Category: Paeds

Paediatric Mental Health

The provision of out of hours mental health services for Children and young people (under the age of 18) is changing: –

Between 8pm and 9am the onsite Mental Health Liason team (RAID) will see these patients initally and help with the mental health aspects of their care. Between 9am and 8pm contact CAMHS via switchboard as normal.

Afebrile Seizure (Paed)

Child (<16) presents with PAROXSYMAL EVENT – episode of loss of consciousness, blank starring or other brief unusual behaviour

History

  • Detailed description of event
  • Before (trigger? Concurrent illness? Behaviour change? Cessation of activity?)
  • During (collapse? Colour change? Altered consciousness? Body stiff or floppy?, limb movements?)
  • After (sleepy?, unusual behaviour? Unsteady?, limb weakness?)
  • Copy and paste YAS EPR entry
  • Can child be distracted at any point
  • Does the event occur during exercise
  • Developmental history
  • Family History
  • Assess for red flags below

Examination

  • Documented neurological examination including gait – observe eye movement, look for a new squint
  • Cardiac Examination including blood pressure (esp if associated with exercise / colour change)

Investigations

  • Ask parents to video events and keep detailed, descriptive diary (day, time, event-before, during and after)
  • ECG
  • Routine bloods are NOT required unless clinically indicated

RED Flags

  • Age < 1year
  • Acute confusion
  • Pervasive behaviour change / lethargy
  • New onset, recurrent convulsive seizures (>1 per week)
  • Abnormal cardiac examination or ECG findings
  • Abnormal neurological examination findings
  • Symptoms of raised intracranial pressure (blurred / double vision, headache at night or on waking, persistent nausea / vomiting)
  • Signs of sepsis / meningitis

Referral

  • RED Flag Ref to PAU (Paeds Reg)
  • Non Urgent Referral –
    • Document history and examination (esp. neuro)
    • Ask parents to video events
    • Send message to Salim Uka and Matthew Taylor through EPR “Communicate”  to request appointment (usually within a few weeks)
  • No Referral Required –
    • The following are examples of benign paroxysmal episodes that do not require a referral to paediatrics if the diagnosis is secure:
      • Breath holding attackes
      • Simple Faint
      • Reflex Anoxic Seizures (document normal ECG)
      • Sleep Myoclonus
      • Night Terrors

Paediatric – Time Critical Transfers (non-trauma)

Definition of a time critical transfer 

Transfer of a patient for life, limb or organ saving treatment when the time taken to provide this treatment is a critical factor in outcome. 

Principles 

  1. Acceptance by the regional centre is NOT dependent on bed availability. 
  2. Time critical transfer should normally be provided by the referring hospital team NOT Embrace. 

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COVID-19 (Paediatric multisystem inflammatory syndrome)

AKA: Paediatric Inflammatory Multi-system Syndrome – Temporally associated with SARS-CoV 2 

Although COVID-19 seems a benign disease in almost all children there are increasing evidence (however rare) of a “Paediatric multisystem inflammatory syndrome”. This is a RARE and newly emerging condition and there are many questions still e.g. It is currently unclear if it is directly related to the COVID-19 pandemic.

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Care of the Next Infant (CONI)

What is CONI?

Parents who have experienced a sudden and unexpected death of a baby or child often feel anxious when they have another baby. CONI is a programme working with local public healthcare providers to facilitate a service for bereaved parents to help with the anxieties around another baby.

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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

0-12yrs WETFLAG

Tips: 

  • If particularly BiIG – go up 1-2 yrs
  • If particularly SMALL – go down 1-2 yr
  • Prepare ET Tubes 0.5mm bigger and smaller
  • Chid’s weight known – specific calculations can be found after tables.

Boys 0-14yrs

AgeBirth1mth3mth6mth12mth18mth2yr3yr4yr5yr6yr7yr8yr9yr10yr11yr12yr14yrAge
Weight3.5kg4.5kg6.5kg8kg9.5kg11kg12kg14kg16kg18kg21kg23kg25kg28kg31kg35kg43kg50kgWeight
Energy20J20J30J30J40J40J50J60J60J80J80J100J100J120J130J140J150J150JEnergy
Tube 3.0/3.5mm3.5mm3.5mm4mm4.5mm4.5mm4.5mm5mm5mm5.5mm5.5mm6mm6mm6.5mm6.5mm6.5mm7.5mm8mmTube
Fluid-Medical70ml90ml130ml160ml200ml220ml240ml280ml320ml360ml420ml460ml500ml500ml500ml500ml500ml500mlFluid-Medical
Fluid - Trauma 35ml45ml65ml80ml100ml110ml120ml140ml160ml180ml210ml230ml250ml250ml250ml250ml250ml250mlFluid-Trauma
Lorazepam 0.4mg0.5mg0.7mg0.8mg1.0mg1.1mg1.2mg1.4mg1.6mg1.8mg2.1mg2.3mg2.5mg2.8mg3.1mg3.5mg4.0mg4.0mgLorazepam
Adrenaline 1:10'0000.4ml0.5ml0.7ml0.8ml1.0ml1.1ml1.2ml1.4ml1.6ml1.8ml2.1ml2.3ml2.5ml2.8ml3.1ml3.5ml4.3ml5.0mlAdrenaline 1:10'000
Glucose 10% (ml)7ml9ml13ml16ml19ml22ml24ml28ml32ml36ml42ml46ml50ml56ml62ml70ml86ml100mlGlucose 10%

Girls 0-14yrs

AgeBirth1mth3mth6mth12mth18mth2yr3yr4yr5yr6yr7yr8yr9yr10yr11yr12yr14yrAge
Weight3.5kg4.5kg6kg7kg9kg10kg12kg14kg16kg18kg20kg22kg25kg28kg32kg35kg43kg50kgWeight
Energy20J20J30J30J40J40J50J60J60J80J80J90J100J120J130J140J150J150JEnergy
Tube 3.0/3.5mm3.5mm3.5mm4mm4.5mm4.5mm4.5mm5mm5mm5.5mm5.5mm6mm6mm6.5mm6.5mm6.5mm7.5mm8mmTube
Fluid-Medical70ml90ml120ml140ml180ml200ml240ml280ml320ml360ml400ml440ml500ml500ml500ml500ml500ml500mlFluid-Medical
Fluid - Trauma 35ml45ml60ml70ml90ml100ml120ml140ml160ml180ml200ml220ml250ml250ml250ml250ml250ml250mlFluid-Trauma
Lorazepam 0.4mg0.5mg0.6mg0.7mg0.9mg1.0mg1.2mg1.4mg1.6mg1.8mg2.0mg2.2mg2.5mg2.8mg3.2mg3.5mg4.0mg4.0mgLorazepam
Adrenaline 1:10'0000.4ml0.5ml0.6ml0.7ml0.9ml1.0ml1.2ml1.4ml1.6ml1.8ml2.0ml2.2ml2.5ml2.8ml3.2ml3.5ml4.3ml5.0mlAdrenaline 1:10'000
Glucose 10% (ml)7ml9ml12ml14ml18ml20ml24ml28ml32ml36ml40ml44ml50ml56ml64ml70ml86ml100mlGlucose 10%

Calculations

  • Energy (J) [max 150J] =4 x Weight(kg)
  • Fluid Medical (ml) = 20 x Weight(kg)
  • Fluid Trauma (ml) = 10 x Weight(kg)
  • Lorazepam (mg) [max 4mg] = 0.1 x Weight(kg)
  • Adrenaline 1:10’000 (ml) [max 10ml] = 0.1 x Weight(kg)
  • Glucose 10% (ml) = 2 x Weight(kg)

Information from APLS Aide-Memoire