therapy, give nasopharyngeal CPAP (NCPAP) of cm H2O. If the child is becoming tired on NCPAP, consider endotracheal intubation and mechanical ventilation using pressure support. When a child is ventilated, a pCO2 of 60-80 mmHg (pH 7.10-7.20) is often appropriate. See the advice about ventilation in the entry on Asthma. Antibiotics should not be given routinely. If the neutrophil I/T ratio is high or PCT >2ng/ml, take cultures and give penicillin (or flucloxacillin) gentamicin. Check blood glucose in an infant who presents with apnoea. If there is apnoea, fever and PCT >2ng/ml, consider lumbar puncture when safe to do so. A trial of nebulised adrenaline and dexamethasone may be useful for children with severe bronchiolitis. Give adrenaline 1% 0.05ml/kg diluted to 6ml plus dexamethasone 0.6mg/kg stat then prednisolone 1mg/kg 8 hourly. Adrenaline may worsen V:Q matching and causes tachycardia, so monitor closely and stop if worsens BRONCHOALVEOLAR LAVAGE Equipment Combicath, simple dressing set, 10ml syringe, sterile saline, drawing-up needle, sterile scissors, mask, gloves, hat. Measure the distance from the patient's xiphisternum to the tragus (ear), then to the outer end of the endotracheal tube. If the total distance is less than 35cm, use a Combicath 58223.19 (short), and if it is 35cm or more use a Combicath 58229.19 (long). Procedure 1. Use a sterile technique (scrub, gloves, mask, hat). 2. Pre-oxygenate the patient. 3. Insert the Combicath through a valved swivel connector (Bodai) and into the endotracheal tube until it is gently wedged. 4. While keeping the white outer protective sheath wedged, pull back the clear inner cannula 0.5 cm so you can remove the 5cm grooved tube that is between the end of the white protective sheath and the end of the clear inner cannula.
therapy, give nasopharyngeal CPAP (NCPAP) of cm H2O. If the child is becoming tired on NCPAP, consider endotracheal intubation and mechanical ventilation using pressure support. When a child is ventilated, a pCO2 of 60-80 mmHg (pH 7.10-7.20) is often appropriate. See the advice about ventilation in the entry on Asthma. Antibiotics should not be given routinely. If the neutrophil I/T ratio is high or PCT >2ng/ml, take cultures and give penicillin (or flucloxacillin) gentamicin. Check blood glucose in an infant who presents with apnoea. If there is apnoea, fever and PCT >2ng/ml, consider lumbar puncture when safe to do so. A trial of nebulised adrenaline and dexamethasone may be useful for children with severe bronchiolitis. Give adrenaline 1% 0.05ml/kg diluted to 6ml plus dexamethasone 0.6mg/kg stat then prednisolone 1mg/kg 8 hourly. Adrenaline may worsen V:Q matching and causes tachycardia, so monitor closely and stop if worsens BRONCHOALVEOLAR LAVAGE Equipment Combicath, simple dressing set, 10ml syringe, sterile saline, drawing-up needle, sterile scissors, mask, gloves, hat. Measure the distance from the patient's xiphisternum to the tragus (ear), then to the outer end of the endotracheal tube. If the total distance is less than 35cm, use a Combicath 58223.19 (short), and if it is 35cm or more use a Combicath 58229.19 (long). Procedure 1. Use a sterile technique (scrub, gloves, mask, hat). 2. Pre-oxygenate the patient. 3. Insert the Combicath through a valved swivel connector (Bodai) and into the endotracheal tube until it is gently wedged. 4. While keeping the white outer protective sheath wedged, pull back the clear inner cannula 0.5 cm so you can remove the 5cm grooved tube that is between the end of the white protective sheath and the end of the clear inner cannula.
PICU%20Guidelines%20Nov%2015th%202017.docx