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Paediatric Guidelines 2013-14 Bedside Clinical Guidelines Partnership In association with Bedside Clinical Guidelines Partnership Paediatric Guidelines In association with 2006 Paediatric Guidelines 2006 Paediatric Guidelines 2013–14 Paediatric These guidelinesISBN: ar 978-0-9567736-1-6e advisory, not mandatory. Every effort has been made to ensure accuracy. The authors cannot accept any responsibility for These guidelinesadverse outcomes.are advisory, not mandatory. Guidelines Every effort has been made to ensure accuracy. SuggestionsThe authors for cannotimprovement accept andany responsibilityadditional for Theseguidelines guidelines would ar adverseebe advisory most outcomes. welcome, not mandatory by the . Every efPartnersfort has in been Paediatrics made toCoor ensurdinatore accuracy, . Suggestions for improvement and additional guidelines The authors cannot accept any responsibility for Tel. 01782would 552002 be most or welcomeEmail nicky by.smith [email protected] in Paediatrics, please contact viaadverse http://www.networks.nhs.uk/nhs-networks/ outcomes. 2013-14 partners-in-paediatrics/guidelines Suggestions for improvement and additional Paediatric Guidelines 2013–14 guidelines would be most welcome by the Partners in Paediatrics Coordinator, Tel. 01782 552002 or Email [email protected] ISSUE 5 Printed by: Sherwin Rivers Ltd, Waterloo Road, Stoke on Trent ST6 3HR Tel: 01782 212024 Fax: 01782 214661 Email: [email protected] This copy belongs to: Name: Further copies can be obtained from Partners in Paediatrics via http://www.networks.nhs.uk/nhs-networks/partners-in-paediatrics/guidelines Published by the Bedside Clinical Guidelines Partnership and Partners in Paediatrics NOT TO BE REPRODUCED WITHOUT PERMISSION Partners in Paediatrics comprises: Birmingham Children’s Hospital NHS Foundation Trust Burton Hospitals NHS Foundation Trust Dudley Clinical Commissioning Group East Cheshire NHS Trust George Eliot Hospital NHS Trust Heart of England NHS Foundation Trust Mid Staffordshire NHS Foundation Trust Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust Shropshire Community NHS Trust South Staffordshire & Shropshire Healthcare NHS Foundation Trust The Royal Wolverhampton Hospitals NHS Trust The Shrewsbury & Telford Hospital NHS Trust University Hospital of North Staffordshire NHS Trust Walsall Healthcare NHS Trust The Bedside Clinical Guidelines Partnership comprises: Ashford & St Peter’s Hospitals NHS Trust (Surrey) Barnet and Chase Farm Hospitals NHS Trust (Middlesex) Burton Hospitals NHS Foundation Trust The Dudley Group NHS Foundation Trust East Cheshire NHS Trust (Macclesfield) The Hillingdon Hospital NHS Foundation Trust (Hillingdon) Ipswich Hospitals NHS Trust Mid Cheshire Hospitals NHS Trust (Leighton, Crewe) Mid Staffordshire NHS Foundation Trust North Cumbria University Hospitals NHS Trust The Pennine Acute Hospitals NHS Trust (Greater Manchester) The Princess Alexandra Hospital NHS Trust (Harlow, Essex) The Royal Wolverhampton Hospitals NHS Trust Salford Royal NHS Foundation Trust Sandwell and West Birmingham Hospitals NHS Trust The Shrewsbury and Telford Hospital NHS Trust University Hospitals Birmingham NHS Foundation Trust University Hospital of North Staffordshire NHS Trust Walsall Healthcare NHS Trust Wye Valley NHS Trust (Hereford) CONTENTS • 1/3 Preface.......................................................................................................................... 6 Acknowledgements....................................................................................................... 8 A: ANAESTHETICS AND CRITICAL CARE APLS – Cardiorespiratory arrest.................................................................................. 9 APLS – Recognition and assessment of the sick child ...............................................12 Intraosseous infusion.................................................................................................. 16 Apparent life threatening event (ALTE)....................................................................... 18 Anaphylaxis................................................................................................................. 20 Pain assessment......................................................................................................... 23 Analgesia.................................................................................................................... 24 Sedation...................................................................................................................... 28 IV Fluid therapy .......................................................................................................... 31 Long line insertion....................................................................................................... 32 Pre-op fasting.............................................................................................................. 35 Post GA monitoring ex-premature infants................................................................... 36 B: BREATHING (RESPIRATORY DISEASE) Asthma – acute management..................................................................................... 37 Bronchiolitis................................................................................................................. 41 Croup........................................................................................................................... 44 Cystic fibrosis – Admission......................................................................................... 46 Cystic fibrosis – Exacerbation.................................................................................... 48 Cystic fibrosis – Microbiology...................................................................................... 50 Cystic fibrosis – Distal intestinal obstruction syndrome (DIOS)..................................52 Pneumonia ................................................................................................................. 53 Pleural effusion........................................................................................................... 56 Pneumothorax ........................................................................................................... 59 C: CARDIOVASCULAR DISEASE Cyanotic congenital heart disease.............................................................................. 61 Heart failure and weak pulses.................................................................................... 63 ECG interpretation...................................................................................................... 65 Tachycardia and bradycardia...................................................................................... 69 Endocarditis prophylaxis............................................................................................. 74 D: DRUGS AND POISONING Poisoning and drug overdose..................................................................................... 75 Alcohol poisoning........................................................................................................ 78 Issue 5 Issued: May 2013 Expires: May 2014 3 CONTENTS • 2/3 Iron poisoning.............................................................................................................. 80 Paracetamol poisoning................................................................................................ 82 Phenothiazine poisoning/side effects.......................................................................... 87 Salicylate poisoning.................................................................................................... 88 Tricyclic poisoning....................................................................................................... 90 E: ENDOCRINE/METABOLISM Diabetes and fasting................................................................................................... 92 Diabetic ketoacidosis.................................................................................................. 96 Diabetes new (non-ketotic)....................................................................................... 103 Hypoglycaemia.......................................................................................................... 105 Ketone monitoring..................................................................................................... 111 Steroid dependence.................................................................................................. 112 G: GASTROENTEROLOGY Abdominal pain.......................................................................................................... 114 Constipation............................................................................................................... 117 Diarrhoea and vomiting............................................................................................. 122 Nutritional first line advice ........................................................................................ 128 Failure to thrive......................................................................................................... 131 Jaundice.................................................................................................................... 134 Vitamin D deficiency NEW ..................................................................................... 137 H: HAEMATOLOGY Blood and platelet transfusions................................................................................
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