Emergencies in Kids

NETS calculator - this has many emergency drugs with water for injection for staff drawing up medications
Meds4Kids : Children Hospital at Westmead on general drug information for ED and wards
Injectable drugs for children Children’s Hospital at Westmead: aimed at nurses drawing up IV drugs
Australian Medicines Handbook General drug dosing useful from prescriptions has general and trade names for dosing and concentrations of suspensions for paediatric patients:
MIMs: May use “Drug interactions” and “add drug” for checking for drug interactions and fairly comprehensive side effects list
eTG

Fact Sheets

Sydney Children's Hospital Fact Sheets

"The Wise Rhino"

The Wise Rhino ( our local Dubbo Emergency Department Website for all staff, curated by emergency specialist Dr Ahbi Mitra; this site is not recommended for patients

Hypoglycaemia algorithm

Hypoglycaemia- Dubbo Emergency Department

Overview

- Hypoglycaemia in children is a medical emergency

- Children with prolonged or recurrent hypoglycaemia are at risk of acute and long-term neurological sequaelae if prompt treatment is not administered

- Defined as a BSL < 2.6mmol/L (or <3 mmol/L if symptomatic)

o Symptoms and signs include:

§ CNS: Lethargy, headache, irritability, confusion, reduced tone, visual disturbance

§ Adrenergic: Tremor, sweaty, pallor, weakness, tachycardia, hunger

Investigations

- First presentation or severe hypoglycaemia should be investigated

- Accelerated starvation (previously known as ‘ketotic hypoglycaemia’):

o Requires a history of a prolonged fast (usually precipitated by illness) with a low BSL, elevated ketones and normalisation of BSL upon feeding

o It is a diagnosis of exclusion and children presenting with their first episode / severe hypoglycaemia may have an underlying metabolic condition (although rare)

- Perform critical bloods immediately in these children prior to glucose administration

- This shouldn’t delay treatment in symptomatic patients or if attempts at IV access are prolonged

Procedure

- Blood collection

o Whilst obtaining critical bloods, ask 1 staff member to prepare glucose solution (see over)

o Also ask additional staff member to call lab and obtain any additional tubes needed: (2 x Purple, 2 x Red, 3 x Light Green, 2 x Dark Green Paediatric Tubes, 1 x VBG)

o Total blood needed: 6mL

o Distribute:

§ 0.5mL each into 2 purple tubes (FBC, Free Fatty Acids)

§ 0.6mL each into 3 light green tubes (UEC, LFT, Plasma Glucose, Ammonia, Growth Hormone)

§ 0.6mL each into 2 red tubes (Insulin, C-Peptide, Cortisol)

§ 0.6mL each into 2 dark green tubes (Carnitine / Acylcarnitine, Amino Acids)

§ 0.8mL for VBG (Lactate) and blood ketones (Beta hydroxybutyrate)

o Send urgently to lab:

§ ON ICE: 1 x Purple, 1 x Dark Green, 1 x Light Green

§ Remainder NOT ON ICE (unless delay sending to lab, then send BOTH dark green on ice)

§ Call ahead to lab and notify urgent bloods coming for immediate processing

o If difficulty obtaining enough blood:

§ Send 1 x Purple 0.5mL for Free Fatty Acids and 1 x Dark Green 0.6mL for Acylcarnitine profile BOTH ON ICE, indicating these tests are the priority

- Urine Collection

o Place urine bag on patient to ensure first urine passed after episode is collected for urine metabolic screen (a urine bag is OK in this instance as it doesn’t matter if it is contaminated)

o Also perform urine dipstick for ketones / glucose / reducing substances