1. Paediatric Emergencies
And Resuscitation

2. Why Listen? Basic Life Support August 2009 May 2009
Structured approach to any Emergency

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

4. Choking
A demonstration

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

6. Rapid Paediatric Assessment
Breathing – the 3 E’s
Effort
Efficacy
Effects on other organs

7. Rapid Assessment Circulation
Pulse volume
Pulse rate
Capillary refill BP
Effects of circulatory inadequacy on other organs
brain, kidneys, breathing, skin

8. Rapid Assessment
Disability A V P U
Don’t ever forget glucose

9. E is for Expose
Injury assessment
Rash -
Purpura
Urticaria
Child abuse

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

11. Life Threatening Asthma
Depressed conscious level
Exhaustion
Poor respiratory effort
Oxygen sats < 85% in air / cyanosis
Silent chest
PFR <35% best

12. Asthma Emergency management
HELP!
High Flow Oxygen
Salbutamol nebulised
Ipratropium Bromide
IV Aminophylline
IV Salbutamol
IV Magnesium

13. Further Management Nurse on HDU Continuous monitoring
Back to back nebs
Ixs
Sats
Pulse
PFR
Consider CXR and gas

14. Shock Causes Hypovolaemic - Distributive - Septicaemia Cardiogenic
Obstructive – tension pneumothorax
Dissociative (carbon monoxide poisoning)

18. Shock Treatment High flow oxygen Venous access
Fluids 20 ml / Kg except in trauma
Specific treatment
Antibiotics
IM adrenalin
Trauma management

19. Shock Investigations Bloods GLUCOSE FBC Clotting Venous gas B/C
U&E, Ca, Mg

20. Septic Screen
Blood
CXR
Urine
LP if stable enough and no Purpuric rash

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

22. DKA Emergency management
Advice from specialist
Oxygen
Fluids cautiously normal saline= 0.9% Saline
Slow reduction in Sugar
Fluids
Insulin

23. DKA Monitoring HDU Frequent reassessment Cap / venous gas U&E
Conscious level
Most important and usually fatal Complication?

24. DKA Treatment Complication
Cerebral Oedema
Mannitol
Head up
Intubate and ventilate keep CO2 low normal
ITU

25. Status Epilepticus Fitting >30 minutes
Or Successive convulsions without recovery
But don’t wait 30 minutes before treating
Mortality in children 1%

26. Status Cause Commonly febrile fit (5% febrile fits present in status)
1-5% patients with epilepsy

27. Status Epilepticus Management
Airway
High flow oxygen
Breathing
Circulation – access
CHECK GLUCOSE
Stop the fit

28. 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

29. Investigations Cause of seizure Effects of seizure / treatment
Metabolic
Source of fever
Structural abnormality
Effects of seizure / treatment
Brain
Glucose
Resps

30. Post Seizure Monitoring HDUA B C
D Conscious level and Don’t ever forget glucose

31. 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

32. Summary Paediatric Emergencies
Call for help
Standardised approach
Don’t panic

33. Any Questions?