
Shock index HR / systolic blood pressure
1.2 for 4-6 years; 1 for 6-12 years; and 0.9 for > 12 years.
For normal healthy adults: 0.5 to 0.7
Target Perfusion Pressure
(MAP – CVP)
55 + (age x 1.5).
Here CVP is considered 0 but in setting of higher CVP or intra-abdominal
pressure (IAP), appropriate correction of targeted perfusion pressure
should be done by adding actual value of CVP or IAP to this formula.

22. Inotropes
• Low-dose epinephrine (0.05–0.3μg/kg/min)
• β2-adrenergic effects in the peripheral vasculature with little α-adrenergic
effect at this dose
• First-line choice for cold hypodynamic shock for its
• Epinephrine stimulates gluconeogenesis and glycogenolysis, and inhibits the
action of insulin Hyperglycemia and high lactate independent of changes in
organ perfusion.
• Dopamine: 5-10 micgm/kg/min
• Dobutamine may be used when there is a low CO state with adequate
or increased SVR.

23. Vasopressors
• Norepinephrine (0.05–0.3μg/kg/min)
• First line agent in adults with fluid-refractory shock.
• Fluid-refractory hypotensive hyperdynamic shock in children
• Septic shock with flash capillary refill, warm extremities, low diastolic
pressure, and bounding pulses
• Dopamine > 15 μg/kg/min,
• Epinephrine > 0.3 μg/kg/min,
• There is no sufficient evidence to support one drug over another

24. Other agents
Milrinone
• Type III phosphodiesterase inhibitors (PDEIs) including improve myocardial
contractility and reduce SVR (inodilator effect).
• Synergistic effect with β-adrenergic agonists
• Useful in state of catecholamine desensitization in sepsis).
Levosimendan
• Increases Ca++/actin/tropomyosin complex binding sensitivity and also has
some type III PDEI and adenosine triphosphate–sensitive K+ channel
activity.
Vasopressin
• Increases MAP, SVR, and urine output

25. Early detection of signs of septic shock
Heart rate (increased or decreased); Peripheral perfusion: cool or warm extremities, CRT >2 sec or flash, Altered skin color &
Temperature; fever or hypothermia; Blood pressure: Normal or hypotension; Altered GCS /AVPU:
Initial stabilization and resuscitation
Airway, breathing & circulation, oxygen, Attach monitors to record HR, BP and SPO2, Vascular access (IV or IO) and sampling
if possible (Ca, glucose, electrolytes, Blood gas, Bl culture)
Fluid bolus: 20 ml/kg isotonic crystalloid over 5-10 minutes, reassess, repeat as needed
Medication: Antimicrobials with in 1 hour, Antipyretics if needed
Reassessment for Signs of Septic Shock
HR, Peripheral pulses, CRT, Skin color & Temp, BP, GCS /AVPU
Resolving signs of Shock
Improved GCS/AVPU, normal HR
and temp, CRT <2 sec, adequate
systolic and diastolic BP
Ongoing Care, treat infection,
organ support
Signs of Shock persist
Fluid Refractory Septic Shock
Critical care consultation and vasoactive drugs
 Shock with cold extremities: Epinephrine 0.05-0.3 mcg/kg/min
 Shock with warm extremities: Norepinephrine 0.05-0.3 mcg/kg/min
 Alternative dopamine 5-10 mcg/kg/min
PICU care, Central venous access, Invasive BP monitoring, Consider mechanical ventilation
Continue and titrate epinephrine/norepinephrine, and bolus fluid therapy as needed
Catecholamine Resistant Shock
Stress-dose hydrocortisone for absolute adrenal insufficiency, Evaluate cortisol if at risk for relative adrenal insufficiency
5 Min
15
Min
1
Hour

26. Reassessment for Signs of Septic Shock
HR, Peripheral pulses, CRT, Skin color & Temperature, Blood pressure, GCS /AVPU
ScvO2 ≥70%, cardiac output/index and perfusion pressure (MAP-CVP) = (55 + age x 1.5)
ScvO2 ≥70%,
cardiac index 3.3 to 6.0 L/min/m2
Signs of shock resolved
Assess for therapeutic end points
Normal HR & pulses, CRT < 2 sec, warm
extremities, Normal BP, GCS / AVPU Urine
output > 1 ml/kg/hr, Improving lactate and
metabolic acidosis
Monitor in ICU, Support organ function,
Treat infection source
ScvO2 ≥70%
warm extremities despite norepinephrine
Additional fluid boluses
Titrate norepinephrine
Add additional vasopressor (vasopressin /
terlipressin) and inotropic therapy
If ScVO2 <70% consider low dose
epinephrine
Support organ function
ScvO2 < 70%
Cold extremities despite epinephrine
Additional fluid boluses
Transfuse if Hgb < 10 g/dL
Low BP: Titrate epinephrine, add
norepinephrine if diastolic BP low
Adequate BP: Add milrinone / dobutamine/
levosimendan and/or vasodilator therapy
Support organ function
Persistent catecholamine resistant Shock
Rule out tension pneumothorax, pericardial effusion, intra-abdominal pressure >12 mmHg
Invasive and non-invasive (USG) measurements to guide fluid and inotropic support
Refractory Shock: ECMO
B
E
Y
O
N
D
1
Hour
PI
C
U

27. Therapeutic End-points of Shock Resolution
• Normal HR or declining from very high towards normal
• Normal peripheral pulses and capillary refill time < 2 sec and warm
extremities
• Normal mental status/ responsiveness
• Normal blood pressure
• Urine output > 1 ml/kg/hr
• Improving serum lactate and metabolic acidosis
• ScvO2 ≥ 70% and cardiac index 3.3 to 6.0 L/min/m2

28. Continuation of care in PICU
• Shock is resolved and therapeutic end points are achieved, organ support to
continue in PICU
• Infection control
• Mechanical ventilation,
• Renal replacement therapy,
• Intracranial pressure management
• Blood transfusion,
• Nutritional supplementation,
• Hypo or hyperglycaemia, dys-electrolytemia, venous thromboembolism, DIC etc.
• Speciality consultations
• Discussion with family on Goals of care and prognosis

29. Mechanical Ventilation
• Early intubation and positive pressure ventilation.
• Sepsis induced ARDS: lung protective strategy
• Low tidal volume 6 mL/kg predicted body weight,
• Max plateau pressure limit of 30 cm H2O,
• Higher PEEP, guided by PEEP- FiO2 tables,
• Recruitment maneuvers and
• To try prone position
• 30 to 45 degrees of head end elevation to limit aspiration risk and to
prevent the development of VAP.
• Spontaneous breathing trials and weaning protocol
• Specific sedation and analgesia scales minimize sedation
Acute respiratory distress syndrome: the Berlin Definition. JAMA (2012)
Shehabi Y, Bellomo R, Reade MC et al Am J Respir Crit Care Med (2012)

30. Blood products
• Targeted Hb in resuscitation phase
• EGDT protocol: 10 gm/dl,
• Surviving sepsis guideline 2017: 7.0 g/dL if there is no myocardial ischemia, severe
hypoxemia, or acute haemorrhage
• FFP for bleeding or an invasive procedure is planned in presence of coagulopathy
• Should not be given just to correct clotting abnormalities in the absence of bleeding
• Platelet transfusion:
• Plt count < 10,000/mm3 in the absence of apparent bleeding
• Plt count < 20,000/mm3 with a significant risk of bleeding
• Target platelet counts 50,000/mm3 for active bleeding, surgery, or invasive procedures
• No evidence to suggest use of IV IG, blood purification techniques, antithrombin,
thrombomodulin or heparin in patients with sepsis or septic shock
• Recommendations for the transfusion of plasma and platelets. Blood Transfus. (2009)
• An evaluation of the feasibility, cost and value of IVIG for sepsis, severe sepsis and septic shock: Health Technol Assess (2012)
• IVIG for treating sepsis, severe sepsis and septic shock. Cochrane Database Syst Rev 9:CD001090 (2013)
Lower versus higher hemoglobin threshold for transfusion in septic shock. N Engl J Med (2014)

31. Glucose control
• A regular monitoring protocol to maintain blood sugar around 150 mg/dL.
• Hypoglycemia (< 60 mg/ dL beyond neonatal period)
• Corrected immediately with IV dextrose (25% dextrose 2-4 ml/kg or 10%
dextrose 5-10 ml/kg).
• Hyperglycaemia (two consecutive blood glucose levels are > 180 mg/dL)
• Insulin infusion (0.05-0.1 unit /kg/hr)
• Monitor every 1 to 2 hours until glucose values and insulin infusion rates
are stable, then every 4 hours
• Glucose levels obtained with POC testing of capillary blood should be
interpreted with caution
• Finfer S, Blair D, Bellomo R et al (2009) N Engl J Med
• Song F, Zhong LJ, Han L et al Intensive insulin therapy for septic patients: a
meta-analysis of randomized controlled trials. Biomed Res Int. 2014:698265

32. Bicarbonate Therapy
• Sodium bicarbonate should not be used to improve hemodynamics or
to reduce vasopressor requirements in patients with hypoperfusion-
induced lactic acidemia with pH ≥ 7.15
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med.2017

33. Venous Thromboembolism Prophylaxis
• Low-molecular-weight heparin (preferred) or unfractionated heparin
(UFH) should be used as prophylaxis against VTE in the absence of
contraindications
• Pharmacologic VTE prophylaxis should be combined with mechanical
prophylaxis, whenever possible.
• If pharmacologic VTE is contraindicated, only mechanical VTE
prophylaxis should be used.
Cochrane Database Syst Rev 9:CD007557 (2012)
Cochrane Database Syst Rev 4:CD005258 (2008)

34. Gastrointestinal Support
• Stress ulcer prophylaxis
• Proton pump inhibitors or histamine-2 receptor antagonists for patients who
have risk factors for GI bleeding
• Ileus and abdominal distention with respiratory compromise.
• Check for hypokalemia and corrected under cardiac monitoring
Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. JPEN J Parenter Enteral
Nutr. 2017

35. Nutrition
• Enteral nutritional support ASAP with close monitoring of caloric intake
serum albumin, electrolytes and liver function
• If intolerance: Continue IV glucose and advance enteral feeds as tolerated
• Prokinetic agents, trophic/hypocaloric feeding and post-pyloric feeding
tubes
• Parenteral nutrition alone or in combination with enteral feedings is NOT
recommended in first 7 days.
• No role of routinely monitoring gastric residual volumes in nonsurgical
critically ill patients without feeding intolerance
• Immunonutrition: omega-3 fatty acids, arginine, IV selenium, glutamine or
carnitine have been studied but none of them are recommended in
critically ill patients at the moment pending further studies.
Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med.2017
Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. JPEN J Parenter Enteral
Nutr. 2017

36. State of the art PICU
12 Beds
AIIMS Patna PICU Protocol book for standard and safe treatment

38. Child Friendly Environment

39. Beyond Hospital
• Modules and videos
prepared at AIIMS
Patna for Pan India
BLS Courses of IAP
• National launch
during Pedicon in Jan
2018 at Nagpur
• 160 courses done in
last Year in length
and width of India

40. Since Launch
160 Courses
across all 5
Zones of India
Apr 05,2019 Indore
Apr 12,2018 Delhi
Apr 13,2018 Kanpur
Apr 13,2018 Anantnag
Apr 15,2018 Bharatpur
Apr 21,2018 Bhopal
Apr 21,2019 New Delhi
Aug 01,2018 Pune
Aug 02,2018 Shivamogga
Aug 03,2018 Gwalior
Aug 04,2018 Mumbai
Aug 06,2018 Patna
Aug 09,2018 Tiruchirappalli
Aug 09,2018 Bengaluru
Aug 10,2018 Shivamogga
Aug 11,2018 Ludhiana
Aug 11,2018 Patna
Aug 12,2018 New Delhi
Aug 16,2018 Shillong
Aug 17,2018 Shillong
Aug 18,2018 Panvel
Aug 18,2018 Patna
Aug 19,2018 Bhopal
Aug 19,2018 New Delhi
Aug 22,2018 Delhi
Aug 23,2018 Chennai
Aug 24,2018 Vijayawada
Aug 25,2018 Patna
Aug 31,2018 Asansol
Dec 01,2018 Patna
Dec 01,2018 Patna
Dec 01,2018 Tirunelveli
Dec 02,2018 Noida
Dec 02,2018 Bhubaneswar
Dec 02,2018 Bhubaneswar
Dec 02,2018 Gwalior
Dec 06,2018 Agra
Dec 07,2018 Pune
Dec 09,2018 Pune
Dec 09,2018 Kozhikode
Dec 12,2018 Jalandhar
Dec 15,2018 Kolkata
Dec 16,2018 Gwalior
Dec 16,2018 Kolkata
Dec 18,2018 Chennai
Dec 20,2018 Chennai
Dec 31,2018 New Delhi
Dec 31,2018 Delhi
Feb 10,2019 New Delhi
Feb 15,2019 Gwalior
Feb 22,2019 Vijayawada
Feb 23,2019 Amritsar
Feb 23,2019 Belagavi
Feb 24,2019 Noida
Feb 28,2019 Bengaluru
Jan 05,2019 Delhi
Jan 05,2019 Bareilly
Jan 09,2019 New Delhi
Jan 11,2019 Ahmednagar
Jan 12,2019 Belagavi
Jan 12,2019 Panvel
Jan 12,2019 Bareilly
Jan 13,2019 Delhi
Jan 19,2019 Faridkot
Jan 19,2019 Pune
Jan 20,2019 Gwalior
Jan 23,2019 Jalandhar
Jan 24,2019 Davanagere
Jan 25,2019 Davanagere
Jan 26,2019 Ahmedabad
Jan 27,2019 Cuttack
Jul 14,2018 Pune
Jul 14,2018 Mumbai
Jul 15,2018 Mhow Cantt
Jul 17,2018 Mhow Cantt
Jul 22,2018 Mhow Cantt
Jul 22,2018 Delhi
Jul 22,2018 Mhow Cantt
Jul 27,2018 Bhopal
Jul 27,2018 Bhopal
Jul 27,2018 Pilibhit
Jul 30,2018 Pune
Jun 03,2018 Dibrugarh
Jun 03,2018 Dibrugarh
Jun 06,2018 Patna
Jun 07,2018 Patna
Jun 08,2018 Shillong
Jun 08,2018 Patna
Jun 13,2018 Patna
Jun 14,2018 Patna
Jun 17,2018 Kanpur
Jun 17,2018 Surat
Jun 22,2018 Hapur
Jun 23,2018 Kolkata
Jun 24,2018 Haldwani
Jun 24,2018 Haldwani
Jun 24,2018 Noida
Jun 27,2018 Bhopal
Jun 28,2018 Bengaluru
Jun 29,2018 Meerut
Jun 29,2018 Meerut
Jun 29,2018 Tirupati
Mar 04,2018 Delhi
Mar 11,2018 New Delhi
Mar 21,2018 Delhi
Mar 24,2018 Patna
May 26,2018 Kolkata
May 27,2018 Bhubaneswar
May 28,2018 Bharatpur
Nov 03,2018 Patna
Nov 10,2018 Cuttack
Nov 10,2018 Patna
Nov 11,2018 Guwahati
Nov 11,2018 Guwahati
Nov 12,2018 Guwahati
Nov 14,2018 Jalandhar
Nov 16,2018 Bhopal
Nov 18,2018
Thiruvananthap
uram
Nov 18,2018 Cuttack
Nov 24,2018 Patna
Nov 27,2018 Bharatpur
Oct 05,2018 Pune
Oct 06,2018 Nagpur
Oct 07,2018 Rudrapur
Oct 10,2018 Jalandhar
Oct 14,2018 Amravati
Oct 14,2018 New Delhi
Oct 14,2018 Kota
Oct 27,2018 Patna
Oct 27,2018 Aurangabad
Oct 28,2018 Gwalior
Sep 01,2018 Patna
Sep 01,2018 Davanagere
Sep 01,2018 Patna
Sep 01,2018 Chandigarh
Sep 02,2018 Davanagere
Sep 02,2018 Ghaziabad
Sep 02,2018 Allahabad
Sep 05,2018 Vellore
Sep 08,2018 Patna
Sep 08,2018 Patna
Jul 01,2018 Gwalior
Jul 06,2018 New Delhi
Jul 08,2018 Lucknow
Jul 14,2018 Chennai
May 06,2018 Bharatpur
May 10,2018 Kolkata
May 20,2018 Mhow Cantt
May 25,2018 Chandigarh
May 25,2018 Shillong
May 25,2018 Hyderabad
Sep 08,2018 Mumbai
Sep 26,2018 Kota
Sep 26,2018 Jalandhar
Sep 27,2018 Jaipur
Sep 29,2018 Surat
Sep 30,2018 Ghaziabad
Sep 30,2018 Delhi

41. SANJEEVANI PROGRAMME
(MASS AWARENESS-CUM-TRAINING)
With the vision of empowering the
mass with knowledge and skill of
CPR, Department of pediatrics (IAP
accredited CPR and ALS training
center) started series of “Sanjeevani”
BLS programme
Inaugurated on 5th August 2018

42. Mass awareness of CPR, Sanjeevani Programme for
the health care providers in the hospital

43. Parental education and mass awareness initiatives in
OPD area and indoor areas.

44. AIIMS Patna: State of the art PICU
AIIMS Patna PICU Protocol book for standard and safe treatment
Questions