New APLS guidelines are sort of here…

The new ILCOR 2010 resuscitation guidelines are now being taught on all life support courses in the UK. We are allowed this year as a transition year as people get trained up. I have put together a Word document (Useful emergency paediatrics bits and pieces (2)) with all the updated APLS “WETFAG” policies and a table with normal paediatric observations as an aide memoire for those leading paediatric resuscitations or stabilising sick and injured children.

Unfortunately version 5.0 of the APLS manual is not going to be available in hard copy until later this year so there may be a bit of confusion about which guidelines to use. The only thing that will affect the care of the individual child is if the leader loses confidence so please, when the chips are down, use the guideline the leader is comfortable with.

APLS instructors have access to the new manual in draft form through their VLE login. Can I remind you that we all have to do some updated VLE sections and print out a certificate to say we’ve done that before instructing on any courses this year?

8 thoughts on “New APLS guidelines are sort of here…

  1. V useful documents, had forgotten one of the amounts and this was the only place I could find it easily online with the mnemonic I learnt initially. This may be a silly question but it there an argument to say fluid resus as 10 ml + 10 ml for meningitis aswell as trauma? I seem to remember there being 2 scenarios for splitting the 20 mg per kg dose. Sorry if this is a glaringly stupid question. Many thanks dan

    1. Hi Dan, thank you for your comment and no question is glaringly stupid.

      The following is an excerpt from version 5.0 of the APLS manual:

      “Give a 20 ml/kg rapid bolus of crystalloid to all patients (caution in those with primary cardiogenic
      shock and in those with signs of raised intracranial pressure). Patients with cardiac
      aetiology (i.e. myocarditis) leading to shock may still benefit from a cautious fluid bolus to
      optimise preload and, instead of 20 ml/kg, a 10 ml/kg fluid bolus should be considered in
      patients where a cardiac cause is suspected. In patients with signs suggestive of raised intracranial
      pressure (i.e. relative bradycardia and hypertension, posturing or seizures), hypotension
      is detrimental for cerebral perfusion, but excessive fluids carry the theoretical risk of
      worsening cerebral oedema; hence fluids should be given cautiously in 10 ml/kg aliquots
      with careful reassessment of clinical signs after each fluid bolus.”

      It is recommended to give 10mls/kg then 10mls/kg in children with DKA – because of the risk of cerebral oedema as above. In trauma we give 10mls + 10mls because “the best clot is the first clot” and it is best not to knock it off if possible – at least until you have the whole trauma team assembled.

      In pure meningitis it may be an idea to give fluids cautiously but we should not hold back on fluids in cases of suspected meningococcal septicaemia. They will need ventilation and inotropes as well but don’t let that stop you giving the fluids they need to treat their shock. See also for posters you can display in your department on management of meningococcal disease and for NICE’s recent guideline on bacterial meningitis in children.


  2. Aged-based weight estimation has limited precision, and 3 formulae are difficult to remember. I’ve developed a little technique to help calculate the latest APLS formulae using finger counting. A small write up of my work, with video and summary PDF is here

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