Category: Paeds
Paediatric Urine Results
Paediatric Urine Microscopy Interpretation and Action
|
Microscopy results
|
Interpretation
|
|
Pyuria and bacteriuria are both positive
|
Assume the baby or child has a urinary tract infection (UTI), ensure treatment with appropriate antibiotics
|
|
Pyuria is positive and bacteriuria is negative
|
Start antibiotic treatment if the baby or child has a symptoms or signs of a UTI
|
|
Pyuria is negative and bacteriuria is positive
|
Assume the baby or child has a UTI, ensure treatment with appropriate antibiotics
|
|
Pyuria and bacteriuria are both negative
|
Assume the baby or child does not have a UTI
|
IF UNDER 6 MONTHS OF AGE OR A NON E COLI BACTERIURIA ASK THE GP TO ARRANGE AN ULTRASOUND SCAN OF THE URINARY TRACT.
Pyuria: White cells on microscopy >50
Bacteriuria: Pure growth of a bacteria >105
If mixed growth or <105 presume bacteriuria is negative
Avoid prescribing nitrofurantoin liquid formulation as it is £250 per bottle!
Alprostadil
To maintain or restore patency of the ductus arteriosus
Only to be used in infants who are ventilated or where ventilation is immediately available
Guideline-for-use-of-Dinoprostone-in-duct-dependent-CHD-1-8-3
DO NOT DELAY IN STARTING Alprostadil if: there is clinical
suspicion of duct dependent CHD while waiting for paediatric cardiology opinion OR echocardiogram, even when in-house echo facilities are present.
PDF: Alprostidil
Hyperammonaemia – Paed
Hyperammonaemia is a TIME CRITICAL medical emergency with the risk of death and serious neurological damage.
0-12yrs WETFLAG
Tips:
- If particularly BIG – go up 1-2 yrs
- If particularly SMALL – go down 1-2 yr
- Prepare ET Tubes 0.5mm bigger and smaller
APLS 7e
APLS 7e Trauma
Information from APLS Aide-Memoire
Paeds Post-ROSC guide
The Yorkshire & Humber Paediatric Critical Care ODN, has released some useful guidance about the Post-ROSC phase of care 
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
