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Paediatric Emergencies

Paediatric Emergencies. And 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. Choking.

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Paediatric Emergencies

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  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)

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

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

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

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

  19. DKAEmergency management • Advice from specialist • Oxygen • Fluids cautiously normal saline= 0.9% Saline • Slow reduction in Sugar • Fluids • Insulin

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

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

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

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

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

  25. 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

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

  27. Post Seizure MonitoringHDU • A • B • C • D Conscious level and Don’t ever forget glucose

  28. 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

  29. SummaryPaediatric Emergencies • Call for help • Standardised approach • Don’t panic

  30. Any Questions?

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