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Emergency Department Paediatric Triage Protocol

All children undergoing triage or receiving treatment in an Emergency Department cubicle must be taken to the resuscitation room immediately if they have any of the following:

Appearance:

Pale, cyanosed or non-blanching rash

Consciousness:

Listless, fitting or unresponsive

Respiration:

Irregular or laboured Respiratory rate >40 or <8 per minute

Pulse:

Irregular, <60 or >130

CRT:

Capillary refill >3 seconds

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ABC – Seriously Ill Child

Dial 6666 and ask for the paediatric team Appear calm and give 100% oxygen!

These are general guidelines for commencing resuscitation until paediatric team leader or Emergency Department consultant arrives

1. Bring to paediatric resus (allow parents to accompany)

2. Assess consciousness, airway, breathing, circulation*( all the usual ‘ABC’ assessment methods apply)

3. Give 100% O2 (use 100% O2 mask or if necessary bag-valve-mask attached to O2)

4. Get iv or intra-osseous access (don’t delay with multiple iv attempts)

5. Take blood (BM stick, blood cultures etc.)

6. Calculate weight ( wt/kg = 2x(Age + 4) )

7. Push 10ml/kg normal Saline into your line via syringe (Omit if cardiac disease or suspected CHF). Repeat 3times. Can give 60ml/kg

8. Give 5ml/kg of 10% Dextrose if hypoglycaemic by iv push. DO NOT USE IN SHOCK.

9. Treat sepsis empirically with cefotaxime 100mg/kg (max2g)slow iv (if meningococcal septicaemia likely, Ceftriaxone 80mg/kg (max2-4g) slow iv

**DO NOT TOUCH A CONSCIOUS CHILD WITH STRIDOR. IF YOU SUSPECT EPIGLOTTITIS OR PARTIAL AIRWAY OBSTRUCTION OF ANY KIND DON’T TOUCH THE CHILD AT ALL UNLESS RESPIRATORY ARREST - GET ANAESTHETIST IMMEDIATELY**

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ABC – Seriously Ill Child TRANSFERS TO THE WARD

The following conditions require supervised transfer with an appropriately trained

and experienced nurse or doctor to the Paediatric ward.

The relevant paediatric doctor on call must be made aware of your concerns about

the child.

• Cap refill >2 seconds (inform paeds reg, needs fluids (0.9%NaCl) given prior to

transfer)

• Altered GCS – drowsy, lethargic, loss of eye contact with parents or irritable

(inform paeds reg )

• Non-blanching rash (inform paeds reg )

• Increased or decreased respiratory rate / abnormal SaO2, less than 95% (inform

paeds reg, transfer with O2)

• Any suspicion of upper airway obstruction(inform paeds reg +/- anaesthetist)

• Pale, toxic or unwell looking child (inform paeds reg )

• Serious parental concern

• Bad medical history

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Basic Paediatric Life Support

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Advanced Paediatric Life Support: Choking child

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Advanced Paediatric Life Support: cardiac arrest

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Advanced Paediatric Life Support: ARRHYTHMIA

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Advanced Paediatric Life Support: Ventricular tachycardia

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Advanced Paediatric Life Support : Newborn Life Support

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Advanced Paediatric Life Support : Anaphylaxis

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The Unconscious Child

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Sudden Unexpected Death in Infancy (SUDI)

This will present to you as cardio-respiratory arrest in an infant. You must get senior Paediatric help immediately in this situation 8-3333# If the baby has rigor mortis or skin changes (stasis) pronounce death but get help. If not commence CPR with O2 until paediatric registrar or a consultant arrives. The patient (Paediatric Registrar) The paediatric registrar will follow the agreed protocol for the investigation of SUDI. This protocol is in the SUDI pack which the registrar will have. The pack is kept on A2 and can only be used by the paediatric registrar. The parents

• The child should be dressed and a photograph taken in case the parents should ask for this now or at a later date

• They should be told that their baby was dead on arrival +/- it was not possible to resuscitate him/her

• If they ask questions about the cause etc tell them that you do not have the answers yet – it’s too soon

• When they are ready for more information tell them that the Coroner must be notified and that the police will be coming to co-ordinate this

• The parents should be allowed to hold their child for as long as they wish The Coroner A message must be left on the Coroner’s answer phone including the name and personal contact number of the doctor who pronounced life extinct.

GP, HEALTH VISITOR AND SOCIAL WORKER MUST BE CONTACTED IN ALL CASES.

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