Table Of ContentADVANCED
PAEDIATRIC
LIFE SUPPORT
The Practical Approach
Third edition
Advanced Life Support Group
Edited by
Kevin Mackway-Jones
Elizabeth Molyneux
Barbara Phillips
Susan Wieteska
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© BMJ Books 1997, 2001
BMJ Books is an imprint of the BMJ Publishing Group,
BMA House,Tavistock Square, London WC1H 9JR
www.bmjbooks.com
All rights reserved. No part of this publication may be reproduced, stored in a retrieval
system, or transmitted, in any form or by any means electronic, mechanical, photocopying,
recording, and, or otherwise, without the prior written permission of the Advanced Life
Support Group.
First published in 1993 by the BMJ Publishing Group
Reprinted 1994
Reprinted 1995
Reprinted 1996
Second edition 1997
Reprinted 1998
Reprinted with revisions 1998
Reprinted 1999
Reprinted 2000
Third edition 2001
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
ISBN 0-7279-1554-1
Typeset in Great Britain by FiSH Books, London
Printed and bound by Selwood Printing Ltd, Burgess Hill, West Sussex
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CONTENTS
Working Group
vii
Contributors
ix
Preface to the Third Edition
xi
Preface to the First Edition
xiii
Acknowledgements
xv
Contact Details and Website Information
xvi
PART I:
INTRODUCTION
Chapter 1
Introduction
3
Chapter 2
Why treat children differently?
7
Chapter 3
Recognition of the seriously ill child
13
PART II:
LIFE SUPPORT
Chapter 4
Basic life support
21
Chapter 5
Advanced support of the airway and ventilation
35
Chapter 6
The management of cardiac arrest
45
Chapter 7
Resuscitation at birth
59
PART III:
THE SERIOUSLY ILL CHILD
Chapter 8
The structured approach to the seriously ill child
71
Chapter 9
The child with breathing difficulties
79
Chapter 10
The child in shock
99
Chapter 11
The child with an abnormal pulse rate or rhythm
117
Chapter 12
The child with a decreased conscious level
127
Chapter 13
The convulsing child
139
Chapter 14
The poisoned child
149
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PART IV:
THE SERIOUSLY INJURED CHILD
Chapter 15
The structured approach to the seriously injured child
161
Chapter 16
The child with chest injury
173
Chapter 17
The child with abdominal injury
179
Chapter 18
The child with trauma to the head
183
Chapter 19
The child with injuries to the extremities or the spine
191
Chapter 20
The burnt or scalded child
199
Chapter 21
The child with electrical injury or near drowning
205
PART V:
PRACTICAL PROCEDURES
Chapter 22
Practical procedures – airway and breathing
213
Chapter 23
Practical procedures – circulation
221
Chapter 24
Practical procedures – trauma
233
Chapter 25
Interpreting trauma X-rays
243
Chapter 26
Transport of children
255
PART VI:
APPENDICES
Appendix A
Acid–base balance
263
Appendix B
Fluid and electrolyte management
269
Appendix C
Child abuse
281
Appendix D
Childhood accidents and their prevention
291
Appendix E
Dealing with death
295
Appendix F
Management of pain in children
297
Appendix G
Triage
303
Appendix H
Envenomation
307
Appendix I
Formulary
313
Index
330
vi
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WORKING GROUP
A. Argent
Paediatric ICU, Cape Town
A. Charters
Emergency Nursing, Sheffield
M. Felix
Paediatrics, Coimbra
J. Fothergill
Emergency Medicine, London
G. Hughes
Emergency Medicine,Wellington
F. Jewkes
Paediatric Nephrology, Cardiff
J. Leigh
Anaesthesia, Bristol
K. Mackway-Jones
Emergency Medicine, Manchester
E. Molyneux
Paediatric Emergency Medicine, Malawi
P. Oakley
Anaesthesia/Trauma, Stoke on Trent
B. Phillips
Paediatric Emergency Medicine, Liverpool and Manchester
C.Tozer
Emergency Nursing, Abergavenny
N.Turner
Anaesthesia, Amsterdam
J.Walker
Paediatric Surgery, Sheffield
S.Wieteska
Course Co-ordinator, Manchester
K.Williams
Paediatric Emergency Nursing, Liverpool
S.Young
Paediatric Emergency Medicine, Melbourne
D. Zideman
Paediatric Anaesthesia, London
vii
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CONTRIBUTORS
R. Appleton
Paediatric Neurology, 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
C. Cahill
Emergency Medicine, Portsmouth
H. Carty
Paediatric Radiology, Liverpool
M. Clarke
Paediatric Neurology, Manchester
J. Couriel
Paediatric Respiratory Medicine, Liverpool
P. Driscoll
Emergency Medicine, Manchester
J. Fothergill
Emergency Medicine, London
P. Habibi
Paediatric Intensive Care, London
D. Heaf
Paediatric Respiratory Medicine, Liverpool
F. Jewkes
Paediatric Nephrology, Cardiff
E. Ladusans
Paediatric Cardiology, Manchester
J. Leggatte
Paediatric Neurosurgery, Manchester
J. Leigh
Anaesthesia, Bristol
CONTRIBUTORS
ix
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S. Levene
Child Accident Prevention Trust, London
M. Lewis
Paediatric Nephrology, Manchester
K. Mackway-Jones
Emergency Medicine, Manchester
J. Madar
Neonatology, Plymouth
T. Martland
Paediatric Neurologist, Manchester
E. Molyneux
Paediatric Emergency Medicine, Malawi
D. Nicholson
Radiology, Manchester
A. Nunn
Pharmacy, Liverpool
P. Oakley
Anaesthesia, Stoke on Trent
B. Phillips
Paediatric Emergency Medicine, Manchester and Liverpool
J. Robson
Paediatric Emergency Medicine, Liverpool
D. Sims
Neonatology, Manchester
A. Sprigg
Paediatric Radiology, Sheffield
J. Stuart
Emergency Medicine, Manchester
J.Tibballs
Paediatric Intensive Care, Melbourne
J.Walker
Paediatric Surgery, Sheffield
W.Whitehouse
Paediatric Neurologist, Birmingham
S.Wieteska
Course Co-ordinator, 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
CONTRIBUTORS
x
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PREFACE TO THIRD EDITION
Since this book was first published in 1993, the Advanced Paediatric Life Support
(APLS) concept and courses have gone a great way towards their aim of bringing simple
guidelines for the management of ill and injured children to front-line doctors and
nurses.
Over the years an increasing number of experts have contributed to the work and we
extend our thanks both to them and also to our instructors who unceasingly provide
helpful feedback.The Advanced Paediatric Life Support Course is now well established
in several countries outside the United Kingdom. These include Australia, New
Zealand, the Netherlands, Portugal and South Africa. APLS is also the recommended
paediatric course for the European Resuscitation Council. Furthermore, material from
APLS is being successfully used in countries with under-resourced health care systems
such as Bosnia-Herzegovina, Malawi and Uganda.
A small “family” of courses have developed from APLS in response to different
training needs. One is the Paediatric Life Support (PLS) course, a one-day locally
delivered course designed for doctors and nurses who have only subsidiary
responsibility for seriously ill or injured children (see note, page xvi). Another is Pre-
Hospital Paediatric Life Support (PHPLS), which has its own textbook and is for the
pre-hospital provider.
Readers will find significant changes in the third edition. The chapters on
resuscitation and the management of arrhythmias have been informed by the new
International Guidelines, produced by an evidence-based process from the
collaboration of many international experts under the umbrella of the International
Liaison Committee on Resuscitation (ILCOR). The chapters on serious illness have
been rewritten both to include new knowledge and practice and also to reflect the
problem-based approach used in teaching. In addition there are some new chapters.
In the past the editors have been criticised for the decision not to include in the text
the many references which support its assertions. We have not changed this now – but
have harnessed the power of the World Wide Web to allow us (and you the reader, the
candidate and the instructor) to keep the evidence available and up to date. Log on to
www.bestbets.org to see how far we have got and how you can help.
KMJ
EM
BP
SW
Manchester 2001
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