Paediatric Acute care Guidelines PMH Emergency Department

Assessment 

Investigations

  • The majority of children require no investigations 
  • Indicated only if systemic symptoms, suspicion of underlying infection or in immunocompromised patient
    • FBC, CRP and Blood cultures are indicated in the unwell child who appears septic

Management

Animal/Human Bites

  • Bites are common injuries prone to infection. All require prophylactic antibiotics.
  • The bite site requires meticulous wound preparation. It should not be closed unless thoroughly irrigated and debrided.
  • Review the patients tetanus immunisation history. Consider the need for Tetanus Prophylaxis.
  • Antibiotics required:
    • Prophylaxis, or mild to moderate infection: Amoxycillin/clavulanic acid 
    • Severe infection or injury: Piperacillin/tazobactam

Human

  • Staphyloccoci, Streptococci, Bacteroides, Anaerobic cocci, Eikenella corrodens

Animal

  • Most common cause is dog bite, then cat bite
  • Increased risk of infection – Staphyloccoci, Streptococci, Bacteroides, Anaerobic cocci and Pasturella multocida (more common in cat bites)
  • Rabies prophylaxis is not routinely required for bites in Australia but beware of patients presenting from rabies-endemic regions (Asia, Africa, Central and South America). Includes Bali from August 2008. See WHO: Rabies enzootic areas. Refer to Rabies and Lyssavirus

Nursing 

  • Apply EMLA if patient condition is suggestive of requiring intravenous antibiotics

Observations

  • Baseline observations include heart rate, blood pressure, respiratory rate, oxygen saturations, temperature and neurovascular observations (if circumferential or significant swelling).
  • Minimum of hourly observations should be recorded whilst in the emergency department.
  • Any significant changes should be reported immediately to the medical team.

References

  1. WA Health Child and Adolescent Health Service. Skin, Soft Tissue and Orthopaedic Infections ChAMP Empiric Guidelines Version 2, August 2014

External Review: Christopher Blyth (Infectious Diseases Consultant) September 2015

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