Paediatric Teaching for Adult ED

Presentation

Paediatric Teaching

7. IV infusions

6. Scenarios

5. WETFLAG

4. Sepsis Update

3. Therapeutic Holding

2. Practical Skills

1. NPEWS

Overview

MTW will provide a mixture of e-learning and CSF led teaching to provide education on what has changed and how to correctly complete and use the chart. MTW plan to have initial obs recorded on sunrise, with any further obs on the new chart. A more succint chart for ED is being developed.

MTW Roll Out Plan

National PEWS Score

NPEWS is a standardised approach to recording paediatric observations and deterioration. It has been created by NHS England and other clinical teams and will be rolled out within this trust in 2025.

+ Info

Detection

The NPEWS score will directly link to a level of escalation. This level dictates the required response from nursing medical staff, informing clear escalation pathways.

Benefits to NPEWS

Escalation

NPEWS creates a much higher score than our current PEWS chart. This will allow staff to improve detection of changes in paediatric conditions.

A standardised method to record paediatric observations will allow consistency in how deterioration in children is recognised.

Consistency

+Info

Baby Blood Glucose & Capillary Gas

Oral Medications

Therapeutic Holding

Nebulisers and Inhalers

Practical Skills

Observations

Therapeutic holding is not just about positioning the child so you can complete your nursing task. It is proven to reduce the release of stress hormones and minimize the physical symptoms associated with anxiety. This can make medical procedures less traumatic for children, and can also help to improve their overall healthcare experience and improve parent satisfaction.

Therapeutic holding is a technique used by healthcare providers to help children feel more comfortable during medical procedures. It can involves positioning the child in the lap of or next to their parent, or in alternative way that is comfortable and calming, while also providing access to the area of the body that needs to be treated.

Babies & Swaddling

Back to Chest

Chest to Chest

Therapeutic Holding

Please take tachycardia seriously...but with a pinch of salt. Fever causes tachycardia, tachypnoeia and poor peripheral perfusion. If a child is crying, unsettled or has a high fever, naturally they will also have a high heart rate. This does not 100% indicate that they have sepsis. It may be wise to administer antipyretics and re-check in 1 hour - it may have drastically improved!

Updated this year. The first page is very similar. Note the categorisation of moderate and severe observations is at the bottom to be used as a quic reference.

Sepsis UK Update

Previously, this was not included in the Sepsis 6.

Previously, this was not included in the Sepsis 6. NOTE: a senior decision maker can de-escalate care!

Sepsis UK Update

40mls

1ml / kg

20mls

2mls / kg

(Age + 4 ) x 2

4J / kg

(Age / 4) + 4

20kg

80 Joules

10mls / kg

5.5

1mg / kg

200mls

20mg

WET FLAG

Please calculate a WETFLAG for a 6 year old.

whether there is a need for observations & discharge advice

Long Term Management

Scenarios

You will be provided with some basic patient information, including their age and presenting complaint. This is not a test! We will use these as a learning tool and I want you all to work together!

a full and structured assessment including any observations

including the initial investigations?bloods / ?urine sample / ?medication

A-E Assessment

Initial Treatment

any direct questioning you need to help with a potential diagnosis

Questions

Scenario 1

Long-Term Management

A-E Assessment

Initial Treatment

Questions

Eva has had cough and congestion for the past 4 days. Seems to cough a lot and not be able to catch her breath. Mum is worried about her breathing.

Eva, 5 months

Has had a cough and temperature for a few days. This morning developed acute difficulty in breathing and has noisy breathing. Has become quite drowsy en route to ED.

Long Term Management

A-E Assessment

Initial Treatment

Questions

Elliott, 4 years

+Info

AGE CAN HELP DIAGNOSIS Age (immune system development) and clinical hisotry are key to determining the cause of wheeze. <1 year is likely bronch; 1-5 years is likely viral wheeze; >5 years may indicate asthma.

+Info

A chronic condition that, when triggered, causes inflammation, narrowing and increased secretions in the airways of the lungs. Children will often attend with an exacerbation of their asthma due to triggers such as pollen, exercise or mould.

+Info

The Differences

Asthma

Wheezing caused by a viral infection. Common in children <3 years due to small airways. The child is usually well in-between ilnesses BUT the wheeze can last for weeks. Main treatments are: oxygen; nebulisers / inhalers

Viral Wheeze

An infection that causes the small airways of the lungs to become swollen. Bronchiolitis is NOT due to muscular constriction, hence NO SALBUTAMOL! Main treatments are: oxygen; high flow; therapeutic measures.

Bronchiolitis

Had vomiting for 24 hours. Has entered the department with parents and is unrousable in the carrier. REMEMBER Think about your differentials. What else could cause this vomiting?

Long Term Management

A-E Assessment

Initial Treatment

Questions

Freya, 2 months

If a child was 32kg - 10 x 100 = 1000mls 10 x 50 = 500mls 12 x 20 = 240 mls Total requirement 1740mls So, for the hourly rate: 1740 / 24 = 72.5 mls / hr

20 mls / kg

50mls / kg

Calculated over 24 hours. To get an hour rate, you MUST divide the total by 24.

100mls / kg

If a child was 6 kg -They would have a total requirement of 600mls

If a child was 16 kg - 10 x 100 = 1000mls 6 x 50 = 300mls Total requirement 1300mls

20 + kg

11-20 kg

1-10kg

You cannot simply hang a bag of fluids for a child (even a big one). Because their circulating volume is so small, it is very easy to overload children and cause problems.

IV MAINTENANCE FLUIDS

PAPER DRUG CHARTS

Prescription : 500mg Use the 1g vial option. Dilute the powder with 9.3mls to get 100mg in a ml or 1000mg (1g) in 10mls. You would have 5mls of medication to give. If injection, you do not need to dilute. If infusion, you can dilute to a max of 10mls, as this is max concentration 50mg in 1ml.

Ceftriaxone

IV INFUSIONS IN PAEDIATRICS

IV INFUSIONS IN PAEDIATRICSphenytoin

1500 ------ x 1 = 3mls 500

In this truust we stock 50% Magnesium Sulfate, which is a concentration of 500mg / 1ml. How many mls do we need to draw up?

40mg x 37.5kg = 1500mg OR 1.5g

You check the BNFc, which states the dose is 40mg / kg. What is the required dose?

You're looking after a 10 year old, weight 37.5kg, who needs a dose of IV Magnesium Sulphate.

Magnesium Sulphate

IV INFUSIONS IN PAEDIATRICS

So, if you add 27mls to the 3 you have drawn up, you will get the 5% infusion solution.

1500 ----- = 30mls 50

dose you need --------------- concentration you require

Magnesium Sulphate

IV INFUSIONS IN PAEDIATRICS

and remember, no question is silly

Any Questions?

NPEWS 0-11 Months

Let the communication flow!

With Genially templates, you can include visual resources to wow your audience. You can also highlight a particular sentence or piece of information so that it sticks in your audience’s minds, or even embed external content to surprise them: Whatever you like! Do you need more reasons to create dynamic content? No problem! 90% of the information we assimilate is received through sight and, what’s more, we retain 42% more information when the content moves.

• Generate experiences with your content.
• It’s got the Wow effect. Very Wow.
• Make sure your audience remembers the message.

Inhaler Technique

Use a spacer that correctly fits the childs face. There are three different sizes.

1. Shake inhaler
2. Attach the spacer, mask and inhaler together.
3. Instruct parents on therapeutic holding if required.
4. Place mask onto child's face, ensuring a tight fit. You should be able to see the rubber seal moving with every breath.
5. Administer one puff and count 10 slow seconds.
6. Remove mask from face and wait 30 seconds, shaking the inhaler in this time.
7. Repeat as many puffs as prescribed.

• We must shake the inhaler to mobilise the medication and ensure equal amounts of medication are delivered in each puff.
• We take a 30 second break between to allow time for the medication to work and 'open the lungs'.

Using Nebulisers

These should only be prescribed and administered for children REQUIRING OXYGEN. You can challenge DR's.

Equipment shown in the photo. The oxygen should be set between 5-8L whilst administering nebulisers. You can use the pot without the mask if the child does not tolerate the mask over their face. Practice therapeutic holding, educating parents on how to do this and what to expect.

• Should be run until the liquid in the pot runs out.
• Can add small amounts of saline as needed to increase the volume in the pot.

Level of Escalation

and the communication and response required

• Generate experiences with your content.
• It’s got the Wow effect. Very Wow.
• Make sure your audience remembers the message.

It is ideal if you can warm the area beforehand as this will improve blood flow. This can be done by extra clothing layers or placing a warm water filled glove over the area. Ensure you angle the tube appropriately so that blood doesn't run through the tube quickly and cause bubbles. Once full, lay on a flat surface or hold with a finger on either end to prevent spillage.

Capillary Gases

Heel Pricks

• On infants < 6 months, the lancet must be used on the heel.
• On smaller children, lancets can be used on the toe or finger.

We can use the normal Unistik Lancet on paediatrics. There are also specialised newborn lancets that are the gold-standard to use on babies (as they are less damaging).