PAEDIATRICS

Response<12 months old
<1 minute duration
Suden onset with return to baseline state
Characterised by 1 or more of:

• Central cyanosis or pallor
• Absent, decreased, or irregular breathing
• Change in tone (hypotonia or hypertonia)
• Altered level of responsiveness

Not explained by identifiable medical condition
If the child requires treatment the event is not considered to be a BRUE

ResponseNo concerning features on history or examination + ALL of:

• Age >=60 days
• Born >=32 weeks gestation and corrected gestational age >=45 weeks
• No CPR by trained healthcare professional
• First event
• Lasted <1minute

ResponseResus required (CPR/mouth to mouth)
Relationship to feeding
Colour (Cyanosis/pallor)
Tone
Resp symptoms
Prematurity
Trauma
Prior apnoeas, airway or respiratory difficulties (Snoring, stridor)
Feeding difficulties current/prior
Immunisation status (?Pertussis)
FHx - SIDS/Cardiac arrhythmia, congenital heart disease
Medication use - child/breastfeeding parent

ResponseNormal physiologic response - Laryngospasm, Gagging
Inflicted injury: Shaken baby, drug overdose, Factious illness by proxy or intentional suffocation
Infection - Pertussis, septicaemia, pneumonia, meningitis
Airway obstruction - congenital abnormalities, infection, hypotonia
Abdominal - intussusception, strangulated hernia, testicular torsion
Metabolic - hypoglycaemia, hypocalcaemia, hypokalaemia, inborn errors metabolism
Cardiac - CHD, Arrhythmia, vascular ring, prolonged QT
Resp - inhaled FB
Toxin/drugs - accidental vs NAI
Neurologic - head injury, seizure, infection, cerebral AVM
Think THE MISFITS and list a cause of each!

ResponseNot a low risk BRUE (list the stuff above)
Abnormal examination
NAI
High risk PMHx (Eg FHx SIDS)
>1 episode in 24h
Parental concern/anxiety
?poor follow up

ResponseEducation to caregivers about BRUES
Offer resources for training in CPR
Arrange follow up within 24h - identify evolving medical problem requiring treatment
Bref period of on hospital observation (1-4h/overnight if presents late) with normal pulse ox and serial observations
12 lead ECG normal (Pay attention to QT)
Consider pertussis testing if <2 months or high risk with resp symptoms

ResponseSee anaesthetics for airway sizes etc.

ResponseCPR 15:2 (For Children)
DC cardioversion 4J/kg
Adrenaline 10 mics/kg
Weight = (age + 4) x 2, or broslow tape, or ask parents

Response20 mL/kg N/S Boluses

Maintainence - 0.9% N/S + 5% Dextrose
4mL/kg/hr up to 10 kg,
2 mL/kg/hr from 10-20 kg
1 mL/kg/hr for every kg >20 kg
You may need to add deficit and divide total by 24 and add to hourly rate

ResponseAdenosine 0.1>>0.2>>0.3 mg/kg
Adrenaline (arrest) - 10 mics/kg IV
Adrenaline infusion - 0.1-0.2 mics/kg/min (RCH 6mg in 1000 mL, start at 0.5 mL/kg/h)
Amiodarone 5mg/kg
Atropine - 20 mics/kg
Calcium gluconate- 0.5 mL/kg (of 10% calcium gluconate)
Sodium Bicarbonate - 0.5-`mmol/kg (1mL/kg 8.4%)
Magnesium 0.1-0.2 mmol/kg
Potassium 0.1 mmol/kg

Response‘Normal’ SBP = (age x 2) + 80
‘Minimum’ SBP = (age x 2) + 70

ResponseRed cells 10 mL/kg
Platelets 10 mL/kg
FFP 15 mL/kg
Cryo 5 mL/kg