Paediatric Treatment/mental health Flashcards
(36 cards)
PAEDIATRIC
Mild-moderate asthma
define and treatment
Severity classified as normal conscious state, some increased work of breathing, tachycardia, speaking in phrases/sentences.
Salbutamol pMDI with spacer at 20 min intervals, with 4 breaths per dose (100mcg per actuation)
* Small child (2-5 years old): 2-6 doses
* Medium child (6+ years old): 4-12 doses
Adequate response
* Transport with reassessment, repeat salbutamol as necessary
Inadequate response after 20 minutes
* Treat as severe asthma
PAEDIATRIC
Severe asthma
define and treatment
Severity classified as agitated/distressed, markedly increased work of breathing, including accessory muscle use/retraction, tachycardia, and speaking in words.
Salbutamol nebulised repeated at 20 min intervals if required.
o Small child (2-4 years old): 2.5mg (1.25mL)
o Medium child (5-11 years old): 2.5mg-5mg (1.25mL-2.5mL)
o (12-15 years old): 5mg (2.5mL)
Ipratropium bromide single dose
o Small child (2-4 years old): 250mcg (1mL)
o Medium child (5-11 years old): 250mcg (1mL)
o (12-15 years old): 500mcg (2mL)
PAEDIATRIC
Critical asthma
define and treatment
Severity is classified as altered conscious state, maximal work of breathing, marked tachycardia, unable to talk.
Salbutamol (all children 2-15 years) 10mg (5mL) nebulised. Repeat salbutamol at 5 min intervals if required
Ipratropium bromide nebulised
o Small/medium child (2-11 years): 250mcg (1mL)
o Adolescent (12-15 years): 500mcg (2mL)
If unable to gain IV or unaccredited in IV
Adrenaline 10mcg/kg (max 500mcg) IM repeated at 5-10 min intervals as required, with a max dose of 30mcg/kg (3 doses)
Dexamethasone 600mcg/kg oral with a max dose of 12mg
MICA ONLY
- give adrenaline IV or if not improved adrenaline infusion
Pain
Mild pain (1-3/10)
Paediatric
Paracetamol oral if not already administered in the past 4 hours
- child <12 years 15mg/kg oral liquid (presented in 120mg in 5mL) (unless < 1 month)
- Adolescent (12 - 15 years) tablet
(<60kg: 500mg)
(≥ 60kg: 1000mg
If pain is not controlled or rapid pain relief is required consider treating it as moderate
Pain
Moderate pain (4-6/10)
Paediatrics
Consider Paracetamol as per mild in combination with opioids (unless <1 month old)
Fentanyl IN
* Small child (10-17kg): 25mcg initial dose with 25mcg repeat at 5-10 min intervals (consult after 3 doses)
* Medium child (18-39kg): 25-50mcg initial dose with a 25-50mcg repeat at 5-10 min intervals (consult after 3 doses)
* Adolescent (≥ 40kg): 50-75mcg initial dose with 50-75mcg repeat at 5-10 min intervals (consult after 3 doses)
* CONSULT WITH V MEDICAL ADVISOR FOR DOSES IN CHILDREN <10KG
For mild/moderate procedural pain or unable to administer fentanyl IN:
* Methoxyflurane 3mL inhaled, 3mL repeat if required with a max dose of 6mL (presented in 3mL bottles)
Pain
Severe pain (8-10/10)
Paediatrics
Fentanyl IN +/- Methoxyflurane as per moderate pain below (consult for further doses of fentanyl IN if required)
* Small child (10-17kg): 25mcg initial dose with 25mcg repeat at 5-10 min intervals (consult after 3 doses)
* Medium child (18-39kg): 25-50mcg initial dose with a 25-50mcg repeat at 5-10 min intervals (consult after 3 doses)
* Adolescent (≥ 40kg): 50-75mcg initial dose with 50-75mcg repeat at 5-10 min intervals (consult after 3 doses)
* CONSULT WITH V MEDICAL ADVISOR FOR DOSES IN CHILDREN <10KG
For mild/moderate procedural pain or unable to administer fentanyl IN:
* Methoxyflurane 3mL inhaled, 3mL repeat if required with a max dose of 6mL (presented in 3mL bottles)
If pain persists despite opioid therapy
Adolescent (12-15 years):
* Morphine 0.05-0.1 mg/kg IV (max 5mg), which can be repeated up to 0.05mg/kg at 5-10 minute intervals (Max dose 0.2 mg/kg without consultation)
* Can give ketamine but to be done by MICA
For children <12 years old Ketamine IV and morphine IV can be given but by MICA
LAST RESORT
IM morphine 0.1mh/kg IM single dose if unable to administer IN and the IV route is unavailable
- unless the patient is heavier than their age-calculated weight, the maximum dose should not exceed 5mg
Paediatric
Anaphylaxis
SUSPECTED ANAPHYLAXIS
* stop the trigger (cease infusion, remove food or wash exposed skin)
* ANY patient with anaphylaxis (including resolved or possible anaphylaxis) or any patient who has received adrenaline for any reason, MUST be transported to the hospital as per clinical flags/patient safety
* Patient required continuous monitoring as deterioration can occur suddenly
ANAPHYLAXIS CRITERIA
Sudden onset of symptoms (usually <30 min or up to 4 hours)
AND
Two or more of R.A.S.H. +/- confirmed exposure it antigen
* R respiratory distress
* A abdominal symptoms
* S skin/mucosal symptoms
* H hypotension
Isolated hypotension following exposure to a known antigen
OR
Isolated respiratory distress following exposure to known antigen
ACTION
Do not sit or walk the patient if possible
* adrenaline 10mcg/kg IM (max 500mcg) (1:1000), repeat @ 5 minute intervals,s as required
* Request MICA if risk factors OR not responsive to initial adrenaline
* Provide high flow O2
* MICA can give an adrenaline infusion
ADDITIONAL THERAPIES IN ORDER OF CLINICAL NEED
Always prioritise adrenaline doses
Airway oedema/stridor
- (adrenaline 5mg nebulised, have to consult for repeat doses if needed and notify receiving hospital)
Broncospasam
Salbutamol nebulised or pDMI
- 12-15 yr (5mg or 4-12 doses)
- 6-11 yr (2.5 - 5mg or 4-12 doses)
- 2-5 yr (2.5mg or 2-6 doses)
Ipratropium bromide
- 12-15 yr (500mcg or 8 doses)
- 6-11 yr (250mcg or 8 doses)
- 2-5 yr (250mcg or 4 doses)
Dexamethasone (600mcg/kg IV/oral, Max 12mg (IV ROUTE MICA ONLY)
MICA ONLY Cardiovascular - hypotension despite initial adrenaline
- consider normal saline
Extremely poor perfusion OR impending cardiac arrest
MICA can give adrenaline IV/IO
Paediatric
hypoglycaemia
Evidence of possible hypoglycaemia
- diabetic, altered conscious state, agitation, pale, diaphoretic
ASSESS
- BGL
- Conscious state assessment
BGL 4-11
Consider other causes
- stroke
- Seizures
- Hypovolaemia
BGL <4 responding to commands
- glucose 15g oral
If inadequate response retry 15 minutes
- considering repeated glucose 15g oral titrated to response (max 30g)
- OR glucagon IM
MICA can give dextrose IV
BGL <4 not responding to commands
If not accredited in IV dextrose or unable to obtain IV access
- <25kg glucagon 0.5 IU (0.5 mL) IM
- >or equal to 25kg glucagon 1 IU (1 mL) IM
MICA can put IV in big vein and give dextrose 10% and normal saline
Hyperglycaemia
paediatrics
Evidence if possible hyperglycaemia
- confusion
- Dehydration
- Tachyponea
- Polydipsia (excessive thirst)
- Polyuria (Passing abnormally large amounts of urine)
- Kussmaul’s breathing (haracterized by rapid, deep breathing at a consistent pace)
ASSESS
- BGL
- Perfusion status assessment
BGL 4-11
Consider other causes
- dehydration
- sepsis
- metabolic disorders
BGL >11
Less than adequate perfusion AND clinical features of DKA/HHS
- confusion
- Dehydration
- Tachyponea
- Polydipsia
- Polyuria
- Kussmaul’s breathing
- History of diabetes
Consider antiemetic per nausea and vomiting CPG
MICA can give saline
Meningococcal septeceamia
Possibly, make sure you are wearing full PPE even
Confirm meningococcal septicaemia
typical purpuric rash
Septicaemia signs
- fever, rigor, joint and muscle pain
- Cool hands and feet
- Tachycardia, hypotension
- Tachypnoea
Meningeal signs
- headache, photophobia, neck stiffness
- Nausea and vomiting
- Altered consciousness
- Irritable or whimpering
ACTION
Have IV access - MICA can only do, to give ceftriaxone IV
No IV access
- unable to gain (MICA ONLY)
- Not IV accredited (MICA ONLY)
Give certriazone 50mg/kg IM (MAX 1000mg)
- dilute 1000mg with 3.5mL lignocaine 1%
- Administer into upper lateral thigh
Paediatric
nausea and vomiting
Actual or potential for nausea and vomiting
ASSESS
- nausea and vomiting OR
- Potential spinal injury
- Potential eye trauma
UNDIFFERENTIATED NAUSEA AND VOMITING:
Ondansetron ODT orally
- small child: 2mg
- Medium child: 4mg
- Adolescent: 4mg (repeat 4mg after 5-10min if symptoms persist - max 8mg ODT/IV or in combination)
- MICA only - if they can get IV in they can give ondansetron
PROPHYLAXIS FOR:
- awake patient GCS 13-15 with potential spinal injury and immobilised
- Eye trauma - penetrating eye injury or hyphema (when blood collects inside the front of the eye)
ACTION
Ondansetron ODT orally:
- Small child: 2mg
- Medium child: 4mg
- Adolescent: 4mg
Peadiatrics
Overdose
OPIOID-NAIVE
Naloxone 10mcg/kg IM (max 800mcg)
- repeat once at 10 minutes if required
MICA only - naloxone IV
OPIOID DEPENDENT
Naloxone 1-2mcg/kg IM (max 100mcg)
- repeat once at 10 minutes if required
- MICA only - Naloxone IV
TRANSPORT
any of the following:
- unable to maintain airway
- SpO2 <92% on room air
- Age <16 or >65
- Suspected aspiration
- APO
- Incomplete response to two doses of Naloxone
- Suspected opioid other than heroin including synthetic opioids
- Pregnancy
Action we do
Transport & monitor
- vital signs
- SpO2
- Nasal capnography may be used
Or
Referral
All of:
- IV opioid only
- Normal vital signs including GCS 15
- SpO2 >or equal on room air
- Chest clear on auscultation
- Competent adult available to supervise for 4 hours
Actions we do
- non transport may be appropriate
- Supply intranasal Naloxone to family/friends where community pack available
- Consider referral to drug support service
Safety netting
- Avoid other sedating agents e.g. alcohol, benzodiazepines
- Local resources
- Provide opioid health information
Paediatric
seizures
SEIZURE ACTIVITY - ASSESS/MANAGE
- evidence of status epilepticus (>equal to 5 minutes of or >equal to 2 seizures without recovery), with GCSE or other SE (including subtle SE)
- Consider other causes e.g. hypoglycaemia, hypoxia, head trauma, stroke/ICH, electrolyte disturbance, meningitis
- Consider p patients own management plan and prescribed medication already given
SEIZURE ACTIVITY CEASED/OTHER SE/SUBTLE SE
- BLS
- Continue to monitor airway, ventilation, conscious state and BP
- If subtle SE suspected, consider time-critical transport to hospital and consult clinician for Midazolam IM
GENERALISED CONVULSIVE SE
- manage airway and ventilation as required
- if airway patent, administer high-flow O
Midazolam
- adolescent (12-15): 5mg IM
- Medium child (5-11): 2.5-5mg IM
- Small child (1-4): 2.5mg IM
- small and large infant (<12 months)1mg IM
- Newborn (birth to 24 hours) 0.5mg
Conti use to monitor airway, ventilation, conscious state and BP
SEIZURE ACTIVITY CEASES
- BLS
- Continue to monitor airway, ventilation, conscious state and BP
SEIZURE ACTIVITY CONTINUES >5 MINUTES
MICA ONLY - get IV access and give Midazolam IV
- can endotracheal intubate if needed
SEIZURE ACTIVITY CONTINUES > 10 MINUTES
no IV access/accreditation
- Repeat original Midazolam IM dose once only
- Consult for further doses
- Continue to monitor airway, ventilation, conscious state and BP
Paeditratics
Croup
MILD ASSESSMENT/TREATMENT
- behaviour: normal
- Stridor: none or only when active
- Respiratory rate: normal
- Accessory muscle use: none
- SpO2: >equal to 96%
Care
- DEXAMETHASONE:
150mcg/kg oral (max 12mg)
- Self care
- Safety netting
- Provide RCH croup factsheet
Disposition: self care
Paeditratics
Croup
MODERATE ASSESSMENT/TREATMENT
- behaviour: intermittent mild agitation
- Stridor: intermittent at rest
- Respiratory rate: increased
- Accessory muscle use: moderate chest wall retraction
- SpO2: >equal to 96%
Care
- dexamethasone:
150mcg/kg oral (max 12mg)
Disposition: VED ambulance referral
Paeditratics
Croup
SEVERE ASSESSMENT/TREAMENT
- behaviour: increasing agitation/drowsiness
- Stridor: persistent at rest/ decreasing (late sign)
- Respiratory rate: marked increase/decrease (late sign)
- Accessory muscle use: marked chest wall retraction
- SpO2: <96%
CARE
ADRENALINE:
(Adrenaline 5mg (5mL, 1:1000) nebulised at 5 minute intervals until improvements)
DEXAMETHASONE (high dose):
(Dexamethasone (high dose): 600mcg/kg oral (max 12mg
Disposition: transport
DOSE TABLE
for croup mediction
Dexamethasone: 150mcg/kg oral (max 12mg)
Dexamethasone (high dose): 600mcg/kg oral (max 12mg)
Adrenaline 5mg (5mL, 1:1000) nebulised at 5 minute intervals until improvements
Unconscious patient asthma paediatric
Unconscious/becomes unconscious with poor or no ventilation but still with cardio output
PATIENT REQUIRES ASSISTED VENTILATION
ACTION
Ventilate: Use ventilation sufficient to achieve rise and fall of the chest
- small child 12-15 ventilations/minute
- Medium child 10-14 ventilations/minute
- Adolescent 5-8 ventilations/minute
Moderately high respiratory pressures
Allow for prolonged expiratory phase
Gentle lateral chest pressure during expiration
ADEQUATE RESPONSE
Treat as per critical asthma
INADEQUATE RESPONSE
- treat as per critical asthma
- MICA can intubate
If patient loses cardiac output at any stage move to loss of cardiac output asthma CPG
Loss of cardiac output asthma paediatric
Patient loses cardiac output
PATIENT REQUIRED IMMEDIATE INTERVENTION
Apnoea 30 seconds
- exclude TPT
- gentle lateral chest pressure
- Prepare for potential resuscitation
CARDIAC OUTPUT RETURNS
Treat as per unconscious asthma
CAROTID PULSE, NO BP
MICA can give adrenaline and normal saline IV
NO RETURN OF CARDIO OUTPUT
Manage per approximate cardiac arrest medical CPG
Paediatrics upper airway obstruction
SUSPECTED UPPER AIRWAY OBSTRUCTION
- newborns: not recommend for this guideline. Use suctioning as per CPG newborn
ASSESS
Identify possible cause
PARTIAL OBSTRUCTION
Effective cough
ACTION
passive technique
- encourage cough
- Utilise gravity
- Maintain basic life support
PARTIAL OBSTRUCTION
Ineffective cough
ACTION
Use manual technique as required
- Utilise gravity
- Back slaps alternating with chest thrusts
IF unconscious or becomes unconscious
- chest compressions
- Suction
- Magill’s forceps
- Forced ventilation
IF loss cardiac output
- treat as per cardiac arrest
CROUP
- treat per CPG
SUSPECTED EPIGLOTTIS
Do not inspect airway
ACTION
- Basic life support
- Treatment
Sedation assessment - SAT assessment
+3
Responsiveness
- combative, violent out of control
Speech
- continual loud outburst
Sedation agent
KETAMINE
IM
- <60kg: 200mg
- 60-90kg: 300mg
- >90kg: 400mg
IV
50-100mg
Sedation assessment - SAT assessment
+2
Responsiveness
- very anxious and agitated
Speech
- loud outburst
Sedation agent
DROPERIDOL - IM/IV
- 5-10mg repeat 5-10mg after 15 minutes if required (once only) OR
- 5mg (<60kg/frail/elderly/sedation from drugs or alcohol) repeat 5mg after 15 minutes if required (once only)
Sedation assessment - SAT assessment
+1
Responsiveness
- anxious/restless
Speech
- normal/talkative
Sedation agent
OLANZAPINE - ORAL
- 10mg repeat initial dose after 20 minutes if required (once only) OR
- 5mg (<60kg/frail/elderly/sedation from drugs of alcohol) repeat initial dose after 20 minutes if required (once only)
Sedation assessment - SAT assessment
0
Responsiveness
- awake and calm/cooperative
Speech
- speaks normally
Sedation
- none
