Peadiatrics CPG Flashcards
<12 years of age
.
Cardiac arrest
Ratios for resp and compressions
Single and 2 responders
- intubated and non intubated
Hypothermia arrest
Remain unresponsive
Non intubated
- 30:2 single responder or 15:2 two paramedics
- 100-120 compressions minute
Intubated or LMA
- Ventilate at @10/min
- 100-120 compressions per min
Hypothermic arrest
- <30 deg double interval for adrenaline
>3 DCCS unlikely to be successful unless re warming
Initial mx
- BVM ventilation with OPA/NPA
- attach multifunction electrode pads
Remain unresponsive
- start CPR when unresponsive and or pulse less/HR <40 (child) <60 (infant)
- if shockable rhythm shock at 4 joule/kg
Seizures
Airway and ventilate
If parent high flow 02
Midazolam Med child 5-11 yr 2.5-5mg IM Small child 1-4 yr 2.5mg IM Small and large infant (up to 12 months) 1mg IM newborn 0.5mg IM
Repeat 10/60 if seizure continues
Pain Relief
Mild pain- Paracetamol 15mg/kg
Moderate pain:
Fentanyl
- Small child (10-17kg) 25mcg IN
- Medium child (18-39kg) 25-50mcg IN
Repeat initial dose 5-10min intervals (consult after 3 doses)
- Consult for <10kg RCH
Consider Paracetamol as per mild
Unable to administer IN Fentanyl/Procedural pain-
Methoxy 3ml
Repeat 3ml
Severe pain:
IN Fentanyl +/- methoxy
Upper airway obstruction
Stop point
Epiglottitis
Croup severity and management
STOP
- Nil back blows to newborn
- Do not inspect airway if Epiglottitis is suspected
- Mx FBAO as per CWI
Epiglotittis
- stridor, inc WOB, drooling and absence of cough is suggestive of epiglottitis
- Other indications include low pitched exp. Stridor/snore and pt preferring to sit in tripod or sniffing position
CROUP
Mild
Stridor/barking cough only present when active or upset
normal RR, none or minimal WOB, no o2 required.
Moderate Some irritability Some stridor at rest Inc RR, tracheal tug and nasal flaring Mod chest wall retractions no o2
Severe Increasing irritability and or lethargy Stridor at rest Marked inc or dec in RR tracheal tug/nasal flaring Marked chets wall retraction Hypoxaemia late stage
Moderate Croup mx
Dexamethesone 600mcg/kg oral (max 12mg)
(if not already admin)
Adrenaline 5mg/5ml (1:1000) neb
If unimproved Rpt Adrenaline 5/60
Asthma Stop point Severity Mild- mod Severe Critical
STOP
Monitor spo2
spo2 improvement may not be a sign of pt improvement
salbutamol isnt indicated for age <2 yr
Severity Mild-Mod CS normal WOB Increased Tachycardia Speech phrases and sentences
Severe CS distressed WOB markedly increased tachycardic Words only
Critical CS altered WOB maximal Marked tachy Unable to speek
Mild-Moderate MX
- Salbutamol pMDI and spacer
>6 yr 4-12 doses
2-5yr 2-6 doses
Severe Salbutamol nebulised - Small child 2-4yr 2.5mg (1.25ml) - Med child (5-11yr) 2.5-5mg (1.25-2.5ml) Rpt 20/60 if req
- Ipatropium Bromide 250mcg (1ml) neb
Critical
- Salbutamol neb 10mg (5ml)
rpt 5/60 if req
- ipatropium Bromide 250mcg (1ml) neb
- Adrenaline 10mcg/kg IM
Rpt 5-10/60 as req (max 30mcg/kg) - Dexamethesone 600mcg/kg IV/oral (max 12 mg)
- note IV route for MICA only)
Asthma Unconscious
Stop point
mx
STOP
- LOC requires immediate assisted ventilation
- Over ventilation may cause barotrauma or compromise perfusion
- accept high etco2
Unconsious
- ventilate to achieve rise and fall of chest
- small child (2-4yr) 12-15 vent/min
- Med child (5-11yr) 10-14 vent/min
Loss of cardiac output (asthma)
Stop point
mx
STOP
- Loss of cardiac output req immediate mx
- over ventilation may cause barotrauma or compromise perfusion
Mx
- Apnoea 30sec
- consider lateral chest pressure
- exclude TPT
- if pulse doesnt return tx as Cardiac Arrest
Nausea and Vomiting
Undifferentiated N+V
- ODT
Small child 2mg
Med child 4mg
Prophylaxis
For awake pt with suspected spinal injury or eye trauma
ODT as above
Hypoglycaemia
BGL < 4 Responding to commands
- Glucose 15g oral
- if inadequate response after 15/60
Consider rpt Glucose 15g once or Glucagon IM
BGL <4 Non responding to commands
- If not accredited in IV Dextrose or unable to gain IV access
- <25kg Glucagon 0.5 IU (0.5ml) IM
>25kg 1 IU (1ml) IM
Hyperglycaemia
-Clinical features of DKA/HHS
Confusion Dehydrated Tachypnoea Polydipsia Polyuria Kussmaul's breathing Hx diabetes
BGL >11 AND clinical features of DKA/HHS AND less than adequate perfusion - consider antiemetic as per N+V
MICA for fluids.
Anaphalaxis
Remove antigen
RASH
10mcg Adrenaline IM/kg (max 500mcg) (1:1000)
- repeat 5/60
Request MICA if risk flags or unresponsive to Adrenaline
- high flow o2
Airway Oedema/Stridor - Adrenaline 5mg neb Bronchospasm - Salbutamol neb/pMDI repeat 20/60 as required 2-5 Yr 2.5mg neb, or 2-6 puffs 6-11 Yr 2.5mg to 5 mg neb, or 4-12 puffs
Ipatropium
6-11YR 250mcg neb or 8 puffs
2-5YR 250mcg or 4 puffs
Dexamethasone 600mcg/kg (max 12mg) oral/IV
