RCEM 2022 Safe sedation in the ED and RCEM Ketamine for paediatric procedural sedation guideline. Please read these documents in full or participate in RCEM learning for further information.
Category: Paeds
COVID-19 (Paediatric multisystem inflammatory syndrome)
AKA: Paediatric Inflammatory Multi-system Syndrome – Temporally associated with SARS-CoV 2
Although COVID-19 seems a benign disease in almost all children there are increasing evidence (however rare) of a “Paediatric multisystem inflammatory syndrome”. This is a RARE and newly emerging condition and there are many questions still e.g. It is currently unclear if it is directly related to the COVID-19 pandemic.
Care of the Next Infant (CONI)
What is CONI?
Parents who have experienced a sudden and unexpected death of a baby or child often feel anxious when they have another baby. CONI is a programme working with local public healthcare providers to facilitate a service for bereaved parents to help with the anxieties around another baby.
Pneumonia – Paeds
CAP is far less common than URTI’s, however, it needs to be considered within your differentials. Depending on severity there is a guide to investigation and treatment.
Clinical Features Typically
- Cough
- Fever
- Breathing difficulties
- Tachypnoea Read more
D&V in kids
Paediatric gastroenteritis can be a pain for everyone but as with most of EM – Keep It Simple
- Not dehydrated – make sure they can tolerate fluids, and encourage hydration, think about ORT
- Dehydrated – look for the red flags that indicate they are developing shock. Use ORT unless IV indicated
- Shocked – you will need access and it will probably be difficult (IO on awake children really isn’t that bad)
Head Injury
Background
- Defined as any traumatic injury to the head other than superficial facial injuries.
- The commonest cause of death and disability in people age 1-40 in the UK.
- Account for 1.4 million ED attendances each year, 95% of these are minor head injuries that can be managed in the ED.
Diabetic Hyperglycaemia (Kids)
Diabetic children sometimes attend ED with hyperglycaemia, but not in DKA (what should we do?)
Paeds have produced some advice to follow:
- Ketones over 0.6?
- <0.6: Encourage fluids & food, may need an insulin correction
- >0.6: ask Question 2
- Are there clinical features of DKA?
- NO: Encourage fluids & food, decide Insulin correction, will need to be monitored
- YES: Will need Paeds admission
0-12yrs WETFLAG
Tips:
- If particularly BIG – go up 1-2 yrs
- If particularly SMALL – go down 1-2 yr
- Prepare ET Tubes 0.5mm bigger and smaller
- Chid’s weight known – specific calculations can be found after tables.
Boys 0-14yrs
Age | Birth | 1mth | 3mth | 6mth | 12mth | 18mth | 2yr | 3yr | 4yr | 5yr | 6yr | 7yr | 8yr | 9yr | 10yr | 11yr | 12yr | 14yr | Age |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Weight | 3.5kg | 4.5kg | 6.5kg | 8kg | 9.5kg | 11kg | 12kg | 14kg | 16kg | 18kg | 21kg | 23kg | 25kg | 28kg | 31kg | 35kg | 43kg | 50kg | Weight |
Energy | 20J | 20J | 30J | 30J | 40J | 40J | 50J | 60J | 60J | 80J | 80J | 100J | 100J | 120J | 130J | 140J | 150J | 150J | Energy |
Tube | 3.0/3.5mm | 3.5mm | 3.5mm | 4mm | 4.5mm | 4.5mm | 4.5mm | 5mm | 5mm | 5.5mm | 5.5mm | 6mm | 6mm | 6.5mm | 6.5mm | 6.5mm | 7.5mm | 8mm | Tube |
Fluid-Medical | 70ml | 90ml | 130ml | 160ml | 200ml | 220ml | 240ml | 280ml | 320ml | 360ml | 420ml | 460ml | 500ml | 500ml | 500ml | 500ml | 500ml | 500ml | Fluid-Medical |
Fluid - Trauma | 35ml | 45ml | 65ml | 80ml | 100ml | 110ml | 120ml | 140ml | 160ml | 180ml | 210ml | 230ml | 250ml | 250ml | 250ml | 250ml | 250ml | 250ml | Fluid-Trauma |
Lorazepam | 0.4mg | 0.5mg | 0.7mg | 0.8mg | 1.0mg | 1.1mg | 1.2mg | 1.4mg | 1.6mg | 1.8mg | 2.1mg | 2.3mg | 2.5mg | 2.8mg | 3.1mg | 3.5mg | 4.0mg | 4.0mg | Lorazepam |
Adrenaline 1:10'000 | 0.4ml | 0.5ml | 0.7ml | 0.8ml | 1.0ml | 1.1ml | 1.2ml | 1.4ml | 1.6ml | 1.8ml | 2.1ml | 2.3ml | 2.5ml | 2.8ml | 3.1ml | 3.5ml | 4.3ml | 5.0ml | Adrenaline 1:10'000 |
Glucose 10% (ml) | 10ml | 13ml | 19ml | 24ml | 28ml | 33ml | 36ml | 42ml | 48ml | 54ml | 63ml | 69ml | 75ml | 84ml | 93ml | 105ml | 129ml | 150ml | Glucose 10% |
Girls 0-14yrs
Age | Birth | 1mth | 3mth | 6mth | 12mth | 18mth | 2yr | 3yr | 4yr | 5yr | 6yr | 7yr | 8yr | 9yr | 10yr | 11yr | 12yr | 14yr | Age |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Weight | 3.5kg | 4.5kg | 6kg | 7kg | 9kg | 10kg | 12kg | 14kg | 16kg | 18kg | 20kg | 22kg | 25kg | 28kg | 32kg | 35kg | 43kg | 50kg | Weight |
Energy | 20J | 20J | 30J | 30J | 40J | 40J | 50J | 60J | 60J | 80J | 80J | 90J | 100J | 120J | 130J | 140J | 150J | 150J | Energy |
Tube | 3.0/3.5mm | 3.5mm | 3.5mm | 4mm | 4.5mm | 4.5mm | 4.5mm | 5mm | 5mm | 5.5mm | 5.5mm | 6mm | 6mm | 6.5mm | 6.5mm | 6.5mm | 7.5mm | 8mm | Tube |
Fluid-Medical | 70ml | 90ml | 120ml | 140ml | 180ml | 200ml | 240ml | 280ml | 320ml | 360ml | 400ml | 440ml | 500ml | 500ml | 500ml | 500ml | 500ml | 500ml | Fluid-Medical |
Fluid - Trauma | 35ml | 45ml | 60ml | 70ml | 90ml | 100ml | 120ml | 140ml | 160ml | 180ml | 200ml | 220ml | 250ml | 250ml | 250ml | 250ml | 250ml | 250ml | Fluid-Trauma |
Lorazepam | 0.4mg | 0.5mg | 0.6mg | 0.7mg | 0.9mg | 1.0mg | 1.2mg | 1.4mg | 1.6mg | 1.8mg | 2.0mg | 2.2mg | 2.5mg | 2.8mg | 3.2mg | 3.5mg | 4.0mg | 4.0mg | Lorazepam |
Adrenaline 1:10'000 | 0.4ml | 0.5ml | 0.6ml | 0.7ml | 0.9ml | 1.0ml | 1.2ml | 1.4ml | 1.6ml | 1.8ml | 2.0ml | 2.2ml | 2.5ml | 2.8ml | 3.2ml | 3.5ml | 4.3ml | 5.0ml | Adrenaline 1:10'000 |
Glucose 10% (ml) | 10ml | 13ml | 18ml | 21ml | 27ml | 30ml | 36ml | 42ml | 48ml | 54ml | 60ml | 66ml | 75ml | 84ml | 96ml | 105ml | 129ml | 150ml | Glucose 10% |
Calculations
- Energy (J) [max 150J] =4 x Weight(kg)
- Fluid Medical (ml) = 20 x Weight(kg)
- Fluid Trauma (ml) = 10 x Weight(kg)
- Lorazepam (mg) [max 4mg] = 0.1 x Weight(kg)
- Adrenaline 1:10’000 (ml) [max 10ml] = 0.1 x Weight(kg)
- Glucose 10% (ml) = 2 x Weight(kg)
Information from APLS Aide-Memoire
EMBRACE & Paediatric Critical Care
In our trust we don’t have paediatric critical care beds. However, in our region we use EMBRACE (a paediatric critical care transport team), who can transfer critically ill children to specialist centers (in or out of region).
EMBRACE
- 0114 268 8180
- Guidance
Y&H Paed Critical Care
Drugs:
- Trust guide
- Remember: Midazolam 10mg/2ml is used(not the 5mg/5ml we have in ED)
- Found in theatres control drug cupboard (see trust guide)
Paediatric Sepsis Podcast (RCPCH)
RCPCH have released a GREAT series of podcasts on paediatric sepsis. It is from a paediatric slant, but is applicable to the ED and well worth a listen [For Docs and Nurses]