Resuscitation Council (UK) logo
home
 

* Frequently asked questions on
     Paediatric Life Support

 

     July 2011

     Updated
     February 2013, October, August 2011

  
Click on the required question from the list below to view the answer 
1. Why does the Resuscitation Council (UK) teach a different weight formula to that which is taught by ALSG?
2. The British Thoracic Society (BTS) has developed guidance for the administration of oxygen in adults (2008) but this does not address children. What is the guidance for emergency oxygen use in children?
3. Why has the dose for glucose changed from 5ml/kg to 2ml/kg for children yet it remains at 2.5ml/kg for newborns?
4. Is it safe to use a point of care test (meter/strips) to measure blood glucose to diagnose hypoglycaemia in an emergency as part of the ABCDE approach?

 

 

Question:
(1)   Why does the Resuscitation Council (UK) teach a different weight formula to that which is taught by ALSG?

 
Answer:
The formula taught on Resuscitation Council (UK) and European Resuscitation Council courses for estimating the weight of a child has not changed.
 
                     (Age + 4)  x  2
 
This simple formula is taught because it is easy to remember and apply in an emergency setting.   It is a useful first calculation, allowing treatment to be given quickly.

Complex calculations may provide greater absolute accuracy but they increase the risks for error. Drug calculations can be altered subsequently depending on further information such as actual weight or length and the response to initial treatment.

It is important to appreciate that plasma levels of drugs will depend on numerous other factors such as age, lean body mass, method of administration, body temperature and the pathophysiology – so absolute, pinpoint accuracy is not essential.

For information, the APLS weight calculation is:
 

1 - 12 months   (0.5  x  age months) + 4
1 - 5 years   (2  x  age years) + 8
6 - 12 years   (3  x  age years) + 7
 
[July 2011]

 
top
 
 

Question:
(2)   The British Thoracic Society (BTS) has developed guidance for the administration of oxygen in adults (2008) but this does not address children. What is the guidance for emergency oxygen use in children?

 
Answer:
Whilst the BTS guidance is evidence-based there is no high quality evidence available in children. The consensus expert view is that the highest possible oxygen concentration should be used for the initial emergency treatment of all children because hypoxia is by far the commonest cause of cardiac arrest and high concentration oxygen will not cause harm in the short term.

The International Liaison Committee on Resuscitation (ILCOR) suggests that once the child is stable, the inspired oxygen should be gradually reduced (whilst ensuring that peripheral oxygen saturations remain in the high 90s) in order to limit hyperoxaemia. In situations where high levels of dissolved oxygen are important however, such as in carbon monoxide poisoning (e.g. after smoke inhalation), severe acute anaemia (e.g. after clear fluid resuscitation from haemorrhage) sickle cell disease or if there is any doubt, the highest possible FiO2 should be maintained.

In the out of hospital situation, pulse oximetry, which is required for oxygen titration, is frequently not available or inaccurate for small children and babies and some of the above conditions are more likely so it is reasonable to continue to use the highest possible FiO2 during resuscitation and transfer to hospital.
 
[August 2011]

 
top
 
 

Question:
(3)   Why has the dose for glucose changed from 5ml/kg to 2ml/kg for children yet it remains at 2.5ml/kg for newborns?

 
Answer:
The reason for the change in the dose of glucose was to avoid unnecessary discrepancies between teaching on the APLS and EPLS/PILS courses, which was causing confusion in the clinical arena (APLS said 2 ml/kg and RC(UK) said 5 ml/kg). It seemed sensible to go with the 2ml/kg as there is a danger of hyperglycaemia at higher doses and the blood sugar levels can be checked and a repeat bolus given if it is still too low. There is no evidence favouring either the 2ml/kg or 5ml/kg bolus for the treatment of hypoglycaemia.

The dosage of 2.5ml/kg for newborns is taken from the NLS guidelines. This did not change with Guidelines 2010. Originally it was chosen rather than 5ml/kg to avoid rebound hypoglycaemia, and what is usually needed in newborns is an infusion.
 
[October 2011]

 
top

Question:
(4)   Is it safe to use a point of care test (meter/strips) to measure blood glucose to diagnose hypoglycaemia in an emergency as part of the ABCDE approach?

 
Answer:
The rapid bedside evaluation of blood glucose as part of the ABCDE assessment is designed to identify hypoglycaemia as a cause of disordered conscious level, as early as possible in the clinical assessment of a patient. Whilst finger prick capillary blood samples and point of care ("bedside") blood glucose meter/strip readings can be inaccurate in certain clinical situations, waiting for the results of a venous or arterial blood sample takes time. If the patient is hypoglycaemic, this delay risks short and long-term neurological damage. The benefits of a rapid bedside diagnosis and early treatment of hypoglycaemia, even if some inaccuracies in measurement are present, generally outweigh the dangers presented by these inaccuracies. Therefore do not delay the treatment of ‘suspected’ hypoglycaemia whilst awaiting a formal laboratory venous or arterial blood sample result.

All staff using blood glucose test strips and/or meters must understand how to perform the test accurately and must also be aware of the many potential sources of error.

Conditions where there may be inaccuracies with point of care testing with blood glucose meters include hypotension, shock, and severe dehydration. The Medicines and Healthcare Products Regulatory Agency (MHRA) provides detailed advice in Point of Care Testing and Blood Glucose Meters (2011):
http://www.mhra.gov.uk/home/groups/dts-pcc/documents/publication/con2015464.pdf
 
[February 2013]

 
top
 
 
 
 
 
 

Page last updated 27 February 2013

Skip to top