Category: Paeds

D&V in kids

Paediatric gastroenteritis can be a pain for everyone but as with most of EM – Keep It Simple

  • Not dehydrated – make sure they can tolerate fluids, and encourage hydration, think about ORT
  • Dehydrated – look for the red flags that indicate they are developing shock. Use ORT unless IV indicated
  • Shocked – you will need access and it will probably be difficult (IO on awake children really isn’t that bad)

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Head Injury

Background

  • Defined as any traumatic injury to the head other than superficial facial injuries.
  • The commonest cause of death and disability in people age 1-40 in the UK.
  • Account for 1.4 million ED attendances each year, 95% of these are minor head injuries that can be managed in the ED.

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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 BIG – 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)10ml13ml19ml24ml28ml33ml36ml42ml48ml54ml63ml69ml75ml84ml93ml105ml129ml150mlGlucose 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)10ml13ml18ml21ml27ml30ml36ml42ml48ml54ml60ml66ml75ml84ml96ml105ml129ml150mlGlucose 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

 

EMBRACE & Paediatric Critical Care

In our trust we don’t have paediatric critical care beds. However, in our region we use EMBRACE (a paediatric critical care transport team), who can transfer critically  ill children to specialist centers (in or out of region).

EMBRACE

Y&H Paed Critical Care

Drugs:

  • Trust guide
  • Remember: Midazolam 10mg/2ml is used(not the 5mg/5ml we have  in ED)