Paediatric emergencies, stadium IID

The course is given by the Department of Paediatrics and the section for Paediatric Anaesthesia and Intensive care, St. Olav University Hospital and NTNU

Course management, spring 2020: Assoc. professor Håkon Bergseng (Paediatrics); Professor Eirik Skogvoll (Anaesthesia); Lecturer Thorstein Sæter (Paediatric surgery); Assoc. professor Sigurd Fasting (Anaesthesia)

Background

Paediatric emergencies occur relatively often and consitute a large work load for general practicioners (GP) on call. While most situations are reasonably easy to handle;  providing care for critically ill children is a demanding task. We feel doctors should be prepared for paediatric emergencies for at least three reasons:


Proper communication between doctor and parents requires that the doctor can handle the stressful situation.
Personal insecurity will be quite visible and can not be compensated for by resorting to ”psychology” or ”communication techniques". We aim to prepare the students theoretically and to a limited degree practically in order to work as on-call GP and intern (aka. house officer); not as a paediatrician or anaesthetist. The course is not compulsory, but we provide opportunity for all students to attend the skill stations.

Expected knowledge and skills to be mastered after the course

     - Efficient use of mask, ventilation bag og oxygen in respiratory arrest

     - Treatment of severe asthma and anaphylaxis

     - Practical use of adrenaline in different settings (formulation/ dose/ administration - see below)

     - Fluid therapy (type/ amount/ administration) in hypovolaemia

 

Modes of teaching

Asthma, accidental hypothermia, febrile convulsions, sepsis, congenital diaphragmatic hernia, anaphylaxis, epiglottitis, diabetes, laryngitis, hyperventilation/ panic attack, head injury, status epilepticus, airway obstruction, delivery during transport, dehydration , gastroenteritis, cardiac arrest, heart failure, drowning, non-accidental injury, trauma, adder snakebite, meningitis, pneumonia, premature birth, poisoning, inhalation injury, neonatal transportation, sudden infant death syndrome, pyloric stenosis, intestinal obstruction.

 

Preparation for the course: literature review

International and European guidelines for CPR in children and neonates were updated in November 2015. Consult http://www.cprguidelines.eu for the complete documents.

Current Norwegian guidelines are found here:

http://nrr.org/index.php/retningslinjer/norske-retningslinjer-2015

You may read the relevant chapters of the Paediatric textbook of your choice. Below are some links to relevant literature. Some are old but still not "outdated".

Tilnærming til det akutt syke barnet

(Approach to the acutely ill child. In Norwegian)
Trond Markestad 
Tidsskr Nor Lægeforen 2001; 121: 608-11

Advanced Paediatric Life Support: A Practical Approach to Emergencies, Sixth Edition

Well-known, comprehensive textbook, which forms the core curriculum for the APLS courses that are arranged worldwide (www.alsg.org). In English.
BMJ Books - Publisher: John Wiley & Sons (Wiley-Blackwell)

Editor(s): Martin Samuels, Sue Wieteska

Published Online: 19 FEB 2016 10:02PM EST

Print ISBN: 9781118947647

Online ISBN: 9781119241225

Spotting the sick child 

British website (free but requires registration) Includes videos, learning points etc. in relation to acutely sick children.

 

Establishing intraosseous access (video from The New England Journal of Medicine)

 


Use of adrenaline [= epinephrine] in various settings

 

Adrenaline for injection

Preparation:     1 mg/ml and 0,1 mg/ml (= 100 µg/ml, ”Katastrofe-adrenalin®”)

Indications and dosage:
Cardiac arrest:  10 µg/kg i.v.
Asthma and anaphylaxis: 5
-10 µg/kg i.m. or s.c.  [not i.v.]

 

Adrenaline for inhalation

Preparation:      1 mg/ml

Indication:        Asthma, laryngitis, post extubation stridor

Dose:              0,1 mg/kg in NaCl to 2-3 ml [i.e. 0.1 ml/kg, or 1 ml/10 kg, added to 2-3 ml NaCl]

 

Racemic adrenaline for inhalation

Preparation:      20 mg/ml or 22.5 mg/ml (depends on manufacturer)

Indication:       Asthma, laryngitis, post extubation stridor
Dose:              0,2 mg/kg in NaCl to 2-3 ml [i.e. 0.01 ml/kg, or 0.1 ml/10 kg, added to 2-3 ml NaCl]

 

 

Organization of the case discussions

Students are divided into groups of about 6 to 10. You will have about 10 minutes to discuss the case from different points of view:

1. Basics: Aetiology, physiology/ pathophysiology, anatomy
2. Clinical: History, clinical examination, supplementary investigations (lab, X-ray, monitoring etc.), clinical management

The discussion is finally summed up in a plenary session, but we are currently experimenting with Team based learning techniques and Kahoot as well.

Feedback

Please tell us what you think about "Paediatric Emergencies". Former student initiatives have led us to make changes, both with respect to organization and to topics covered.