Advanced Paediatric Life Support (eBook)

A Practical Approach to Emergencies

Stephanie Smith (Herausgeber)

eBook Download: EPUB

2023 | 7. Auflage
528 Seiten
Wiley (Verlag)
978-1-119-71617-4 (ISBN)

Infos

ADVANCED PAEDIATRIC LIFE SUPPORT
A PRACTICAL APPROACH TO EMERGENCIES

The gold standard for treating paediatric emergencies

Advanced Paediatric Life Support: A Practical Approach to Emergencies is the internationally renowned manual on emergency paediatric care. Written to support the course run by the Advanced Life Support Group, the book uses their structured approach: a tried and tested practical method of treating children during the crucial first few hours of a life-threatening illness or injury. Advanced Paediatric Life Support is used by doctors, nurses and allied health professionals dealing with emergencies in children. Its clear layout and straightforward style make it a highly practical tool both for training and in the event of an emergency.

In the seventh edition you will find descriptions of both common and uncommon paediatric emergencies which you may encounter in clinical practice, their causes, and how to best treat them during the first hours after presentation.

This book offers a thoroughly evidence-based approach to its subject, which includes:

• The latest International Liaison Committee on Resuscitation (ILCOR) 2021 guidelines
• A thorough introduction to the structured approach to paediatric emergencies, including important non-technical skills and communication
• Comprehensive explorations of the seriously ill child, including airway and breathing, circulation, decreased consciousness, seizures and exposure
• Practical discussions of the seriously injured child, including examinations of chest, abdominal, brain and spinal injuries
• Evidence-based life support treatment and the practical application of the Advanced Paediatric Life Support structured management

Perfect for emergency care physicians, nurses and other allied health professionals, Advanced Paediatric Life Support: A Practical Approach to Emergencies will also benefit paediatric clinicians, doctors-in-training and anyone else with an interest in the team management and treatment of paediatric emergencies.

Autor

Advanced Life Support Group (ALSG), Manchester, UK. ALSG's medical education & training programmes improve outcomes for people in life-threatening situations, anywhere along the health care pathway, anywhere in the world. As a charity, ALSG invests all profits in educational resources and partners with the most effective and respected organisations worldwide to develop exceptionally high-quality programmes. ALSG education quality is verified, accredited and internationally recognised as 'best in class', contributing to better outcomes for patients in life-threatening situations. Stephanie Smith, PhD, is Emergency Paediatric Consultant, Clinical Director at Nottingham Children's Hospital.

Inhalt

Contributors to seventh edition vii

Foreword xi

Preface to first edition xii

Preface to seventh edition xiii

Acknowledgements xv

Contact details and further information xix

PART 1: Introduction 1

1 Introduction and structured approach to paediatric emergencies 3

2 Getting it right: non-technical factors and communication 19

PART 2: The seriously ill child 29

3 Structured approach to the seriously ill child 31

4 Airway and Breathing 45

5 Circulation 65

6 Decreased conscious level (with or without seizures) 93

7 Exposure 115

PART 3: The seriously injured child 125

8 Structured approach to the seriously injured child 127

9 The child with chest injury 147

10 The child with abdominal injury 157

11 The child with traumatic brain injury 161

12 The child with injuries to the extremities or the spine 173

13 The burned or scalded child 183

14 The child with an electrical injury 191

15 Special considerations 195

PART 4: Life support 207

16 Basic life support 209

17 Support of the airway and ventilation 227

18 Management of cardiac arrest 245

PART 5: Practical application of APLS 259

19 Practical procedures: airway and breathing 261

20 Practical procedures: circulation 277

21 Practical procedures: trauma 295

22 Imaging in trauma 309

23 Structured approach to stabilisation and transfer 323

PART 6: Appendices 337

Appendix A Acid-base balance and blood gas interpretation 339

Appendix B Fluid and electrolyte management 357

Appendix C Paediatric major trauma 371

Appendix D Safeguarding 375

Appendix E Advance decisions and end of life 383

Appendix F General approach to poisoning and envenomation 397

Appendix G Resuscitation of the baby at birth 419

Appendix H Drowning 439

Appendix I Point of care ultrasound 445

Appendix J Formulary 455

List of algorithms 477

Working group for seventh edition 479

References and further reading 481

Index 487

How to use your textbook 508

Textauszug

CHAPTER 1
Introduction and structured approach to paediatric emergencies

Learning outcomes

After reading this chapter, you will be able to:

• Appreciate the focus and principles of the APLS course
• Describe the structured approach to identifying and managing paediatric emergencies
• Identify the important differences in children and the impact these have on the management of emergencies
• Appreciate that the absolute size and relative body proportions change with the age of the child
• Identify the approach to triage of a child

1.1 Introduction

The Advanced Paediatric Life Support (APLS) course equips those caring for children with the necessary skills and structured approach to identify and safely manage ill or injured children whenever or wherever they encounter them.

Children continue to die from preventable causes throughout the world. The reasons for their deaths differ between countries, however the structure and principles for managing the underlying causes are universal.

Child mortality is the lowest it has ever been and has halved in the last three decades, which is a huge achievement (12.5 million deaths of under 5‐year‐olds worldwide in 1990 compared with 5 million in 2020).

Worldwide data from the World Health Organization (WHO) show the leading cause of death in this age group is pneumonia, followed by preterm birth and then diarrhoeal illnesses. This compares with recent data from the USA showing the leading cause in children to be gun‐related injuries. In the UK, Office for National Statistics (ONS) data show that cancer is the leading cause of death in all children followed by accidents and then congenital abnormalities.

The COVID‐19 pandemic has not directly had a significant impact on child mortality. However, there are ongoing concerns about the indirect impact due to strained and under‐resourced health systems; a reduction in care‐seeking behaviours; a reduced uptake of preventative measures such as vaccination and nutritional supplements; and socioeconomic challenges.

1.2 The APLS approach

In the structured approach it is essential to remember that:

• The child’s family will need support from a qualified member of the team
• Absolute size and body proportions change with age
• Observations and therapy in children must be related to their age and weight
• The psychological needs of children must be considered
• It is key to support each other as the clinical team

Physiological differences

Children, especially young ones, have significantly lower physiological reserves than adults. As a consequence, they may deteriorate rapidly when severely ill or injured and respond differently from adults to various interventions. It is essential to manage and support their respiratory and cardiovascular systems in a timely and structured manner to prevent further deterioration or even cardiovascular arrest. (See normal ranges table, inside front cover.)

Relationship between disease progression and outcomes

The further a disease process is allowed to progress, the worse the outcome is likely to be. The outcomes for children who have a cardiac arrest out of hospital are generally poor. This may be because cardiac arrest in children is less commonly related to cardiac arrhythmia, but is more commonly a result of hypoxaemia and/or shock with associated organ damage and dysfunction. By the time that cardiac arrest occurs, there has already been substantial damage to various organs. This is in contrast to situations (more common in adults) where the cardiac arrest is the consequence of cardiac arrhythmia – with preceding normal perfusion and oxygenation. Thus the focus of the course is on early recognition and effective management of potentially life‐threatening problems before there is progression to respiratory and/or cardiac arrest (Figure 1.1).

Figure 1.1 Pathways leading to cardiac arrest in childhood (with examples of underlying causes)

ICP, intracranial pressure

Standardised structure for assessment and stabilisation

A standardised approach for resuscitation enables the provision of a standard working environment and access to the necessary equipment to manage ill or injured children. The use of the standardised structure enables the whole team to know what is expected of them and in which sequence.

Once basic stabilisation has been achieved, it is appropriate to investigate the underlying diagnoses and provide definitive therapy.

Definitive therapy (such as surgical intervention) may be a component of the resuscitation

Resource management

Provision of effective emergency treatment depends on the development of teams of healthcare providers working together in a coordinated, well‐led manner (Figure 1.2). It is important that all training in paediatric life support focuses on how to best use the equipment and human resources available and emphasises the key nature of effective communication.

Figure 1.2 Advanced paediatric life support (APLS) in action

Early referral to appropriate teams for definitive management

Emergency departments are unlikely to be able to provide definitive management for all paediatric emergencies, and a component of stabilisation of critically ill or injured children is the capacity to call for help as soon as possible, and where necessary transfer the child to the appropriate site safely.

Ongoing care until admission to appropriate care

In most parts of the world it is impossible to transfer critically ill children into intensive care units or other specialised units within a short time of their arrival in the emergency area. Therefore, it is important to provide training in the ongoing therapy that is required for a range of relatively common conditions once initial stabilisation has been completed.

1.3 Important differences in children

Children are a diverse group, varying enormously in weight, size, shape, intellectual ability and emotional responses. At birth a child is, on average, a 3.5 kg, 50 cm long individual with small respiratory and cardiovascular reserves and an immature immune system. They are capable of limited movement, have immature emotional responses though still perceive pain and are dependent upon adults for all their needs. At the other end of childhood, the adolescent may be more than 60 kg, 160 cm tall and look physically like an adult, often exhibiting a high degree of independent behaviour but who may still require support in ways that are different from adults.

Competent management of a seriously ill or injured child who may fall anywhere between these two extremes requires a knowledge of these anatomical, physiological and emotional differences and a strategy of how to deal with them.

Weight

The most rapid changes in weight occur during the first year of life. An average birth weight of 3.5 kg will have increased to 10 kg by the age of 1 year. After that time weight increases more slowly until the pubertal growth spurt. This is illustrated in the weight charts shown in Figure 1.3.

As most drugs and fluids are given as the dose per kilogram of body weight, it is important to determine a child’s weight as soon as possible. The most accurate method for achieving this is to weigh the child on scales; however, in an emergency this may be impracticable. Very often, especially with infants, the child’s parents or carer will be aware of a recent weight. If this is not possible, various formulae or measuring tapes are available. The Broselow or Sandell tapes use the height (or length) of the child to estimate weight. The tape is laid alongside the child and the estimated weight read from the calibrations on the tape. This is a quick, easy and relatively accurate method. Various formulae may also be used although they should be validated to the population in which they are being used.

If a child’s age is known, the normal ranges table will provide you with an approximate weight (inside front cover) and allow you to prepare the appropriate equipment and drugs for the child’s arrival in hospital. Whatever the method, it is essential that the carer is sufficiently familiar with the tools to use them quickly and accurately under pressure. When the child arrives, you should quickly review their size to check if it is much larger or smaller than predicted. If you have a child who looks particularly large or small for their age, you can go up or down one age group.

Figure 1.3 Example of centile chart for weight in girls (2–18 years)

©Reproduced with kind permission of RCPCH and Harlow Printing Limited

Anatomical

As the child’s weight increases with age the size, shape and proportions of various organs also change. Particular anatomical changes are relevant to emergency care.

Airway

The airway is influenced by anatomical changes in the tissues of the mouth and neck. In a young child the occiput is...

Produkt-Details

• Erscheint lt. Verlag: 10.7.2023
• Reihe/Serie: Advanced Life Support Group
• Reihe/Serie: Advanced Life Support Group
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Allgemeines / Lexika
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Notfallmedizin
• Schlagworte: Acute, Critical & Emergency Care • Emergency Medicine & Trauma • Intensiv- u. Notfallpflege • Krankenpflege • Medical Science • Medizin • Notfallmedizin • Notfallmedizin u. Traumatologie • nursing • Pädiatrie • Pediatrics
• ISBN-10: 1-119-71617-9 / 1119716179
• ISBN-13: 978-1-119-71617-4 / 9781119716174