Category: Paeds-Resus

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

Paediatric Flow at HRI

There is rapidly growing evidence, outcomes for children are improved by early attendance at specialist sites. As there is NO onsite paediatric speciality provision at HRI. It has been agreed that children likely to benefit from early Paediatric/Neonatal care move to CRH as swiftly as possible. This will be done using the agreed pathway, to reduce treatment and speciality input delay.

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