Waiting for the Paediatric Retrieval Team

This section covers the management of the critically ill child who needs intensive care support to be initiated outside the intensive care environment. It provides a structured approach to the initial resuscitation & stabilisation and provides advice on ongoing care until this is taken over by the paediatric intensive care retrieval team.

Collapsed Neonate

Like any sick child the initial management of the ‘Collapsed Neonate’ involves an ABCDE approach. While there are many possible causes, four major diagnoses must be considered…

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Bronchiolitis

Bronchiolitis is a viral infection of the lower airways, most often in infants but can affect children up to two years of age. It is commonly caused by respiratory syncytial virus (RSV), although it can be caused by numerous other viruses and it has a peak incidence in the autumn/winter…

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Raised Intracranial Pressure

Airway opening manoeuvres (avoid head-tilt and chin-lift in trauma, use jaw thrust) as required with high flow oxygen (10-15 litre/minute via face-mask with reservoir bag) and suction airway as needed. Immobilise cervical spine in trauma patient…

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Sepsis

Urgent semi-elective intubation and ventilation should be undertaken if there is ongoing signs of shock unresponsive to 40 ml/kg of fluid resuscitation or if there is airway obstruction/loss of protective airway reflexes at any stage (cardiovascular resuscitation should occur before induction of anaesthesia)…

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Status Epilepticus

Airway opening manoeuvres with high flow oxygen (10-15 litre/minute via face-mask with reservoir bag) and suction secretions as needed. Consider nasopharyngeal airway if difficultly maintaining airway (insertion of oropharyngeal airway normally not possible due to clenched teeth)…

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Acute Asthma

Intubate if there are life threatening features that are refractory to standard treatment i.e. silent chest, oxygen saturations <92%, cyanosis, poor respiratory effort, hypotension, altered consciousness or exhaustion...

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About the Author

Dr Christopher Flannigan

Dr Christopher Flannigan

Consultant Paediatric Intensivist - Royal Belfast Hospital for Sick Children

I’m a Paediatric Intensivist from Northern Ireland and my goal is to improve the care delivered to critically ill and injured children. I have a particular interest in the initial resuscitation & stabilisation and in the use of information technology in the clinical environment. I have designed a number of medical applications which have been shown to improve emergency prescribing.

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