Advanced Paediatric Life Support, Australia and New Zealand

A Practical Approach to Emergencies

• Publisher: Wiley-Blackwell
• Year: 2017
• ISBN:
  9781119385479
• Edition: 6
• Topic: Medicine
• Subtopic: Emergency Medicine & Critical Care

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. This edition has been adapted specifically for use in Australia and New Zealand, with the latest procedures, medications and clinical best practice to match the guidelines of the Australia and New Zealand Resuscitation Councils. 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:

• Fully adapted for use in Australia and New Zealand, with updates to chapters on shock, the choking child, basic life support and cardiac arrest
• 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.

PART 1
Introduction

CHAPTER 1
Introduction

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Learning outcomes

After reading this chapter, you will be able to:

• Describe the focus of the APLS course
• Identify the important differences in children and their impact on the management of emergencies

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1.1 Introduction

Over the last two decades there has been a substantial reduction in childhood mortality across the world. This has been related to improvements in many areas such as maternal education, access to clean water, access to food, immunisation against an increasing number of infectious conditions, and improved access to healthcare services. Even conditions such as human immunodeficiency virus infections have potentially come under control with the development of highly effective antiretroviral therapeutic regimes. However, children across the world continue to suffer potentially life‐threatening acute illness (sometimes on a background of chronic illness) and injury. The Advanced Paediatric Life Support (APLS) course is directed at training healthcare workers to recognise life‐threatening illness or injury in children; provide effective emergency intervention; and ensure that children receive the appropriate definitive management of the condition as soon as possible. This approach is potentially applicable in many different settings across the world.

1.2 Principles

There are a number of principles that underpin this approach.

Physiological differences

Most clinical medicine is taught with the underlying assumption that adults best exemplify ‘normal’ in health. This is perhaps justified by the reality that in most parts of the world the majority of the population is made up of adults, but in poorer countries up to 40% of the population may be made up of children (depending on how children are defined). Thus it is important to highlight where children are different to adults in terms of physiology, pathophysiology and responses to various interventions (see Section 1.3). Among the most important differences are the substantially lower physiological reserves in children, particularly young children. A consequence of this is that in the face of injury or severe illness their condition may deteriorate more rapidly than would be expected for adult patients. Thus particular attention has to be paid to timeliness and effective support of the respiratory and cardiovascular systems.

Children come in a range of sizes, and a consequence of this is the constant requirement to adjust all therapy, interventions and selection of equipment or consumable to the size of the particular patient (see Table 1.1 in Section 1.3).

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

Age	Guide weight (kg)		RR At rest Breaths per minute 5th–95th centile	HR Beats per minute 5th–95th centile	BP Systolic
	Boys	Girls			5th centile	50th centile	95th centile
Birth	3.5	3.5	25–50	120–170	65–75	80–90	105
1 month	4.5	4.5
3 months	6.5	6	25–45	115–160
6 months	8	7	20–40	110–160
12 months	9.5	9			70–75	85–95
18 months	11	10	20–35	100–155
2 years	12	12	20–30	100–150	70–80	85–100	110
3 years	14	14		90–140
4 years	16	16		80–135
5 years	18	18			80–90	90–110	111–120
6 years	21	20		80–130
7 years	23	22
8 years	25	25	15–25	70–120
9 years	28	28
10 years	31	32
11 years	35	35
12 years	43	43	12–24	65–115	90–105	100–120	125–140
14 years	50	50		60–110
Adult	70	70

Relationship between disease progression and outcomes

The further a disease process is allowed to progress, the worse the outcome is likely to be. The outcomes for children who have a cardiac arrest out of hospital are generally poor (this may be related to the fact that in children cardiac arrest is rarely related to cardiac arrhythmia, but more commonly is a sequel of hypoxaemia and/or shock with associated organ damage and dysfunction). By the time that cardiac arrest occurs, there has already been substantial damage to various organs. This is in contrast to situations (more common in adults) where the cardiac arrest was the consequence of cardiac arrhythmia – with preceding normal perfusion and oxygenation. Thus the focus of the course is on early recognition and effective management of potentially life‐threatening problems before there is progression to respiratory and/or cardiac arrest (Figure 1.1).

Figure 1.1 Pathways leading to cardiac arrest in childhood (with examples of underlying causes). [ICP, intracranial pressure]

Standardised structure for assessment and stabilisation

The use of a standardised structure for resuscitation provides benefits in many areas. Firstly it provides a structured approach to a critically ill child who may have multiple problems. The standardised approach enables the provision of a st...