338 Paediatric Emergencies
GENERAL ASSESSMENT4 Most emergencies are frightening to children causing distress to the child
that adds to parental anxiety.
(i) Explain things as clearly as possible to both the child and the
parent.
(ii) Use toys and picture books to placate the distressed infant.
(iii) Allow the parent to stay with the child at all times.Figure 11.1 Paediatric resuscitation chart
Drug doses, endotracheal tube sizes and defibrillator settings are read off the chart
according to the age, weight, or body length. DC, direct current; SVT, supraventricular
tachycardia; VF, ventricular fibrillation; VT, ventricular tachycardia. Reproduced with kind
permission from the BMJ Publishing Group.Endotracheal tube
Oral
length(cm)Internal
diameter(mm)
18 –21
uncuffed7.07.5–8.0cuffed
18
17
16
15
14
1312
106.5
6.0
5.5
5.0
4.5
4.0
3.5
3.0 –3.5Length (cm)Weight (kg)50
14
12
10
8
6
4
2
160 70 80 90 100 110 120 130140 150 160Age (years)9 months
6 months
3 months
510 203040 50
0.5
0.512345
1 2 3 45
1246 66
— 0.3 0.7 1 1 1
551010 20 30 40 500.25 0.75 1.2520 30 40 50
3 4 5
2224 511 2 3
551020304050—
—
————0.5 1 2
0.40.50.52.52.5 mg 5 mg 5 mg 5 mg 5 mg0.8 1.6
2.5 mg 5 mg 10 mg 10 mg 10 mg 10 mg20 40 80 120 160 200100 200 400 600 800 1000Adrenaline (epinephrine) (mL of 1 in 10 000)Initial intravenous or intraosseous
Adrenaline (mL of 1 in 1000)intravenous or intraosseous (or initial endotracheal) subsequent
Atropine (mL of 100Intravenous or intraosseous or double if endotrachealmg/mL)
Atropine (ml of 600mg/ml)
Bicarbonate (mL of 8.4%)Intravenous or intraosseous (dilute to 4.2% in infants)
Calcium chloride (mL of 10%)Intravenous or intraosseous
Diazepam (ml of 5 mg/mLIntravenous or rectal emulsion)
DiazepamRectal (mg rectal tube solution)
Glucose (mL of 50%)Intravenous or intraosseous (dilute to 25% in infants)
Lignocalne (lidocaine) (mL of 1%)Intravenous or intraosseous
NaloxoneIntravenous or intraosseous neonatal (mL of 20mg/mL)
Naloxone adult (mL of 400mg/mL)
Salbutamol (mgvia nebulizer (dilute to 2.5 nebulizer solution–5.0 mL in normal saline))
Initial DC defibrillation ( J)for VF or VT with no pulse
Initial DC cardioversion ( J)for SVT with shock (synchronous)
or VT with shock (non-synchronous)
Initial fluid bolus in shock (mL)Crystalloid or colloid
CAUTION!Use atropine Non-standard drug concentrations may be available: 100 mg/mL or prepare by diluting 1 mg to 10 mL or 600mg to 6 mL in normal saline.
Note that 1mL of calcium chloride 10% is equivalent to 3mL of calcium gluconate 10%.Use lignocaine (lidocaine) (without adrenaline/epinephrine) 1% or give twice the volume of 0.5%. Give half the volume of 2% or
dilute appropriately.*****1246 66
— 0.3 0.7 1 1 1
551010 20 30 40 500.25 0.75 1.2520 30 40 50
3 4 5
2224 511 2 3
551020304050—
—
————0.5 1 2
0.40.50.52.52.5 mg 5 mg 5 mg 5 mg 5 mg0.8 1.6
2.5 mg 5 mg 10 mg 10 mg 10 mg 10 mg20 40 80 120 160 200100 200 400 600 800 1000()
Atropine (mL of 100Intravenous or intraosseous or double if endotrachealmg/mL)
Atropine (ml of 600mg/ml)
Bicarbonate (mL of 8.4%)Intravenous or intraosseous (dilute to 4.2% in infants)
Calcium chloride (mL of 10%)Intravenous or intraosseous
Diazepam (ml of 5 mg/mLIntravenous or rectal emulsion)
DiazepamRectal (mg rectal tube solution)
Glucose (mL of 50%)Intravenous or intraosseous (dilute to 25% in infants)
Lignocalne (lidocaine) (mL of 1%)Intravenous or intraosseous
NaloxoneIntravenous or intraosseous neonatal (mL of 20mg/mL)
Naloxone adult (mL of 400mg/mL)
Salbutamol (mgvia nebulizer (dilute to 2.5 nebulizer solution–5.0 mL in normal saline))
Initial DC defibrillation ( J)for VF or VT with no pulse
Initial DC cardioversion ( J)for SVT with shock (synchronous)
or VT with shock (non-synchronous)
Initial fluid bolus in shock (mL)Crystalloid or colloid
CAUTION!Use atropine Non-standard drug concentrations may be available: 100 mg/mL or prepare by diluting 1 mg to 10 mL or 600mg to 6 mL in normal saline.
Note that 1mL of calcium chloride 10% is equivalent to 3mL of calcium gluconate 10%.Use lignocaine (lidocaine) (without adrenaline/epinephrine) 1% or give twice the volume of 0.5%. Give half the volume of 2% or
dilute appropriately.Salbutamol may also be given by slow intravenous injection (5mg/kg). but beware of the different concentrations available (e.g. 50 and 500mg/mL).*****20 40 80 120 160 200
5 1020304050Adrenaline (epinephrine (mL of 1 in 10 000)Initial intravenous or intraosseous
Atropine (mL of 100 μg/mL)Intravenous or intraosseous or double if endotracheal
Atropine (ml of 600 μg/mL)
Bicarbonate (mL of 8.4%)Intravenous or intraosseous (dilute to 4.2% in infants)
Calcium chloride (mL of 10%)Intravenous or intraosseous
Diazepam (ml of 5 mg/mLIntravenous or rectal emulsion)
Diazepam (mg Rectal rectal tube solution)
Glucose (mL of 50%)Intravenous or intraosseous (dilute to 25% in infants)
Lignocalne (lidocaine) (mL of 1%)Intravenous or intraosseous
Naloxone neonatalIntravenous or intraosseous(mL of 20 μg/mL)
Naloxone adult(mL of 400 μg/mL)
Salbutamol (mgvia nebulizer (dilute to 2.5–5.0 mL in normal saline)nebulizer solution)
Initial DC defibrillation (J)for VF or VT with no pulse
Initial DC cardioversion (J)for SVT with shock (synchronous)
or VT with shock (non-synchronous)
Initial fluid bolus in shock (mL)Crystalloid or colloid
CAUTION!Use atropineNon-standard drug concentrations may be available.100 μg/mL or prepare by diluting 1 mg to 10 mL or 600 μg in 6 mL to normal saline.
Note that 1 mL of calcium chloride 10% is equivalent to 3 mL of calcium gluconate 10%.Use lignocalne(lidocaine) (without adrenaline/epinephrine) 1% or give twice the volume of 0.5%. Give half the volume of 2% or dilute
approximately.Salbutamol may also be given by slow intraveous injection (5 μg/kg), but beware the different concentrations available (e.g. 50 and 500 μg/mL).