CHAPTER AUTHORS
Section I:
ACUTE CARE PEDIATRICS
1: Resuscitation
Melanie Bechard, BSc, MD
Fellow, Emergency Medicine (CHEO)
Andrew Helmers, MDCM, MHSc(c), MSc, FRCPC
Fellow, Critical Care Medicine
Lianne J. McLean, MB, BCh, BAO, MHI, FRCPC
Staff Physician, Emergency Medicine
2: Emergency Medicine
MariePier Liree, MBChB
Resident, Pediatrics
Maa HarelSerlin, MD
Fellow, Emergency Medicine
Iwna Baran, MD, FRCPC
Staff Physician, Emergency Medicine
Sanne Ben, MD, FRCPC, D(ABP)
Staff Physician, Emergency Medicine
3: Poisonings and Toxicoogy
amin Ladha, MD, MSc
Resident, Pediatrics
lana a, MD
Fellow, Emergency Medicine
Saihiri Ranaalan, MBBS, PhD, FRCP(), FRCP(C), FAAP
Staff Physician, Emergency Medicine and Clinical Pharmacology & oicology
: Pain and Sedation
ahira Daa, MD
Fellow, Emergency Medicine (niersity of lerta)
Lisa Isaac, MD, FRCPC
Staff nesthesiologist, nesthesia and Pain Medicine
: Procedures
achar Pancer, BPH, MBBS Fellow, Emergency Medicine
Mehan ille, MD, FRCPC Fellow, Emergency Medicine
Jnahan Pirie, MD, Md, FRCPC
Staff Physician, Emergency Medicine
Section II: SUBSPECIALTY PEDIATRICS
: Adoescent Medicine
alene Sinh, MD
Resident, Pediatrics
Samanha Marin, MD, FRCPC Fellow, dolescent Medicine
Alene lan, MD, MSc, FRCPC
Staff Physician, dolescent Medicine
: Aergy
Sehanie rdle, MD Fellow, mmnology and llergy (C Children’s Hosital)
Melanie Cnwa, MD, FRCPC Fellow, mmnology and llergy
Adelle R Ainsn, MD, FRCPC
Staff Physician, mmnology and llergy
: Cardioogy
Michael D. Fridman, MD, FRCPC Fellow, Cardiology
Jnahan n, BMBS, FRCPC, FAAP Fellow, Cardiology
elle Panea, MD, FRCPC, FAAP Fellow, Cardiology
Jennier L. Rssell, MD, FRCPC
Staff Physician, Cardiology
: Cid Matreatment
ani Aarwal, MD
Resident, Pediatrics
Reecca an, MD
Resident, Pediatrics
ldie Aril, MD
Fellow, Pediatric Medicine
Rm Ch, MD, FRCPC
Staff Physician, Pediatric Medicine
Jennier Smih, BMBS, MSc, FRCPC
Staff Physician, Pediatric Medicine
1: entistry
Rdd Mran, BDSc, DCD, FRACDS
Fellow, entistry
Jane H, DCD
Fellow, entistry
Shnna Masse, HBSc, DDS, FRCDC
Staff entist, entistry
11: ermatoogy
Lara Mrrisse, MD
Resident, Pediatrics
imerl anc, MD
Fellow, ermatology
Reecca Le, MD, FRCPC
Staff Physician, ermatology
12: eeoment
Adre illran, MD
Resident, Pediatrics
Claire . en, BSc, MSc, LLB, MPH, MD
Fellow, eelomental Pediatrics
Jenna Di, MD, FRCPC
Staff Physician, eelomental Pediatrics
Amer Main, MD, BHSc, FRCPC
Staff Physician, eelomental Pediatrics
13: iagnostic maging
Alisha Jamal, MD, MSc, FRCPC
Fellow, Emergency Medicine
Jere raici, MD
Staff Radiologist, iagnostic maging
1: Endocrinoogy
J Swemim, BSc, MD
Resident, Pediatrics
Jlia Srara, MD, FRCPC
Fellow, Endocrinology
Jnahan D. asserman, MD, PhD
Staff Physician, Endocrinology
1: uids Eectroytes and Acid–ase
Lara Becherman, MD
Resident, Pediatrics
mma lrich, MD
Fellow, ehrology
aie Sllian, MBChB
Fellow, ehrology
Damien ne, MB BCh BAO, MSc
Staff Physician, ehrology
1: astroenteroogy and Heatoogy
Ameilia ellar, MD, MSc
Resident, Pediatrics
ileen Crwle, MB BCh BAO, MRCPI, MSc
Fellow, astroenterology, Heatology and trition
mas alers, MBBS, MSc, FRACP
Staff Physician, astroenterology, Heatology and trition
1: enera Surgery
Jnahn Hael, MD
Resident, Pediatrics
Jsna M.linsa,MD,FRCSC,MPH(c)
Staff Srgeon, eneral and horacic Srgery
eres Aie, MD, FRCSC
Staff Srgeon, eneral and horacic Srgery
1: enetics and Teratoogy
Aree Mah, MD
Resident, erology
rer Csain, MD, PhD
Resident, Medical enetics and enomics
Rer MendaLndn, MD, MS, FRCPC, FCCM
iision
Head, Clinical and Metaolic enetics
1: rot and utrition
Jsin Lam, MD
Resident, Pediatrics
Lara inlin, MD, MPH, FRCPC
Fellow, Pediatric Medicine
Mea an den Heel, MD, PhD
Staff Physician, Pediatric Medicine
Mara AleanianFarr, MSc, RD
Clinical ietician, nfant and oddler rowth and Feeding
Alisa BarDaan, RD
Clinical ietitian, Endocrinology
Jrdan Bealie, RD
Clinical ietitian, Pediatric Medicine and Comle Care
else allaher, RD
Clinical ietitian, Endocrinology and Rhematology
Daina alnins, MSc, RD
irector, Clinical ietetics
Alissa Seiner, RD
Clinical ietitian, Endocrinology
Lri ira, RD
Clinical ietician, Critical Care
Lara res, MSc, RD
Clinical ietitian, Pediatric Medicine and Comle Care
ellie elch, BASc, RD
Clinical ietitian, Pediatric Medicine and Resiratory Medicine
Carline Crrie, R, IBCLC
actation Secialist, reastfeeding Program
Lara Mclean, BSc, IBCLC
Registered rse and actation Consltant
Samanha Sllian, R, IBCLC
Registered rse and actation Consltant
Ashle raham, MScO, MHM
Occational heraist, Rehailitation
Serices
2: ynecoogy
Laren Friedman, BHSc, MD
Resident, Pediatrics
Heaher Millar, MIPH, MD, FRCSC
Staff Physician, ynecology
Anali Aarwal, MD, MHSc, FRCSC
Staff Physician, ynecology
21: Hematoogy
Adam an, MD
Resident, Pediatrics
ana Caric, MD
Resident, Pediatrics
Smira le, MD, MSc, FRCPC
Fellow, HematologyOncology
Michaela Cada, MD, FRCPC, FAAP, MPH
Staff Physician, HematologyOncology
22: mmunoogy
Ori Sc, MD, FRCPC Fellow, mmnology and llergy
Amiirah Anarain, MSc, MD, FRCPC Fellow, mmnology and llergy
im, MD, MScCH, FRCPC
Staff Physician, mmnology and llergy
23: mmunoroyaxis
Ana C. Blanchard, MDCM, MSc, FRCPC Fellow, nfectios iseases
Shama Sd, MD Fellow, mmnology and llergy
Shan . Mrris, MD, MPH, FRCPC, FAAP, DMH
Staff Physician, nfectios iseases
2: nectious iseases
Ran ir, MD Resident, Pediatrics
Jennier am, MD, MHP, FRCPC Fellow, nfectios iseases
Ari Binn, MD, MSc, FRCPC
Staff Physician, nfectios iseases
2: Menta Heat
arielle Salmers, MBBS Fellow, Commnity Pediatrics
Dahne J rca, MD, MSc, FRCPC (eds), FRCPC (sch)
Staff Physician, Child and dolescent Psychiatry
2: Metaoic isease
Carsen reer, MD
Resident, Pediatrics
Resham a, MD
Resident, Clinical and Metaolic enetics
eal Sndheimer, MD, PhD
Staff Physician, Clinical and Metaolic enetics
2: eonatoogy
Am irs, MD
Resident, Pediatrics
Jlia DiLai, MD, MSc
Fellow, eonatalPerinatal Medicine
aas larni
M Ch O, FRCPC
Fellow, eonatalPerinatal Medicine
Aideen Mre, MD, MHSc, FRCPC
Staff Physician, eonatology
2: eroogy and Uroogy
Madalena Riedl, MD, PhD
Resident, Pediatrics
Mallr L. Dwnie, MD, FRCPC
Fellow, ehrology
Anne Shie Blais, MD, FRCSC
Fellow, rology
Jana Ds Sans, MD, MHSc, FRCPC
Staff Medical rologist, rology
Seeha Radharishnan, MDCM, FRCPC, MScCH
Staff Physician, ehrology
2: euroogy and eurosurgery
Drda Drdeic, MD
Resident, erology
rin Char, MD
Resident, erology
Crisina . , MD
Staff Physician, erology
Ahaa larni, MD, PhD, FRCSC
Staff Srgeon, erosrgery
Lia Plcine,MD,MSc,FRCPC
Staff Physician, erology
3: Oncoogy
Am L, BHSc, MD
Resident, Pediatrics
Mhammed Al aimi, BSc, MD, FRCPC
Fellow, HematologyOncology
Reena Paari, MSc, MD, FRCPC Fellow, HematologyOncology
Smi a, MD, PhD, FRCPC
Staff Physician, HematologyOncology
31: Otamoogy
Shel msn, BSc, MD
Resident, Pediatrics
Asim Ali, MD, FRCSC
OhthalmologistinChief, Ohthalmology and ision Sciences
32: Ortoedics
Allsn Shre, MD
Resident, Pediatrics
nni araanan, MBBS, MSc, FRCSC
Staff Srgeon, Orthoedic Srgery
33: Otoaryngoogy
alia reensn, MD, HBA
Resident, Pediatrics
Sharn L. Cshin, MD, MSc, FRCSC
Staff Srgeon, Otolaryngology
3: Pastic Surgery
Lara aman, MD
Resident, Pediatrics
risen M. Daide, MD, MSc, FRCSC
Staff Srgeon, Plastic Srgery
3: Resiroogy
ler res, MBBS
Resident, Pediatrics
allace B.ee, MD, BASc, MHSc, FRCPC
Fellow, Resiratory Medicine
e J. Mraes, MD, PhD, FRCPC
Staff Physician, Resiratory Medicine
3: Reumatoogy
Desmnd She, MD
Resident, Pediatrics
Dilan Dissanaae, MD, PhD, FRCPC Fellow, Rhematology
Shirle M.L. se, MD, FRCPC
Staff Physician, Rhematology
3: Tecnoogy and Medica
Comexity
Sarna Sharma, MD
Resident, Pediatrics
Maria Maran, MD, FRCPC, MSc
Fellow, Comle Care Medicine
Reshma Amin, MD, FRCPC, MSc
Staff Physician, Resiratory Medicine
Sana Mahan, MD, FRCPC, MSc
Staff Physician, Pediatric Medicine
3: Transantation
Lc Dan, MD
Fellow, mmnology and llergy
Jessica P. lsn, MD, FRCPC Fellow, astroenterology, Heatology and trition
risa an Resel, M, PPediarics
rse Practitioner, ier and owel ranslant
ic , MD, FRCPC
Staff Physician, astroenterology, Heatology and trition
Medical irector, ier ranslant Program
Section III: LABORATORY REFERENCE VALUES AND TRANSFUSION
MEDICINE
3: aoratory Reerence aues and Transusion Medicine
hsrw Adeli, PhD, FCACB, DABCC, FAACC
Head, Clinical iochemistry, Pediatric aoratory Medicine
Ssan Richardsn, MDCM, FRCPC
Chief, Pediatric aoratory Medicine
n Li, BSc
Resorce echnologist, Hematology, Pediatric aoratory Medicine
end La, MBBS, FRCPC
irector, ransfsion Medicine, Pediatric aoratory Medicine
Benamin Jn, PhD, FCACB
Clinical iochemist, Pediatric aoratory Medicine
icria Hiins, BSc
Ph Candidate, Pediatric aoratory Medicine
Mar ahrn Bhn, BSc
Ph Candidate, Pediatric aoratory Medicine
Section IV: DRUG DOSING GUIDELINES
: rug osing uideines
laine La, BScPhm, PharmD, MSc, RPh
rg nformation Coordinator, Pharmacy
e All chaers were wrien residens, ellws and sa e Hsial r Sic
Children Chaer ahrs are aliaed wih
e Hsial r Sic Children nless
herwise ned.
Resuscitation
Melanie Bechard • Andrew Helmers • Lianne Mclean
Common abbreviations
Useful calculations
Team dynamics
Clinical assessment of the ill child
Respiratory support during resuscitation
Circulatory support during resuscitation
Advanced airway management
PALS algorithms
Post-resuscitation care
COMMON ABBREVIATIONS
Also see page xviii for a list of other abbreviations used throughout this book
ABC airway, breathing, circulation
ABG arterial blood gas
APLS advanced pediatric life support
B bagvalve ask
CPAP continuous positive airway pressure
CP cardiopulonary resuscitation
endotracheal tube
i fraction of inspired oxygen
C functional residual capacity
LA laryngeal ask airway
PALS Pediatric Advanced Life Support
PA pulseless electrical activity
PC pediatric intensive care unit
SC return of spontaneous circulation
S rapid seuence intubation
S systeic vascular resistance
USEFUL CALCULATIONS
Hypotension (systolic blood pressure)
a , onth , g
b – onths os , g
c – years yrs , 1 3age g
d . yrs , g
Estimated weight in kg APLS th ed
a – os 3age in os 1
b – yrs 3age in yrs 1
c – yrs 3age in yrs 1
Endotracheal tube (ETT) size
a ncued age in yrs 1
b Cued age in yrs 1
ETT depth
a , yr
i ropharyngeal intubation c at lip age in yrs 1
ii asopharyngeal intubation c at nare age in yrs 1
b . yr
i ropharyngeal intubation c at lip age in yrs 1
3 diaeter
ii asopharyngeal intubation c at lip age in yrs 1
TEAM DYNAMICS
esuscitation teamwork, communication, and leadership all have a signicant ipact on patient outcoes
eore a resuscitation
nticipate needs
a Contact necessary personnel eg, respiratory therapy if available, consider anesthesiology and consider available euipent
b Seek help when needed e g , contact anesthesiology or otolaryngology if a dicult airway is anticipated
ssign roles clearly dene roles and responsibilities of each tea eber
now your resources
a ailiarie yourself with the resuscitation euipent of your hospital ward and eergency departent
b now your provincial or state resources for coordinating transfer to tertiary care centers, if applicable
uring a resuscitation
A leader should
a er constructie eedback “Please perfor copressions faster—we’re aiing for to per inute”
b ink out loud share thoughts and suggestions to create a shared ental odel “ suspect this child has septic shock” Avoid preature xation on a diagnosis and be ready to shi§ perspective
c Perfor periodic reiews suarie and reevaluate the case ¨is helps to ensure adherence to algoriths and oers opportunities for new ideas to reduce bias
d Encourage inormation sharing and bidirectional transission of ideas “Are there other thoughts about which edications should be used before intubation”
e eain “hands o ” if possible leaders who focus on coordinating the tea rather than participating in the resuscitative eorts perfor better §en this necessitates delegating obs that can detract fro focused leadership ie, assigning a specic person to calculate resuscitation edication doses
PEARL
Closed-loop communication is important in a resuscitation; e g , wen ordering epineprine during a cardiac arrest
Proider 1 “Te patient’s weigt is 2 g please gie 2 mg o 11, epineprine intraenously, wic is 2 m”
Proider 2 “.2 mg o 11, epineprine, wic is 2 m, now ready to gie ”
Proider 1 “Tan you, please administer tat dose”
Proider 2 “ose administered”
All tea ebers should
a se closedloop communication iproves the safety and eciency of care provided by reoving abiguity fro instructions and allowing for correctionsclarifying uestions if needed
b Be respectul vidence suggests rudeness negatively ipacts resuscitation teas’ perforance
c Support amily presence during resuscitation there is a strong parental preference to be present
er a resuscitation
very eort should be ade to conduct a debrie ebrieng involves guided re¯ection of edical issues, eotional ipact on care providers, and provides perforance feedback to the tea
¨ere are any debrieng forats eg, standardied fors, “hot” debrief within inutes to hours of the resuscitation, “cold” debrief days to weeks a§er resuscitation
nsure your hospital has a culture of safe and nonudgental debriefs, which follow a consistent structure to ensure that provider distress is addressed and that constructive feedback is incorporated into future events f it is clear that tea ebers have experienced distress eg, a resuscitation that ends with patient deise, it is iportant to identify this in the debrief and ensure channels exist to explore and support this further
CLINICAL ASSESSMENT OF THE ILL CHILD
Ealuation o Es
See able
