Translating Emergency Knowledge for Kids

Most acutely ill and injured children are managed within emergency departments that are not part of a children’s hospital. Difficulties in getting the right resources and training have been cited as barriers to providing the best possible care in these settings. This has resulted in variable levels of emergency care for children. TREKK is a knowledge mobilization network established to address these critical knowledge gaps and improve emergency care for children. 

2018 AHA PALS Update – Nothing New


The optimal sequence of PALS interventions, including administration of antiarrhythmic drugs during resuscitation, and the preferred manner and timing of drug administration in relation to shock delivery are still not known. One study reported a statistically significant improvement in return of spontaneous circulation when lidocaine administration was compared with amiodarone for pediatric ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest. However, no difference in survival to hospital discharge was observed among patients who received amiodarone, lidocaine, or no antiarrhythmic medication.

Normal (Abnormal) Saline vs. Ringer’s Lactate

The choice of crystalloid fluid for volume resuscitation is debated often. With rising concern about the effect of hyperchloremic metabolic acidosis associated with normal saline, clinicians more commonly are opting for balanced crystalloids, such as lactated Ringer’s solution or Plasma-Lyte. 

American Heart Association Guidelines for CPR & Emergency Cardiovascular Care 2017

 

These highlights summarize the key issues and changes in the adult and pediatric basic life support (BLS) 2017 focused updates to the American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC).

 

Hands-Only CPR

Hands-Only CPR is CPR without mouth-to-mouth breaths. It is recommended for use by people who see a teen or adult suddenly collapse in an “out-of-hospital” setting (such as at home, at work or in a park). It consists of two easy steps:

 

 

Management of Crush Injury/Syndrome

Crush syndrome is a life and limb-threatening condition that can occur as a result of entrapment of the extremities accompanied by extensive damage of a large muscle mass. It can develop following as little as 1 hour of entrapment. Effective medical care is required to reduce the risk of kidney damage, cardiac arrhythmia, and death. Management includes;

  • Fluids: IV fluid to provide 1L/h for 24 to 48 hours (depending on evacuation availability)
  • Equipment: ECG, laboratory tests for serum potassium and urine myoglobin, Foley catheter with graduated collection system, tourniquets
  • Medications: hyperkalemia
  • Manage Pain
  • Give Antibiotics
  • Continuous monitor with portable monitor; 15-minute to hourly vital signs, examination, urine output documented on flow sheet

 

Intraosseous Access 101

  • IO access provides rapid vascular access in a variety of emergency situations.
  • There are several types of IO devices that can be used.
  • The humeral site is generally the least painful and quickest to access
  • All resuscitation and anaesthetic drugs can be given via the IO route.
  • Fluids need to be administered under pressure.
  • All devices need to be monitored and a clear handover given.