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Paediatric emergencies

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Version Jan 2023

Paediatric emergencies

Important Values: Also see Paediatric emergency drug chart
High flow oxygen for all Adrenaline 1 in 10,000 : 10 mcg/kg IV/IO Fluid bolus: 0.9% Saline 20 ml/Kg IV/IO consider warmed Glucose 10% 2ml/kg IV/IO for hypoglycaemia Sodium Bicarbonate 8.4% 1 mmol/kg Defibrillation 4 joules/kg Compression rate 100-120/min

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Start with ABCDE moving through it quickly
Give high flow oxygen and consider ventilation if remains hypoxic
Get pulse oximetry and heart monitoring started and access

Airways and Breathing

Look listen and feel and smell
- Rash: Meningococcal disease, measles, chickenpox
- Cyanosis, anaemia, trauma, rashing - see if it blanches
- Ketones on breath ? (Check CBG) DKA or Alcoholic drinks
Airways obstruction or respiratory distress
- Jaw and neck positioning: Head tilt, chin lift, jaw thrust but immobilize neck if cervical injury suspected
- Oxygen and suctioning and remove any foreign body
- Chest compressions may be needed
Work of breathing and effort
Respiratory rate
Wheeze or stridor
Ausculate for air entry is it bilateral and equal
Central cyanosis

Circulation

Heart rate and pulse volume
Capillary refill time : prolonged if more than 2 seconds
Blood pressure

Disability

Level of consciousness
Posture: low tone, decorticate, decerebrate
Pupil size and reactivity. Unilateral Dilated pupil is an ominous sign

Shock

Hypovolaemia: Often due to dehydration from GI losses, DKA, Blood loss
Cardiogenic: Arrhythmias, heart failure
Stridor: Croup/epiglottitis, foreign body, congenital malformations, trauma
Lung disorders: Asthma, Bronchiolitis, Pneumonia, Pneumothorax

Shock

Hypovolaemia: Dehydration from GI losses, DKA, Blood loss
Cardiogenic: Arrhythmias, heart failure

Breathing issues

Stridor: Croup/epiglottitis, foreign body, congenital malformations, trauma
Lung disorders: Asthma, Bronchiolitis, Pneumonia, Pneumothorax

Drowsy

DKA (high CBG) or Hypoglycaemia (Low CBG)
Post ictal
Head injury
Meningitis/Encephalitis
Inborn errors of metabolism
Drug or Poison ingestions ? naloxone
Intracranial haemorrhage

Acute Abdomen

Appendicitis
Intestinal obstruction
Perforation and Peritonitis
Intussusception
Malrotation, Bowel atresia/stenosis

2015 Resuscitation council

References

Guidelines Paediatric basic life support 2015

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. The official launch will be at the end of 2018. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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