Life-threatening emergencies:essential knowledge

essential knowledge

Weight: (1 kg = 2·2 lb)

Infant: 0–1 years = 3–10 kg 5 months: double birth weight 12 months: treble birth weight After 1 year: wt in kg = 2 (age + 4) 2 years: quadruple birth weight.

Airway and breathing (endotracheal intubation) − under 25 kg = uncuffed

Full term infant = 3·0–3·5 mm ID Infant < 1 year = 4·0–4·5 mm ID Child > 1 year = age/4 + 4 ID.                    Age + 12 cm for oral tube Length of tube =                      2+ 14 cm for nasal tube

Circulation (dehydration treatment: deficit in ml = % dehydration × weight in kg × 10) Blood pressure systolic = 80 + (age year × 2) Cuff must be   two-thirds size of upper arm and the largest that will fit Capillary refill = 2 seconds or less after 5 seconds pressure   (sternum) Drip rates for clear fluids: (standard giving set)   20 drops = 1 ml   ml/h divided by 3 = drops/min Minimum urine output: > 1 ml /kg/h in children, > 2 ml/kg/h   in infants 12 ml /kg/24 h if > 1 year 15 ml/kg/24 h if an infant 24 ml /kg/24 h if preterm increased if in hot climate by around 50% increased if fever by 50% Fluid management Blood volume is 100 ml/kg at birth falling to 80 ml/kg at 1 year. Total body water varies from 800 ml/kg in the neonate to 600 ml/kg at one year and thereafter. Of this about two thirds (400 ml/kg) is intracellular. Clinically, dehydration is not detectable until >5% (50 ml/kg). Insensible losses: 300 ml/m2/24 h or 12 ml /kg/24 h if > 1 year 15 ml/kg/24 h if an infant 24 ml /kg/24 h if preterm increased if in hot climate by around 50% increased if fever by 50% Fluid management Blood volume is 100 ml/kg at birth falling to 80 ml/kg at 1 year. Total body water varies from 800 ml/kg in the neonate to 600 ml/kg at one year and thereafter. Of this about two thirds (400 ml/kg) is intracellular. Clinically, dehydration is not detectable until >5% (50 ml/kg). Fluid requirements: Replace insensible losses through sweat, respiration, gastrointestinal loss etc. Replace of essential urine output, the minimal urine output to allow excretion of the products of metabolism etc. Extra fluid to maintain a modest state of diuresis. Fluid to replace abnormal losses such as blood loss, severe diarrhoea, diabetic polyuria losses etc. Essential drug doses Aminophylline: IV loading dose 5 mg/kg over 20 minutes   (max = 250 mg) then 1 mg/kg/h by IV infusion Benzyl penicillin: 50 mg/kg IV 4–6 hourly Cefotaxime: IV 50 mg/kg 6 hourly Diazepam IV or IO 100–250 micrograms/kg or rectal 500   micrograms/kg (max = 10 mg) Lorazepam IV or IO 50–100 micrograms/kg Paraldehyde rectal or IM 0·4 ml/kg (max 10 ml rectal, 5 ml IM   at one site) Epinephrine (adrenaline): 10 micrograms/kg (0·1 ml/kg 1 in   10 000 or 0·01 ml/kg of 1 in 1000) Epinephrine: 1 in 1000 = 1 mg/ml: 1 in 10 000 = 100   micrograms/ml Fluid resuscitation: 20 ml/kg 0·9% saline or colloid or blood   (10 ml/kg in neonate) Frusemide: 1 mg/kg IV Glucose: 5 ml/kg of 10% IV (0.5 g/kg) Mannitol: 250–500 mg/kg IV over 20 minutes Morphine: IV 100 micrograms/kg over 5 minutes (50–100   micrograms/kg in the neonate) Salbutamol: 100–1000 micrograms inhaler (1–10 sprays) or   nebuliser (dose 2·5 mg < 5 years and 5 mg > 5 years) Salbutamol: IV loading dose = 4–6 micrograms/kg over   15 minutes monitor ECG and ensure K+ normal Sodium bicarbonate: 1 mmol/kg (= 2 ml/kg of 4·2%). Disability Assessment of neurological function (AVPU) (see page 29 for   modified Glasgow Coma Scale) A = alert, V = responds to voice, P = responds to pain, U =   unresponsive. Pupillary size and reaction, posture, muscle tone, presence   of convulsive movements.