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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

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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

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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:

  1. Ketones over 0.6?
    • <0.6: Encourage fluids & food, may need an insulin correction
    • >0.6: ask Question 2
  2. Are there clinical features of DKA?
    • NO: Encourage fluids & food, decide Insulin correction, will need to be monitored
    • YES: Will need Paeds admission

Are You CO Aware?

With the onset of colder weather, many households in the UK are turning on their heating for the first time in months. Heating appliances need chimneys and flues to work safely – and these can block up over the summer months. So autumn is traditionally the period when people get poisoned by carbon monoxide (although it can happen any time of the year!)

Carbon monoxide (CO) is produced when anything containing carbon burns or smoulders. For practical purposes, this means the burning of any kind of fuel, commonly:

  • Gas
  • Coal
  • Wood/Paper/Card
  • Oil/Petrol/Diesel – (All UK cars have a ‘catalytic converter’ in the exhaust system, which converts carbon monoxide (CO) to carbon Dioxide (CO2), which is less poisonous. However, these converters need to warmed up – a cold car produces fatal amounts of CO in the exhaust)

CO is very poisonous. Exposure to as little as 300 parts per million (that’s just 0.03%) can prove fatal.

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