Dr F Hignett, September 2015 ST4 Paediatrics

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Presentation transcript:

Dr F Hignett, September 2015 ST4 Paediatrics paediatric Rapid Evaluation and ReSuscitation of the Unwell Simulated Patient Dr F Hignett, September 2015 ST4 Paediatrics

Objectives To help you throughout your medical student training & on day 1 as an F1, by developing a robust system for assessing an unwell child Gain experience of assessing, diagnosing and treating acute paediatric conditions through simulation Recognise when you need to call for help and how to do it Revise and practice basic life support

A - Airway B - Breathing C - Circulation D - Disability E - Exposure The Approach A - Airway B - Breathing C - Circulation D - Disability E - Exposure

Patent/At Risk/Compromised A - Airway Patent/At Risk/Compromised Observation: Examination: Talking Snoring Stridor Choking Vomiting Foreign body Vomit

B - Breathing Observation: Examination: Respiratory rate Saturations Colour Expansion Work of breathing Recession Nasal flaring Head bobbing Saturations Central trachea Auscultation Air entry, crackles, wheeze Percussion Dull, resonant

C - Circulation Observation: Examination: Colour ?Sweaty Urine Output Pulse Rate, rhythm, character CRT BP Peripheral temperature JVP/Peripheral Oedema Auscultation

D - Disability BLOOD SUGAR Observation: Examination: AVPU GCS Pupils Eyes Voice Motor Pupils Temperature BLOOD SUGAR

E - Exposure Observation: Examination: Abdo/GI ENT LOOK!! Top to toe Front to back Drug chart Obs chart Notes Abdo/GI ENT Any other relevant system Remember to LISTEN to the parents

Observations AGE HR RR Systolic BP <1 110 - 160 30 - 40 70 - 90 1-2 (years) HR (min) RR Systolic BP (mm/Hg) <1 110 - 160 30 - 40 70 - 90 1-2 100 - 150 25 - 35 80 - 95 2-5 95 - 140 25 - 30 80 - 100 5-12 80 - 120 20 - 25 90 - 110 >12 60 - 100 15 - 20 100 - 120 Taken from APLS Manual

ASSESS TREAT REASSESS NEED HELP?!

Assessment www.spottingthesickchild.com

ASSESS TREAT REASSESS NEED HELP?!

Possible Intervention / Treatment System Intervention Treatment A – Airway Airway Adjuncts NIV I&V Oxygen Nebulised/IM Adrenaline Nebulised/Oral Steroids B - Breathing Blood Gas CXR Nebulise Salbutamol +/- Ipratropium Hypertonic Saline PO/IV Steroids C - Circulation Access Bloods, Cultures Lactate Catheter Fluid Bolus 10/20ml/kg 0.9% Saline IM Adrenaline 10mcg/kg or 0.1ml/kg of 1:1000 D - Disability Airway Positioning Immobilisation Recovery Position 10% Dextrose Bolus 2ml/kg Anti-epileptics Naloxone E - Exposure Remove Clothing - Look Top to Toe & Front to Back Antibiotics Antipyretics

WET FLAG – Resuscitation Calculations W – Weight 0-12 months – (age x 0.5) + 4 1-5 years – (age x 2) + 4 6-12 years – (age x 3) + 7 (age +4) x 2 E – Energy 4J/Kg T – Tube Diameter: (age/4) +4 Length: (age/2) +12 F - Fluid 20ml/kg of 0.9% Saline L - Lorazepam 0.1mg/kg Lorazepam A – Adrenaline 0.1ml/Kg of 1:10,000 Adrenaline G - Glucose 2ml/Kg of 10% Dextrose

SORT www.sort.nhs.uk Advice & Support Drug Calculator Guidelines

ASSESS TREAT REASSESS NEED HELP?!

Calling For Help In SGH: SBAR Paediatric SHO: Bleep 2212 Paediatric Ref: Bleep 2201 Paediatric Cons: Through Switch Outreach Nurses: Bleep 1442 Paediatric Arrest Team: DIAL 2222 SBAR Situation Background Assessment/Action Reccomendation/Result

KEY TAKE HOME MESSAGES… WHEN IN DOUBT CALL FOR HELP!!

BLS

Meet the Chokeables

Choking

KEY TAKE HOME MESSAGES… WHEN IN DOUBT CALL FOR HELP!!

Resuscitation guidelines and algorhythms Helpful Resources Resource Website Description Spotting the Sick Child www.spottingthesickchild.com Interactive teaching resource on the assessment of the unwell child SORT www.sort.nhs.uk Advice & referral to PICU Drug Calculator Guidelines RESUS Council www.resus.org.uk Resuscitation guidelines and algorhythms BNFc www.bnf.org Medication dosing pRESUS team Email: pRESUScourse@gmail.com For advice about the pRESUS course, pursuing a career in paediatrics or any paediatric related queries!