Advanced Paediatric Life Support-A

Practical Approach to Emergencies

(Advanced Life Support Group), 7e (Oct
2,
2023)_(1119716136)_(Wiley-Blackwell)
Stephanie Smith
Visit to download the full and correct content document:
https://ebookmass.com/product/advanced-paediatric-life-support-a-practical-approach
-to-emergencies-advanced-life-support-group-7e-oct-2-2023_1119716136_wiley-blac
kwell-stephanie-smith/
More products digital (pdf, epub, mobi) instant
download maybe you interests ...

Chronic Total Occlusions-A Guide to Recanalization, 3e

(Nov 29, 2023)_(1119517273)_(Wiley-Blackwell) Ron
Waksman

https://ebookmass.com/product/chronic-total-occlusions-a-guide-
to-recanalization-3e-nov-29-2023_1119517273_wiley-blackwell-ron-
waksman/

eTextbook 978-1285852683 A Guide to Computer User

Support for Help Desk and Support Specialists

https://ebookmass.com/product/etextbook-978-1285852683-a-guide-
to-computer-user-support-for-help-desk-and-support-specialists/

Enhancing Student Support in Higher Education: A

Subject-Focused Approach 1st Edition Nick Pilcher

https://ebookmass.com/product/enhancing-student-support-in-
higher-education-a-subject-focused-approach-1st-edition-nick-
pilcher/

Cardiopulmonary Transplantation and Mechanical

Circulatory Support Maziar Khorsandi

https://ebookmass.com/product/cardiopulmonary-transplantation-
and-mechanical-circulatory-support-maziar-khorsandi/
Trapped: Brides of the Kindred Book 29 Faith Anderson

https://ebookmass.com/product/trapped-brides-of-the-kindred-
book-29-faith-anderson/

The School Counseloru2019s Guide to Multi-Tiered

Systems of Support

https://ebookmass.com/product/the-school-counselors-guide-to-
multi-tiered-systems-of-support/

Cardiology-An Integrated Approach (Human Organ Systems)

(Dec 29, 2017)_(007179154X)_(McGraw-Hill) 1st Edition
Elmoselhi

https://ebookmass.com/product/cardiology-an-integrated-approach-
human-organ-systems-dec-29-2017_007179154x_mcgraw-hill-1st-
edition-elmoselhi/

Behavior Support (Teachers’ Guides) – Ebook PDF Version

https://ebookmass.com/product/behavior-support-teachers-guides-
ebook-pdf-version/

Pharmacotherapeutics for Advanced Practice: A Practical

Approach (Ebook PDF)

https://ebookmass.com/product/pharmacotherapeutics-for-advanced-
practice-a-practical-approach-ebook-pdf/
 SEVENTH EDITION
0
* *
Support

ADVANCED
PAEDIATRIC
LIFE SUPPORT
A PRACTICAL APPROACH TO EMERGENCIES
r.

lira
i A
11
wm

Ki K ,

i /!
ii sH
f r? Nj/ jSML
T'j
f ? i

V 'O
1

9
V
<#g Paediatrics

L r
Advanced Paediatric
Life Support
SEVENTH EDITION
Advanced
Paediatric Life
Support
A Practical Approach
to Emergencies
SEVENTH EDITION

Advanced Life Support Group

EDITED BY

Stephanie Smith
This seventh edition first published 2023
© 2023 John Wiley & Sons Ltd

Edition History
3e © 2001 John Wiley & Sons, Ltd.; 4e © 2005 John Wiley & Sons, Ltd.; 5e © 2011 John Wiley & Sons, Ltd.;
6e © 2016 John Wiley & Sons, Ltd.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted,
in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as
permitted by law. Advice on how to obtain permission to reuse material from this title is available at
http://www.wiley.com/go/permissions.

The right of Advanced Life Support Group (ALSG) to be identified as the authors of the editorial material in
this work has been asserted in accordance with law.

Registered Offices
John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USA
John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK

For details of our global editorial offices, customer services, and more information about Wiley products visit
us at www.wiley.com.

Wiley also publishes its books in a variety of electronic formats and by print-­on-­demand. Some content that
appears in standard print versions of this book may not be available in other formats.

Trademarks: Wiley and the Wiley logo are trademarks or registered trademarks of John Wiley & Sons, Inc.
and/or its affiliates in the United States and other countries and may not be used without written permission.
All other trademarks are the property of their respective owners. John Wiley & Sons, Inc. is not associated
with any product or vendor mentioned in this book.

Limit of Liability/Disclaimer of Warranty

The contents of this work are intended to further general scientific research, understanding, and discussion
only and are not intended and should not be relied upon as recommending or promoting scientific method,
diagnosis, or treatment by physicians for any particular patient. In view of ongoing research, equipment
modifications, changes in governmental regulations, and the constant flow of information relating to the use
of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided
in the package insert or instructions for each medicine, equipment, or device for, among other things,
any changes in the instructions or indication of usage and for added warnings and precautions. While the
publisher and authors have used their best efforts in preparing this work, they make no representations
or warranties with respect to the accuracy or completeness of the contents of this work and specifically
disclaim all warranties, including without limitation any implied warranties of merchantability or fitness for a
particular purpose. No warranty may be created or extended by sales representatives, written sales materials
or promotional statements for this work. This work is sold with the understanding that the publisher is not
engaged in rendering professional services. The advice and strategies contained herein may not be suitable
for your situation. You should consult with a specialist where appropriate. The fact that an organization,
website, or product is referred to in this work as a citation and/or potential source of further information does
not mean that the publisher and authors endorse the information or services the organization, website, or
product may provide or recommendations it may make. Further, readers should be aware that websites
listed in this work may have changed or disappeared between when this work was written and when it is
read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages,
including but not limited to special, incidental, consequential, or other damages.

Library of Congress Cataloging-­in-­Publication Data applied for

Paperback ISBN: 9781119716136

Cover Design: Wiley

Cover Image: © Russell Ashworth

Set in 10/12 Montserrat by Straive, Pondicherry, India

Contents

Contributors to seventh edition vii

Forewordxi
Preface to first edition xii
Preface to seventh edition xiii
Acknowledgementsxv
Contact details and further information xix

PART 1: Introduction 1
1 Introduction and structured approach to paediatric emergencies 3
2 Getting it right: non-­technical factors and communication 19

PART 2: The seriously ill child 29

3 Structured approach to the seriously ill child 31
4 Airway and Breathing 45
5 Circulation 65
6 Decreased conscious level (with or without seizures) 93
7 Exposure 115

PART 3: The seriously injured child 125

8 Structured approach to the seriously injured child 127
9 The child with chest injury 147
10 The child with abdominal injury 157
11 The child with traumatic brain injury 161
12 The child with injuries to the extremities or the spine 173
13 The burned or scalded child 183
14 The child with an electrical injury 191
15 Special considerations 195

v
vi Contents

PART 4: Life support 207

16 Basic life support 209
17 Support of the airway and ventilation 227
18 Management of cardiac arrest 245

PART 5: Practical application of APLS 259

19 Practical procedures: airway and breathing 261
20 Practical procedures: circulation 277
21 Practical procedures: trauma 295
22 Imaging in trauma 309
23 Structured approach to stabilisation and transfer 323

PART 6: Appendices 337

Appendix A Acid–base balance and blood gas interpretation 339
Appendix B Fluid and electrolyte management 357
Appendix C Paediatric major trauma 371
Appendix D Safeguarding 375
Appendix E Advance decisions and end of life 383
Appendix F General approach to poisoning and envenomation 397
Appendix G Resuscitation of the baby at birth 419
Appendix H Drowning 439
Appendix I Point of care ultrasound 445
Appendix J Formulary 455

List of algorithms 477

Working group for seventh edition 479
References and further reading 481
Index 487

How to use your textbook 508

Contributors to seventh
edition

Working group chair

Stephanie Smith BM BS FRCPCH, Honorary Emergency Paediatric Consultant, Nottingham

Children’s Hospital, Nottingham, UK

Associate editors

The seriously ill child

Andrew Baldock FRCA FFICM, Consultant Paediatric Anaesthetist and Intensivist, Southampton
Children’s Hospital, Southampton, UK
Els Duval MD PhD, Clinical Head Pediatric Intensive Care Unit, University Hospital Antwerp,
Edegem, Belgium
Jacquie Schutz MBBS FRACP DipObs, Paediatric Emergency Physician, Paediatric Emergency,
Department Women’s and Children’s Hospital, Adelaide, South Australia

The seriously injured child

Alan Charters RGN RSCN RNT DHealthSci MAEd BSc(Hons) PgDip(Ed), Consultant Practitioner,
Paediatric Emergency Care, Portsmouth, UK
Bimal Mehta MBChB BSc FRCPCH FRCEM, Consultant in Paediatric Emergency Medicine, Alder
Hey Children’s Hospital NHS Foundation Trust, Liverpool, UK

Life support
Jason Acworth MBBS FRACP (PEM), Paediatric Emergency Physician, Queensland Children’s
Hospital; Clinical Professor, Faculty of Medicine, University of Queensland, Australia
Marijke van Eerd MSc BSc RN RN(Child) PGCE, Paediatric Advanced Clinical Practitioner, Children
and Young People’s Emergency Department, Nottingham University Hospitals NHS Trust,
Nottingham, UK

Appendices
Peter Davis MRCP(UK) FRCPCH FFICM, Consultant in Paediatric Critical Care Medicine, Bristol
Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust,
Bristol, UK
Esyld Watson MBBCH FCEM FAcadMEd PgDip(Med Ed), Consultant in Paediatric and Adult
Emergency Medicine Prince Charles Hospital, Merthyr Tydfil, Wales

vii
viii Contributors to seventh edition

Contributors to chapters

James Armstrong BSc BMBS FRCA, Consultant in Paediatric Anaesthesia, Nottingham University
Hospitals NHS Trust, Nottingham
Dave Bramley FRCSEd(A&E) FRCEM FIMCRCSEd, Consultant in Emergency Medicine and Pre-­
Hosptial Emergency Medicine, South Tyneside and Sunderland NHS Foundation Trust; Chief
Medical Officer for the Great North Air Ambulance Service
Andrea Burgess FRCS-­ORLHNS, Consultant Paediatric ENT Surgeon, Southampton Children’s
Hospital, Southampton
Jonathan Davies MB BChir MA DCH FRCA, Consultant Paediatric Anaesthetist, Nottingham
University Hospitals NHS Trust, Nottingham
Joe Fawke MBCHB FRPCH, Consultant in Neonatal Medicine, University Hospitals Leicester NHS Trust;
National Course Director, RCUK Newborn Life Support (NLS) and Advanced Resuscitation of the
Newborn Infant Courses; ILCOR NLS Task Force Member; Head of East Midlands School of Paediatrics
Chris FitzSimmons FRCEM, Consultant in Paediatric Emergency Medicine, Sheffield Children’s
Hospital NHS Foundation Trust, Sheffield
Julie Grice MRCPCH, Consultant in Paediatric Emergency Medicine, Alder Hey Children’s Hospital
NHS Foundation Trust, Liverpool
Michael J. Griksaitis MBBS(Hons) MSc MRCPCH FFICM, Consultant Paediatric Intensivist,
Southampton Children’s Hospital; Honorary Senior Clinical Lecturer, Faculty of Medicine,
University of Southampton, Southampton
Rachel Harwood MRCS PhD, Registrar in Paediatric Surgery, Alder Hey Children’s Hospital NHS
Foundation Trust; Honorary Clinical Fellow, University of Liverpool, LIverpool
Dan B. Hawcutt BSc(Hons) MBChB(Hons) MD MRCPCH, Reader in Paediatric Clinical
Pharmacology, University of Liverpool; Honorary Consultant, Alder Hey Children’s Hospital;
Director of NIHR, Alder Hey Clinical Research Facility
Giles Haythornthwaite MRCPCH, Paediatric Emergency Medicine Consultant; Clinical Director for
Medical Specialties, Bristol Royal Children’s Hospital; Clinical Lead for Paediatric Trauma,
Southwest Operational Delivery Network, Bristol
Richard Hollander MD, Consultant in Pediatric Critical Care, Beatrix Children’s Hospital, University
Medical Centre Groningen, the Netherlands
Hasnaa Ismail-­Koch DM FRCS-­ORLHNS, Consultant Paediatric ENT Surgeon, Southampton
Children’s Hospital
Musa Kaleem MBBS MRCPCH FRCR, Consultant Paediatric Radiologist, Alder Hey Children’s NHS
Foundation Trust, Liverpool
Angela Lee MBE PgDip Bsc(Hons) RGN RSCN, Nurse Consultant Paediatric Trauma and
Orthopaedics, Royal Berkshire NHS Foundation Trust, Reading
Chris Moran MD FRCS, National Clinical Director for Trauma, NHS-­England and NHS-­
Improvement; Professor of Orthopaedic Trauma Surgery, Nottingham University Hospital;
Honorary Colonel, 144 Parachute Squadron, 16 Medical Regiment
Clare O’Connell MB BCh BAO FRCEM, Consultant in Emergency Medicine and Paediatric
Emergency Medicine, North Cumbria Intergrated Care Trust
Ahmed Osman MSc MRCPCH FHEA, Consultant Paediatric Intensivist, Southampton Children’s
Hospital, Southampton
Paul Reavley MBChB FRCEM FRCS (A&E)Ed MRCGP DipMedTox, Paediatric Emergency Medicine
Consultant, Bristol Royal Hospital for Children, Bristol
Martin Samuels MD FRCPCH, Consultant Respiratory Paediatrician, Staffordshire Children’s
Hospital and Great Ormond Street Hospital, London
Nandini Sen DTM&H FRCEM, Consultant in Emergency Medicine, Manchester University NHS
Foundation Trust, Manchester
 Contributors to seventh edition ix

Andrew Simpson FRCS(Ed) FRCEM MClinEd DCH, Consultant in Emergency and Paediatric
Emergency Medicine, North Tees and Hartlepool NHS Foundation Trust
Edward Snelson MRCPCH, Consultant Paediatric Emergency Medicine, Clinical Lead, Children’s
Emergency Department, Norfolk and Norwich University Hospital, Norwich
Eleanor Sproson FRCS, Consultant Paediatric ENT Surgeon, Queen Alexandra Hospital,
Portsmouth
Sarah Stibbards FRCEM BSc(Hons), Clinical Director, Major Trauma and Consultant Paediatric
Emergency Medicine, Alder Hey Children’s Hospital NHS Foundation Trust, Liverpool
Neil Thompson BSc BMedSci BM BS RCPCH, Consultant in Paediatric Emergency Medicine,
Imperial College Healthcare NHS Trust, London, UK
Robert Tinnion RCPCH MD, Consultant Neonatologist, Royal Victoria Infirmary, Newcastle
Hospitals NHS Foundation Trust, Newcastle
Paul Turner BM BCh FRCPCH PhD, Clinical Reader and Honorary Consultant in Paediatric Allergy
and Clinical Immunology, Imperial College London; Chairperson, Anaphylaxis Committee, World
Allergy Organization
Jamie Vassallo PgCert DipIMC PhD, Emergency Medicine and Pre Hospital Emergency Medicine
Registrar, Post Doctoral Research Fellow, Academic Department of Military Emergency
Medicine
Julian White AM MB BS MD FACTM, Consultant Clinical Toxinologist and Unit Head, Toxinology
Department, Women’s and Children’s Hospital, North Adelaide; Clinical Academic, Discipline of
Paediatrics, Medical School, University of Adelaide, Australia
Andrea Whitney MRCP, Consultant Paediatric Neurologist, Southampton Children’s Hospital,
Southampton
Sarah Wood Paediatric and Neonatal Surgical Consultant, TPD and Governance Lead, Alder Hey
Childrens Hospital NHS Foundation Trust, Liverpool
Bogdana S. Zoica MD, Paediatric Critical Care Consultant, King’s College Hospital, London

Contributors to the status epilepticus algorithm

Richard Appleton Alder Hey Children’s Hospital NHS Foundation Trust, Liverpool
Melody Bacon Royal London Hospital, Barts Health NHS Trust, London
Harish Bangalore Great Ormond Street Hospital, London
Celia Brand Royal Hospital for Children and Young People, NHS Lothian, Edinburgh
Juliet Browning University Hospitals Dorset, Poole, Dorset
Richard Chin University of Edinburgh; Royal Hospital for Children and Young People, NHS
Lothian, Edinburgh
Susana Saranga Estevan Addenbrooke’s Hospital, Cambridge
Satvinder Mahal Great Ormond Street Hospital, London
Kirsten McHale Royal Alexandra Children’s Hospital, University Hospitals Sussex NHS Foundation
Trust, Brighton
Ailsa McLellan Royal Hospital for Children and Young People, NHS Lothian, Edinburgh
Nicola Milne Epilepsy Scotland, Glasgow
Suresh Pujar Great Ormond Street Hospital, London
Tekki Rao Luton and Dunstable University Hospital, Luton
Steven Short Scottish Ambulance Service, Edinburgh
Stephen Warriner Portsmouth Hospitals University Trust, Portsmouth
Michael Yoong Royal London Hospital, Barts Health NHS Trust, London
Foreword

It hardly seems possible that it is 30 years ago that I sat down as an overconfident senior registrar
and wrote the preface for the Advanced Paediatric Life Support manual. Now, three decades later:
older, even balder, definitely less overconfident and most probably a little bit wiser, I have been
given the opportunity to reflect on the evolution of the APLS manual and the APLS course by writing
the Foreword to this -­the seventh edition.
Believe it or not, at the time it was first published, APLS was a disruptive intervention. By that I mean
that it challenged the status quo and sought to change the very fundamentals of emergency
­paediatric practice. At the most basic level it implied quite bluntly that the old Oslerian paradigm of
history, examination, differential diagnosis, investigation and treatment was not fit for purpose in
an emergency situation. Rather the new concept of primary assessment and resuscitation followed
by secondary assessment and emergency treatment was advocated. To make matters worse it
went on to derive, publish and teach a set, algorithmic approach to many clinical problems that had
traditionally been managed by physician choice. As an example, I can well remember the conversa-
tions we, the editors, had about the algorithm for the management of status epilepticus. We finally
constructed an APLS status epilepticus treatment algorithm from the wisps of published evidence
and filled in the gaps with our best guesses. Our logic was that forearmed with an algorithm any
trained practitioner could manage the situation to the point of arrival of an expert. This approach
upset a number of established clinicians who felt that, as practitioners of the art of medicine, they
could craft personalised treatment only by having free choice, and that anything that interfered
with that free choice was bad for patients. Over the next 6 editions of APLS these arguments have
abated and, indeed, the algorithms themselves are often now owned and regularly updated by
expert sub-­speciality groups. The smell of paraldehyde and the need for glass syringes has become
history, and debates continue as evidence based medicine evolves.
Most practitioners who deal with paediatric emergencies nowadays will never have known
­anything other than the ‘APLS approach’ to emergency care, and that is the true success of the
disruption the manual and course started all those years ago. There are, of course, dangers in
becoming the new normal, in particular it is easy to rest on the laurels of success. Avoiding
­complacency is important and is why this latest (seventh) edition is as important as the first e
­ dition
was all those years ago. The current APLS working group and the book editors are at the peak of
their careers and are wholly committed to keeping the content and teaching of APLS at the very
cutting edge of current practice. Knowing the energy they bring as the current custodians of APLS
is why I have no hesitation in recommending this new edition to you. It will serve you, and sick and
injured c­ hildren, well.
Kevin Mackway-­Jones
Manchester, 2023

xi
Preface to first edition

Advanced Paediatric Life Support: The Practical Approach was written to improve the emergency
care of children, and has been developed by a number of paediatricians, paediatric surgeons,
­emergency physicians and anaesthetists from several UK centres. It is the core text for the APLS
(UK) course, and will also be of value to medical and allied personnel unable to attend the course. It
is designed to include all the common emergencies, and also covers a number of less common
diagnoses that are amenable to good initial treatment. The remit is the first hour of care, because it
is during this time that the subsequent course of the child is set.
The book is divided into six parts. Part I introduces the subject by discussing the causes of child-
hood emergencies, the reasons why children need to be treated differently and the ways in which a
seriously ill child can be recognised quickly. Part II deals with the techniques of life support. Both
basic and advanced techniques are covered, and there is a separate section on resuscitation of the
newborn. Part III deals with children who present with serious illness. Shock is dealt with in detail,
because recognition and treatment can be particularly difficult. Cardiac and respiratory emergen-
cies, and coma and convulsions, are also discussed. Part IV concentrates on the child who has been
seriously injured. Injury is the most common cause of death in the 1–14-­year age group and the
importance of this topic cannot be overemphasised. Part V gives practical guidance on performing
the procedures mentioned elsewhere in the text. Finally, Part VI (the appendices) deals with other
areas of importance.
Emergencies in children generate a great deal of anxiety – in the child, the parents and in the
­medical and nursing staff who deal with them. We hope that this book will shed some light on the
subject of paediatric emergency care, and that it will raise the standard of paediatric life support. An
understanding of the contents will allow doctors, nurses and paramedics dealing with seriously ill
and injured children to approach their care with confidence.
Kevin Mackway-­Jones
Elizabeth Molyneux
Barbara Phillips
Susan Wieteska
Editorial Board
1993

xii
Preface to seventh edition

The Advanced Paediatric Life Support (APLS) course is now delivered in 76 centres across the United
Kingdom and 17 centres on every continent across the world. This amazing achievement is due to
the small, dedicated team based at the Advanced Life Support Group (ALSG) in Manchester and
to the thousands of trained instructors from many disciplines, who give their time and expertise so
generously. Thank you all.
This manual (the seventh in the last 30 years) supports the APLS and Paediatric Life Support (PLS)
courses, as well as being used as a gold standard for acute paediatric clinical practice. It builds on
the contributions from previous authors whose names can be found on the ALSG website. Thank
you to them and to all those who have worked so hard to produce this edition.
This manual has been updated throughout. There is an increased emphasis on preparation for
effective team working to improve patient safety. The seriously ill child section has been restruc-
tured to consolidate information into chapters reflecting the ABCDE approach.
Evolving techniques such as point of care ultrasound (POCUS) are included in several chapters, and
POCUS is described in more detail in an excellent appendix at the end of the manual. APLS does not
specifically teach this skill, rather we acknowledge its place in many aspects of emergency
­management and care.
The entire manual has been updated in line with the 2021 International Liaison Committee on
Resuscitation (ILCOR) guidelines as well as with consensus best practice. The international nature
of APLS means the manual is written to reflect different cultures and clinical practices wherever
possible.
Additional and detailed information for those who wish to take their learning further is included in
the 10 appendices. This information is not essential knowledge for all but we hope will be
­interesting reading for many.
Since the sixth edition of APLS there has been the worldwide COVID-­19 pandemic which had an
impact on the way courses were delivered as well as the timescale for this edition of the manual.
It is essential that we incorporate the lessons learned from this experience into delivery of both
healthcare and the way it is taught.
Stephanie Smith
May 2023

xiii
Acknowledgements

A great many people have put a lot of hard work into the production of this book, and the
accompanying Advanced Paediatric Life Support course. The editors would like to thank all the
contributors for their efforts and all the APLS instructors who took the time to send us their
comments on the earlier editions.
We are greatly indebted to Kirsten Baxter and Kate Denning for their exceptional hard work and
dedication towards this publication; their encouragement and guidance throughout the process
has been gratefully received.
We would like to express our special thanks to Ayşe Mehta for producing the excellent line drawings,
Jason Acworth and Children’s Health Queensland for the new photographs that illustrate the text
and Catherine Giaquinto for designing the new algorithms for this edition.
For the cover image, thank you to Russell Ashworth and his son Noah Ashworth, Chloe Donaldson,
Manivannan Manoharan, Julia Maxted, Angela Armitage and Nila Prince.
We would also like to thank Laura May for kindly allowing adaptation of the UHCW NHS Trust
Paediatric TRAUMATIC list. Rowan Pritchard Jones and Michael Watts for allowing images from the
Mersey Burns App. Michael J. Griksaitis and Bogdana Zoica for the POCUS chapter and figures.
Jamie Vassallo for the PTCA algorithm. Marijke van Eerd for the Paediatric Major Trauma and
analgesia calculation chart. Ross Smith on behalf of the Child and Young Person’s Advance Care
Plan. Tim Nutbeam and Ron Daniels on behalf of the UK Sepsis Trust. The Status Epilepticus
Guidelines development group.
For the shared use of their images, illustrations, tables and algorithms, we would like to thank:
Alder Hey Radiology Department Teaching Library
ASIA – American Spinal Injury Association
Bristol Royal Hospital for Children and RTIC Severn
British Society for Paediatric Endocrinology and Diabetes
British Thoracic Society/Scottish Intercollegiate Guidelines Network
Children’s Health Queensland
National Tracheostomy Safety Project: Paediatric Working Party
Northern Neonatal Network
Resuscitation Council UK
Royal College Paediatrics and Child Health and Harlow Printing
Safeguard Medical Technologies
Teleflex Medical Australia and New Zealand
Victorian Department of Health
ALSG gratefully acknowledge the support of the Royal College of Paediatrics and Child Health (UK).
The Specialist Groups of the RCPCH agreed to advise on the clinical content of chapters relevant to
their specialism. ALSG wish to thank the following:

xv
xvi Acknowledgements

Association of Paediatric Emergency Medicine

Anastasia Alcock FRCPCH DTM&H DRCOG PgDIP, Paediatric Emergency Medicine Consultant,
Evelina London
Jane Bayreuther FRCPCH, Consultant in Paediatric Emergency Medicine, Southampton. On behalf
of APEM
Charlotte Clements BSc(Hons) MBChB MRCPCH MSc PGCert (Darzi), Consultant Paediatrician,
Clinical Lead for the Paediatric Emergency Department, North Middlesex University Hospital NHS
Trust; Secretary, Association of Paediatric Emergency Medicine
Miki Lazner MBChB MMSc (Child Health) FRCPCH, Paediatric Emergency Medicine Consultant,
Clinical Lead Paediatric Trauma, University Hospitals Sussex NHS Foundation Trust; Paediatric Lead,
Sussex Trauma Network; Guidelines Representative and Executive Committee Member, Association
of Paediatric Emergency Medicine (APEM)
Michael Malley MA MBBS MRCPCH DTMH, Consultant in Paediatric Emergency Medicine, Bristol
Royal Hospital for Children
Rachael Mitchell MRCPCH MA (Cantab), Consultant in Paediatric Emergency Medicine, Kings
College Hospital NHS Foundation Trust

British Association General Paediatrics

Christine Brittain RCPCH, Sub-­speciality PEM, Acute Paediatric Consultant, PAU Lead, Musgrove
Park Hospital Somerset Foundation Trust

British Association of Perinatal Medicine

Hannah Shore MBChB MRCPCH MD, Consultant Neonatologist, Lead Clinician for Leeds Centre for
Newborn Care
Tim J. van Hasselt MBChB BMedSc MRCPCH, Neonatal sub-­specialty trainee, West Midlands, NIHR
Doctoral Research Fellow, University of Leicester

British Paediatric Allergy, Immunity and Infection Group

Alasdair Bamford MBBS FRCPCH DTM+H PhD, Consultant and Specialty Lead in Paediatric Infectious
Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust; Honorary Associate
Professor, UCL GOSH Institute of Child Health; British Paediatric Allergy Infection and Immunity
Group (BPAIIG) secretary
Enitan Carrol MBChB MD DTMH FRCPCH, Professor and Honorary Consultant in Paediatric
Immunology and Infectious Diseases, University of Liverpool and Alder Hey Children’s NHS
Foundation Trust
Saul Faust MBBS PhD FRCPCH OBE, Professor and Honorary Consultant in Paediatric Immunology
and Infectious Diseases, University of Southampton and University Hospital Southampton NHS
Foundation Trust
Paul Turner BM BCh FRCPCH PhD, Clinical Reader and Honorary Consultant in Paediatric Allergy
and Clinical Immunology, Imperial College London; Chairperson of Anaphylaxis Committee, World
Allergy Organization
Elizabeth Whittaker MB BAO BCh MRCPCH DTM&H PhD, Consultant in Paediatric Infectious
Diseases; Clinical Lead in Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust,
London; Senior Clinical Lecturer in Paediatric Infectious Diseases, Imperial College London; Convenor
for British Paediatric Allergy Immunity and Infectious Diseases Group (BPAIIG)
 Acknowledgements xvii

British Paediatric Respiratory Society

Elise Weir MBChB MRCPCH PGCert Child Health, Consultant in Paediatric Respiratory Medicine,
Royal Hospital for Children, Glasgow

British Society of Paediatric Radiology – trauma imaging

Judith Foster MB ChB(Hons) FRCR, Consultant Paediatric Radiologist, University Hospitals Plymouth;
Paediatric Trauma Lead for British Society of Paediatric Radiology

Child Protection Special Interest Group

David Lewis MBBS MSc(Paeds) MRCP FRCPCH, Consultant Community Paediatrician and
Designated Doctor for Child Protection (Herefordshire and Worcestershire ICB); Chair of the Child
Protection Specialist Interest Group (affiliated to the Royal College of Paediatrics and Child Health)

Paediatric Critical Care Society

David Finn MBBS MRPCH MSc, Paediatric Intensive Care Consultant, Leeds Children’s Hospital
Rum Thomas MB BS DNB (Paediatrics) FRCPCH, Consultant in Paediatric Critical Care, Sheffield
Children’s NHS Foundation Trust; Clinical Lead, Paediatric Critical Care Operational Delivery Network
Yorkshire and Humber South
Hanna Tilly BSc BMedSci BMBS, Specialist Registrar in Paediatrics, North Central and East London
Mark Worrall MB ChB FRCA MRCPCH FFICM, Consultant in Paediatric Intensive Care and Paediatric
Anaesthesia, Royal Hospital for Children, Glasgow; Consultant in Paediatric Critical Care Transport,
ScotSTAR, Scottish Ambulance Service

RCEM Intercollegiate group

Anne Frampton MPhil BSc MB ChB MRCP DipIMC DCH FRCEM, Consultant in Emergency Medicine
(Paediatrics), Bristol Royal Hospital for Children, UHBW NHS FT
Michelle Jacobs BSc MB BCh FRCEM ARSM, Consultant in Paediatric Emergency Medicine, ED
Clinical Lead for Paediatric Emergency Department, London North West University Healthcare NHS
Trust (Northwick Park Hospital)
Damian Roland B(Med)Sci BMBS FRCPCH PhD, Honorary Professor and Consultant in Emergency
Medicine, Head of Service, Children’s Emergency Department, Leicester Hospitals and University
Rob Stafford MBBS MRCA PGCertMedEd FHEA FRCEM, Consultant in Adult and Paediatric
Emergency Medicine; Chair, RCEM Paediatric Emergency Medicine Professional Advisory Group

We would like to thank, in advance, those of you who will attend the Advanced Paediatric Life
Support course and others using this text for your continued constructive comments regarding the
future development of both the course and the manual.
Contact details and
further information
ALSG: www.alsg.org
For details on ALSG courses visit the website or contact:
Advanced Life Support Group
ALSG Centre for Training and Development
29–31 Ellesmere Street
Swinton, Manchester
M27 0LA
Tel: +44 (0) 161 794 1999
Email: enquiries@alsg.org

Updates

The material contained within this book is updated on approximately a 4-­yearly cycle. However,
practice may change in the interim period. We will post any changes on the ALSG website, so we
advise you to visit the website regularly to check for updates (www.alsg.org).

References

To access references, visit the ALSG website www.alsg.org – references are on the course pages as
well as at the end of this book.

On-­line feedback

It is important to ALSG that the contact with our providers continues after a course is completed.
We now contact everyone 6 months after their course has taken place asking for on-­line feedback
on the course. This information is then used whenever the course is updated to ensure that the
course provides optimum training to its participants.

xix
PART 1

Introduction

1
 CHAPTER 1

Introduction and
structured approach to
paediatric emergencies
Learning outcomes
After reading this chapter, you will be able to:
zz Appreciate the focus and principles of the APLS course
zz Describe the structured approach to identifying and managing paediatric emergencies
zz Identify the important differences in children and the impact these have on the management
of emergencies
zz Appreciate that the absolute size and relative body proportions change with the age of the
child
zz Identify the approach to triage of a child

1.1 Introduction

The Advanced Paediatric Life Support (APLS) course equips those caring for children with the
necessary skills and structured approach to identify and safely manage ill or injured children
whenever or wherever they encounter them.
Children continue to die from preventable causes throughout the world. The reasons for their
deaths differ between countries, however the structure and principles for managing the underlying
causes are universal.
Child mortality is the lowest it has ever been and has halved in the last three decades, which is a huge
achievement (12.5 million deaths of under 5‐­year‐­olds worldwide in 1990 compared with 5 million in 2020).
Worldwide data from the World Health Organization (WHO) show the leading cause of death in this
age group is pneumonia, followed by preterm birth and then diarrhoeal illnesses. This compares
with recent data from the USA showing the leading cause in children to be gun‐­related injuries. In
the UK, Office for National Statistics (ONS) data show that cancer is the leading cause of death in all
children followed by accidents and then congenital abnormalities.
The COVID‐­19 pandemic has not directly had a significant impact on child mortality. However, there
are ongoing concerns about the indirect impact due to strained and under‐­resourced health
­systems; a reduction in care‐­seeking behaviours; a reduced uptake of preventative measures such
as vaccination and nutritional supplements; and socioeconomic challenges.

Advanced Paediatric Life Support: A Practical Approach to Emergencies, Seventh Edition. Edited by Stephanie Smith.
© 2023 John Wiley & Sons Ltd. Published 2023 by John Wiley & Sons Ltd.

3
4 PART 1 Introduction

1.2 The APLS approach

In the structured approach it is essential to remember that:

zz The child’s family will need support from a qualified member of the team
zz Absolute size and body proportions change with age
zz Observations and therapy in children must be related to their age and weight
zz The psychological needs of children must be considered
zz It is key to support each other as the clinical team

Physiological differences
Children, especially young ones, have significantly lower physiological reserves than adults. As a
consequence, they may deteriorate rapidly when severely ill or injured and respond differently
from adults to various interventions. It is essential to manage and support their respiratory and
cardiovascular systems in a timely and structured manner to prevent further deterioration or even
cardiovascular arrest. (See normal ranges table, inside front cover.)

Relationship between disease progression and outcomes

The further a disease process is allowed to progress, the worse the outcome is likely to be. The
outcomes for children who have a cardiac arrest out of hospital are generally poor. This may be
because cardiac arrest in children is less commonly related to cardiac arrhythmia, but is more
commonly a result of hypoxaemia and/or shock with associated organ damage and dysfunction.
By the time that cardiac arrest occurs, there has already been substantial damage to various
organs. This is in contrast to situations (more common in adults) where the cardiac arrest is the
consequence of cardiac arrhythmia – with preceding normal perfusion and oxygenation. Thus the
focus of the course is on early recognition and effective management of potentially life‐­threatening
problems before there is progression to respiratory and/or cardiac arrest (Figure 1.1).

Pathways to cardiac arrest

Respiratory Respiratory Fluid Fluid

obstruction depression loss maldistribution

Foreign body Convulsions Blood loss Sepsis

Asthma Poisoning Burns Anaphylaxis
Croup Raised ICP Vomiting Cardiac failure

Respiratory failure Circulatory failure

Cardiac arrest

Figure 1.1 Pathways leading to cardiac arrest in childhood (with examples of underlying causes)
ICP, intracranial pressure
 C H A PTE R 1 Introduction and structured approach to paediatric emergencies 5

Standardised structure for assessment and stabilisation

A standardised approach for resuscitation enables the provision of a standard working environment
and access to the necessary equipment to manage ill or injured children. The use of the standardised
structure enables the whole team to know what is expected of them and in which sequence.
Once basic stabilisation has been achieved, it is appropriate to investigate the underlying diagnoses
and provide definitive therapy.

Definitive therapy (such as surgical intervention) may be a component of the resuscitation

Resource management
Provision of effective emergency treatment depends on the development of teams of healthcare
providers working together in a coordinated, well‐­led manner (Figure 1.2). It is important that all
training in paediatric life support focuses on how to best use the equipment and human resources
available and emphasises the key nature of effective communication.

Figure 1.2 Advanced paediatric life support (APLS) in action

Early referral to appropriate teams for definitive management

Emergency departments are unlikely to be able to provide definitive management for all paediatric
emergencies, and a component of stabilisation of critically ill or injured children is the capacity to
call for help as soon as possible, and where necessary transfer the child to the appropriate site safely.

Ongoing care until admission to appropriate care

In most parts of the world it is impossible to transfer critically ill children into intensive care units or
other specialised units within a short time of their arrival in the emergency area. Therefore, it is
important to provide training in the ongoing therapy that is required for a range of relatively
common conditions once initial stabilisation has been completed.
Another random document with
no related content on Scribd:
above the band. The front must be 5½ inches deep; it will require
some more shaped rows, therefore, before you work the last 6
rounds of the back. Work on the 2nd, 3rd and 4th needles as many
more half-rows, repeating the directions, until you have the right
depth.
You now work the 6 rounds to finish the Head-piece, increasing
every 6th stitch in each alternate round.
You next work 18 rounds with no decreasings; then decrease for
the crown.
The knitting, according to the work from which this is written,
measured 36 inches in circumference. Make a decreasing every
16th and 17th stitch by knitting those two stitches together; the 2nd
and 3rd rounds no decreasings. Knit in this manner until there are
only 10 stitches on the needle, cast these off with a row of double
crochet, make a rosette, and place in the centre; add ribbons behind.
Line the head with silk, and the band with thin leather or double
linen.
No. 5.
 BICYCLING OR PATROL CAP.
Crocheted with Andalusian wool, and a fine bone crochet hook; a
knot of fine mohair cord, or very fine black bobbin cord; the former is
the best for use. The whole of the crochet is worked over this cord,
which gives a raised appearance, and makes the shape better.
Make a chain of 4, unite, draw the cord through the chain, loop it
securely over the cord and chain; work 8 double crochet. The cord
must, throughout the work, be held in its place by the finger and
thumb of the left hand, keeping it at the edge of the row, underneath
and behind the needle.
2nd round—In the 8 double crochet work 16 treble. Take up all the
stitches through both loops, or your work will not have the ribbed
appearance it should have.
3rd round—Work 2 treble in every stitch.
4th and successive rounds—Work round and round, increasing to
keep the work flat, until you have 15 rounds. You now commence the
band round the hat. In the first round you must slightly tighten
together the cord, as well as in succeeding rounds, to keep it the
right shape; work 9 rounds for this head-band, and finish with 2 of
double crochet. You then line with black linen, and sew in a piece of
leather. Work a small round of crochet to cover a button for the
centre, and make a crochet rosette to go round it.

The Rosette.
Make a chain of 8, unite.
In this work 1 chain, 1 double crochet, 8 times.
2nd round—1 double crochet in the first chain, *2 treble on the
double crochet, 1 double crochet in the next chain; repeat from *.
 3rd round—1 double crochet on the double crochet, * 5 treble on
the 2 treble, 1 double crochet on the next double crochet, repeat
from *. Take the cord and work it round the next row.
4th round—* 1 double crochet on the double crochet, 2 treble on
the 1st treble, 1 long on the 2nd, 2 double long on the 3rd, 1 long
and 1 treble on the 4th, 1 treble on the 5th; repeat from *.
6th round—1 single on each stitch of last row. This is laid on the
middle of the hat and the button placed in the centre.
No. 6.
 TARBUCH
In black netting silk and gold thread.
The Tarbuch is taken from one worked in Egypt, and is the correct
shape. It is worked with very fine purse silk, twelve skeins; Japanese
or Chinese gold thread, the finest size, wind this in balls; a fine
crochet hook. The pattern consists of a star in the centre of the
crown: this star has 10 divisions, a border of vine leaves round the
edge, and powdered ground.
Commence the crown with black silk, with a chain of 4, unite; in
this work 10 double crochet.
2nd round—In every stitch of last round work 1 black and 1 gold.
In working with two colours you should knot the two threads together
in beginning, and throughout the work hold both evenly over the
same finger of the left hand, then, as you proceed, keep the thread
not in use in regular rotation over and under the thread in use; by
this means you work them in. Care must be taken never to
completely finish a stitch with the one colour; if it is done you have
two stitches of the colour and throw the pattern wrong. In this 2nd
round put the needle into the stitch, draw through the black silk, take
up the gold and finish the stitch; take up the next stitch with gold,
finish it with black. You have now two distinct stitches.
3rd round—1 black on the black, 2 gold on the 1 in last round.
4th round—1 black on the black, 3 gold on the 2 in the last round.
5th round—1 black on the black, 4 gold on the 3 underneath.
6th round—1 black on the black, 5 gold on the 4 underneath.
7th round—1 black on the black, 6 gold on the 5 underneath.
8th round—1 black on the black, 7 gold over the 6.
9th round—1 black on the black, 8 gold over the 7.
 10th round—1 black on the black, 9 gold over the 8.
11th round—1 black on the black, 10 gold over the 9.
12th round—1 black on the black, 11 gold over the 10.
13th round—1 black on the black, 12 gold over the 11.
14th round—1 black on the black, 13 gold over the 12.
15th round—1 black on the black, 14 gold over the 13.
16th round—1 black on the black, 15 gold over the 14.
17th round—2 black on the 1st black, * 14 gold over 14 gold, 1
black on the 15th, 2 black on the next black; repeat from *.
18th round—5 black over the 3 black, 13 gold over 13 gold.
19th round—Care must be taken to make the gold begin exactly
on the same stitch in each division, as the right-hand side of each
must be even, one less worked each row on the left side. 3 black, 1
gold, 3 black over the 3 black and the last gold; 12 gold over the 12
gold.
20th round—Over the 13th gold and 7 black work 9 black, 11 gold
over 11.
21st round—10 gold over 10, on the last gold and the black work
11 black.
22nd round—9 gold over 9, 2 black, 1 gold, 7 black, 1 gold, 2
black, over the 11 and last.
23rd round—8 gold over 8, 15 black over the 13 black and 1 gold.
24th round—7 gold over 7, 17 black over the 15 and last gold.
25th round—6 gold over 6, 9 black, 1 gold, 9 black over the black.
26th round—5 gold over 5, 21 black over the black.
27th round—4 gold over 4, 23 black over 21 underneath.
28th round—3 gold over 3, 8 black, 1 gold, 7 black, 1 gold, 8
black, over the black.
29th round—2 gold over 2, 27 black.
 30th round—1 gold over 1, 30 black.
31st round—On the point of the star (the one gold stitch) work 2
with black; on the next black work 7 black, 1 gold, 7 black, 1 gold, 7
black, 1 gold, 7 black; then repeat with 2 on the next gold.
32nd round—Between each point increase 3 stitches, and work
entirely with black.
33rd round—Black, and no increasings.
34th round—You work 1 gold exactly between the 1st gold stitch in
the 31st round and the point, then 7 black, 1 gold, repeating all
round.
35th and 36th rounds—Black; repeat from 34th round 5 more
times. In the last plain row work an extra stitch every 23rd stitch.
52nd round—* 8 black, 1 gold, 7 black, 1 gold, 7 black, 1 gold, 7
black, 1 gold; repeat from *.
53rd and 54th rounds—Repeat these 3 rounds twice more;
increase until you have 360 stitches, which will bring you to the part
for the border. Work a row of black double crochet, and begin

The Border.
1st round—2 black, 3 gold, * 12 black, 3 gold, repeat from *; end
the round with 10 black.
2nd round—6 gold, 8 black, * 7 gold, 8 black, repeat from *; end
the round with 1 gold.
3rd round—4 black, 3 gold, * 4 black, 4 gold, 4 black, 3 gold,
repeat from *, and end the round with 4 gold.
4th round—* 7 gold, 3 black, 3 gold, 2 black, repeat from *.
5th round—2 gold, * 4 black, 1 gold, 3 black, 2 gold, 1 black, 4
gold, repeat from *, and end the round with 2 gold.
6th round—1 gold, * 7 black, 3 gold, 1 black, 4 gold, repeat from *;
end the round with 3 gold.
 7th round—* 8 black, 2 gold, 1 black, 4 gold, repeat from *.
8th round—* 9 black, 4 gold, repeat from *, and end the round with
2 black.
9th round—* 5 gold, 2 black, 2 gold, 1 black, 2 gold, 3 black,
repeat from *.
10th round—1 gold, * 3 black, 3 gold, 6 black, 3 gold, repeat from
*; end the row with 2 gold.
11th round—* 6 black, 3 gold, 2 black, 3 gold, 7 black, repeat from
*, and end the round with 1 black.
12th round—* 2 gold, 1 black, 2 gold, 3 black, 4 gold, 2 black, 3
gold, 1 black, repeat from *; end round with 1 gold.
13th round—3 black, 4 gold, * 11 black, 4 gold, repeat from *, and
end with 8 black.
14th round—1 black, * 2 gold, 1 black, 4 gold, 8 black, repeat from
*, and end with 7 black.
15th round—1 black, 3 gold, * 1 black, 4 gold, 7 black, 3 gold,
repeat from *; end the round with 6 black.
16th round—3 black, * 2 gold, 2 black, 3 gold, 4 black, 1 gold, 3
black, repeat from *, and end the round with 1 gold.
17th round—3 black, 4 gold, * 2 black, 6 gold, 3 black, 4 gold,
repeat from *; end with 1 gold.
18th round—* 4 black, 5 gold, 3 black, 3 gold, repeat from *.
19th round—7 black, * 7 gold, 8 black, repeat from *.
20th round—10 black, * 4 gold, 11 black, repeat from *, and end
the round with 1 black.
21st, 22nd and 23rd rounds—Black.
24th round—* 7 black, 1 gold, repeat from *.
25th round—* 5 black, 3 gold, repeat from *.
26th and 27th rounds—Gold only, and fasten off.
 This completes the Cap. It should, properly speaking, be put upon
a block; this may be made of cardboard. Line the Cap through with a
blue satin lining, gathering it in at the top and sew over neatly with a
large button covered with satin. This must not be sewn in until the
tassel is passed through.

The Tassel.
Wind the netting silk round a piece of cardboard 5 inches long,
wind a sufficient quantity to make it look handsome. Under the silk
pass a doubled length, and tie it all together very tightly, slip it off the
card, and wind two thicknesses of silk firmly over the tied end for the
depth of three-quarters of an inch, leave an end about half a yard
long, thread a strong needle with this end, pass it through the tassel,
under the silk wound over, and bring the needle out at the top; make
a firm chain of about 2 inches long with this silk.
You next crochet a covering for the top of the tassel. This is
worked in double crochet. Begin with 5 chain, work 7 double crochet
on it, on the 7 double crochet work 10, on the 10 work 14, and
increase until it will fit tightly over the silk you have wound over; work
the depth to cover the winding, sew it down strongly. Pass the chain
through the foundation chain of the cap, and sew very securely.
No. 7.
 FISHERMAN’S CAP, for a Man.
One oz. of dark red, one oz. of gold wool.
These Caps should be knitted in stripes to suit the Jersey, jacket,
or shirt of the wearer. They are knitted in Merino wool, or 2-fold Ice
silk, on No. 17 needles. On a Lamb’s knitting machine use the finest
red silk; knit the Cap the full length in stripes; then, on each side and
in the middle, decrease until you come to a point; sew this together,
and the hat is made.
To knit the Cap with the wool or silk named, cast on on 4 needles
260 stitches with red wool, knit 16 rounds; change, take the gold, knit
16 rounds. Knit 16 stripes in this manner, 8 of red, 8 of gold, then
begin to decrease for the top.
Black stripe—Knit 2, knit 2 together, knit 57, knit 2 together, knit 4,
knit 2 together, knit 57, knit 2 together, knit 4, knit 2 together, knit 57,
knit 2 together, knit 4, knit 2 together, knit 57, knit 2 together, knit 2.
Knit 3 rounds plain.
5th round—Knit like the first row in the black stripe, but with 55
stitches between, instead of 57. Work in this manner, with 3 plain
rounds between each round of decreasing, until you have 41 stitches
between each set of decreasings, then decrease every 3rd round
until you have only 27 on the needle between the decreasings; after
that, decrease every alternate round until the decreased stitches
come close together; you then * knit 2, knit 2 together, all round;
repeat from *. In the next round knit 1, * knit 3 together, knit 2, repeat
from *; then decrease by knitting 2 together every stitch until you
have a point. Make a tassel of the two colors, and sew on to the
point. Hem up the foundation round inside the work, folding the
knitting evenly in the middle of the third black stripe.
 This Cap can, of course, be knitted in any material; the finer the
wool, the more suitable. The size must be determined by measuring
the head; knit a small piece of knitting of 20 stitches square with the
materials you intend to use, and measure this with a tape measure.
A simple multiplication of the number of stitches you have in an inch
will enable you at once to cast on the required number of stitches,
then work as directed. A very handsome Cap is made by using a
combination of colors. Commence with black, ¼-inch, 3 rounds of
red, 1 of gold, 2 of blue, 1 of gold, 2 of red, 3 of gold, 2 of red, 1 of
gold, 5 of blue, 1 of gold, 2 of red, 3 of gold, 2 of red, 1 of gold, 2 of
blue, 1 of gold, 3 of red, 20 of black, then commence the red again
for one or two more stripes, and work the remainder of the Cap in
one color, or continue it in stripes.
No. 8.
 CAP, TURBAN-SHAPE, FOR
FOOTBALL, Etc.
Crocheted with Japanese Silk, using black and gold, or any of the
colours required for clubs. You require a ball of gold Japanese silk,
one of black, a steel crochet needle, No. 12.
With the black make a chain of 3, unite, work round and round,
increasing to keep flat, until you have 32 stitches.
Take the gold silk, work 2 rounds of double crochet; turn.
3rd round—In the 1st stitch work * 2 double crochet, 1 in the 2nd,
take up the 2nd double crochet in the 1st of these 3 rounds, work 4
treble in it, join the 1st and 4th of these long stitches together by a
single; repeat from *. Work 2 stitches in every stitch after the treble
stitches.
4th and 5th rounds—Black, double crochet, increasing to keep the
work flat.
6th and 7th rounds—Gold silk, double crochet, increasing as
necessary.
8th round—Like the 3rd round. Work in this manner until you have
7 rounds of raised work, which will make the cap the right shape; it
should be 6½ to 7 inches in diameter. Then continue the same with
no decreasings for the band round the head; you require 4 rows of
patterns for this. Finish the work with 2 rounds of black silk. Line the
cap, add a piece of leather round the edge, and put a button,
covered with double crochet worked in gold silk, in the centre.
For a Smoking Cap this shape, add a silk tassel, to hang down
over the side.
No. 9.
 FOOTBALL CAP.
Crocheted in Japanese Silk or Eider Wool; Crochet hook, No. 12;
3 balls of silk, or 1½ oz. of wool.
Make a chain of 3, unite, in this work 6 double crochet.
2nd round—Work 12 double crochet.
3rd round—* Insert the needle in the next stitch, draw the thread
through the thread round the needle, draw through the same loop
again, the thread on the needle, draw through all the loops on the
needle; repeat from * for each stitch. Work the round, and make 2
stitches in every 3rd stitch of the round underneath.
4th round—Work the same stitch as last round, and in each
successive round, but work between the stitches of the previous
round. The work must be kept rather tight. Increase every 5th stitch.
5th round—No increasings.
Work in this manner, increasing gradually, until the work is nearly 7
inches across. This will allow the size to be just under 21 inches;
about 22½ is a usual size in hats. The brim of the hat is increased
very gradually indeed. Work 4 rounds with no increasings; in the
next, divide the work into quarters; work an extra stitch in beginning
each quarter; and do the same every 3rd round, which will give the
brim the desired slope. When you have worked the top, work round
and round, with no increasings, for 6 rounds; then take the
contrasting colour and work 1½ inches of it; fasten off. Work another
small round of the same stitch in this colour, cover a large button or
curtain ring with it, and place at the top of the cap. Line the crown
and sides with black silk, and sew a piece of leather, 3 inches deep,
round the rim.
 Transcriber’s Notes
pg 18 Changed an unknown symbol to an asterisk at beginning of line:
* knit 1, purl 1; repeat from * to the middle of the 4th needle
pg 23 Changed: knot the two threads together in begining
to: knot the two threads together in beginning
*** END OF THE PROJECT GUTENBERG EBOOK THE BOOK OF
HATS AND CAPS ***

Updated editions will replace the previous one—the old editions will
be renamed.

Creating the works from print editions not protected by U.S.

copyright law means that no one owns a United States copyright in
these works, so the Foundation (and you!) can copy and distribute it
in the United States without permission and without paying copyright
royalties. Special rules, set forth in the General Terms of Use part of
this license, apply to copying and distributing Project Gutenberg™
electronic works to protect the PROJECT GUTENBERG™ concept
and trademark. Project Gutenberg is a registered trademark, and
may not be used if you charge for an eBook, except by following the
terms of the trademark license, including paying royalties for use of
the Project Gutenberg trademark. If you do not charge anything for
copies of this eBook, complying with the trademark license is very
easy. You may use this eBook for nearly any purpose such as
creation of derivative works, reports, performances and research.
Project Gutenberg eBooks may be modified and printed and given
away—you may do practically ANYTHING in the United States with
eBooks not protected by U.S. copyright law. Redistribution is subject
to the trademark license, especially commercial redistribution.

START: FULL LICENSE

THE FULL PROJECT GUTENBERG LICENSE