Paediatric Advanced Life Support Kit
The paramedic may ask you for equipment. Be familiar with the appropriate sized pieces of equipment.
BLS ratio for patients aged infant to puberty
15:2 @ 100-120
children and infants responses to illness
Severely unwell children can appear well then suddenly collapse.
More respiratory cause than cardiac in arrests.
Paediatric assessment triangle
Appearance.
Work of breathing.
Circulation to skin.
TICLS
Tone. Inter-activeness. Consolability. Look/Gaze. Speech/Cry.
CLITS
Consolability. Look/Gaze. Interactiveness. Tone. Speech/Cry.
Work of Breathing - assessment - Effort
Respiratory rate. Recession. Accessory muscle. Nasal flare. Stridor & Wheeze. Expiratory grunting.
Work of breathing - assessment - Efficiency & Effect
Chest expansion. Air entry. Pulse rate. Colour. Mental status.
Circulation to skin
Colour.
Capillary refill.
Warmth of skin.
Respiratory Emergencies
Common 30-40% of acute admissions in children.
Potentially life threatening.
Early recognition and treatment saves lives.
Respiratory Emergencies - Assessment
Effort of breathing.
Efficiency of breathing.
Effects of respiratory inadequacy.
Signs of deterioration
Increasing recession. Increasing respiratory rate. Fatigue. Altered mental status. Cyanosis.
Upper Airway Emergency causes
Croup.
Inhaled foreign body.
Anaphylaxis.
Epiglottitis.
Upper Airway Emergencies - Acute upper airway obstructions are:
Infections.
Foreign bodies.
Angiodema (swelling i.e lips).
Trauma.
Croup - signs and symptoms
Common. Not usually life threatening. Viral infection. Age 6months - 9yrs. Gradual onset. Harsh stridor. Barking cough. No drooling. Temperature <38.5. Able to drink.
Epiglottitis - signs and symptoms
Rare. Life threatening. Bacterial infection. Age 2-6yrs. Rapid onset. Soft stridor. Looks very unwell. Quiet, sitting up. Drooling. Temperature >38.5. Unable to drink.
Upper Airway Emergency - management
Maintain the airway.
Minimise time on scene.
Do not agitate the child.
Anaphylaxis - signs and symptoms
Severe allergic reaction.
Respiratory difficulty.
Hypotension.
Anaphylaxis - treatment
ABCDE. IV fluid. IM adrenaline. Chlorphenamine. Hydrocortisone.
Acute Asthma - information
Still results in death.
Night/early morning presentation.
Precipitated by infection/pollen.
Acute inflammation of the airways - wheeze, mucus, plugging, hypoxia, dehydration.
Complication of Acute Asthma can be…
A Spontaneous Pneumothorax.
Acute Asthma - Indicators of severity
Wheeze = poor. Accessory Muscle = better SPO2 = poor Respiratory rate = better ETCO2 = better
Severe Asthma - signs and symptoms
Too breathless to feed or talk. Recession/use of accessory muscles. RR >50 (2-5yrs). RR >30 (5-18yrs). HR >120BPM. Peak flow < 50% predicted.
Life Threatening Asthma - signs and symptoms
Agitated/altered level of consciousness.
Poor respiratory effort/exhaustion.
Reduced RR.
SPO2 <33%.
Asthma Management
Calm.
High flow oxygen.
Nebulisers: salbutamol 2.5mg & ipratropium bromide 0.125-0.25mg.
In hospital: Steroids. Magnesium sulphate. IV salbutamol. Antibiotics.
Bronchiolitis - information
50% of infants will suffer form it during first 2 years of life.
Seasonal.
Viral.
Wheeze/cough.
Respiratory distress.
Apnoea (suspension of external breathing).
Asthma & Bronchiolitis - treatment
Oxygen.
Salbutamol (para)
Ipratropium bromide (para)
Hydrocortisone (para)
Pneumonia - signs & symptoms
Fever. Lethargy. SOB. Pleuritic chest pain. Responsible for 150 deaths per annum.
Inhaled foreign body - signs & symptoms
Inspiratory stridor (creaking or grating noise)/apnoea.
Sudden onset.
History of coughing/gagging.
Unilateral wheezing.
Inhaled foreign body - treatment
Never perform blind finger sweep. Back blows. infants 1yr = 5 x abdominal thrusts. Check mouth. Repeat. Open airway. 5 x ventilations. BLS. Laryngoscopy (para)
Convulsing child - Simple Febrile
<15 mins, do not recur within 24 hrs
Convulsing child - Complex Febrile
> 15 mins, recurs within 1hr-24hrs
Convulsing child - Status Febrile
> 30 mins
Convulsing child - causes
Febrile.
Epilepsy
Other causes.
Convulsing child - treatment
Protect patient. ABC. BM measurement. Oxygen. Dextrose 40% gel (para) IM glucagon (para). IV glucose (para) Glucose (para). Diazepam (para).
Poisoning - assessment
Intentional by child. Accidental. Deliberate by adult. Admit all overdoses. Psychiatric involvement.
Meningococcal septicaemia
Respiratory rate and effort increase. Heart rate increase. Capillary refill increase. Skin cool, mottled. SpO2 <95%. Temperature increase. 1 in 10 cases fatal.