9. Shocked?
• FEAST
• cap refill 3 sec, or
• leg temp gradient, or
• weak radial pulse
volume, or
• tachycardia
• CRT or 3 seconds or more, or a lower limb temperature
gradient, or a weak radial pulse volume (21%) or severe
tachycardia, based on age – over 180 for infants, over 160
for 1-5 years and over 140 for children over 5 years of age.
(i
WHO
Cold hands and feet and
cap refill 4 sec and
fast weak pulse
14. • Hyponatraemia and death or permanent
brain damage in healthy children. Arieff BMJ 1992
• Fatal Hyponatraemic brain oedema... Sjoblom
ICM 1997
• Fatal Iatrogenic Hyponatraemia. Playfor ADC 2003
• Acute Hyponatraemia in children admitted
to hospital. Halberthal BMJ 2001
• Prevention of Hospital acquired
hyponatraemia. Moritz Pediatrics 2003
15. “From three to 120 inpatient hours after hypotonic fuid administration patients developed
progressive lethargy, headache, nausea and emesis with explosive onset of respiratory arrest”.
Moritz Pediatrics 2003
28. What should you do
differently?
• Resuscitate with saline/colloid/blood
• Maintenance with more salt and enough
glucose at usual rate
• Check your patient