OXFORD MEDICAL PUBLICATIONS Emergencies in Paediatrics and Neonatology Published and forthcoming titles in the Emergencies in … series: Emergencies in Adult Nursing Edited by Philip Downing Emergencies in Anaesthesia Edited by Keith Allman, Andrew McIndoe, and Iain H. Wilson Emergencies in Cardiology Edited by Saul G. Myerson, Robin P. Choudhury, and Andrew Mitchell Emergencies in Children’s and Young People’s Nursing Edited by E.A. Glasper, Gill McEwing, and Jim Richardson Emergencies in Clinical Surgery Edited by Chris Callaghan, Chris Watson and Andrew Bradley Emergencies in Critical Care, 2e Edited by Martin Beed, Richard Sherman, and Ravi Mahajan Emergencies in Gastroenterology and Hepatology Marcus Harbord and Daniel Marks Emergencies in Mental Health Nursing Edited by Patrick Callaghan Emergencies in Obstetrics and Gynaecology Edited by S. Arulkumaran Emergencies in Oncology Edited by Martin Scott-Brown, Roy A.J. Spence, and Patrick G. Johnston Emergencies in Paediatrics and Neonatology, 2e Edited by Stuart Crisp and Jo Rainbow Emergencies in Palliative and Supportive Care Edited by David Currow and Katherine Clark Emergencies in Primary Care Chantal Simon, Karen O’Reilly, John Buckmaster, and Robin Proctor Emergencies in Psychiatry, 2e Basant Puri and Ian Treasaden Emergencies in Radiology Edited by Richard Graham and Ferdia Gallagher Emergencies in Respiratory Medicine Edited by Robert Parker, Catherine Thomas, and Lesley Bennett Emergencies in Sports Medicine Edited by Julian Redhead and Jonathan Gordon Head, Neck and Dental Emergencies Edited by Mike Perry Medical Emergencies in Dentistry Nigel Robb and Jason Leitch Emergencies in Paediatrics and Neonatology Second edition Edited by Stuart Crisp FRCPCH , FRACP (Paeds) Consultant Paediatrician, Orange Health Service, Honorary Clinical Lecturer, University of Sydney, New South Wales, Australia and Jo Rainbow MRCPCH , FRACP (Paeds) Staff Specialist, Orange Health Service, New South Wales, Australia 1 1 Great Clarendon Street, Oxford OX2 6DP Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries © Oxford University Press 2013 The moral rights of the authors have been asserted First Edition published 2007 Second Edition published 2013 Impression: 1 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by licence or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this work in any other form and you must impose this same condition on any acquirer British Library Cataloging in Publication Data Data available ISBN 978–0–19–960553–8 Printed in China by C&C Offset Printing Co. Ltd Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding. Links to third party websites are provided by Oxford in good faith and for information only. Oxford disclaims any responsibility for the materials contained in any third party website referenced in this work. v Preface to second edition Since the fi rst edition of Emergencies in Paediatrics and Neonatology , there has been an explosion in ‘evidence-based guidelines’ and a need to ensure that our practice complies with the ‘best available evidence’. This second edition has been thoroughly revised to include evidence wherever it is available. In addition, feedback from those using the fi rst edition has been used to make the second edition even more user-friendly. We hope we have maintained the pragmatic, hands-on approach whilst incorporating information from the NICE and Cochrane reviews, and using relevant guidelines endorsed by Children’s Hospitals. Most impor- tantly, after the 2010 International Liaison Committee On Resuscitation 5-yearly review, the chapter on ‘Resuscitation’ has been fully updated. However, much of what we do in paediatrics has little or no evidence base. So then, we rely on best practice and common sense — the latter remains a fundamentally critical part of the management of children. On-going medical education supplements what we read in our text books, clinical guidelines and on-line. We must continually: • ask answerable questions; • access the best information; • appraise the information for validity and relevance; • and apply the information to patient care. 1 As medicine changes— through new evidence, the impact of new vaccines, changes in society (e.g. obesity and its consequences), or the arrival of new treatments—we must keep up to date and be willing to question what we have been doing and whether there might be a better way. We hope this second edition of Emergencies in Paediatrics and Neonatology can play a small part in that important quest. As always, we would appreciate comments from readers on where further improvements can be made. Stuart Crisp Jo Rainbow August 2012 1 Craig JC, Irwig LM, Stockler MR (2001). Evidence-based medicine: useful tools for decision making. Med J Aust 174: 248–53. vi Preface to fi rst edition This book has been written for anyone who assesses and manages acutely unwell children. It has been written by doctors who do just that, day in, day out. It provides clear, simple, but defi nitive early management for pae- diatric conditions seen in the Emergency Department. Some children pre- senting will be seriously ill, but many will not. There is, therefore, a coding system of icons, indicating the likely severity and consequent urgency of treatment. The book is symptom-based, as that is how children present. It covers resuscitation and immediate management in detail, to get you through those fi rst nerve-racking minutes. Longer-term treatment is then dis- cussed. For each condition, the key features of the history are described, along with the cardinal signs to be elicited on examination. The judicious use of investigations is also covered (as well as what the results mean!). Frequent re-assessment is emphasized to detect any clinical deterioration. Potential complications are listed, along with what to do next and when to seek further specialist advice. Drug doses are included within the text. The doses have been taken from BNF for Children (2009 ISBN 978 0 85369 847 0, Royal Pharmaceutical Company of Great Britain). Being an at-a-glance reference, the book is in the form of short notes and bullet points, with critical information highlighted. Flow diagrams guide you through the more complex areas. All are based on the best available evidence or on accepted best practice. Topics are grouped by body system, with a detailed index to provide easy access to information. Cross references have been kept to a minimum to facilitate use at the bedside. Where a complex subject is mentioned, consul- tation of the more detailed Oxford Handbook of Paediatrics is recommended. This book is ideal for any health professional or student who has to treat unwell children. Most of these will present to the Emergency Department, but some will be fi rst seen by their local doctor (GP or LMO) or other specialists in related fi elds. The book is therefore aimed at: • Paediatricians and doctors in the Emergency Department. • Nurse practitioners, both Paediatric and Emergency Department. • Anaesthetists, surgeons. • GP and GP trainees. • Medical students. • Allied health professionals. We hope you fi nd it useful, but please let us know if you have suggestions for improvement. Stuart Crisp Jo Rainbow March 2007 vii Acknowledgements Much has changed in the world of acute Paediatrics since the fi rst edition of Emergencies in Neonatology and Paediatrics. Consequently, there are many people to thank for producing the updated second edition. We are indebted to the original authors, who have revised their chapters: Steve Allen, Gordon Bates, Julie Edge, Paul Johnson, Huw Pullen, Ita Kelly, Tamsin Sleep, and Ingo Scholler. The editorial team at OUP have been patient, tolerant and always helpful, so particular thanks to Fiona Richardson, Katy Loftus, and their teams. Finally, thank you to our long-suffering families, without whose support, this would have been impossible. Dedication With love to Cari, Titch, Mopsy, and Tinks, Wade, Jack, Sophie, and Beeboo. ix Contents Contributors xi Symbols and abbreviations xiii Introduction xxiii 1 How to communicate well with patients and parents 1 2 Neonatal emergencies 15 3 Resuscitation 47 4 Shock 87 5 Trauma 95 6 Environmental conditions 115 7 Febrile illness 129 8 Ingestion 153 9 Cardiovascular 173 10 Respiratory 195 11 Gastroenterology 231 12 Renal 257 13 Urology 273 14 General