Advanced Paediatric Life Support E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: Advanced Life Support Group
• Sprache: Englisch

Seitenzahl: 772

Veröffentlichungsjahr: 2016

Beschreibung

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. 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:

• 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.

This title is also available as a mobile App from MedHand Mobile Libraries. Buy it now from iTunes, Google Play or the MedHand Store.

Leseprobe

Table of Contents

Cover

Title Page

Clinical conditions list

Working group

Contributors

Preface to the first edition

Preface to the sixth edition

Acknowledgements

Contact details and further information

How to use your textbook

PART 1: Introduction

CHAPTER 1: Introduction

1.1 Introduction

1.2 Principles

1.3 Important differences in children

1.4 Summary

CHAPTER 2: Structured approach to paediatric emergencies

2.1 Introduction

2.2 Preparation

2.3 Teamwork

2.4 Communication

2.5 Triage

2.6 Managing pain

2.7 Summary

Explanatory notes of the Alder Hey Triage Pain Score

CHAPTER 3: Human factors

3.1 Introduction

3.2 Extent of healthcare error

3.3 Causes of healthcare error

3.4 Human error

3.5 Learning from error

3.6 Communication

3.7 Team working, leadership and followership

3.8 Situation awareness

3.9 Improving team and individual performance

3.10 Summary

PART 2: The seriously ill child

CHAPTER 4: Structured approach to the seriously ill child

4.1 Introduction

4.2 Primary assessment of airway and breathing

4.3 Primary assessment of the circulation

4.4 Primary assessment of disability

4.5 Primary assessment of exposure

4.6 Structured approach to the seriously ill child

4.7 Primary assessment and resuscitation

4.8 Secondary assessment and emergency treatment

4.9 Summary

CHAPTER 5: The child with breathing difficulties

5.1 introduction

5.2 Susceptibility to respiratory failure

5.3 Clinical presentations of the child with breathing difficulty

5.4 Primary assessment and resuscitation

5.5 Secondary assessment and looking for key features

5.6 Approach to the child with stridor

5.7 Approach to the child with wheeze

5.8 Approach to the child with fever

5.9 Approach to the child with heart failure

5.10 Approach to the child with anaphylaxis

5.11 Approach to the child with metabolic and poisoning problems

5.12 Summary

CHAPTER 6: The child in shock

6.1 Introduction

6.2 Pathophysiology of shock

6.3 Classification of the causes of shock

6.4 Approach to the child in shock

6.5 Primary assessment and resuscitation

6.6 Key features of the child in shock

6.7 Approach to the child with non-haemorrhagic fluid loss

6.8 Approach to the child with septic shock

6.9 Approach to the child with anaphylaxis

6.10 Approach to the infant with a duct-dependent congenital heart disease

6.11 Approach to the child with shock due to cardiomyopathy

6.12 Approach to the child with profound anaemia

6.13 Approach to the child with sickle cell crisis

6.14 After resuscitation and emergency treatment of shock

6.15 Use of fluids in resuscitation

6.16 Summary

CHAPTER 7: The child with an abnormal pulse rate or rhythm

7.1 Introduction

7.2 Primary assessment and resuscitation

7.3 Approach to the child with bradycardia

7.4 Approach to the child with supraventricular tachycardia

7.5 Approach to the child with ventricular tachycardia

7.6 Summary

CHAPTER 8: The child with a decreased conscious level

8.1 Introduction

8.2 Pathophysiology of raised intracranial pressure

8.3 Primary assessment and resuscitation

8.4 Secondary assessment and looking for key features

8.5 Further general treatment of coma

8.6 Approach to the child with meningitis/encephalitis

8.7 Approach to the child poisoned with opiates

8.8 Approach to the child with metabolic coma

8.9 Approach to the child with malaria

8.10 Approach to the child with systemic hypertensive crisis

8.11 Stabilisation and transfer to definitive care

CHAPTER 9: The convulsing child

9.1 Introduction

9.2 Pathophysiology of prolonged convulsions

9.3 Primary assessment and resuscitation

9.4 Secondary assessment and looking for key features

9.5 Emergency treatment of the convulsion

9.6 Approach to the child with systemic hypertensive crisis

9.7 Hypertension emergency treatment

9.8 Summary

PART 3: The seriously injured child

CHAPTER 10: Introduction to the seriously injured child

10.1 Introduction

10.2 Injury prevention

10.3 Epidemiology

10.4 Levels of injury prevention

10.5 Trauma systems

10.6 Trauma teams

10.7 Summary

CHAPTER 11: Structured approach to the seriously injured child

11.1 Introduction

11.2 Primary survey and resuscitation

11.3 Secondary survey and looking for key features

11.4 Emergency treatment

11.5 Continuing stabilisation

11.6 Summary

CHAPTER 12: The child with chest injury

12.1 Introduction

12.2 Injuries posing an immediate threat to life

12.3 Serious injuries discovered later

12.4 Other injuries

12.5 Practical procedures

12.6 Referral

12.7 Continuing stabilisation

12.8 Summary

CHAPTER 13: The child with abdominal injury

13.1 Introduction

13.2 History

13.3 Assessment of the injured abdomen

13.4 Definitive care

13.5 Summary

CHAPTER 14: The child with traumatic brain injury

14.1 Introduction

14.2 Triage

14.3 Primary survey and resuscitation

14.4 Secondary survey and looking for key features

14.5 Emergency treatment

14.6 Detailed review and continuing stabilisation

14.7 Transfer to definitive care

14.8 Summary

CHAPTER 15: The child with injuries to the extremities or the spine

15.1 Extremity trauma: introduction

15.2 Assessment of extremity trauma

15.3 Primary survey and resuscitation of extremity trauma

15.4 Secondary survey and looking for key features of extremity trauma

15.5 Emergency treatment of extremity trauma

15.6 Extremity trauma: summary

15.7 Spinal trauma: introduction

15.8 Injuries of the cervical spine

15.9 Injuries of the thoracic and lumbar spine

15.10 Spinal cord injury without radiographic abnormality

15.11 Spinal trauma: summary

CHAPTER 16: The burned or scalded child

16.1 Introduction

16.2 Primary survey and resuscitation

16.3 Secondary survey and looking for key features

16.4 Emergency treatment

16.5 Continuing stabilisation and transfer to definitive care

16.6 Toxic shock syndrome

16.7 Summary

CHAPTER 17: The child with an electrical injury or drowning

17.1 Electrical injuries: introduction

17.2 Initial treatment of electrical injuries

17.3 Primary survey of electrical injuries and resuscitation

17.4 Secondary survey and looking for key features of electrical injuries

17.5 Stabilisation of electrical injuries and transfer to definitive care

17.6 Electrical injuries: summary

17.7 Drowning: introduction

17.8 Primary survey of drowning and resuscitation

17.9 Secondary survey and looking for key features in drowning

17.10 Emergency treatment and stabilisation in drowning

17.11 Prognostic indicators in drowning

17.12 Outcome of drowning

17.13 Drowning: summary

PART 4: Life support

CHAPTER 18: Basic life support

18.1 Introduction

18.2 Primary assessment and resuscitation

18.3 Basic life support and infection risk

18.4 The choking child

18.5 Summary

CHAPTER 19: Support of the airway and ventilation

19.1 Introduction

19.2 Airway and breathing management: principles

19.3 Primary assessment and resuscitation

19.4 Secondary assessment

19.5 Emergency treatment

19.6 Team aspects of airway management

19.7 Equipment for providing oxygen and ventilation

19.8 Equipment for managing the airway

19.9 Monitoring an intubated patient

19.10 Management of a blocked tracheostomy (Figure 19.5)

19.11 Summary

CHAPTER 20: Management of cardiac arrest

20.1 Introduction

20.2 Non-shockable rhythms

20.3 Shockable rhythms

20.4 When to stop resuscitation

20.5 Parental presence

20.6 Summary

PART 5: Practical application of APLS

CHAPTER 21: Practical procedures: airway and breathing

21.1 Ventilation without intubation

21.2 Oropharyngeal airway (Guedel) insertion

21.3 Nasopharyngeal airway insertion

21.4 Tracheal intubation and rapid sequence induction

21.5 Drugs

21.6 Intubation algorithm

21.7 Laryngeal mask airway

21.8 Surgical airway

21.9 Management of a blocked tracheostomy

CHAPTER 22: Practical procedures: circulation

22.1 Vascular access

22.2 Defibrillation

CHAPTER 23: Practical procedures: trauma

23.1 Needle thoracocentesis

23.2 Chest drain placement

23.3 Clamshell thoracotomy

23.4 Pericardiocentesis

23.5 Femoral nerve block

23.6 Cervical spine immobilisation

CHAPTER 24: Imaging in trauma

24.1 Introduction

24.2 Cervical spine imaging

24.3 Chest radiograph

24.4 The role of further imaging

24.5 Summary

CHAPTER 25: Structured approach to stabilisation and transfer

25.1 Stabilisation of the child

25.2 Assessment after stabilisation

25.3 Principles of safe transfer and retrieval

25.4 Summary

PART 6: Appendices

APPENDIX A: Acid–base balance

A.1 Introduction

A.2 Hydrogen ion concentration, acidity and pH

A.3 Carbonic acid reaction

A.4 Standard bicarbonate

A.5 Stewart’s strong ion theory

A.6 Applying this in practice

A.7 Summary

APPENDIX B: Fluid and electrolyte management

B.1 Introduction

B.2 Fluid balance

B.3 Diabetic ketoacidosis

B.4 Summary

APPENDIX C: Child abuse and neglect

C.1 Introduction

C.2 Recognition of child abuse and neglect

C.3 Assessment

C.4 Initial management

C.5 Referral

C.6 Medicolegal aspects

C.7 Summary

APPENDIX D: When a child dies

D.1 Introduction

D.2 Dealing with the family

D.3 Post-death procedures

D.4 Take care of the staff

D.5 Summary

APPENDIX E: General approach to poisoning and envenomation

E.1 Poisoning: introduction

E.2 Primary assessment and resuscitation in poisoning

E.3 Emergency treatment in poisoning

E.4 Emergency treatment of specific poisons

E.5 Envenoming (envenomation): introduction

E.6 Resuscitation and support in envenoming (envenomation)

E.7 Specific envenoming issues

E.8 Button battery ingestion

E.9 Summary

APPENDIX F: Resuscitation of the baby at birth

F.1 Introduction

F.2 Normal physiology

F.3 Pathophysiology

F.4 Equipment

F.5 Strategy for assessing and resuscitating a baby at birth

F.6 Response to resuscitation

F.7 Tracheal intubation

F.8 Laryngeal mask airway

F.9 Preterm babies

F.10 Summary

APPENDIX G: Formulary

G.1 General guidance on the use of the formulary

Index

End User License Agreement

List of Tables

Chapter 1

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

Chapter 2

Table 2.1 Triage scale

Table 2.2 The Alder Hey Triage Pain Score: reference scoring chart

Chapter 3

Table 3.1 Types of errors

Table 3.2 Elements of communication

Chapter 4

Table 4.1 Normal ranges: respiratory rate (RR), heart rate (HR) and blood pressure (BP)

Chapter 5

Table 5.1 Causes of breathing difficulty in children, according to mechanism

Table 5.2 Causes of stridor

Table 5.3 Symptoms of severe and life-threatening asthma

Table 5.4 Drug treatment of severe acute asthma

Table 5.5 Bronchiolitis: characteristic findings on examination

Table 5.6 Features that help distinguish heart failure from bronchiolitis

Chapter 6

Table 6.1 Causes of shock

Table 6.2 Symptoms and signs in allergic reaction

Chapter 8

Table 8.1 Glasgow Coma Scale and Children’s Glasgow Coma Scale

Table 8.2 Summary of pupillary changes

Chapter 9

Table 9.1 Drug therapy of severe hypertension

Chapter 11

Table 11.1 Recognition of clinical signs indicating blood loss requiring urgent treatment

Table 11.2 Template for note taking

Chapter 14

Table 14.1 Glasgow Coma Scale and Children’s Glasgow Coma Scale

Table 14.2 The best grimace response

Chapter 17

Table 17.1 Prognostic indicators in drowning

Chapter 18

Table 18.1 Summary of basic life support techniques in infants and children

Chapter 19

Table 19.1 Laryngeal mask airway (LMA) sizes

Table 19.2 I-gel sizes

Table 19.3 DOPE mnemonic for airway and ventilator problems in intubated patients

Chapter 22

Table 22.1 Surface anatomy of the brachial and long saphenous veins

Chapter 23

Table 23.1 Position of staff for the 20° tilt

Table 23.2 Tasks of individual members of staff

Appendix A

Table A.1 The pH scale

Table A.2 pH in different parts of the body

Appendix B

Table B.1 Fluid requirements in well, normal children

Table B.2 Signs and symptoms of dehydration and shock (adapted from NICE, 2009)

Table B.3 Commonly available crystalloid fluids

Table B.4 Water, electrolyte and energy requirements in well, normal children

Table B.5 Causes of hypo- and hyperkalaemia

Appendix C

Table C.1 Classification of child abuse

Appendix E

Table E.1 Diagnostic clues from the primary assessment

Table E.2 Clues to the diagnosis of an unknown poison

Table E.3 Major types of venomous animals injuring humans with a summary of clinical effects, first aid and treatment

List of Illustrations

Chapter 1

Figure 1.1

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

[ICP, intracranial pressure]

Figure 1.2

Advanced paediatric life support (APLS) in action

Figure 1.3

Centile chart for weight in (a) boys (0–5 years) and (b) girls (5–20 years)

Figure 1.4

Summary of significant upper airway anatomy

Figure 1.5

Differences in children

Chapter 2

Figure 2.1

Structured approach to paediatric emergencies

Figure 2.2

Faces scale and pain ladder

Chapter 3

Figure 3.1

The ‘Swiss cheese’ model

Figure 3.2

Similar package design of two different medications

Chapter 4

Figure 4.1

(a–d) Capillary refill assessment: apply pressure for 5 seconds and then release. Count in seconds how long it takes for the skin colour to return to normal

Figure 4.2

(a) Decorticate posturing, and (b) decerebrate posturing

Chapter 5

Figure 5.1

(a) Larynx with foreign body obstruction, and (b) normal larynx

Figure 5.2

(a) Larynx epiglottitis, and (b) normal larynx

Figure 5.3

Chest X-ray of bronchiolitis

Figure 5.4

Chest X-ray of pneumonia

Chapter 6

Figure 6.1

Emergency treatment of anaphylaxis.

[ET, endotracheal]

Chapter 7

Figure 7.1

Algorithm for the management of bradycardia

Figure 7.2

Sinus tachycardia

Figure 7.3

Supraventricular tachycardia

Figure 7.4

Algorithm for the management of supraventricular tachycardia

Figure 7.5

Algorithm for the management of ventricular tachycardia

Chapter 8

Figure 8.1

Herniations of the brain

Figure 8.2

Algorithm for the initial management of coma.

[ICP, intracranial pressure]

Chapter 9

Figure 9.1

Status epilepticus algorithm.

[ICU, intensive care unit; RSI, rapid sequence induction]

Chapter 11

Figure 11.1

Child on a scoop stretcher

Figure 11.2

Blood and fluid therapy in severe uncontrolled haemorrhage after trauma.

[FFP, fresh frozen plasma]

Chapter 12

Figure 12.1

Thoracostomy

Figure 12.2

Ported chest seal

Chapter 15

Figure 15.1

Algorithm for spinal imaging, referral and clearance

Chapter 16

Figure 16.1

Differences in body surface area (per cent) in children.

Chapter 18

Figure 18.1

Basic life support algorithm

Figure 18.2

The initial SSS approach

Figure 18.3

Head tilt and chin lift in infants: neutral position in an infant

Figure 18.4

Head tilt and chin lift: sniffing position in a child

Figure 18.5

Looking, listening, feeling

Figure 18.6

Jaw thrust

Figure 18.7

Mouth to mouth and nose in an infant

Figure 18.8

Hand-encircling technique

Figure 18.9

Chest compressions in an infant

Figure 18.10

Chest compressions: one hand

Figure 18.11

Chest compressions: two-handed

Figure 18.12

Example recovery position

Figure 18.13

FBAO algorithm.

[FB, foreign body]

Figure 18.14

Back blows

Figure 18.15

Chest thrusts

Figure 18.16

Child supported in a forward leaning position

Figure 18.17

Heimlich manoeuvre in a supine child

Figure 18.18

Basic life support algorithm

Chapter 19

Figure 19.1

Face masks, bag–valve–mask and oxygen mask with reservoir

Figure 19.2

Sizing an oropharyngeal airway

Figure 19.3

View of an infant larynx with a laryngoscope blade in the vallecula

Figure 19.4

Green bands show compatibility between the fibreoptic laryngoscope blade and handle

Figure 19.5

Management of a blocked tracheostomy.

[BVM, bag–valve–mask]

Chapter 20

Figure 20.1

Cardiac arrest algorithm.

[CPR, cardiopulmonary resuscitation; PEA, pulseless electrical activity; VF, ventricular fibrillation; VT, ventricular tachycardia]

Figure 20.2

Asystole

Figure 20.3

Pulseless electrical activity

Figure 20.4

Protocol for asystole and pulseless electrical activity.

[CPR, cardiopulmonary resuscitation; ROSC, return of spontaneous circulation]

Figure 20.5

Ventricular fibrillation

Figure 20.6

Pulseless ventricular tachycardia

Figure 20.7

Protocol for ventricular fibrillation and ventricular tachycardia.

[CPR, cardiopulmonary resuscitation; ROSC, return of spontaneous circulation]

Chapter 21

Figure 21.1

Mask position for mouth-to-mask ventilation in (a) a child and (b) an infant

Figure 21.2

Bag-and-mask ventilation

Figure 21.3

Two-person bag-and-mask ventilation

Figure 21.4

(a–c) Airway insertion using the rotational technique

Figure 21.5

Intubation checklist.

[CPAP, continuous positive airway pressure; ECG, electrocardiogram; ENT, ear, nose and throat; ETCO

2

, end-tidal CO

2

; ETT, endotracheal tube; LMA, laryngeal mask airway; NGT, nasogastric tube; NIBP, non-invasive blood pressure; OGT, orogastric tube]

Figure 21.6

Technique using (a) a straight-blade laryngoscope, and (b) a curved-blade laryngoscope

Figure 21.7

Failed intubation algorithm.

[ENT, ear, nose and throat; ETT, endotracheal tube; LMA, laryngeal mask airway; NGT, nasogastric tube; OGT, orogastric tube]

Figure 21.8

(a–d) Insertion of a laryngeal mask airway

Figure 21.9

Surgical airway anatomy

Figure 21.10

Needle cricothyroidotomy

Chapter 22

Figure 22.1

Tibial technique for intraosseous infusion

Figure 22.2

The course of the external jugular vein

Figure 22.3

Umbilical cord cross-section

Figure 22.4

Site of a long saphenous cut-down and its technique

Figure 22.5

The course of the central veins of the neck

Figure 22.6

Ultrasound-guided needle approach

Figure 22.7

Ultrasound image of the femoral region.

[A, artery; N, nerve; V, vein]

Figure 22.8

Standard anterolateral paddle placement

Figure 22.9

Anteroposterior paddle placement

Chapter 23

Figure 23.1

Needle thoracocentesis

Figure 23.2

Chest drain insertion – landmarks

Figure 23.3

Chest drain insertion – clearing the path

Figure 23.4

Needle pericardiocentesis – angle

Figure 23.5

Needle pericardiocentesis – direction

Figure 23.6

Ultrasound-guided needle approach

Figure 23.7

Ultrasound image of the femoral region.

[A, artery; N, nerve; V, vein]

Figure 23.8

Ultrasound-guided block.

[ASIS, anterior superior iliac spine]

Figure 23.9

Manual in-line stabilisation (MILS)

Figure 23.10

20° tilt (four-person technique)

Figure 23.11

20° tilt (three-person technique)

Chapter 24

Figure 24.1

Assessing rotation – straight chest film

Figure 24.2

Vertical fracture of the thoracic spine

Appendix A

Figure A.1

Relationship between hydrogen ion concentration and pH. As can be seen a pH of 7.4 relates to a hydrogen ion concentration of 40 nmol/l (0.000040 mmol/l)

Figure A.2

Ions and their charges in extracellular fluid.

[AG, anion gap; X

A

–

, unmeasured weak acids]

Figure A.3

Expansion of the components of the anion gap

Figure A.4

Changes in acid–base homeostasis

Figure A.5

Primary and compensatory changes in respiratory acidosis. Note the direction of changes in the numerator (HCO

3

–

) and denominator (

P

CO

2

) are in the same direction (arrows) – to normalise the ratio

Figure A.6

Primary and compensatory changes in respiratory alkalosis. Note the direction of changes in the numerator (HCO

3

–

) and denominator (

P

CO

2

) are in the same direction (arrows) – to normalise the ratio

Appendix B

Figure B.1

Algorithm for the management of hyperkalaemia

Appendix E

Figure E.1

Nomogram indicating the level of blood paracetamol at which acetylcysteine should be given intravenously.

Figure E.2

Algorithm for the management of organophosphate poisoning

Appendix F

Figure F.1

Response of a mammalian fetus to total, sustained asphyxia starting at time 0.

Figure F.2

Effects of lung inflation and a brief period of ventilation on a baby born in early terminal apnoea but before failure of the circulation.

Figure F.3

Response of a baby born in terminal apnoea. In this case lung inflation is not sufficient because the circulation is already failing. However, lung inflation delivers air to the lungs and then a brief period of chest compressions delivers oxygenated blood to the heart, which then responds.

Figure F.4

Neutral position in babies

Figure F.5

Jaw thrust

Figure F.6

Bag-and-mask ventilation

Figure F.7

Hand-encircling technique for chest compressions

Figure F.8

Newborn resuscitation algorithm. HR, heart rate.

Guide

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Advanced Paediatric Life Support

A Practical Approach to Emergencies

SIXTH EDITION

Advanced Life Support Group

EDITED BY

Martin SamuelsSue Wieteska

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ISBN: 9781118947647

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Clinical conditions list