PAEDIATRICS

ResponseMaternal GBS
Prematurity
Maternal peri-partum illness/fever/infection
PROM (>24h)

ResponseE. Coli
Group B strep
Listeria (In textbooks but very uncommon in reality)
HSV

ResponseTHE MISFITS

Trauma - NAI vs accidental. Rib trauma, shaken baby, SAh, neglect with dehydration
Heart - congenital cardiac disease (duct dependant)
Endocrine - Electolyte disturbance, CAH, HYPOGLYCAEMIA
Metabolic - Inborn errors of metabolisim, mitochondrial disorder, Fatty oxidation disorder
Iatrogenic
Sepsis - meningitis/pneumonia, Group B Strep bacteraemia
Feeding problems - formula dilution vs overconcentration
Intestinal emergencies
Toxins - NAI, Botulism/food poisoning
Seizures

ResponseEarly recognition/seeking senior help
Assess airway and breathing and administer oxygen if required

• Conscious - 15L via NRB >> HFNC 2L/kg, CPAP, BIPAP
• Unconscious - ? ETT

Rapid vascular access (IV/IO)
Empiric antibiotic therapy

• Benpen 60 mg/kg + cefotaxime 50 mg/kg
• Aciclovir 20 mg/kg IV if concerns for HSV encephalitis

Carefully titrated fluid resuscitation

• 20 mL/kg N/S + repeat after fluid status assessment being aware of overload
• If fails after 40 mL/kg reconsider diagnosis and treatment

Early initiation of inotropes

• Adrenaline 6mg in 1000 mL - start at 0.5 mL/kg/hr (=0.05 mics/kg/min)

Early involvement of critical care services
Source control
Hypoglycaemia

• BSL check + Correct - 2 mL/kg 10% dextrose

Congenital heart disease suspected

• Prostaglandin infusion

CAH suspected/refractory shock

• Hydrocortisone 25mg IV/IM

Frequent reassessment
Above from RCH as better than answer, modified with more detail
Bloods for cultures - VBG, BSL, FBC, Lactate
Full history and examination
LP (Can be delayed)
Explanation to carer
Above leftover from original answers

ResponseCommence CPR 15:2 – 2 rescuers, 100/min
Apply 100% O2 via BVM / intubate OK
IV access and fluid bolus O.9% saline 20ml/kg (or similar) (200ml)
IV adrenaline 10mcg/kg (12 month old approx. 10kg – accept 100mcg)
Seek and treat hypoglycaemia with IV 5ml/kg 10% dextrose (ie 50ml 10%)
IV antibiotics OK – ceftriaxone / cefotaxime – 50-100/kg

ResponseThere are 4 differences to adults (pretty much doses not anything else)
Ratio 15:2 (<8 years old or some references puberty)
Shock is 4 J/kg
Adrenaline is 10 mics/kg
Shockable after 2nd shock then every 2nd loop
Non shockable immediately then every 2nd loop
Amiodarone 5mg/kg after 3rd shock (shockable rhythms)
10% glucose 2 mL/kg (Some say 5 mL/kg)

ResponseYounger population more likely to have asphyxia as cause of arrest so increased emphasis on ventilation (A/B) vs compressions ©
Note BLS (as in st. John ambulance etc) says 30:2 for everyone to reduce confusion and increase bystander CPR attempts

ResponseAnswer I’m going with: 3.0-3.5 Cuffed

There are a LOT of conflicting things on this - Have seen anything from 2.5-3.5 cuffed, 3.0-4.0 uncuffed for newborn and no clear consensus.
UNCUFFED = Gestational age/10 (ie: 25 weeks =2.5, 40 wks =4.0)
CUFFED = UNCUFFED size -0.5. - Start with 3.5 cuffed

RCH:
Size of cuffed ETT (internal diameter in mm) = Age/4 + 3.5
Tubes of the size calculated above, plus tube 0.5 mm ID smaller and 0.5 mm ID larger, should all be available on the child's bed.

Depth = 10cm (oral), 12cm (nasal) in term neonate
Formulas: weight (kg) + 6, ETT size x3, 12+ Age/2

ResponseHistorically uncuffed tubes were preferred
Narrowest part of paediatric airway is subglottic
Older paediatric ETT’s had small volume, high pressure cuffs made of poorly tolerated material leading to tracheal injury and subsequent subglottic stenosis
Newer devices have large volume, lower pressure cuffs and don’t tend to cause this

ResponseBVM/Neopuff
Miller 1 blade
ETT size 3.5 cuffed
Stylette/bougie
LMA size 1
Capnography, ECG, Pulsoxymetry
Laryngoscope 1+2 Miller
Ventilator (Paediatric appropriate)
Suction catheter
Oropharyngeal/nasopharyngeal

ResponseInduction
Sux 1-2mg/kg
Midaz 0.15 mg/kg
Fentanyl 2-3 mic/kg (may cause chest wall rigidity)
Morphine 0.2mg/kg
Ketamine 1-2 mg/kg
Propofol 1mg/kg
Thiopentone 1mg/kg (2-5 mg/kg)

Rescue
Atropine 20 mics/kg

ResponseTV 6-8 mL/kg
RR 40
FiO2 titrated to saturations 95-98%

ResponseANZCOR suggests that in infants and children who are unresponsive and not breathing normally, healthcare providers should begin CPR unless they can definitely palpate a pulse within 10 seconds
CPR 15:2 rate 100/min
Apply 100% O2 via BVM (+ intubate?)
IV access and fluid bolus 20 mL/kg N/S (10 mL/kg + repeat to 40 mL/kg - APLS)
IV adrenaline 10 mics/kg
Seek and treat hypoglycaemia - IV 10% dextrose 5mL/kg
IV antibiotics

ResponseHypoxia
Hypovolaemia
Hyper/hypokalaemia
Hypothermia
HYPOGLYCAEMIA - not really but worth checking

Tamponade
Tension pneumothorax
Thrombus (Cardiac/Pulmonary)
Toxin

ResponseAllows parents to see all treatment being provided
In case of unsuccessful resuscitation allows initiation of grieving process
Can worsen staff grief around events of highly emotive resus
Potential for interference with resuscitation from parents unless dedicated staff member caring for patient (then one less in resus)