Paediatric Paediatric EmergenciesEmergencies

Paediatric Paediatric EmergenciesEmergencies

And ResuscitationAnd Resuscitation

Why Listen?• Basic Life Support

• August 2009

• May 2009

• Structured approach to any Emergency

Paediatric Resuscitation

• ‘SAFE’ Approach• Airway opening• Check for breaths (LLF)• 5 rescue breaths• Check pulse• 15 :2• Get help

ChokingChokingChokingChoking

A demonstrationA demonstration

Paediatric Emergencies• A Choking• B Status Asthmaticus• C Shock• C DKA• D Status Epilepticus

Rapid Paediatric Assessment

• Breathing – the 3 E’s– Effort– Efficacy– Effects on other organs

Rapid Assessment Circulation

Pulse volumePulse rateCapillary refillBPEffects of circulatory inadequacy on

other organsbrain, kidneys, breathing, skin

Rapid Assessment• Disability

– A– V– P– UDon’t ever forget glucose

E is for Expose• Injury assessment

• Rash - – Purpura– Urticaria

• Child abuse

Acute severe Asthma• Too breathless to talk / feed• Increased respiratory effort• PFR < 50% normal• Tachycardia > 140 why?• Tachypnoea >50

Life Threatening Asthma

• Depressed conscious level• Exhaustion• Poor respiratory effort• Oxygen sats < 85% in air / cyanosis• Silent chest• PFR <35% best

Asthma Emergency management

• HELP!• High Flow Oxygen• Salbutamol nebulised• Ipratropium Bromide• IV Aminophylline• IV Salbutamol• IV Magnesium

Further Management• Nurse on HDU • Continuous monitoring• Back to back nebs• Ixs

– Sats– Pulse– PFR– Consider CXR and gas

Shock Causes• Hypovolaemic -• Distributive - Septicaemia• Cardiogenic• Obstructive – tension

pneumothorax• Dissociative (carbon monoxide

poisoning)

Shock Treatment• High flow oxygen• Venous access• Fluids 20 ml / Kg except in trauma• Specific treatment

– Antibiotics– IM adrenalin– Trauma management

Shock Investigations• Bloods

– GLUCOSE– FBC – Clotting– Venous gas– B/C– U&E, Ca, Mg

Septic Screen• Blood• CXR• Urine• LP if stable enough and no

Purpuric rash

Shock Monitoring• HDU• Pulse• Sats• BP• Cap refill• Temp• Urine OP• Conscious level

DKAEmergency

management• Advice from specialist• Oxygen• Fluids cautiously normal saline=

0.9% Saline• Slow reduction in Sugar

– Fluids– Insulin

DKA Monitoring• HDU• Frequent reassessment• Cap / venous gas• U&E• Conscious level• Most important and usually fatal

Complication?

DKA Treatment Complication

• Cerebral Oedema– Mannitol– Head up– Intubate and ventilate keep CO2 low

normal– ITU

Status Epilepticus• Fitting >30 minutes• Or Successive convulsions without

recovery• But don’t wait 30 minutes before

treating

Mortality in children 1%

Status Cause• Commonly febrile fit (5% febrile

fits present in status)

• 1-5% patients with epilepsy

Status Epilepticus Management

• Airway– High flow oxygen

• Breathing• Circulation – access

– CHECK GLUCOSE

• Stop the fit

Stopping the fit• Lorazepam 0.1 mg / Kg IV / IO• Lorazepam 0.1 mg / Kg• Paraldehyde 0.4 ml / Kg in equal

volume olive oil PR• Phenytoin 18 mg / Kg IV• RSI with Thiopentone• 10 minute intervals between drugs

Investigations• Cause of seizure

– Metabolic– Source of fever– Structural abnormality

• Effects of seizure / treatment– Brain– Glucose– Resps

Post Seizure MonitoringHDU

• A• B• C• D Conscious level and Don’t ever

forget glucose

Practical Task• Work out how to make up a bag of

Aminophylline in saline and what rates to set the pump on in order to administer a loading dose of 5mg/Kg over 20 minutes then a continuous infusion of 1 mg / Kg / hour

• The patient is 6 years old

SummaryPaediatric Emergencies• Call for help

• Standardised approach

• Don’t panic

Any Questions?Any Questions?Any Questions?Any Questions?