The Yorkshire & Humber Paediatric Critical Care ODN, has released some useful guidance about the Post-ROSC phase of care 
As we know “TIME is BRAIN” so early recognition of stroke is vital so BE FAST! Read more
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Neonatal Resus
PUT OUT A NEONATAL CRASH CALL
CRH – will result in at least a Neonatal SpR, SHO +/- a neonatal nurse.
HRI – may not generate a response. Consider a crash bleep to anaesthetics
CALL NEONATAL CONSULTANT (WILL ONLY GIVE ADVICE AS AT CRH)
CALL THE ED CONSULTANT
***Remember Grab Box***
Unless within the first few hours of life using the APLS algorithm is equally if not more appropriate
Paediatric Hypoglycaemia
Paediatric Hypoglycaemia (BM <2.6) is a relatively common presentation in the Emergency Department. However, if we don’t do the BM it’s easy to miss.
Hypoglycaemia in paediatric diabetic patients is managed separately – see here
Hypoglycaemia in neonates (<72 hours of life) also has specific management – see here (Flowcharts A + B)
Hypoglycaemia is generally caused by disruption in one of the following:
- Carbohydrate intake
- Carbohydrate absorption
- Gluconeogenesis
- Glycogenolysis
DKA in Kids
Diabetic Ketoacidosis – remember in paediatrics this may be the 1st presentation of diabetes.
- Fluid – are more considered than adults due to the risk of cerebral oedema
- Insulin – WAIT – need 1hr of fluid first
- Paeds – involve them early
- USE the BSPED DKA Management flow charts, calculators and full guidelines for when electrolytes won’t play ball which are all linked below.
DKA Management Calculator (recommended by paediatrics)- HERE
DKA Management Flow Chart – HERE
Full CHT DKA Guideline – HERE
Diabetic Hyperglycaemia (Kids)
Diabetic children sometimes attend ED with hyperglycaemia, but not in DKA (what should we do?)
Paeds have produced some advice to follow:
- Ketones over 0.6?
- <0.6: Encourage fluids & food, may need an insulin correction
- >0.6: ask Question 2
- Are there clinical features of DKA?
- NO: Encourage fluids & food, decide Insulin correction, will need to be monitored
- YES: Will need Paeds admission
Stroke – BE FAST
Immobilisation Protocol for Trauma Patients
Purpose of pathway
To clarify the immobilisation strategy for patients requiring Poly-Trauma CT Scans (anything more than an isolated CT Head)
Paediatric Surgical Pathway
As there are now no longer a paediatric clinical team at HRI, the paediatric surgical pathway is up-dating, this is the current provisional pathway, to ensure care falls inline with GIRFT report.
Status Epilepticus – APLS 2021
APLS 2021 Status Epilepticus Guide
Self-Discharge
Still in the ED
- Explain why we would like them to stay and the management options as clearly as possible
- Assess mental capacity (over 16 years)
- Complete
- Remember under 18’s, legally don’t have the right to refuse treatment (however, the principles of the mental capacity act should be applied)
Left ED
- Assess the risk, do we need to:
- Police safe & well check
- Contact patient/next-of-kin
- Inform GP
- Inform Safeguarding team
- Did not wait/complete treatment– flow chart
- Inform Nurse-in-Charge
- Add to handover board if actions are required by the in-hours team
