Medical emergencies in the community
Overview
Drug treatment outlined below is intended for use by
appropriately qualified healthcare professionals. Only drugs
that are used for immediate relief are shown; advice on
supporting care is not given. Where the child’s condition
requires investigation and further treatment, the child
should be transferred to hospital promptly.Airways disease, obstructive
▶ASTHMA: ACUTE
Regard each emergency consultation as being forsevere
acute asthmauntil shown otherwise; failure to respond
adequatelyat any timerequires immediate transfer to
hospital
▶EITHERSalbutamol aerosol inhaler p. 156
(100 micrograms/metered inhalation)
BY AEROSOL INHALATION VIA LARGE-VOLUME SPACER (AND A CLOSE-
FITTING FACE MASK IF CHILD UNDER 3 YEARS)
▶Child: 2 – 10 puffs each inhaled separately, repeated
every 10 – 20 minutes or as necessary
▶ORSalbutamol nebuliser solution(1 mg/mL, 2 mg/mL)
BY INHALATION OF NEBULISED SOLUTION (VIA OXYGEN-DRIVEN
NEBULISER IF AVAILABLE)
▶Child 4 years and below: 2. 5 mg every 20 – 30 minutes or as
necessary
▶Child 5–11 years: 2. 5 – 5 mg every 20 – 30 minutes or as
necessary
▶Child 12–17 years: 5 mg every 20 – 30 minutes or as
necessary
▶ORTerbutaline sulfate nebuliser solution p. 158(2.5 mg/mL)
BY INHALATION OF NEBULISED SOLUTION (VIA OXYGEN-DRIVEN
NEBULISER IF AVAILABLE)
▶Child 4 years and below: 5 mg every 20 – 30 minutes or as
necessary
▶Child 5–11 years: 5 – 10 mg every 20 – 30 minutes or as
necessary
▶Child 12–17 years: 10 mg every 20 – 30 minutes or as
necessary
▶PLUS(in all cases)
▶EITHERPrednisolone tablets p. 442 (orprednisolone soluble
tablets)(5 mg)
BY MOUTH
▶Child 11 years and below: 1 – 2 mg/kg (max. 40 mg) once
daily for up to 3 days or longer if necessary; if child has
been taking an oral corticosteroid for more than a few
days, give prednisolone 2 mg/kg (max. 60 mg) once
daily
▶Child 12–17 years: 40 – 50 mg once daily for at least 5 days
▶ORHydrocortisone p. 440 (preferably as sodium succinate)
BY INTRAVENOUS INJECTION
▶Child 17 years and below: 4 mg/kg (max. 100 mg) every
6 hours until conversion to oral prednisolone is
possible; alternative dose if weight unavailable:
▶Child 1 year and below: 25 mg
▶Child 2–4 years: 50 mg
▶Child 5–17 years: 100 mg
High-flowoxygenshould be given if available (via face mask
in children)
Monitor response 15 to 30 minutes after nebulisation; if any
signs of acute asthma persist, arrange hospital admission.
While awaiting ambulance, repeatnebulised beta 2 agonist
(as above) and give withIpratropium bromide nebuliser solution p. 153
(250 micrograms/mL)
BY INHALATION OF NEBULISED SOLUTION (VIA OXYGEN-DRIVEN
NEBULISER IF AVAILABLE)
▶Child 11 years and below: 250 micrograms, repeated every
20 – 30 minutes for thefirst 2 hours, then every
4 – 6 hours as necessary
▶Child 12–17 years: 500 micrograms every 4 – 6 hours as
necessary▶CROUP
Dexamethasone oral solution p. 439(2 mg/5 mL)
BY MOUTH
▶Child 1 month–2 years: 150 micrograms/kg as a single doseAnaphylaxis
▶ANAPHYLAXIS
Adrenaline/epinephrine injection p. 136(1 mg/mL (1 in 1000))
BY INTRAMUSCULAR INJECTION
▶Child 5 years and below: 150 micrograms ( 0. 15 mL),
repeated every 5 minutes if necessary
▶Child 6–11 years: 300 micrograms ( 0. 3 mL), repeated every
5 minutes if necessary
▶Child 12–17 years: 500 micrograms ( 0. 5 mL), repeated
every 5 minutes if necessary; 300 micrograms ( 0. 3 mL)
should be given if child is small or prepubertalHigh-flowoxygenandintravenousfluidsshould be given
as soon as available.Chlorphenamine maleate injection p. 178
BY INTRAMUSCULAR OR INTRAVENOUS INJECTION
May help counter histamine-mediated vasodilation and
bronchoconstriction.Hydrocortisone (preferably as sodium succinate)
BY INTRAVENOUS INJECTION
Has delayed action but should be given to severely affected
patients to prevent further deterioration.Bacterial disease
▶MENINGOCOCCAL DISEASE
Benzylpenicillin sodium injection p. 338(600 mg, 1.2 g)
BY INTRAVENOUS INJECTION (OR BY INTRAMUSCULAR INJECTION IF
VENOUS ACCESS NOT AVAILABLE)
▶Neonate: 300 mg
▶Child 1 month–11 months: 300 mg
▶Child 1–9 years: 600 mg
▶Child 10–17 years: 1. 2 g
NOTEA single dose should be given before urgent transfer to
hospital, so long as this does not delay the transfer.
▶ORif history of allergy to penicillinCefotaxime injection p. 320(1 g)
BY INTRAVENOUS INJECTION (OR BY INTRAMUSCULAR INJECTION IF
VENOUS ACCESS NOT AVAILABLE)
▶Neonate: 50 mg/kg
▶Child 1 month–11 years: 50 mg/kg (max. 1 g)
▶Child 12–17 years: 1 g
NOTEA single dose can be given before urgent transfer to
hospital, so long as this does not delay the transfer.