Bedside Paediatric Guidelines 2022-2024 Pdf

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Prescribing regimens and nomograms
The administration of certain drugs, especially those given intravenously, requires great care if
hazardous errors are to be avoided. These guidelines do not include all guidance on the
indications, contraindications, dosage and administration for all drugs. Please refer to the British
National Formulary for Children (BNFc).
Antibiotics
Recommendations are based on national guidance reflecting a balance between common
antibiotic sensitivities and the narrowest appropriate spectrum to avoid resistance but local
policies may reflect frequently encountered sensitivity patterns in individual local patient groups.
Antimicrobials
Recommendations are generic. Please check your local microbiology advice.
Practical procedures
DO NOT attempt to carry out any of these practical procedures unless you have been trained to
do so and have demonstrated your competence.
National guidelines
Where there are different recommendations the following order of prioritisation is followed:

NICE > NPSA > SIGN > RCPCH > National specialist society > BNFc > Cochrane > Meta-
analysis > systematic review > RCT > other peer review research > review > local practice.

Evidence base
These have been written with reference to published medical literature and amended after
extensive consultation. Wherever possible, the recommendations made are evidence based.
Where no clear evidence has been identified from published literature the advice given
represents a consensus of the expert authors and their peers and is based on their practical
experience.
Supporting information
Where supporting evidence has been identified it is graded 1 to 5 according to standard criteria of
validity and methodological quality as detailed in the table below. A summary of the evidence
supporting each statement is available, with the original sources referenced. The evidence
summaries are being developed on a rolling programme which will be updated as each guideline
is reviewed.

APLS – CARDIORESPIRATORY ARREST ● 3/3 

 Defibrillation
 Use hands-free paediatric pads in children, may be used anteriorly and posteriorly
 Resume 2 min of cardiac compressions immediately after giving DC shock, without checking monitor or
feeling for pulse
 Briefly check monitor for rhythm before next shock: if rhythm changed, check pulse
 Adrenaline and amiodarone are given after the 3rd and 5th DC shock, and then adrenaline only every
other DC shock
 Automatic external defibrillators (AEDs) do not easily detect tachyarrythmias in infants but may be used
at all ages, ideally with paediatric pads, which attenuate the dose to 50–80 J
PARENTAL PRESENCE
 Evidence suggests that presence at their child’s side during resuscitation enables parents to gain a
realistic understanding of efforts made to save their child. They may subsequently show less anxiety and
depression
 Designate 1 staff member to support parents and explain all actions
 Team leader, not parents, must decide when it is appropriate to stop resuscitation
WHEN TO STOP RESUSCITATION
 No time limit is given to duration of CPR
 no predictors sufficiently robust to indicate when attempts no longer appropriate
 cases should be managed on individual basis dependent on circumstances
 Prolonged resuscitation has been successful in:
 hypothermia (<32C)
 overdoses of cerebral depressant drugs (e.g. intact neurology after 24 hr CPR)
 Discuss difficult cases with consultant before abandoning resuscitation
POST-RESUSCITATION MANAGEMENT
Identify and treat underlying cause
Monitor
 Heart rate and rhythm
 Oxygen saturation
 CO2 monitoring
 Core and skin temperatures
 BP
 Urine output
 Arterial blood gases and lactate
 Central venous pressure
Request
 CXR
 Arterial and central venous gases
 Haemoglobin and platelets
 Group and save serum for crossmatch
 Sodium, potassium, U&E
 Clotting screen
 Blood glucose
 LFTs
 12-lead ECG
 Transfer to PICU
 Hold team debriefing session to reflect on practice