Paediatric Emergencies And Resuscitation. Why Listen? Basic Life Support August 2009 May 2009...
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Transcript of Paediatric Emergencies And Resuscitation. Why Listen? Basic Life Support August 2009 May 2009...
![Page 1: Paediatric Emergencies And Resuscitation. Why Listen? Basic Life Support August 2009 May 2009 Structured approach to any Emergency.](https://reader035.fdocuments.us/reader035/viewer/2022062722/56649f295503460f94c422fc/html5/thumbnails/1.jpg)
Paediatric Paediatric EmergenciesEmergencies
Paediatric Paediatric EmergenciesEmergencies
And ResuscitationAnd Resuscitation
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Why Listen?• Basic Life Support
• August 2009
• May 2009
• Structured approach to any Emergency
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Paediatric Resuscitation
• ‘SAFE’ Approach• Airway opening• Check for breaths (LLF)• 5 rescue breaths• Check pulse• 15 :2• Get help
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ChokingChokingChokingChoking
A demonstrationA demonstration
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Paediatric Emergencies• A Choking• B Status Asthmaticus• C Shock• C DKA• D Status Epilepticus
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Rapid Paediatric Assessment
• Breathing – the 3 E’s– Effort– Efficacy– Effects on other organs
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Rapid Assessment Circulation
Pulse volumePulse rateCapillary refillBPEffects of circulatory inadequacy on
other organsbrain, kidneys, breathing, skin
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Rapid Assessment• Disability
– A– V– P– UDon’t ever forget glucose
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E is for Expose• Injury assessment
• Rash - – Purpura– Urticaria
• Child abuse
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Acute severe Asthma• Too breathless to talk / feed• Increased respiratory effort• PFR < 50% normal• Tachycardia > 140 why?• Tachypnoea >50
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Life Threatening Asthma
• Depressed conscious level• Exhaustion• Poor respiratory effort• Oxygen sats < 85% in air / cyanosis• Silent chest• PFR <35% best
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Asthma Emergency management
• HELP!• High Flow Oxygen• Salbutamol nebulised• Ipratropium Bromide• IV Aminophylline• IV Salbutamol• IV Magnesium
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Further Management• Nurse on HDU • Continuous monitoring• Back to back nebs• Ixs
– Sats– Pulse– PFR– Consider CXR and gas
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Shock Causes• Hypovolaemic -• Distributive - Septicaemia• Cardiogenic• Obstructive – tension
pneumothorax• Dissociative (carbon monoxide
poisoning)
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Shock Treatment• High flow oxygen• Venous access• Fluids 20 ml / Kg except in trauma• Specific treatment
– Antibiotics– IM adrenalin– Trauma management
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Shock Investigations• Bloods
– GLUCOSE– FBC – Clotting– Venous gas– B/C– U&E, Ca, Mg
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Septic Screen• Blood• CXR• Urine• LP if stable enough and no
Purpuric rash
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Shock Monitoring• HDU• Pulse• Sats• BP• Cap refill• Temp• Urine OP• Conscious level
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DKAEmergency
management• Advice from specialist• Oxygen• Fluids cautiously normal saline=
0.9% Saline• Slow reduction in Sugar
– Fluids– Insulin
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DKA Monitoring• HDU• Frequent reassessment• Cap / venous gas• U&E• Conscious level• Most important and usually fatal
Complication?
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DKA Treatment Complication
• Cerebral Oedema– Mannitol– Head up– Intubate and ventilate keep CO2 low
normal– ITU
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Status Epilepticus• Fitting >30 minutes• Or Successive convulsions without
recovery• But don’t wait 30 minutes before
treating
Mortality in children 1%
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Status Cause• Commonly febrile fit (5% febrile
fits present in status)
• 1-5% patients with epilepsy
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Status Epilepticus Management
• Airway– High flow oxygen
• Breathing• Circulation – access
– CHECK GLUCOSE
• Stop the fit
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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
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Investigations• Cause of seizure
– Metabolic– Source of fever– Structural abnormality
• Effects of seizure / treatment– Brain– Glucose– Resps
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Post Seizure MonitoringHDU
• A• B• C• D Conscious level and Don’t ever
forget glucose
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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
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SummaryPaediatric Emergencies• Call for help
• Standardised approach
• Don’t panic
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Any Questions?Any Questions?Any Questions?Any Questions?