Advanced Paediatric Life Support, Australia and New Zealand (eBook)

A Practical Approach to Emergencies

eBook Download: EPUB

2017 | 6th Edition, Australia and New Zealand
John Wiley & Sons (Verlag)
9781119385479 (ISBN)

Infos

Advanced Paediatric Life Support is the internationally renowned manual on emergency paediatric care, written to support the course run by the Advanced Life Support Group.  This edition has been adapted specifically for use in Australia and New Zealand, with the latest procedures, medications and clinical best practice to match the guidelines of the Australia and New Zealand Resuscitation Councils. Using 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.

The sixth edition includes major new features bringing it right up to date, including:

• Fully adapted for use in Australia and New Zealand, with updates to chapters on shock, the choking child, basic life support and cardiac arrest
• The latest International Liaison Committee on Resuscitation (ILCOR) 2015 Guidelines
• The latest consensus guidelines on paediatric trauma
• Enhanced discussions on the importance of human factors
• A new and improved design including full colour photographs and diagrams
• Free access to the Wiley E-Text

With this book at hand, all those providing care during paediatric emergencies can be confident in having comprehensive and authoritative guidance on the recognition and management of life threatening conditions necessary to save a child's life.

The Advanced Life Support Group (ALSG), Manchester UK, began life in 1990 and became a registered medical education charity in 1993. The organisation exists to 'preserve life by providing training and education to the general public and in particular but not exclusively to doctors, nurses and other members of the medical profession, in life saving techniques'.
The book is written and edited by Emergency Medicine specialists who are Advanced Life Support Group (ALSG) trainers.

Inhalt

Clinical conditions list vii

Working group x

Contributors xii

Preface to the first edition xvii

Preface to the sixth edition xviii

Preface to the modified Australia and New Zealand sixth edition xix

Acknowledgements xx

Contact details and further information xxi

How to use your textbook xxii

PART 1: Introduction 1

1 Introduction 3

2 Structured approach to paediatric emergencies 13

3 Human factors 23

PART 2: The seriously ill child 33

4 Structured approach to the seriously ill child 35

5 The child with breathing difficulties 49

6 The child in shock 67

7 The child with an abnormal pulse rate or rhythm 81

8 The child with a decreased conscious level 89

9 The convulsing child 99

PART 3: The seriously injured child 107

10 Introduction to the seriously injured child 109

11 Structured approach to the seriously injured child 115

12 The child with chest injury 127

13 The child with abdominal injury 135

14 The child with traumatic brain injury 139

15 The child with injuries to the extremities or the spine 147

16 The burned or scalded child 155

17 The child with an electrical injury or drowning 161

PART 4: Life support 167

18 Basic life support 169

19 Support of the airway and ventilation 185

20 Management of cardiac arrest 199

PART 5: Practical application of APLS 209

21 Practical procedures: airway and breathing 211

22 Practical procedures: circulation 225

23 Practical procedures: trauma 239

24 Imaging in trauma 249

25 Structured approach to stabilisation and transfer 255

PART 6: Appendices 267

Appendix A Acid-base balance 269

Appendix B Fluid and electrolyte management 281

Appendix C Child abuse and neglect 291

Appendix D When a child dies 299

Appendix E General approach to poisoning and envenomation 303

Appendix F Resuscitation of the baby at birth 317

Appendix G Formulary 333

Index 351

Textauszug

CHAPTER 1
Introduction

Learning outcomes

After reading this chapter, you will be able to:

• Describe the focus of the APLS course
• Identify the important differences in children and their impact on the management of emergencies

1.1 Introduction

Over the last two decades there has been a substantial reduction in childhood mortality across the world. This has been related to improvements in many areas such as maternal education, access to clean water, access to food, immunisation against an increasing number of infectious conditions, and improved access to healthcare services. Even conditions such as human immunodeficiency virus infections have potentially come under control with the development of highly effective antiretroviral therapeutic regimes. However, children across the world continue to suffer potentially life‐threatening acute illness (sometimes on a background of chronic illness) and injury. The Advanced Paediatric Life Support (APLS) course is directed at training healthcare workers to recognise life‐threatening illness or injury in children; provide effective emergency intervention; and ensure that children receive the appropriate definitive management of the condition as soon as possible. This approach is potentially applicable in many different settings across the world.

1.2 Principles

There are a number of principles that underpin this approach.

Physiological differences

Most clinical medicine is taught with the underlying assumption that adults best exemplify ‘normal’ in health. This is perhaps justified by the reality that in most parts of the world the majority of the population is made up of adults, but in poorer countries up to 40% of the population may be made up of children (depending on how children are defined). Thus it is important to highlight where children are different to adults in terms of physiology, pathophysiology and responses to various interventions (see Section 1.3). Among the most important differences are the substantially lower physiological reserves in children, particularly young children. A consequence of this is that in the face of injury or severe illness their condition may deteriorate more rapidly than would be expected for adult patients. Thus particular attention has to be paid to timeliness and effective support of the respiratory and cardiovascular systems.

Children come in a range of sizes, and a consequence of this is the constant requirement to adjust all therapy, interventions and selection of equipment or consumable to the size of the particular patient (see Table 1.1 in Section 1.3).

Table 1.1 Normal ranges: respiratory rate (RR), heart rate (HR) and blood pressure (BP)

Age

Guide weight (kg)

RR At rest Breaths per minute 5th–95th centile

HR Beats per minute 5th–95th centile

BP Systolic

Boys

Girls

5th centile

50th centile

95th centile

Birth

3.5

3.5

25–50

120–170

65–75

80–90

105

1 month

4.5

4.5

3 months

6.5

6

25–45

115–160

6 months

8

7

20–40

110–160

12 months

9.5

9

70–75

85–95

18 months

11

10

20–35

100–155

2 years

12

12

20–30

100–150

70–80

85–100

110

3 years

14

14

90–140

4 years

16

16

80–135

5 years

18

18

80–90

90–110

111–120

6 years

21

20

80–130

7 years

23

22

8 years

25

25

15–25

70–120

9 years

28

28

10 years

31

32

11 years

35

35

12 years

43

43

12–24

65–115

90–105

100–120

125–140

14 years

50

50

60–110

Adult

70

70

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 related to the fact that in children cardiac arrest is rarely related to cardiac arrhythmia, but more commonly is a sequel 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 was 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

The use of a standardised structure for resuscitation provides benefits in many areas. Firstly it provides a structured approach to a critically ill child who may have multiple problems. The standardised approach enables the provision of a standard working environment, ensuring that all the necessary equipment is available as required. By focusing attention on life‐threatening issues and dealing with those in a logical sequence it is possible to stabilise the child’s condition as quickly as possible. The use of the standardised structure enables the entire team to know what is likely to be expected of them and in what sequence.

There may well be discussion around the optimum sequence of resuscitation, but in this course a particular approach has been accepted as being reasonable, and most in keeping with the available research information. It is likely that aspects of this approach will change over time, and in fact it may be appropriate to modify the approach in particular working environments and contexts.

Once basic stabilisation has been achieved, it is then appropriate to investigate the underlying diagnoses and proceed to definitive therapy. Occasionally, definitive therapy (such as surgical intervention) may be a component of the resuscitation.

Resource management

There is increasing realisation that provision of effective emergency treatment depends on the development of teams of healthcare providers who are able to work together in a coordinated and appropriately directed way (Figure 1.2). Thus part of training in paediatric life support must focus on understanding how the human resources available for a particular resuscitation episode can be utilised most effectively.

Figure 1.2 Advanced paediatric life support (APLS) in action

Early referral to appropriate teams for definitive management

It is clear that emergency areas 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. Thus 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...

Produkt-Details

• Erscheint lt. Verlag: 9.5.2017
• Reihe/Serie: Advanced Life Support Group
• 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
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Pädiatrie
• Themenwelt: Medizin / Pharmazie ► Studium
• Schlagworte: Advanced Life Support Group course manual • advanced paediatric life support • Australia and New Zealand Resuscitation Councils guidelines • basic life support for children • emergency care for children • emergency healthcare for children • Emergency Medicine & Trauma • emergency paediatric care manual • how to treat a child in cardiac arrest • how to treat a child in shock • how to treat the choking child • International Liaison Committee on Resuscitation (ILCOR) Guidelines • internationally renowned emergency paediatric care manual • latest paediatric life support procedures, medications and clinical best practices • medical education • Medical Science • Medizin • Medizinstudium • Notfallmedizin u. Traumatologie • paediatric trauma guidelines • practical emergency treatment methods for children's illness or injury
• ISBN-13: 9781119385479 / 9781119385479