1. Emergencies in peadiatrics
Krzysztof
Narębski
Toruń

2. Problems to discuss Child assessment Neonatal resuscitation Shock
Septicaemia
Status epilepticus / febrile seizures
Dyspnoea
Anaphylaxis
Inhaled foreign body 2

3. Child assessment Basic / Advanced Live Support
Primary assessment
ABCD scale or
AVPU scale
Resuscitation
Etiologic treatment 3

4. „SICK CHILD”, „SEPTIC” A - Arousal, Alertness, Activity, Apathy
B - Breathing difficulties
C - poor Colour (pale) and
Circulation (Cold peripheries)
D - Decreased fluids intake (fewer than half a normal intake) and
Decreased urine output (fewer than 4 wet nappies a day) 4

5. Level of awareness, Coma
A Alert
V - responds to Voice
P - responds to Pain
U Unresponsive 5

6. Neonatal
Resuscitation
at birth 6

7. NR first 30 sec = routine care !!!7

8. NR breathing and chest compressions8

9. Neonatal resuscitation
Adrenaline iv 10 – 30 mcg / kg
(0.01 – 0.03 mg / kg)
Amp. 0,1 % (1 : 1000), 1 ml
1 ml - 1 mg = 1000 mcg
Dilution 10 x >>
1 ml mg = 100 mcg
>> give 0.1 – 0.3 ml / kg (= 10 – 30 mcg)

10. Apgar score : good 8 – 10 points, intermediated 4 - 7, bad 0 - 3
Score of 0
Score of 1
Score of 2
Acronym
Skin color
Blue / pale all over
Body pink, Blue extremities
All pink
Appearance
Pulse rate
Absent
< 100 /min
> 100 /min
Pulse
Reflex irritability
No respond to stimuli
Grimace
Cry
Muscle tone
None
Some flexion
Flexed legs & arms
Activity
Breathing
Weak, irregular
Strong cry
Respiration 10

11. Shock Definition : inadequate circulation to meet the tissues’ demands
Etiology :
- Hypovolemia !!! viral gastroenteritis
- Maldistribution of fluid :
Sepsis
Anaphylaxis

12. Signs of shock Early (compensated shock) tachypnoea and tachycardia
sunken eyes and fontanelle
mottled, pale, cold skin
decreased skin turgor
decreased capillary refill (> 2 sec)
decreased urinary output
(< 1 ml/kg/h) 12

13. Signs of shock Late (decompensated shock)
confusion / depressed cerebral state
bradycardia
hypotension
blue peripheries
absent urine output 13

14. Hydratation 14

15. Decreased skin turgor 15

16. 16

17. Hypovolemia - treatment
Fluids resuscitation :
% saline iv
- 20 ml / kg
- in 10 – 20 min,
- repeat if necessary !!!
(Ringer if urine output present)
2. Blood if trauma 17

18. Figure 6.8 Initial fluid resuscitation in shock.
Downloaded from: StudentConsult (on 26 February :39 PM)
© 2005 Elsevier

19. Fluids intake at different ages
Body weight
Fluids requirement / 24 hours
Volume / kg per hour
First 10 kg
100 ml / kg
4 ml / kg
Second 10 kg
50 ml / kg
2 ml / kg
Subsequent kg
20 ml / kg
1 ml / kg
Examples of calculations
Infant 7 kg
700 ml
29 ml / h
Child 18 kg
= 1400 ml
= 56 ml/h
Child 42 kg
= 1940 ml
= 78 ml/h 19

20. Toruń 20

21. Septicaemia - meningococcal purpura
Poor state
+ fever
+ rash
that does not blanch when
pressed
under a glass 21

22. Septicaemia - meningococcal purpura22

23. Septicaemia - clinical features
History :
- fever
- poor feeding
- irritability, lethargy
Examination :
- tachycardia, tachypnoea, hypotension
shock, multi organ failure
purpuric rash
ABCD / AVPU scale
Vaccination 23

24. Septicaemia - treatment
Antibiotic immediately iv
Hospital (Intensive Care Unit)
Treatment of shock 24

25. Seizures
Definition :
Uncontrolled electrical activity in the brain, which may produce a physical convulsion. 25

26. Status epilepticus / febrile seizures
Status epilepticus - definition :
- seizure lasting 30 min or
- successive frequent seizures with unconsciousness
Febrile seizures - definition :
- seizure accompanied by a fever in absence of intracranial infection

27. Seizures - etiology Febrile seizures – any infections & fever Also :
Metabolic (hypoglycemia, hypoCa, hypoMg, hypo or hypernatraemia)
Meningitis and encephalitis
Cerebral trauma or tumor
Toxins (poison, metabolic disorders)
Epilepsy and others 27

28. Seizures - treatment Febrile seizures – antipyretics !!!
- Diazepam 0.5 mg / kg pr
Seizures or status epilepticus :
Phenobarbital iv 10 – 20 mg / kg
Phenytoin iv 20 mg / kg
Repeat if no response in 5 min !!!
Give oxygen !!! >> PICU
If hypoglycemia < 3 mmol/L
Give 10 % glucose iv 2 ml / kg 28

29. Toruń 29

30. Dyspnoea - Croup
The degree of subcostal, intercostal and sternal recession is a more useful indicator of severity of upper airways obstruction than the respiratory rate.

31. Dyspnoea - Croup
Features : viral, 6 months to 6 years, harsh, loud stridor, coryza, mild fever
Treatment
Inhalation of fresh air
Steroids :
prednisolon oral, im, iv or
inhaled budesonid
Nebulised adrenaline with oxygen 31

32. Dyspnoea – Asthma fit Treatment - Oxygen !!!
History of allergy or asthma
Symptoms and signs :
- too breathless to eat or talk
- use of accessory muscles
- distended chest
- wheeze or silent chest
- cyanosis and alter level of consciousness
Treatment - Oxygen !!!
- Bronchodilators (B2-agonist)
- Steroids iv, oral or inhaled 32

33. Anaphylaxis Definition :
Severe, whole – body reaction to an allergen, after being previously exposed to this allergen (sensitization to it).
This reaction happen very quickly. 33

34. Anaphylaxis History of allergy / anaphylaxis
Food or insect sting venom allergy
Symptoms immediately :
- airways : swelling, hoarseness, stridor
- breathing : tachypnea, wheeze, cyanosis, SpO2< 92 %
- circulation : pale, clammy, hypotension, drowsy, coma 34

35. Anaphylaxis - treatment
Adrenaline / epinephrine 1 : 1000 im
< 6 years mcg (0.15 ml)
6 – 12 years mcg (0.3 ml)
> 12 years mcg (0.5 ml)
Hydrocortison im or iv 35

36. Inhaled foreign body 36

37. In infants, back blows and chest thrusts are recommended to expel an inhaled foreign body. Abdominal thrusts are best avoided in infants as they may cause intra-abdominal injury.

38. Abdominal thrusts (Heimlich manoeuvre) in older children to expel an inhaled foreign body. One hand is formed into a fist and placed against the child's abdomen between umbilicus and xiphisternum. The other hand is placed over the fist. Both hands are thrust into abdomen. Repeat several times. The child can be standing, kneeling, sitting or supine.

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42. Thank you 42