The Yorkshire & Humber Paediatric Critical Care ODN, has released some useful guidance about the Post-ROSC phase of care 
Category: Paeds
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
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
Faltering Growth
Faltering growth and poor weight gain in neonates are handled very differently.
Fortunately for us our paediatric colleagues have developed a very robust (read long) guideline to help us understand what we may need to do for these children.
They also appreciated we aren’t so good in PED at reading long guidelines so please refer to the bottom of the linked document for the appendices – one for babies and one for children.
Enjoy
Vaccination Schedules UK & International
Working out what your patient might have been vaccinated for can be tricky, and more so if they were raised outside of the UK. Luckily there are a couple of tools online you can use to make this easier.
