Welcome

I struggled to find PEM resources for my CT3 year, despite the variety of excellent resources out there. I hope this website will help point you in the right direction. I'm not a PEM expert, but am following the guidance CEM have issued (in the form of a syllabus) to put together this page. This page is not endorsed by CEM, and any mistakes are mine.

Please comment with corrections, additions and further suggestions.

All the information here is collected from the internet, and it might be out of date or inaccurate, so please use your judgement and adhere to your hospital's protocols. If you do notice any errors or omissions please comment so we can put them right!

To navigate, decide whether you want to start with a PMP or a PAP. You can then select which PMP or PAP you want to look at. You will then be taken to the summary page for that PMP, with links expanded topic collections. If you know what topic you want to look at already, click on the link on the right hand side.
Showing posts with label NLS. Show all posts
Showing posts with label NLS. Show all posts

Thursday, 27 October 2016

Collapsed Neonates

Resuscitate
As per appropriate
Adrenaline 10mcg/kg

Prostin -  
    - 5 ng/kg/min if clinically well
    - 20 ng/kg/min if unstable or absent femoral pulses
    - 50-100 ng/kg/min if no response
Apnoea common: 1st hr of Rx, dose
Hypotension may occur with high dose

Prostin
- 5 ng/kg/min if clinically well
- 20 ng/kg/min if unstable or absent femoral pulses
- 50-100 ng/kg/min if no response
Apnoea common: 1st hr of Rx, dose

Hypotension may occur with high dose

Think about Causes
Infection
Group B strep, E Coli - PROM, maternal GBS, fever in labour
Herpes Simplex - GCS, coagulopathy, ALT, family cold sores
MRSA - Unresponsive 1st line antibiotics,+ contact

Cardiac
Coarctation aorta - Systolic arm/leg gradient > 20 mmHg
Hypoplastic Left heart - Poor pulses –may be pink= pulm. overcirculation
Transposition (TGA) - Preductal sats < post ductal sats
TAPVD (obstructed) - Shocked & cyanosed/CXR plethoric
SVT  - HR>220 despite fluid, f ixed HR, narrow QRS
Myocarditis - Cardiac failure, tachycardia, small QRS

Injury 
Intracranial bleed  - Focal neuro signs, fontanel le , retinal bleeds
Intrabdominal bleed - Unexplained anaemia, abdominal bruising

Cardiac

Metabolic
Vomiting, reduced GCS, hypoglycaemia
Stop the feeds. Give fluid and dextrose as highly likely to be fluid depleted

References
http://paediatricem.blogspot.co.uk/search/label/NLS
http://www.rcemlearning.co.uk/references/congenital-heart-disease/ 
http://www.rcemlearning.co.uk/modules/the-shocked-neonate/ 
http://www.rcemfoamed.co.uk/portfolio/metabolic-babies-in-the-ed-easy-as-1-2-3/ 

Monday, 5 August 2013

Newborn Life Support

Having to perform NLS is rare, but is an easy exam scenario. The NLS course is a very useful one day course to attend. If you can't get on an NLS course, I'd recommend reading the NLS course manual - it has many useful pictures and tips. It is worth remembering that the N in NLS stands for "Newborn" and NOT "Neonatal". This means that if you have a poorly baby who is even six hours old, they are not a new born, so APLS guidelines should be used, not NLS.

If you look hard enough, there are quite a few neonatal life support resources.
The resus council protocol is here: Newborn Life Support.
The American Heart Association guidelines are here.

Life in the fast lane have a very useful (no pictures, so quick to load) summary here with the SMACC conference video on newborn resuscitation. AAFP also has guidelines here.  PedEMMorsels has a very matter of fact summary here. The anaesthetists have had their own update here. WikiEM also has a very thorough summary. Academic life in EM has some good videos, supplemented with pictures of stick men!

Make sure you know your hospital's protocols. Many hospitals have a seperate Neonatal resuscitation team, as well as the Paediatric resus team.
If you have a resuscitaire in your department, check that you know how to use it. If you don't have a resuscitaire, where is your nearest?





And if you were wondering - yes, you can use an LMA in new born resus - sanscrit and resus.me have the answers.