BNF for Children 2011-2012

Medical emergencies in thecommunityDrug treatment outlined below is intended for use bycommunity healthcare professionals. Only drugs thatare used for immediate relief are shown; advice onsupporting care is not given. Where the child’s conditionrequires investigation and further treatment, thechild should be transferred to hospital promptly.Anaphylaxis(section 3.4.3)Adrenaline injection (1 mg/mL (1 in 1000)). By intramuscular injectionChild under 6 years 150 micrograms (0.15 mL),repeated every 5 minutes if necessaryChild 6–12 years 300 micrograms (0.3 mL),repeated every 5 minutes if necessaryChild 12–18 years 500 micrograms (0.5 mL),repeated every 5 minutes if necessary; 300 micrograms(0.3 mL) should be given if child is small orprepubertalHigh-flow oxygen (section 3.6) and intravenousfluids should be given as soon as available.Chlorphenamine injection by intramuscular or intravenousinjection (section 3.4.1) may help counter histamine-mediatedvasodilation and bronchoconstriction.Hydrocortisone (preferably as sodium succinate) byintravenous injection (section 6.3.2) has delayed actionbut it should be given to severely affected children toprevent further deterioration.Asthma: acute(section 3.1)Regard each emergency consultation as being forsevere acute asthma until shown otherwise; failure torespond adequately at any time requires immediatetransfer to hospitalEither salbutamol aerosol inhaler (100 micrograms/metered inhalation). By aerosol inhalation via large-volume spacer (anda close-fitting face mask if child under 3 years)Child under 18 years 2–10 puffs each inhaledseparately, repeated at 10–20 minute intervals or asnecessaryor salbutamol nebuliser solution (1 mg/mL, 2 mg/mL). By inhalation of nebulised solution (via oxygendrivennebuliser if available)Child under 5 years 2.5 mg every 20–30 minutes oras necessaryChild 5–12 years 2.5–5 mg every 20–30 minutes oras necessaryChild 12–18 years 5 mg every 20–30 minutes or asnecessaryor terbutaline nebulised solution (2.5 mg/mL). By inhalation of nebulised solution (via oxygendrivennebuliser if available)Child under 5 years 5 mg every 20–30 minutes or asnecessaryChild 5–12 years 5–10 mg every 20–30 minutes oras necessaryChild 12–18 years 10 mg every 20–30 minutes or asnecessaryPlus (in all cases)Either prednisolone tablets (or prednisolone solubletablets) (5 mg). By mouthChild under 12 years 1–2 mg/kg (max. 40 mg) oncedaily for up to 3 days or longer if necessary; if thechild has been taking an oral corticosteroid for morethan a few days, give prednisolone 2 mg/kg (max.60 mg) once dailyChild 12–18 years 40–50 mg once daily for at least5 daysor hydrocortisone (preferably as sodium succinate). By intravenous injectionChild up to 18 years 4 mg/kg (max. 100 mg) every 6hours, until conversion to oral prednisolone is possible;alternative dose if weight unavailable, Childunder 2 years 25 mg, 2–5 years 50 mg, 5–18 years100 mgHigh-flow oxygen (section 3.6) should be given if availableMonitor response 15 to 30 minutes after nebulisation; ifany signs of acute asthma persist, arrange hospitaladmission. While awaiting ambulance, repeat nebulisedbeta 2 agonist (as above) and give withipratropium nebuliser solution (250 micrograms/mL). By inhalation of nebulised solution (via oxygendrivennebuliser if available)Child under 12 years 250 micrograms repeatedevery 20–30 minutes for the first 2 hours, then every4–6 hours as necessaryChild 12–18 years 500 micrograms every 4–6 hoursas necessaryConvulsive (including febrile) seizureslasting longer than 5 minutes(section 4.8.2 and section 4.8.3)Either midazolam buccal solution (5 mg/mL, 10 mg/mL) or injection solution given by buccal route. By buccal administration, repeated once after 10minutes if necessaryNeonate 300 micrograms/kgChild 1–6 months 300 micrograms/kg (max.2.5 mg)Child 6 months–1 year 2.5 mgChild 1–5 years 5 mgChild 5–10 years 7.5 mgChild 10–18 years 10 mgor diazepam rectal solution (2 mg/mL, 4 mg/mL). By rectum, repeated once after 10 minutes if necessaryNeonate 1.25–2.5 mgChild 1 month–2 years 5 mgChild 2–12 years 5–10 mgChild 12–18 years 10–20 mg