They are different types of paediatric emergency. They
are listed below:
are listed below:
i.
Hypothermia
ii.
Head injury
iii.
Burn injury
iv.
Wheezing child
v.
Asthma, shock, cardiac failure, convulsions,
Appendix, diabetes mellitus (type ii and type ii)
vi.
Epistaxis
vii.
Acute rheumatic fever
viii.
Hypoglycemia
Hypothermia
Hypothermia is a potentially dangerous drop in body
temperature, usually caused by prolonged exposure to cold temperatures.
temperature, usually caused by prolonged exposure to cold temperatures.
Temperature less than 36.50
Risk Factors
i.
Low Birth weight and or premature new born.
ii.
Septic New born.
iii.
New born with asphyxial birth
iv.
All New born who do not receive heat less
prevention measure.
Signs and Symptoms
i.
Shock and Scleroma
ii.
Cyanosis and pallor
iii.
Haemorrhage and hypoglycaemia
iv.
Dyspnea and apnea
Complications
i.
Increase in oxygen consumption
ii.
Difficulties with extra-uterine adaptation
because of hypoxia
iii.
Thermal shock which can lead to death
Management
Immediately after birth or arrival at the hospital
i.
Dry infant and keep under warming light
ii.
Obtain temperature within first hour of life
iii.
Normal temperature 36.5-37.50c
Head injury: Injury to the head may
occur as a result of a blow or a fall. The severity of the injury depends on
whether the brain is affected. A blow may shake or bruise the brain. (Blades,
2014).
occur as a result of a blow or a fall. The severity of the injury depends on
whether the brain is affected. A blow may shake or bruise the brain. (Blades,
2014).
Injuries of the head include:
a) Skull fracture: Damage of the skull
b) Concussion: Temporary loss of
consciousness with no significant anatomical brain injury.
consciousness with no significant anatomical brain injury.
c) Epidural hematoma: Mass lesion resulting
from tear of middle meningeal artery in parieto-temporal region of skull may
cause acute deterioration and cerebal herniation in the field. In padritic
patient may result from venous bleed and have less acute course. Prognosis
excellent if properly treated acutely.
from tear of middle meningeal artery in parieto-temporal region of skull may
cause acute deterioration and cerebal herniation in the field. In padritic
patient may result from venous bleed and have less acute course. Prognosis
excellent if properly treated acutely.
d) Parenchymal hematoma: Mass
lesion within brain tissue itself associated with severe primary brain injury
and poor prognosis.
lesion within brain tissue itself associated with severe primary brain injury
and poor prognosis.
Signs and Symptoms
i.
Attended level of consciousness
ii.
Disoriented
iii.
Vomiting
iv.
Headache
Late Signs
i.
Posturing (flexor or extention)
ii.
Central neurogenic hyper ventilation, irregular
respiration
iii.
Classic cushing triad of hypertension,
bradycardia and hypoventilation may not occur
iv.
Pupillary dilatation especially one “blown”
pupil
Field management
i.
Control external bleeding
ii.
Do not remove penetrating object unless they
interfere with essential resuscitation or extraction
iii.
Treat suspected elevation of interanial pressure
(Romig, 2010).
Burn injury: Tissue damage resulting
from contact with heat, electricity, chemicals or radiation. Burns are
classified according to the severity of damage to the skin.
from contact with heat, electricity, chemicals or radiation. Burns are
classified according to the severity of damage to the skin.
Calculation of total body
surface area burned “Rule of Nines” applies to adult because children have
relatively large heads and smaller low extremies than do adults, it must be
modified to determine the body surface area burned on a child or infant.
surface area burned “Rule of Nines” applies to adult because children have
relatively large heads and smaller low extremies than do adults, it must be
modified to determine the body surface area burned on a child or infant.
Management
1. Remove from source of injury protecting self
2. Attend
to ABC’s-C-Spine of other injury also involved.
to ABC’s-C-Spine of other injury also involved.
3. Cover
patient with clean sheet
patient with clean sheet
4. Keep
patient warm
patient warm
5. IV
access if;
access if;
·
burn
15% of body surface
burn
15% of body surface
·
Long transport time (30 mins)
Long transport time (
30 mins)
·
may be placed through burned skins.
may be placed through burned skins.
6. Remove jewellery from burned extremities
7. May cool with clean dressing soaked in tap
water for 15mins and total body surface are involved is 10%.
water for 15mins and total body surface are involved is 10%.
1. Do not
Break
blister
blister
2. Apply
greasy Substances
greasy Substances
3. Apply
ice or cold solution (Romig, 1997).
ice or cold solution (Romig, 1997).
Wheezing Child
A wheeze is a musical and
continues sound that originates from oscillations in narrowed airways. Wheezing
is hard mostly in expiration as a result of critical airway obstruction.
continues sound that originates from oscillations in narrowed airways. Wheezing
is hard mostly in expiration as a result of critical airway obstruction.
Causes
1. Brachioitis
2. Asthma
3. Oesophageal Foreign bodies
4. Aspiration Syndrome
(gastro-oesophageal reflex disease)
(gastro-oesophageal reflex disease)
(Gregory
and Bluma, 2006)
and Bluma, 2006)
2.2.5 Asthma: Is a chonic
inflammatory condition of the lung airways resulting in episode airflow
obstruction.
inflammatory condition of the lung airways resulting in episode airflow
obstruction.
Cause
i.
Allegergies
ii.
Medicines (propranolol and aspirin)
iii.
Environment
iv.
Emotion
v.
Family history
vi.
Gastro esophagal
Signs and symptom
i.
Breathlessness
ii.
Wheezing
iii.
Cough
iv.
Exercise induced cough
v.
Chest lightness
vi.
Sputum production
Normal rate of breathing in awake children
<2months
:< 60mins
:< 60mins
2-12 months: <50mins
1-5 years :< 40mins
6-8years :< 30mins
Diagnosis
Asthma can often be diagnosed on the basis of
patient symptoms and medical history
patient symptoms and medical history
Complication
Uncontrolled/poorly
controlled asthma can lead to severe lung damage.
controlled asthma can lead to severe lung damage.
Severe asthma exacerbation can cause repertory failure
and death
and death
Investigation
1. Lung function to confirm
diagnosis and assess severity
diagnosis and assess severity
2. Peak expiratory flow rate
can help diagnosis and follow up
can help diagnosis and follow up
3. Additional diagnosis tests
4. Allergy testing (where
applicable)
applicable)
5. Chest X-ray
6. FBC for exclusion of super
infection (Brain and Crindle, 2010)
infection (Brain and Crindle, 2010)
Convulsion: This is a status
epilepticus that persists for 30mins to prevent recovery of consciousness and
return to baseline between attacks.
epilepticus that persists for 30mins to prevent recovery of consciousness and
return to baseline between attacks.
Causes
i.
CNS infection
ii.
Hypoxic Ischemic Insult
iii.
Traumatic brain injury
iv.
Cerebrovascular accident
v.
Electrolyte imbalances
vi.
Intoxication
Clinical signs and symptoms
Seizure lasting 
30mins or repetitive
seizure activity without return to baseline consciousness.
30mins or repetitiveseizure activity without return to baseline consciousness.
Complications
i.
Death
ii.
Hyperthermia
iii.
Renal failure
iv.
Respiratory depression or failure due to
neurologic status or aspiration.
Investigation
i.
EEG
ii.
CT scans of the brain
iii.
MRI of the brain
Management
i.
Manage airway breathing-circulation
ii.
Place patient on side at 20-30 headpin to
prevent aspiration
iii.
Control fever with tepid sponging
iv.
Administer oxygen to maintain SaO2 of
90 diabe
(American Heart association 2005)
Diabetes mellitus (type I and
type II)
type II)
Diabetes mellitus is a
disorder of absolute or relative insulin deficiency that results in increased
blood glucose and disruption of energy storage and metabolism. Diabetes
mellitus i and diabetes mellitus type II
disorder of absolute or relative insulin deficiency that results in increased
blood glucose and disruption of energy storage and metabolism. Diabetes
mellitus i and diabetes mellitus type II
Type I diabetes: this result from destruction of the pancreatic
beta cells that leads to absolute insulin deficiency. Type 1A is secondary to
auto immune destruction of the beta cells. Type 1B is secondary accounts for
approximately 2/3 of the new diagnosis of diabetes in patient
19 years old there is a component of genetic
susceptibility and close relatives of patients with types I DM are at higher
risk of developing the disease.
beta cells that leads to absolute insulin deficiency. Type 1A is secondary to
auto immune destruction of the beta cells. Type 1B is secondary accounts for
approximately 2/3 of the new diagnosis of diabetes in patient
19 years old there is a component of geneticsusceptibility and close relatives of patients with types I DM are at higher
risk of developing the disease.
Type II diabetes: This is secondary to varying of insulin
resistance and insulin deficiency and related to both genetic and environmental
influences including predisposing medication such as steroids and some ARV’S it
is most common type of diabetes mellitus in adults.
resistance and insulin deficiency and related to both genetic and environmental
influences including predisposing medication such as steroids and some ARV’S it
is most common type of diabetes mellitus in adults.
Signs and Symptoms
1. Polyuria: This occurs when the
serum glucose concentration rises above 180mg/dl exceeding the renal threshold
for glucose and leads to increased urinary glucose excretion and a subsequent
osmotic diuresis. This may be present as nocturia, bedwetting etc.
serum glucose concentration rises above 180mg/dl exceeding the renal threshold
for glucose and leads to increased urinary glucose excretion and a subsequent
osmotic diuresis. This may be present as nocturia, bedwetting etc.
2. Polydipsia: This is
secondary to increased thirst from increased serum osmolality and dehydration.
secondary to increased thirst from increased serum osmolality and dehydration.
3. Polyphagia
4. Weight loss
5. Weakness/lethargy with
ultimate progression to coma
ultimate progression to coma
6. Visual disturbances
Investigation
1. Blood sugar: The diagnosis
is made based on abnormalities of the blood glucose. See diagnostic criteria
below.
is made based on abnormalities of the blood glucose. See diagnostic criteria
below.
2. Additional studies to
evaluate severity and complication of disease
evaluate severity and complication of disease
3. Blood gas if concern for
diabetic ketoacidosis
diabetic ketoacidosis
4. Electrolytes
5. Renal function test
6. Lipid profile
7. Foot examination
Diabetes mellitus (DM) TEST
1. Symptoms of DMplus random
plasma glucose200mg/dl (11.1mmol/L)
plasma glucose
200mg/dl (11.1mmol/L)
2. Fasting plasma glucose 126mg/dl (7.0mmol/L).
Fasting is defined as no oral intake for at least 8 hours.
126mg/dl (7.0mmol/L).Fasting is defined as no oral intake for at least 8 hours.
3. Two-hour plasma glucose 200mg/dl during an oral
glucose tolerance text (OGTT) as described by the WHO
200mg/dl during an oralglucose tolerance text (OGTT) as described by the WHO
4. HgAIC 6.5%:This test should be performed in
certified laboratory with an assay standardized to the diabetes control and
complications trial (DCCT)
6.5%:This test should be performed incertified laboratory with an assay standardized to the diabetes control and
complications trial (DCCT)
Management:
1. The majority of children
with diabetes mellitus hate type 1 diabetes and may have diabetic ketoacidosis
(DKA)
with diabetes mellitus hate type 1 diabetes and may have diabetic ketoacidosis
(DKA)
2. Diabetes mellitus type 1:
Children with diabetes mellitus type 1 require insulin therapy the patient is
insulin dependent and while the insulin therapy may be adjusted based on the
clinical condition and blood glucose results. The insulin therapy should NEVER
be stopped completely as this could result in the development of DKA and death.
(American diabetes association 2007)
Children with diabetes mellitus type 1 require insulin therapy the patient is
insulin dependent and while the insulin therapy may be adjusted based on the
clinical condition and blood glucose results. The insulin therapy should NEVER
be stopped completely as this could result in the development of DKA and death.
(American diabetes association 2007)
Cardiac Failure
It is the inability of the
heart to deliver adequate cardiac output to meet the metabolic need of the
body.
heart to deliver adequate cardiac output to meet the metabolic need of the
body.
Causes
1.
Congential heart disease
Congential heart disease
2.
Acquired heart diseases
Acquired heart diseases
3.
Severe anaemia
Severe anaemia
4.
Fluid over load
Fluid over load
5.
Acute hypertension
Acute hypertension
Signs and Symptoms
1.
Signs due to congestion
Signs due to congestion
2.
Polypnea (cough)
Polypnea (cough)
3.
Exercise Induced dyspnea
Exercise Induced dyspnea
4.
Enlarged, tender liver
Enlarged, tender liver
5.
Basal crackle on auscultation
Basal crackle on auscultation
6.
Elevated jugular venous pressure (JVP)
Elevated jugular venous pressure (JVP)
7.
Weight gain due to oedema
Weight gain due to oedema
8.
Cold extremities
Cold extremities
9.
Capillary refill time to see
Capillary refill time to see
10. Decreased Blood pressure
11. Weak pulse
Complication
·
Failure to thrive
Failure to thrive
·
Cardiogenic shock and death.
Cardiogenic shock and death.
Investigation
1. Chest X-ray
2. FBC (Full Blood count)
3. Ultra sound
4. ECG
5. BUN (Blood Urea Nitrogen)
Management
1. Admit the child
2. Diuretics (furosemide inj
/v/-4mg /kg/ day-divided into 2.3 doses. Maximum dose 8mg/kg/day)
/v/-4mg /kg/ day-divided into 2.3 doses. Maximum dose 8mg/kg/day)
3. Supplementary potassium if
frusemide is given for more than 5 days.
frusemide is given for more than 5 days.
4. Treating the underlining
cause (surgical treatment)
cause (surgical treatment)
(Brain and Crindle, 2010)
Epistaxis
Definition: Epistaxis
is nose bleeding
is nose bleeding
Causes
1.
Local (trauma, inflammation, foreign bodies,
tumours of the nose and rhinopharynx, chronic using of nasal steroides, intra
nasal growth like polyps,).
Local (trauma, inflammation, foreign bodies,
tumours of the nose and rhinopharynx, chronic using of nasal steroides, intra
nasal growth like polyps,).
2.
Systemic (cardiovascular diseases, blood diseases,
liver diseases, kidney diseases, febrile diseases).
Systemic (cardiovascular diseases, blood diseases,
liver diseases, kidney diseases, febrile diseases).
3.
Upper respiratory disease ( sinusitis, allergic
rhinitis ).
Upper respiratory disease ( sinusitis, allergic
rhinitis ).
4.
Juvenile nasopharyngeal angiofibroma if profuse
unilateral epistaxis associated with a nasal mass in adolescent boys.
Juvenile nasopharyngeal angiofibroma if profuse
unilateral epistaxis associated with a nasal mass in adolescent boys.
5.
Idiopathic (causes not known)
Idiopathic (causes not known)
Signs and symptoms
1.
Blood coming from the nose or the rhinopharynx
Blood coming from the nose or the rhinopharynx
2.
History of recurrent nasal bleeding
History of recurrent nasal bleeding
Complications
1.
Hypovolemic shock
Hypovolemic shock
2.
Anaemia
Anaemia
Investigations in
complicated or recurrent cases
complicated or recurrent cases
1.
Full Blood Count, clotting time, bleeding time,
prothrombin time.
Full Blood Count, clotting time, bleeding time,
prothrombin time.
2.
CT scan and MRI if Juvenile nasopharyngeal
angiofibroma.
CT scan and MRI if Juvenile nasopharyngeal
angiofibroma.
3.
Other investigations should be requested based on
general examination findings.
Other investigations should be requested based on
general examination findings.
Management
Non pharmaceutical treatment
1.
Sit the
patient up to avoid aspiration
Sit the
patient up to avoid aspiration
2.
Cleaning
of blood clots from the nose
Cleaning
of blood clots from the nose
3.
Direct
pressure applied by pinching the soft fleshy part of the nose applied for at
least five minutes and up to 20 minutes
Direct
pressure applied by pinching the soft fleshy part of the nose applied for at
least five minutes and up to 20 minutes
4.
Application
of cold compresses on the nose
Application
of cold compresses on the nose
5.
Room
humidifier
Room
humidifier
6.
Pack with
ribbon gauze impregnated with topical ointments (Vaseline) and remove it after
12-24 hours.
Pack with
ribbon gauze impregnated with topical ointments (Vaseline) and remove it after
12-24 hours.
Pharmaceutical treatment
1.
Application
of a topical antibiotics ointment to the nasal mucosa has been shown to be an
effective treatment for recurrent epistaxis
Application
of a topical antibiotics ointment to the nasal mucosa has been shown to be an
effective treatment for recurrent epistaxis
2.
Topical
vasoconstrictor: Xylometazoline spray (otrivine) 0.5mg/ml
Topical
vasoconstrictor: Xylometazoline spray (otrivine) 0.5mg/ml
3.
Cauterization
of the bleeding site with Silver nitrate or 20% of solution Trichloracetic
acid under topical anesthesia
Cauterization
of the bleeding site with Silver nitrate or 20% of solution Trichloracetic
acid under topical anesthesia
4.
Electro
coagulation
Electro
coagulation
5.
If severe
bleeding with shock/or anemia, immediate blood transfusion is recommended
If severe
bleeding with shock/or anemia, immediate blood transfusion is recommended
Recommendations
1.
Investigate
for underlying causes
Investigate
for underlying causes
2.
Refer
cases of severe and recurrent epistaxis
Refer
cases of severe and recurrent epistaxis
3.
Refer to
ENT specialist for otolaryngologic evaluation if bilateral bleeding or
hemorrhage that not arise from Kiesselbach plexus
Refer to
ENT specialist for otolaryngologic evaluation if bilateral bleeding or
hemorrhage that not arise from Kiesselbach plexus
Acute Rheumatic Fever
Definition:
This is an acute, systemic connective tissue disease in children related
to an immune reaction to untreated group A Beta haemolytic streptococcus
infection of the upper respiratory tract .The initial attack of acute rheumatic
fever occurs in most cases between the ages of 3 and 15 years.
This is an acute, systemic connective tissue disease in children related
to an immune reaction to untreated group A Beta haemolytic streptococcus
infection of the upper respiratory tract .The initial attack of acute rheumatic
fever occurs in most cases between the ages of 3 and 15 years.
Causes
Auto-immune
disease
disease
Signs
and symptoms (Revised Jones Criteria)
and symptoms (Revised Jones Criteria)
|
Major manifestations:
|
Minor manifestations:
|
Group A Strep(GAS) Infection:
|
|
|
Carditis
|
Fever
|
GAS on throat swab (culture)
|
|
|
Arthritis
|
Arthralgia
|
Raised Anti-streptolysin O titre (ASOT)
|
|
|
Sydenham’s Chorea
|
Prolonged P-R interval on ECG
|
Raised Anti-deoxyribonuclease B (Anti-DNase B)
|
|
|
Erythema marginatum
|
Raised ESR or CRP
|
||
|
Subcutaneous nodules
|
|||
Criteria
for ARF diagnosis according to the WHO
for ARF diagnosis according to the WHO
The first episode of
ARF can be confirmed if:
ARF can be confirmed if:
1.
MAJOR, or
1 MAJOR and 2 MINOR manifestations are present plus there is
evidence of preceding Group A streptococcal infection.
MAJOR, or
1 MAJOR and 2 MINOR manifestations are present plus there is
evidence of preceding Group A streptococcal infection.
Recurrent ARF (with
no RHD) can be confirmed if:
no RHD) can be confirmed if:
1.
MAJOR, or
1 MAJOR and 2 MINOR manifestations are present plus there is
evidence of preceding Group A streptococcal infection.
MAJOR, or
1 MAJOR and 2 MINOR manifestations are present plus there is
evidence of preceding Group A streptococcal infection.
Recurrent ARF (with
existing RHD) can be confirmed if
existing RHD) can be confirmed if
1.
MINOR
manifestations are present plus there is evidence of preceding Group A
streptococcal infection.
MINOR
manifestations are present plus there is evidence of preceding Group A
streptococcal infection.
Complication
1. Rheumatic heart
disease
disease
Investigations
1.
Throat
swab for culture (positive throat culture of group A Streptoccocal infection)
Throat
swab for culture (positive throat culture of group A Streptoccocal infection)
2.
Raised
ASOT/ASLO antibodies titre (Anti-streptolysin-0-titre – ASOT of 1:300)
Raised
ASOT/ASLO antibodies titre (Anti-streptolysin-0-titre – ASOT of 1:300)
3.
Anti DNase
B
Anti DNase
B
4.
FBC/
ESR/CRP
FBC/
ESR/CRP
5.
Chest
x-ray – Features of cardiomegaly
Chest
x-ray – Features of cardiomegaly
6.
ECG
ECG
7.
Echocardiogram
Echocardiogram
Management
Admit the patient
N.B: Persons with
symptoms of ARF should be hospitalized to ensure accurate diagnosis, and to
receive clinical care and education about preventing further episodes of ARF
symptoms of ARF should be hospitalized to ensure accurate diagnosis, and to
receive clinical care and education about preventing further episodes of ARF
Give
• A single injection of Benzathine penicillin G (Extencilline): 25,000–50,000
units/kg/dose STAT; maximum 1.2 mega units dose
units/kg/dose STAT; maximum 1.2 mega units dose
OR
•
Oral Penicillin (Pen V) 25–50mg/kg/day in divided 3 doses for 10 days (Erythromycin
30-50mg/kg/day divided in 3 doses if penicillin allergy)
Oral Penicillin (Pen V) 25–50mg/kg/day in divided 3 doses for 10 days (Erythromycin
30-50mg/kg/day divided in 3 doses if penicillin allergy)
Relieve symptoms
Arthritis and fever
1.
Aspirin
75–100mg/kg/day in 4–6 divided doses. Treatment
continued until fever and joint inflammation are controlled and then gradually
reduced over a 2-week period
Aspirin
75–100mg/kg/day in 4–6 divided doses. Treatment
continued until fever and joint inflammation are controlled and then gradually
reduced over a 2-week period
2.
Add an
antacid to reduce risk of gastric irritation
Add an
antacid to reduce risk of gastric irritation
3.
Prednisolone
1-2mg OD for 2 weeks then taper for 2 weeks with
good response begin
Prednisolone
1-2mg OD for 2 weeks then taper for 2 weeks with
good response begin
4.
Aspirin
in the 3rd week and continue until 8th week tapering
in the final 2 weeks
Aspirin
in the 3rd week and continue until 8th week tapering
in the final 2 weeks
Chorea
·
Most
mild-moderate cases do not need medication
Most
mild-moderate cases do not need medication
·
Provide
calm and supportive environment (prevent accidental self-harm)
Provide
calm and supportive environment (prevent accidental self-harm)
For severe cases:
Carbamazepine
per os:
per os:
<6 years:
10-20mg/kg/day divided in 3 doses,
10-20mg/kg/day divided in 3 doses,
6-12 years:
400-800mg/day divided in 3 doses,
400-800mg/day divided in 3 doses,
>12 years: 200mg x
2/day
2/day
Valproic
acid 20-30mg/kg/day
divided in 2 doses
acid 20-30mg/kg/day
divided in 2 doses
Duration: 2 weeks
Carditis
·
Bed rest
if in cardiac failure
Bed rest
if in cardiac failure
·
Anti-failure
medication as above
Anti-failure
medication as above
·
Anti-coagulation
medication if atrial fibrillation is present
Anti-coagulation
medication if atrial fibrillation is present
·
Management
plan when the acute episode is controlled
Management
plan when the acute episode is controlled
·
Administer
the first dose of secondary prophylaxis
Administer
the first dose of secondary prophylaxis
·
Register
the individual with the local health authority or RHD Program.
Register
the individual with the local health authority or RHD Program.
Hypoglycemia
Definition:
Blood glucose levels below the lower limit of the
normal range (blood glucose < 2.2 mmol/L, for malnourished children <3
mmmol/L).
Blood glucose levels below the lower limit of the
normal range (blood glucose < 2.2 mmol/L, for malnourished children <3
mmmol/L).
Causes/Risk
factors
factors
Individuals with
diabetes
diabetes
1.
Excessive
dose of medication anti−diabetic medication
Excessive
dose of medication anti−diabetic medication
2.
Omitted
or inadequate amount of food
Omitted
or inadequate amount of food
3.
Unaccustomed
physical over activity
Unaccustomed
physical over activity
4.
Alcohol
intake
Alcohol
intake
Signs and
symptoms
symptoms
|
– Dizziness
– Blurred vision
– Headaches
– Palpitation
– Irritability and abnormal behavior
|
– Sweating
– Tremors
– Tachycardia
– Confusion
– Unconsciousness
– Convulsions
|
Investigation
Blood glucose
Management
10% Glucose, IV, 2−4
ml/kg body weight 1 to 3 minutes through a large vein followed by 5−10%
Glucose, IV, according to total daily fluid requirement until the patient is
able to eat normally
ml/kg body weight 1 to 3 minutes through a large vein followed by 5−10%
Glucose, IV, according to total daily fluid requirement until the patient is
able to eat normally
Alternatively,
1.
Glucagon, IV, IM or subcutaneous,
Glucagon, IV, IM or subcutaneous,
2.
Over 8 years of age (or body weight over 25 kg);
Over 8 years of age (or body weight over 25 kg);
3.
Give 1 mg stat IM if available
Give 1 mg stat IM if available
4.
Under 8 years of age (or body weight less than 25
kg);
Under 8 years of age (or body weight less than 25
kg);
5.
Give 500 microgram stat IM if available
Give 500 microgram stat IM if available
Recommendation
Control
blood glucose 30 minutes after 10% bolus of glucose
blood glucose 30 minutes after 10% bolus of glucose