OSCE & Practical Prescribing Skills Flashcards
Broadly there are three indications for IV fluids in infants and children:
routine maintenance, replacement and resuscitation.
Replacement fluid therapy is required if there is an existing fluid deficit and the oral route is not possible or impractical.
For example:
Prolonged poor oral intake
Vomiting
Diarrhoea
Increased insensible losses (e.g. fever, excessive sweating)
Diabetic ketoacidosis
Burn injuries
Resuscitation is required if the patient is shocked. Types of shock and their underlying causes include:
Hypovolaemic: gastroenteritis, burns, diabetic ketoacidosis, heatstroke, haemorrhage
Distributive: sepsis, anaphylaxis, neurological injury (neurogenic)
Cardiogenic: congenital heart disease, arrhythmia
Obstructive: cardiac tamponade, tension pneumothorax, congenital heart disease
Clinical shock is defined by the presence of one or more of:
Decreased level of consciousness
Pale or mottled skin
Cold extremities
Prolonged capillary refill time
Weak peripheral pulses
Pronounced tachycardia/ tachypnoea
Hypotension - sign of decompensated shock and indicates that the child is critically unwell.
Children have a large physiological reserve. They will compensate until they become very unwell and then deteriorate rapidly
What fluids are given for resucictation purposes in children?
0.9% sodium chloride (write out in full) as a bolus
10ml/kg dose given over 10 minutes
What fluids are given for maintenance purposes in children?
always 0.9% sodium chloride + 5% glucose
100 ml/kg/day for the first 10kg of weight
50 ml/kg/day for the next 10kg of weight
20 ml/kg/day for weight over 20kg
What maintenance fluids are given for neonates?
Day 1 - 50ml/kg/day
Day 2 - 75 ml/kg/day
Day 3 - 100ml/kg/day
Day 4 - 120 ml/kg/day
Day 5 - 150 ml/kg/day
What should you write in the volume section of a child’s fluid prescription chart?
always 500mls (bag size) NOT the overall volume for their weight - remember the chart serves as an instruction to the nurses about what to give
The amount given to each child will be shown by the rate :
volume of fluid needed for child’s weight / 24
= rate in mls/hour
What should you write in the time/date to reassess box for a child’s fluid prescription?
review daily
What should you be sure to write in the indication section of a prescription chart for a child with an infection?
whether the infection is suspected or confirmed
What should you put for course length on the prescription chart if you are treating a suspected infection?
review pending results (e.g. of blood culture, LP)
What is the calculation for a child’s percentage dehydration?
(well weight (kg) - current weight (kg) / well weight) x 100
How can you clinically estimate a child’s percentage dehydration?
Clinical signs of dehydration are only detectable when the patient is 2.5 – 5% dehydrated. Therefore, a child that has symptoms/signs of dehydration, but no red flag features will be approximately 5% dehydrated.
If any red flag features of dehydration are present, or the child is clinically shocked, then it is common practice to assume 10% dehydration.
How do you calculate the replacement fluids that a child requires?
1% dehydration is additional 10ml/kg
2% dehydration is additional 20ml/kg
3% dehydration is additional 30ml/kg … etc etc
How do you know what a child’s surface area is in m2?
Use the BNFC
Search Body surface area in children
Use the conversion chart of weight to m2