Cover
Title Page
Clinical conditions list
Working group
Contributors
Preface to the first edition
Preface to the sixth edition
Acknowledgements
Contact details and further information
How to use your textbook
PART 1: Introduction
1. CHAPTER 1: Introduction
  1. 1.1 Introduction
  2. 1.2 Principles
  3. 1.3 Important differences in children
  4. 1.4 Summary
2. CHAPTER 2: Structured approach to paediatric emergencies
  1. 2.1 Introduction
  2. 2.2 Preparation
  3. 2.3 Teamwork
  4. 2.4 Communication
  5. 2.5 Triage
  6. 2.6 Managing pain
  7. 2.7 Summary
  8. Explanatory notes of the Alder Hey Triage Pain Score
3. CHAPTER 3: Human factors
  1. 3.1 Introduction
  2. 3.2 Extent of healthcare error
  3. 3.3 Causes of healthcare error
  4. 3.4 Human error
  5. 3.5 Learning from error
  6. 3.6 Communication
  7. 3.7 Team working, leadership and followership
  8. 3.8 Situation awareness
  9. 3.9 Improving team and individual performance
  10. 3.10 Summary
PART 2: The seriously ill child
1. CHAPTER 4: Structured approach to the seriously ill child
  1. 4.1 Introduction
  2. 4.2 Primary assessment of airway and breathing
  3. 4.3 Primary assessment of the circulation
  4. 4.4 Primary assessment of disability
  5. 4.5 Primary assessment of exposure
  6. 4.6 Structured approach to the seriously ill child
  7. 4.7 Primary assessment and resuscitation
  8. 4.8 Secondary assessment and emergency treatment
  9. 4.9 Summary
2. CHAPTER 5: The child with breathing difficulties
  1. 5.1 introduction
  2. 5.2 Susceptibility to respiratory failure
  3. 5.3 Clinical presentations of the child with breathing difficulty
  4. 5.4 Primary assessment and resuscitation
  5. 5.5 Secondary assessment and looking for key features
  6. 5.6 Approach to the child with stridor
  7. 5.7 Approach to the child with wheeze
  8. 5.8 Approach to the child with fever
  9. 5.9 Approach to the child with heart failure
  10. 5.10 Approach to the child with anaphylaxis
  11. 5.11 Approach to the child with metabolic and poisoning problems
  12. 5.12 Summary
3. CHAPTER 6: The child in shock
  1. 6.1 Introduction
  2. 6.2 Pathophysiology of shock
  3. 6.3 Classification of the causes of shock
  4. 6.4 Approach to the child in shock
  5. 6.5 Primary assessment and resuscitation
  6. 6.6 Key features of the child in shock
  7. 6.7 Approach to the child with non-haemorrhagic fluid loss
  8. 6.8 Approach to the child with septic shock
  9. 6.9 Approach to the child with anaphylaxis
  10. 6.10 Approach to the infant with a duct-dependent congenital heart disease
  11. 6.11 Approach to the child with shock due to cardiomyopathy
  12. 6.12 Approach to the child with profound anaemia
  13. 6.13 Approach to the child with sickle cell crisis
  14. 6.14 After resuscitation and emergency treatment of shock
  15. 6.15 Use of fluids in resuscitation
  16. 6.16 Summary
4. CHAPTER 7: The child with an abnormal pulse rate or rhythm
  1. 7.1 Introduction
  2. 7.2 Primary assessment and resuscitation
  3. 7.3 Approach to the child with bradycardia
  4. 7.4 Approach to the child with supraventricular tachycardia
  5. 7.5 Approach to the child with ventricular tachycardia
  6. 7.6 Summary
5. CHAPTER 8: The child with a decreased conscious level
  1. 8.1 Introduction
  2. 8.2 Pathophysiology of raised intracranial pressure
  3. 8.3 Primary assessment and resuscitation
  4. 8.4 Secondary assessment and looking for key features
  5. 8.5 Further general treatment of coma
  6. 8.6 Approach to the child with meningitis/encephalitis
  7. 8.7 Approach to the child poisoned with opiates
  8. 8.8 Approach to the child with metabolic coma
  9. 8.9 Approach to the child with malaria
  10. 8.10 Approach to the child with systemic hypertensive crisis
  11. 8.11 Stabilisation and transfer to definitive care
6. CHAPTER 9: The convulsing child
  1. 9.1 Introduction
  2. 9.2 Pathophysiology of prolonged convulsions
  3. 9.3 Primary assessment and resuscitation
  4. 9.4 Secondary assessment and looking for key features
  5. 9.5 Emergency treatment of the convulsion
  6. 9.6 Approach to the child with systemic hypertensive crisis
  7. 9.7 Hypertension emergency treatment
  8. 9.8 Summary
PART 3: The seriously injured child
1. CHAPTER 10: Introduction to the seriously injured child
  1. 10.1 Introduction
  2. 10.2 Injury prevention
  3. 10.3 Epidemiology
  4. 10.4 Levels of injury prevention
  5. 10.5 Trauma systems
  6. 10.6 Trauma teams
  7. 10.7 Summary
2. CHAPTER 11: Structured approach to the seriously injured child
  1. 11.1 Introduction
  2. 11.2 Primary survey and resuscitation
  3. 11.3 Secondary survey and looking for key features
  4. 11.4 Emergency treatment
  5. 11.5 Continuing stabilisation
  6. 11.6 Summary
3. CHAPTER 12: The child with chest injury
  1. 12.1 Introduction
  2. 12.2 Injuries posing an immediate threat to life
  3. 12.3 Serious injuries discovered later
  4. 12.4 Other injuries
  5. 12.5 Practical procedures
  6. 12.6 Referral
  7. 12.7 Continuing stabilisation
  8. 12.8 Summary
4. CHAPTER 13: The child with abdominal injury
  1. 13.1 Introduction
  2. 13.2 History
  3. 13.3 Assessment of the injured abdomen
  4. 13.4 Definitive care
  5. 13.5 Summary
5. CHAPTER 14: The child with traumatic brain injury
  1. 14.1 Introduction
  2. 14.2 Triage
  3. 14.3 Primary survey and resuscitation
  4. 14.4 Secondary survey and looking for key features
  5. 14.5 Emergency treatment
  6. 14.6 Detailed review and continuing stabilisation
  7. 14.7 Transfer to definitive care
  8. 14.8 Summary
6. CHAPTER 15: The child with injuries to the extremities or the spine
  1. 15.1 Extremity trauma: introduction
  2. 15.2 Assessment of extremity trauma
  3. 15.3 Primary survey and resuscitation of extremity trauma
  4. 15.4 Secondary survey and looking for key features of extremity trauma
  5. 15.5 Emergency treatment of extremity trauma
  6. 15.6 Extremity trauma: summary
  7. 15.7 Spinal trauma: introduction
  8. 15.8 Injuries of the cervical spine
  9. 15.9 Injuries of the thoracic and lumbar spine
  10. 15.10 Spinal cord injury without radiographic abnormality
  11. 15.11 Spinal trauma: summary
7. CHAPTER 16: The burned or scalded child
  1. 16.1 Introduction
  2. 16.2 Primary survey and resuscitation
  3. 16.3 Secondary survey and looking for key features
  4. 16.4 Emergency treatment
  5. 16.5 Continuing stabilisation and transfer to definitive care
  6. 16.6 Toxic shock syndrome
  7. 16.7 Summary
8. CHAPTER 17: The child with an electrical injury or drowning
  1. 17.1 Electrical injuries: introduction
  2. 17.2 Initial treatment of electrical injuries
  3. 17.3 Primary survey of electrical injuries and resuscitation
  4. 17.4 Secondary survey and looking for key features of electrical injuries
  5. 17.5 Stabilisation of electrical injuries and transfer to definitive care
  6. 17.6 Electrical injuries: summary
  7. 17.7 Drowning: introduction
  8. 17.8 Primary survey of drowning and resuscitation
  9. 17.9 Secondary survey and looking for key features in drowning
  10. 17.10 Emergency treatment and stabilisation in drowning
  11. 17.11 Prognostic indicators in drowning
  12. 17.12 Outcome of drowning
  13. 17.13 Drowning: summary
PART 4: Life support
1. CHAPTER 18: Basic life support
  1. 18.1 Introduction
  2. 18.2 Primary assessment and resuscitation
  3. 18.3 Basic life support and infection risk
  4. 18.4 The choking child
  5. 18.5 Summary
2. CHAPTER 19: Support of the airway and ventilation
  1. 19.1 Introduction
  2. 19.2 Airway and breathing management: principles
  3. 19.3 Primary assessment and resuscitation
  4. 19.4 Secondary assessment
  5. 19.5 Emergency treatment
  6. 19.6 Team aspects of airway management
  7. 19.7 Equipment for providing oxygen and ventilation
  8. 19.8 Equipment for managing the airway
  9. 19.9 Monitoring an intubated patient
  10. 19.10 Management of a blocked tracheostomy (Figure 19.5)
  11. 19.11 Summary
3. CHAPTER 20: Management of cardiac arrest
  1. 20.1 Introduction
  2. 20.2 Non-shockable rhythms
  3. 20.3 Shockable rhythms
  4. 20.4 When to stop resuscitation
  5. 20.5 Parental presence
  6. 20.6 Summary
PART 5: Practical application of APLS
1. CHAPTER 21: Practical procedures: airway and breathing
  1. 21.1 Ventilation without intubation
  2. 21.2 Oropharyngeal airway (Guedel) insertion
  3. 21.3 Nasopharyngeal airway insertion
  4. 21.4 Tracheal intubation and rapid sequence induction
  5. 21.5 Drugs
  6. 21.6 Intubation algorithm
  7. 21.7 Laryngeal mask airway
  8. 21.8 Surgical airway
  9. 21.9 Management of a blocked tracheostomy
2. CHAPTER 22: Practical procedures: circulation
  1. 22.1 Vascular access
  2. 22.2 Defibrillation
3. CHAPTER 23: Practical procedures: trauma
  1. 23.1 Needle thoracocentesis
  2. 23.2 Chest drain placement
  3. 23.3 Clamshell thoracotomy
  4. 23.4 Pericardiocentesis
  5. 23.5 Femoral nerve block
  6. 23.6 Cervical spine immobilisation
4. CHAPTER 24: Imaging in trauma
  1. 24.1 Introduction
  2. 24.2 Cervical spine imaging
  3. 24.3 Chest radiograph
  4. 24.4 The role of further imaging
  5. 24.5 Summary
5. CHAPTER 25: Structured approach to stabilisation and transfer
  1. 25.1 Stabilisation of the child
  2. 25.2 Assessment after stabilisation
  3. 25.3 Principles of safe transfer and retrieval
  4. 25.4 Summary
PART 6: Appendices
1. APPENDIX A: Acid–base balance
  1. A.1 Introduction
  2. A.2 Hydrogen ion concentration, acidity and pH
  3. A.3 Carbonic acid reaction
  4. A.4 Standard bicarbonate
  5. A.5 Stewart’s strong ion theory
  6. A.6 Applying this in practice
  7. A.7 Summary
2. APPENDIX B: Fluid and electrolyte management
  1. B.1 Introduction
  2. B.2 Fluid balance
  3. B.3 Diabetic ketoacidosis
  4. B.4 Summary
3. APPENDIX C: Child abuse and neglect
  1. C.1 Introduction
  2. C.2 Recognition of child abuse and neglect
  3. C.3 Assessment
  4. C.4 Initial management
  5. C.5 Referral
  6. C.6 Medicolegal aspects
  7. C.7 Summary
4. APPENDIX D: When a child dies
  1. D.1 Introduction
  2. D.2 Dealing with the family
  3. D.3 Post-death procedures
  4. D.4 Take care of the staff
  5. D.5 Summary
5. APPENDIX E: General approach to poisoning and envenomation
  1. E.1 Poisoning: introduction
  2. E.2 Primary assessment and resuscitation in poisoning
  3. E.3 Emergency treatment in poisoning
  4. E.4 Emergency treatment of specific poisons
  5. E.5 Envenoming (envenomation): introduction
  6. E.6 Resuscitation and support in envenoming (envenomation)
  7. E.7 Specific envenoming issues
  8. E.8 Button battery ingestion
  9. E.9 Summary
6. APPENDIX F: Resuscitation of the baby at birth
  1. F.1 Introduction
  2. F.2 Normal physiology
  3. F.3 Pathophysiology
  4. F.4 Equipment
  5. F.5 Strategy for assessing and resuscitating a baby at birth
  6. F.6 Response to resuscitation
  7. F.7 Tracheal intubation
  8. F.8 Laryngeal mask airway
  9. F.9 Preterm babies
  10. F.10 Summary
7. APPENDIX G: Formulary
  1. G.1 General guidance on the use of the formulary
Index
End User License Agreement

List of Tables

Chapter 1
1. Table 1.1 Normal ranges: respiratory rate (RR), heart rate (HR) and blood pressure (BP)
Chapter 2
1. Table 2.1 Triage scale
2. Table 2.2 The Alder Hey Triage Pain Score: reference scoring chart
Chapter 3
1. Table 3.1 Types of errors
2. Table 3.2 Elements of communication
Chapter 4
1. Table 4.1 Normal ranges: respiratory rate (RR), heart rate (HR) and blood pressure (BP)
Chapter 5
1. Table 5.1 Causes of breathing difficulty in children, according to mechanism
2. Table 5.2 Causes of stridor
3. Table 5.3 Symptoms of severe and life-threatening asthma
4. Table 5.4 Drug treatment of severe acute asthma
5. Table 5.5 Bronchiolitis: characteristic findings on examination
6. Table 5.6 Features that help distinguish heart failure from bronchiolitis
Chapter 6
1. Table 6.1 Causes of shock
2. Table 6.2 Symptoms and signs in allergic reaction
Chapter 8
1. Table 8.1 Glasgow Coma Scale and Children’s Glasgow Coma Scale
2. Table 8.2 Summary of pupillary changes
Chapter 9
1. Table 9.1 Drug therapy of severe hypertension
Chapter 11
1. Table 11.1 Recognition of clinical signs indicating blood loss requiring urgent treatment
2. Table 11.2 Template for note taking
Chapter 14
1. Table 14.1 Glasgow Coma Scale and Children’s Glasgow Coma Scale
2. Table 14.2 The best grimace response
Chapter 17
1. Table 17.1 Prognostic indicators in drowning
Chapter 18
1. Table 18.1 Summary of basic life support techniques in infants and children
Chapter 19
1. Table 19.1 Laryngeal mask airway (LMA) sizes
2. Table 19.2 I-gel sizes
3. Table 19.3 DOPE mnemonic for airway and ventilator problems in intubated patients
Chapter 22
1. Table 22.1 Surface anatomy of the brachial and long saphenous veins
Chapter 23
1. Table 23.1 Position of staff for the 20° tilt
2. Table 23.2 Tasks of individual members of staff
Appendix A
1. Table A.1 The pH scale
2. Table A.2 pH in different parts of the body
Appendix B
1. Table B.1 Fluid requirements in well, normal children
2. Table B.2 Signs and symptoms of dehydration and shock (adapted from NICE, 2009)
3. Table B.3 Commonly available crystalloid fluids
4. Table B.4 Water, electrolyte and energy requirements in well, normal children
5. Table B.5 Causes of hypo- and hyperkalaemia
Appendix C
1. Table C.1 Classification of child abuse
Appendix E
1. Table E.1 Diagnostic clues from the primary assessment
2. Table E.2 Clues to the diagnosis of an unknown poison
3. Table E.3 Major types of venomous animals injuring humans with a summary of clinical effects, first aid and treatment

List of Illustrations

Chapter 1
1. Figure 1.1 Pathways leading to cardiac arrest in childhood (with examples of underlying causes). [ICP, intracranial pressure]
2. Figure 1.2 Advanced paediatric life support (APLS) in action
3. Figure 1.3 Centile chart for weight in (a) boys (0–5 years) and (b) girls (5–20 years)
4. Figure 1.4 Summary of significant upper airway anatomy
5. Figure 1.5 Differences in children
Chapter 2
1. Figure 2.1 Structured approach to paediatric emergencies
2. Figure 2.2 Faces scale and pain ladder
Chapter 3
1. Figure 3.1 The ‘Swiss cheese’ model
2. Figure 3.2 Similar package design of two different medications
Chapter 4
1. Figure 4.1 (a–d) Capillary refill assessment: apply pressure for 5 seconds and then release. Count in seconds how long it takes for the skin colour to return to normal
2. Figure 4.2 (a) Decorticate posturing, and (b) decerebrate posturing
Chapter 5
1. Figure 5.1 (a) Larynx with foreign body obstruction, and (b) normal larynx
2. Figure 5.2 (a) Larynx epiglottitis, and (b) normal larynx
3. Figure 5.3 Chest X-ray of bronchiolitis
4. Figure 5.4 Chest X-ray of pneumonia
Chapter 6
1. Figure 6.1 Emergency treatment of anaphylaxis. [ET, endotracheal]
Chapter 7
1. Figure 7.1 Algorithm for the management of bradycardia
2. Figure 7.2 Sinus tachycardia
3. Figure 7.3 Supraventricular tachycardia
4. Figure 7.4 Algorithm for the management of supraventricular tachycardia
5. Figure 7.5 Algorithm for the management of ventricular tachycardia
Chapter 8
1. Figure 8.1 Herniations of the brain
2. Figure 8.2 Algorithm for the initial management of coma. [ICP, intracranial pressure]
Chapter 9
1. Figure 9.1 Status epilepticus algorithm. [ICU, intensive care unit; RSI, rapid sequence induction]
Chapter 11
1. Figure 11.1 Child on a scoop stretcher
2. Figure 11.2 Blood and fluid therapy in severe uncontrolled haemorrhage after trauma. [FFP, fresh frozen plasma]
Chapter 12
1. Figure 12.1 Thoracostomy
2. Figure 12.2 Ported chest seal
Chapter 15
1. Figure 15.1 Algorithm for spinal imaging, referral and clearance
Chapter 16
1. Figure 16.1 Differences in body surface area (per cent) in children.
Chapter 18
1. Figure 18.1 Basic life support algorithm
2. Figure 18.2 The initial SSS approach
3. Figure 18.3 Head tilt and chin lift in infants: neutral position in an infant
4. Figure 18.4 Head tilt and chin lift: sniffing position in a child
5. Figure 18.5 Looking, listening, feeling
6. Figure 18.6 Jaw thrust
7. Figure 18.7 Mouth to mouth and nose in an infant
8. Figure 18.8 Hand-encircling technique
9. Figure 18.9 Chest compressions in an infant
10. Figure 18.10 Chest compressions: one hand
11. Figure 18.11 Chest compressions: two-handed
12. Figure 18.12 Example recovery position
13. Figure 18.13 FBAO algorithm. [FB, foreign body]
14. Figure 18.14 Back blows
15. Figure 18.15 Chest thrusts
16. Figure 18.16 Child supported in a forward leaning position
17. Figure 18.17 Heimlich manoeuvre in a supine child
18. Figure 18.18 Basic life support algorithm
Chapter 19
1. Figure 19.1 Face masks, bag–valve–mask and oxygen mask with reservoir
2. Figure 19.2 Sizing an oropharyngeal airway
3. Figure 19.3 View of an infant larynx with a laryngoscope blade in the vallecula
4. Figure 19.4 Green bands show compatibility between the fibreoptic laryngoscope blade and handle
5. Figure 19.5 National Tracheostomy Safety Project paediatric tracheostomy emergency management algorithm. [BVM, bag–valve–mask]
Chapter 20
1. Figure 20.1 Cardiac arrest algorithm. [CPR, cardiopulmonary resuscitation; PEA, pulseless electrical activity; VF, ventricular fibrillation; VT, ventricular tachycardia]
2. Figure 20.2 Asystole
3. Figure 20.3 Pulseless electrical activity
4. Figure 20.4 Protocol for asystole and pulseless electrical activity. [CPR, cardiopulmonary resuscitation; ROSC, return of spontaneous circulation]
5. Figure 20.5 Ventricular fibrillation
6. Figure 20.6 Pulseless ventricular tachycardia
7. Figure 20.7 Protocol for ventricular fibrillation and ventricular tachycardia. [CPR, cardiopulmonary resuscitation; ROSC, return of spontaneous circulation]
Chapter 21
1. Figure 21.1 Mask position for mouth-to-mask ventilation in (a) a child and (b) an infant
2. Figure 21.2 Bag-and-mask ventilation
3. Figure 21.3 Two-person bag-and-mask ventilation
4. Figure 21.4 (a–c) Airway insertion using the rotational technique
5. Figure 21.5 Intubation checklist. [CPAP, continuous positive airway pressure; ECG, electrocardiogram; ENT, ear, nose and throat; ETCO₂, end-tidal CO₂; ETT, endotracheal tube; LMA, laryngeal mask airway; NGT, nasogastric tube; NIBP, non-invasive blood pressure; OGT, orogastric tube]
6. Figure 21.6 Technique using (a) a straight-blade laryngoscope, and (b) a curved-blade laryngoscope
7. Figure 21.7 Failed intubation algorithm. [ENT, ear, nose and throat; ETT, endotracheal tube; LMA, laryngeal mask airway; NGT, nasogastric tube; OGT, orogastric tube]
8. Figure 21.8 (a–d) Insertion of a laryngeal mask airway
9. Figure 21.9 Surgical airway anatomy
10. Figure 21.10 Needle cricothyroidotomy
Chapter 22
1. Figure 22.1 Tibial technique for intraosseous infusion
2. Figure 22.2 The course of the external jugular vein
3. Figure 22.3 Umbilical cord cross-section
4. Figure 22.4 Site of a long saphenous cut-down and its technique
5. Figure 22.5 The course of the central veins of the neck
6. Figure 22.6 Ultrasound-guided needle approach
7. Figure 22.7 Ultrasound image of the femoral region. [A, artery; N, nerve; V, vein]
8. Figure 22.8 Standard anterolateral paddle placement
9. Figure 22.9 Anteroposterior paddle placement
Chapter 23
1. Figure 23.1 Needle thoracocentesis
2. Figure 23.2 Chest drain insertion – landmarks
3. Figure 23.3 Chest drain insertion – clearing the path
4. Figure 23.4 Needle pericardiocentesis – angle
5. Figure 23.5 Needle pericardiocentesis – direction
6. Figure 23.6 Ultrasound-guided needle approach
7. Figure 23.7 Ultrasound image of the femoral region. [A, artery; N, nerve; V, vein]
8. Figure 23.8 Ultrasound-guided block. [ASIS, anterior superior iliac spine]
9. Figure 23.9 Manual in-line stabilisation (MILS)
10. Figure 23.10 20° tilt (four-person technique)
11. Figure 23.11 20° tilt (three-person technique)
Chapter 24
1. Figure 24.1 Assessing rotation – straight chest film
2. Figure 24.2 Vertical fracture of the thoracic spine
Appendix A
1. Figure A.1 Relationship between hydrogen ion concentration and pH. As can be seen a pH of 7.4 relates to a hydrogen ion concentration of 40 nmol/l (0.000040 mmol/l)
2. Figure A.2 Ions and their charges in extracellular fluid. [AG, anion gap; X_A^–, unmeasured weak acids]
3. Figure A.3 Expansion of the components of the anion gap
4. Figure A.4 Changes in acid–base homeostasis
5. Figure A.5 Primary and compensatory changes in respiratory acidosis. Note the direction of changes in the numerator (HCO₃^–) and denominator (PCO₂) are in the same direction (arrows) – to normalise the ratio
6. Figure A.6 Primary and compensatory changes in respiratory alkalosis. Note the direction of changes in the numerator (HCO₃^–) and denominator (PCO₂) are in the same direction (arrows) – to normalise the ratio
Appendix B
1. Figure B.1 Algorithm for the management of hyperkalaemia
Appendix E
1. Figure E.1 Nomogram indicating the level of blood paracetamol at which acetylcysteine should be given intravenously.
2. Figure E.2 Algorithm for the management of organophosphate poisoning
Appendix F
1. Figure F.1 Response of a mammalian fetus to total, sustained asphyxia starting at time 0.
2. Figure F.2 Effects of lung inflation and a brief period of ventilation on a baby born in early terminal apnoea but before failure of the circulation.
3. Figure F.3 Response of a baby born in terminal apnoea. In this case lung inflation is not sufficient because the circulation is already failing. However, lung inflation delivers air to the lungs and then a brief period of chest compressions delivers oxygenated blood to the heart, which then responds.
4. Figure F.4 Neutral position in babies
5. Figure F.5 Jaw thrust
6. Figure F.6 Bag-and-mask ventilation
7. Figure F.7 Hand-encircling technique for chest compressions
8. Figure F.8 Newborn resuscitation algorithm. HR, heart rate.

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(updated August 2019)

Condition	Pages
abdominal injury	135–137
acidosis	269, 273–274, 275, 277–279
alkalosis	271, 272, 273, 276, 277, 279, 286, 289, 308
anaemia	78
anaphylaxis	56–57, 74–76, 75
asthma	50, 57–61
bradycardia	38, 81, 82, 83–84
bronchiolitis	50, 61–63
burns	155–160
carbon monoxide poisoning	159, 306
cardiac arrest	4, 199–207
cardiac tamponade	130
cardiomyopathy	77–78
cerebral oedema	290
chest injury	127–133
child abuse	291–298
choking	50, 53, 54, 56, 128, 180–183
coarctation	65, 69, 76, 105
coma	50, 89
congenital heart disease (duct-dependent)	76–77
conscious level	16, 40–41, 89–98
convulsions	50, 145
croup	50, 53, 55
dehydration	282, 283–284
diabetic ketoacidosis	50, 97, 269, 289–290
diphtheria	57
drowning	162–166
electrical injury	161–163
empyema, pleural effusion	50
encephalitis	96–97
encephalopathy, hypertensive	95
envenomation	310–315
epiglottitis	50, 53–54, 55–56
extremity trauma	147–150
flail chest	129–130
foreign body aspiration	46, 49, 50, 52, 53, 54, 56, 173, 174, 180, 183
foreign body ingestion	316
gastroenteritis	69, 71, 72, 84, 283, 284, 285
haemothorax	129
head injury	21, 139–146
heart block, heart failure	63, 65–66
hypercalcaemia	289
hyperglycaemia	96, 140, 207, 259, 289, 308, 327
hyperkalaemia	202, 286–288
hypernatraemia	285
hypertension	105–106
hypocalcaemia	202, 288–289
hypoglycaemia	44, 71, 90, 93, 95, 96, 97, 98, 100, 101, 122, 140, 144, 145, 207, 257, 259, 288, 290, 327
hypokalaemia	202, 286
hyponatraemia	285–286
hypothermia	9, 37, 93, 100, 121, 125, 163–165, 202, 207, 258, 304, 306
infectious mononucleosis	57
intracranial haemorrhage	89, 144, 254
malaria (cerebral)	97–98
meningitis	96–97
meningococcaemia	72
myocarditis	77–78
non-accidental injury (NAI)	292, 293
overhydration	284
patent ductus arteriosus	65
pleural effusion	50, 64
pneumonia	50, 63–65
pneumothorax	50, 128–129, 132, 196, 202, 253
poisoning	50, 66, 97, 202, 275, 303–310
pulmonary oedema	50
raised intracranial pressure	50, 140, 165
retropharyngeal abscess	57
salicylate poisoning	66
scalds	155–160
septic shock/septicaemia	39, 72–74
shock	50, 67–80
sickle cell disease/crisis	78
spine injury	150–153, 151
status epilepticus	40, 99, 101, 102, 104, 217, 339
stings	310–315
tachycardia, SVT, VT	81, 82, 84–87
tonsillitis, acute	57
toxic shock syndrome	72, 159
tracheitis	50, 55

Contributors

Contributors to the sixth edition

S. Ainsworth Paediatrics and Neonatology, Kirkcaldy

R. Appleton Paediatric Neurology, Liverpool

A. Argent Paediatric Intensive Care, Cape Town

J. Armstrong Paediatric Anaesthesia, Nottingham

P. Arrowsmith Paediatric Resuscitation, Liverpool

A. Baldock Paediatric Anaesthesia, Southampton

K. Berry Paediatric Emergency Medicine, Birmingham

V. Bhole Paediatric Cardiology, Birmingham

D. Bramley Emergency Medicine, Sunderland

A. Burgess Paediatric ENT Surgery, Southampton

S. Bush Urgent Care, Leeds

A. Charters Paediatric Emergency Care, Portsmouth

R. Cheung General Paediatrics, London

F. Davies Emergency Medicine, Leicester

J. Davison Paediatric Metabolic Medicine, London

J. Doherty Paediatrics, Dorchester

I. Doull Paediatric Respiratory Medicine, Cardiff

E. Duval Paediatric Intensive Care, Maastricht

R. Fisher Paediatric Surgery, Sheffield

C. Fitzsimmons Paediatric Emergency Medicine, Sheffield

P-M. Fortune Paediatric Intensive Care, Manchester

J. Foster Paediatric Radiology, Plymouth

A. Gandhi Paediatric Cardiology, Birmingham

J. Grice Paediatric Emergency Medicine, Liverpool

G. Haythornthwaite Paediatric Emergency Medicine, Bristol

M. Hegardt-Janson Paediatric Surgery, Lund

M. Hellaby North West Simulation Education Network, Manchester

S. Hewitt Emergency Medicine, Derby

L. Hudson Paediatrics, London

P. Hyde Paediatric Intensive Care, Southampton

H. Ismail-Koch Paediatric ENT Surgery, Southampton

B. Ko Community Paediatrics, London

A. Lee Paediatric Trauma and Orthopaedics, Reading

S. Lewena Paediatric Emergency Medicine, Melbourne

C. Loew Anaesthesia, Poole

M. Lyttle Paediatric Emergency Medicine, Bristol

L. Mackintosh Community Paediatrics, Bristol

K. Mackway-Jones Emergency Medicine, Manchester

N. Makwana Paediatrics, Birmingham

W. Marriage Paediatrics, Bristol

P. McMaster Paediatric Infectious Diseases, Manchester

P. McQuillan Paediatric Intensive Care, Portsmouth

B. Mehta Paediatric Emergency Medicine, Liverpool

P. Oakley Anaesthesia, Stoke on Trent

B. Okoye Paediatric Surgery, London

F. O’Leary Paediatric Emergency Medicine, Sydney

L. Prentice Paediatric Anaesthetist, Melbourne

T. Rajka Paediatric Intensive Care, Oslo

T. Ralph Paediatric Resuscitation Training, Sheffield

G. Roberts Paediatric Allergy and Respiratory Medicine, Southampton

S. Roberts Paramedic; Pre hospital Trauma and Paediatric Care, West Midlands

M. Samuels Paediatrics, Stoke-on-Trent and London

D. Schenk General Paediatrics, Newcastle

N. Sen Emergency Medicine, Manchester

A. Simpson Emergency Medicine, Stockton-on-Tees

H. Smith Paediatrics, Southampton

S. Smith Emergency Paediatrics, Nottingham

E. Snelson Paediatric Emergency Medicine, Sheffield

K. Soanes Emergency Medicine, Birmingham

K. Thies Anaesthetics, Birmingham

R. Tinnion Neonatology, Middlesborough

Y. Tse Paediatric Nephrology, Newcastle

C. Vallis Paediatric Anaesthesia, Newcastle

A. Walker Paediatric Anaesthesia, Glasgow

L. Walton Paediatric Emergency Medicine, Nottingham

J. White Toxinologist, Adelaide

S. Wieteska ALSG CEO, Manchester

S. Wood Paediatric Surgery, Liverpool

J. Wyllie Neonatology, Middlesbrough

A. Young Paediatric Anaesthesia, Bristol

Contributors to previous editions

S. Agrawal Paediatric Intensive Care, London

R. Appleton Paediatric Neurology, Liverpool

A. Argent Paediatric Intensive Care, Cape Town

C. Baillie Paediatric Surgery, Liverpool

P. Baines Paediatric Intensive Care, Liverpool

I. Barker Paediatric Anaesthesia, Sheffield

D. Bickerstaff Paediatric Orthopaedics, Sheffield

R. Bingham Paediatric Anaesthesia, London

P. Brennan Paediatric Emergency Medicine, Sheffield

J. Britto Paediatric Intensive Care, London

G. Browne Paediatric Emergency Medicine, Sydney

C. Cahill Emergency Medicine, Portsmouth

H. Carty Paediatric Radiology, Liverpool

A. Charters Emergency Nursing, Portsmouth

M. Clarke Paediatric Neurology, Manchester

J. Couriel Paediatric Respiratory Medicine, Liverpool

P. Driscoll Emergency Medicine, Manchester

P-M. Fortune Paediatric Intensive Care, Manchester

J. Fothergill Emergency Medicine, London

P. Habibi Paediatric Intensive Care, London

D. Heaf Paediatric Respiratory Medicine, Liverpool

J. K. Heltne Anaesthesia, Haukeland

F. Jewkes Pre-Hospital Paediatrics, Wiltshire

E. Ladusans Paediatric Cardiology, Manchester

J. Leggatte Paediatric Neurosurgery, Manchester

J. Leigh Anaesthesia, Bristol

S. Levene Child Accident Prevention Trust, London

M. Lewis Paediatric Nephrology, Manchester

K. Mackway-Jones Emergency Medicine, Manchester

I. Maconochie Emergency Paediatrics, London

J. Madar Neonatology, Plymouth

T. Martland Paediatric Neurologist, Manchester

D. McKimm Paediatric Intensive Care Nursing, Belfast

E. Molyneux Paediatric Emergency Medicine, Malawi

S. Nadel Paediatric Intensive Care, London

D. Nicholson Radiology, Manchester

A. Nunn Pharmacy, Liverpool

E. Oakley Paediatrics, Victoria

P. Oakley Anaesthesia, Stoke on Trent

R. Perkins Paediatric Anaesthesia, Manchester

B. Phillips Paediatric Emergency Medicine, Liverpool

T. Rajka Paediatrics, Oslo

J. Robson Paediatric Emergency Medicine, Liverpool

I. Sammy Paediatric Emergency Medicine, Trinidad

M. Samuels Paediatric Intensive Care, Stoke on Trent

D. Sims Neonatology, Manchester

A. Sprigg Paediatric Radiology, Sheffield

B. Stewart Paediatric Emergency Medicine, Liverpool

J. Stuart Emergency Medicine, Manchester

L. Teebay Child Protection and Paediatric Emergency Medicine, Liverpool

J. Tibballs Paediatric Intensive Care, Melbourne

N. Turner Paediatric Anaesthesia and Intensive Care, Utrecht

J. Walker Paediatric Surgery, Sheffield

W. Whitehouse Paediatric Neurologist, Nottingham

S. Wieteska ALSG Group Manager, Manchester

M. Williams Emergency Medicine, York

B. Wilson Paediatric Radiology, Manchester

J. Wyllie Neonatology, Middlesbrough

S. Young Paediatric Emergency Medicine, Melbourne

D. Zideman Anaesthesia, London

Acknowledgements

A great many people have put a lot of hard work into the production of this book, and the accompanying advanced life support course. The editors would like to thank all the contributors for their efforts and all the APLS instructors who took the time to send us their comments on the earlier editions.

We are greatly indebted to Helen Carruthers, MMAA, Mary Harrison, MMAA and Kate Wieteska for producing the excellent line drawings that illustrate the text. The information in Table 6.1 is taken from Lessons from Research for Doctors in Training produced by the Meningitis Research Foundation. We would also like to thank Mark Hellaby, NW Simulation Education Network Manager for his input into the Human factors chapter. We would also like to thank National Tracheostomy Safety Project: Paediatric Working Party for the provision of the paediatric tracheostomy emergency management algorithm.

ALSG gratefully acknowledge the support of the Royal College of Paediatrics and Child Health (UK). The Specialist Groups of the RCPCH agreed to advise on the clinical content of chapters relevant to their specialism. ALSG wish to thank the following:

Association of Paediatric Anaesthetists Dr A. Walker, Paediatric Anaesthesia, Glasgow

Association of Paediatric Emergency Medicine Dr K. Berry, Paediatric Emergency Medicine, Birmingham; Dr N. Sargant, Paediatric Emergency Medicine, Bristol

British Association for Paediatric Nephrology Dr Y. Tse, Paediatric Nephrology, Newcastle

British Association of Community Child Health Dr B. Ko, Community Paediatrics, London

British Association of Paediatric Surgeons – trauma committee Mr B. Okoye, Paediatric Surgery, London

British Inherited Metabolic Disease Group Dr J. Davison, Paediatric Metabolic Medicine, London

British Paediatric Allergy, Immunology and Infection Group Dr G. Roberts, Paediatric Allergy and Respiratory Medicine, Southampton; Dr P. McMaster, Paediatric Infectious Diseases, Manchester and Dr N. Makwana, Paediatrics, Birmingham

British Paediatric Neurology Association Dr R. Appleton, Paediatric Neurology, Liverpool

British Paediatric Respiratory Society Dr I. Doull, Paediatric Respiratory Medicine, Cardiff

British Society of Paediatric Radiology Dr J. Foster, Paediatric Radiology, Plymouth

Child Protection Special Interest Group Dr L. Mackintosh, Community Paediatrics, Bristol; Dr J. Doherty, Paediatrics, Dorchester; Dr H. Smith, Paediatrics, Southampton

Paediatric Intensive Care Society Dr P-M. Fortune, Paediatric Intensive Care, Manchester

Paediatricians with Expertise in Cardiology Special Interest Group Dr A. Gandhi, Paediatric Cardiology, Birmingham

We are also grateful to the following groups who have advised on the clinical content of chapters relevant to their specialism:

European Resuscitation Council: European Trauma Course Mr K. Thies, Anaesthetics, Birmingham

MARSIPAN group Dr L. Hudson, Paediatrics, London

Royal College of Surgeons: Advanced Trauma Life Support Dr H. Walmsley, Anaesthetics, Eastbourne; Dr A. Duby, Military Emergency Medicine, Birmingham; Mr S. Bush, Emergency Medicine, Leeds; Mr M. Bagnall, General Surgery, Redhill; Mr J. Hambidge, Trauma and Orthopaedics, Romford; Dr R. O’Donnell, Paediatric Emergency Medicine, Cambridge; Dr L. Zibners, Paediatric Emergency Medicine, London

Finally, we would like to thank, in advance, those of you who will attend the Advanced Paediatric Life Support course and other courses using this text; no doubt, you will have much constructive criticism to offer.

Advanced Paediatric Life Support

A Practical Approach to Emergencies

Clinical conditions list

Working group

Associate editors

Working group

Contributors

Contributors to the sixth edition

Contributors to previous editions

Preface to the first edition

Preface to the sixth edition

Acknowledgements

Contact details and further information

Updates

References

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PART 1
Introduction