Response to sick child (PRI)

Sick children should not be presented to PRI ED and instead should be directed to Ninewells. This guideline discusses the steps to take in case that a child arrives at PRI ED regardless. There should be no 999 presentations of unwell children to PRI (including Paediatric Cardiac Arrest) due to agreed ambulance bypass arrangements. All these cases should go to Ninewells ED. Unfortunately, there may be situations where there is an injured or unwell child presented to the PRI site.

Early identification and rapid blue light transfer to Ninewells ED is the optimum pathway.

Early discussion with ED Consultant on #6699 is advised after identification of the unwell child.

The majority of cases

1. Discuss with ED Consultant on #6699 and contact PRI resident anaesthetist bleep 5200.

2. Organise immediate 999 transfer by ambulance. This may require ongoing resuscitation and assessment for requirement of medical transfer (most commonly PRI anaesthetic resident but may depend on skill set).

If immediate or urgent intubation and ventilation is required

If the child requires immediate or urgent intubation and ventilation, it may be appropriate to perform this in PRI prior to transfer.

This should be co-ordinated by the ED Consultant (#6699) who can liaise with:

On call PRI Anaesthetic Consultant(switchboard)
On call Paediatric Anaesthetic Consultant (Switchboard or 32175 in hours)
On Call Paediatrician (bleep 4190 or switchboard OOH).

Ninewells or SCOTSTAR?

The decision regarding ongoing transfer (Ninewells or SCOTSTAR to Edinburgh/Glasgow) will need to be made on a case by case basis, depending on diagnosis and availability/timing of the SCOTSTAR team.

Early contact with SCOTSTAR is advised tel. 03333 990 222

Mobilisation of staff

It may take time to mobilise paediatrics and additional anaesthetic clinicians due to where they are based. In these rare circumstances specialty consultants may choose to mobilise a different member of their team due to locality.

PRI ED Consultant involvement

Do not delay transfer to Ninewells for paediatric support if the child is stable enough to be moved. Consideration should be given to using NHS attend 'Near me consult now' function to enable clinical advice to bedside from remote team.

Appendix 1 Considerations during safe stabilisation pending Scotstar transfer

Safe Location:

If Scotstar arrival is not imminent, please consider where the patient may be best cared for safely awaiting the transfer. Options include ED resus or medical HDU

Safe Equipment.

Oxylog 3000 cannot be used to safely ventilate patients below 5kg and performance is variable between 5 and 10kg bodyweight. The Primus should be considered in this situation. Requires small volume ventilator circuits and HME.
Infusion pumps need to be ones which can deliver small fluid volumes

Safe Drugs & Fluid Calculations

Weight: if not known use ED resus charts for appropriate age
Antibiotic Teddyfor recommended antibiotics (Our websites>Childrens Hospital>Pharmacy)
Iv monographs on administration (Our websites>Childrens Hospital>Pharmacy)
BNFC for all standard meds
Scotstar Drug Calculator for all resus drugs and infusions

Special Considerations

Parents: ideally allocate a member of staff to liaise with family and keep updated, identify appropriate room for them if need time away from bedside, especially during procedures
Hypoglycaemia: check BM hourly
Temperature control: sick children will cool very quickly consider need for transwarmers (do not place directly onto skin of small infants place 1 layer of sheet between skin and mattress). There are open warm cots in the CMU.
Venous access can be challenging, may need IO, need exceedingly high pressures so unlikely that pump will deliver infusion via IO.

Useful Contacts and links

NHS Tayside Paediatric Guidelines: Our Websites>Children͛'s Hospital
SCOTSTAR website and guidelines
Paediatric Registraron Call: bleep 4184
Paediatric HDU Xn: 33554 or 33887