Conclusion for Paediatric Resuscitation Course in HOSHAS

WETFAG ( mnemonic)

Let us imagine receiving a call that:

6 years old boy , history from parents, less responsive child with history of having fever x
10/7 , vomiting & diarrhea for 3/7

When he came in to ED,

Gcs : E3 , V2, M4
Crt 5 s, cold periph, hr 130, Bp 80/45, hydration very poor.

W=Weight ( 8 + ((6)2)= 20kg

E=Energy ( 20kg 4 j/kg) = 80J >>incase need shock later on, child with sepsis sometimes
can develop arrythmias

T=Tube ( (6) 4 ) + 4= 5.5 , ett standby 3 sizes: 5.0, 5.5, 6.0 ,

Length anchored ( (62) + 12) = 15

F=Fluid
Normal child = 20cc/kg
Child with heart dz / trauma = 10cc/kg
In this case, 20cc/kg 20kg = 400cc NS
Max Bolus can be given x 3 only, bp still not picking up, consider your ionotropes.

A=Adrenaline
1: 10 000
0.1mls/kg
In this case, 2.0mls

G=Glucose
2mls/kg
In this case, if gm < 3,
to give 2mls/kg 20kg = 40mls D 10% and then maintain with HSD5 Full maintenance..

While finish resuscitating the boy, suddenly he develop fitting..

ABC secured..

If fitting lasting more than 2 mins and not aborted, give your diazepam( per rectal or iv if got
iv access 0.2mg/kg)
Max giving diazepam = 2 x
If still fitting , loading with iv phenytoin 20mg/kg..

Don't forget you baseline lab ix, blood c&s, cxr, ct brain and starts him on iv abx,

Diagnosis that should ran through your mind whenever you get the history and presentation
was:

Hypovolamic shock? Yes, after hydration, parameter should improved.

Septic shock? Bp not improving post bolus hydration 3, considering ionotropes

Meningitis? Yes, pt had fitting, and do not forget to expose the pt body, look for rash
(meningococcal meningitis)

DKA

Morning story: Today, we are having a cme with the Physician from HOSHAS,
Dr Francis.The hot topics was "DKA"
Several point stressed by him..
To all my colleagues in KK/Hosp:
1) No more impending DKA as your dx, either DKA/ Severe DKA/ Uncontrolled
DM
2)Should not omit basal insulin once in dka (continue insulatard ON)
3) Criteria DKA = RBG >11 + serumketone >3 or urineKetone > 2+ & ph <7.3,
hC03<15
4) Normal Insulin: s/c Actrapid should not be higher or equal to your s/c
insulatard dosage
5) Should aid Potassium in your maintenance fluid despite normal K
( 3.5-5.5) , do not wait until K<= 3.5
6) DKA patient should not be kept NBM as it provoked ketosis
7) Insulin calculation per body weight (0.5 to 0.75 unit/kg)
Let say 72 kg man..
72kg x 0.5 unit = 36 unit in 24 hours
Divide by 2 : 36 2
= s/c 18 unit insulatard ON & 18 unit actrapid.
Then 18 unit actrapid 3 ( 6 unit tds)