Pediatric emergencies

By
Roderick T. Vito, MD, FPCEM
 Introduction
• Every day children die from trauma
• Many are admitted in children < 14 y.o.  MVA,
drowning, burns, poisonings and fall
• Age category
• Each age group has different emotional and physical
characteristics that can complicate care- not small
adult
• Dealing with parentsunderstand their reactions,
take the history allows them to verbalize their
emotions thank them and assure them you will
take care of their children
• Let them be present or participate in caring or
calming their children
• Explain to them what you are doing using
simple language
• Always ask how their child normally act or
when you are comparing a finding
• Dealing with a Child consider their reactions
by age
 Reaction by age
• Infants : at 6-8 months not to separate them from
their parents. Start PE toe- to- head making sure the
ABC`s are intact.
• Toddlers: up to age 5. they are frightened easily. Be
calm , you have to earn their trust. Reassure them.
Explain to them in simple terms what you will be
doing. Be direct in dealing their physical fears.
• Children from age 6: cooperative and curious. Make
them partners in their care. Honesty is important,
explain each procedure in detail. Accidents 
pedestrian, bicycle, sports injuries, gunshot wounds
 Reaction by age
• Adolescents : need respect given to adults and
support given to children. Reassure them. Be
relaxed in dealing with them. Most are
reluctant in sharing their sexual history, drug
us, personal habits and illegal activities. Their
bodies preoccupy adolescents. They are
modest, they need calm and professional
treatment. Examine the genital area the last.
Sources of trauma same as children more than
6.
 Obtaining medical history
• Do primary survey
• Stay compose among anxious and agitated
parents
• In trauma obtain details of the accident, time,
mechanism of injury
• Do emergency care
 Vital signs for children
• Check a child vital signs more frequently than you
would do on adults
• Marvelous compensatory mechanisms that conceal
physiological insult for some time.
• Always scan and touch a child`s skin. Note for skin
color.
• Observe the movement of child`s stomach during
breathing. Check breathing if its adequate.
• Checking the blood pressure use correct cuff size.
Check capillary refill time . Volume loss of 10% give
rise to add 20 beats /min.
• In checking the pulse it is preferred to auscultate for
the apical pulse ( higher and more central as
compared to an adult).
• May also use the radial, brachial pulse. A rapid pulse
may be caused by shock, fever or O2 deficiency.
• Bradycardia in a child worrisome
• Feel for the pulse more peripheral, better the cardiac
output.
• Temperature determination done rectally or
axillary. Infection is the most common
cause of high temperature
• Lowering body temperature:
– Give child fluids
– Sponge bath with water not with alcohol
– Wrap in wet sheet and use fans
– Shivering  stop bathing
• Most common cause results of high fever are
dehydration and convulsions
• Low body temperature  signs of shock, near
drowning or exposure
– Passive warming by removal of wet clothes. Wrap in
blankets
– Core warming by warmed IV fluids
• Abdomen : inspection area, gentle palpation
look for tenderness, listen for bowel sounds.
• Neurological Assessment:
– Among head injury
– Level of consiousness
– Pupillary size
– AVPU method
– Able to move , recognize
• Pediatric Coma Scale
– Eye opening
– Best motor response
– Best verbal response
• Trauma ABCDE trauma life support
• Pediatric field scoring
– Weight
– Airway
– Systolic BP
– CNS
– Wounds
– Fractures
 Pediatric trauma scale
• Score
– Score of 0  child will certainly die
– Score of + 6  child has 30 % chance of dying
– Score of + 8  child has 1 % chance of dying

For a score +8 or lower  rapid transport to trauma

center or a hospital
 Common pediatric emergencies
• Respiratory emergencies :
– rapid breathing: tachypnea
– Noisy breathing : rales, stridor, wheezing
– Diminished breath sounds
– Obstructed airway : smaller air passage, less
reserve capacity,immature cartilage of the trachea,
due to bigger head as compared to the body
among infants, proprtionally large tongue among
infants
• CROUP
– 1 to 5 years old
– Swelling beneath the glottis progressively
narrowing the airway.
– Inhalation producing a whooping cough, stridor,
high pitch squeaking sound
– Worsens develop nasal flaring, tugging at the
throat, intercostal retractions
– Give humidified oxygen and kept on a
comfortable position, propped up with little
disturbance
• EPIGLOTTITIS
– Bacterial infection of that inflames the epiglottis
causing it to swell
– Pain on swallowing, high fever, drooling( unable
to swallow saliva), patient is sitting up and leaning
forward, chin is thrust outward, painful speaking
– Treat with oxygen
– Racemic epinephrine nebulization
– Surgical airway directly access the trachea
• ASTHMA
– Thick mucus plugging, inflammation of bronchial walls,
bronchiole spasm
– Air trapping
– Children with sever e attacks appear exhausted , unable to
move. Children less than 2 yo , no agitation, easily get
distracted even with tachypnea.
– Changes in the level of consciousness: O2 deficiency or
CO2 retention
– Cardiac arrhythmias is an ominous sign
– Signs of dehydration , acrocyanosis, perioral cyanosis
– Listen to rales and wheezing
– Calm the child , give O2, beta agonist nebulizations
 I

– BRONCHIOLITIS
• Confused with asthma
• Viral infection of the small bronchioles
• Usually common among children less than 1 year old
– CARDIAC ARREST
• Ventricular standstill or ventricular fibrillation
• 95% caused by respiratory arrest and airway
obstruction
• Keep the brain alive
• Start early CPR
• CONVULSIONS:
– Conditions that can produce seizure in adults
– Common among 2 to 6 years old
– 5% have febrile seizures
– Childs arms and legs become rigid., back arches, muscle
twitch, eye rolls up, pupils dilate, irregular breathing, loose
bowel and bladder control, copious saliva
– Self limiting, within 15 minutes, 2 to 3 minutes, grand mal
in nature usually not recur
– Complex febrile seizure: longer than 15 min. may occur
without recovery period ( status epilepticus)
– Emergency care: oxygen, protect the patient from injury,
maintain airway, suction secretions
• SHOCK:
– ominous sign in children when they develop severe
shock may go into cardiac arrest
– Major causes : blood loss, acute infection, heart failure
secondary to vehicular accident and extensive burn
– Newborns with large surface areas tend to loose heat,
since they cannot shiver shock
– Children prone to hypothermia from shock use blankets,
warmed IV fluids, hot packs on the trunk, head and
extremities
– S/Sx: pallor, coldness, sweatiness, low BP, rapid thready
pulse, lack vitality, extreme anxiety, unconscious
• Septicimea
– Systemic infection of the blood stream
– Serious  septic shock
– Pneumonia, ear infection or infected wound
– Fever, lethargic, irritable, low BP
– Among infants fontanelles are flat
• Meningitis:
– Infection of the lining of the brain and spinal cord from a
bacterial or viral infection
– Prior history of ear or respiratory tract infection
– High fever, irritability, sever headache, stiff neck
– Infants : lethargic , will not eat, fontanelles may bulge
• Sudden infant death syndrome
– Sudden and unexpected death of an infant or young
children autopsy fails to identify cause of death
– Post mortem diagnosis
– “Crib death or cot death”
– Prematurely born infants  healthy, ages four weeks to
seven months occurring while sleeping
– No apparent illness
– Theories:
• Complete upper airway obstruction
• Incomplete development of the respiratory center in the
medulla forgot to breath
• SIDS:
– Only way to diagnose is thru autopsy
– Exclude other causes such as pneumonia,
meningitis, unsuspected abnormality
– It is not caused by external suffucation
– It is not caused by vomiting and choking
– It is not contagious. Not common amomg ages
above 1 year old
– Not cause pain or suffering to the infant
– Cannot be predicted
• CHILD ABUSE and NEGLECT
– Homicide by child abuse only major cause of pediatric
death
– Increasing rate
– Unrelated male companions of the childs mother
– Adult : evasive, little information volunteered,
contradictory information what happened to the child
– Parents show hostility, rarely shoes any guilt
– Identify abuse :
• Physical, emotional, sexual
• Distinct characteristics of physical and behavioral indicators
• Risk of abuse: boys and urban children
• Fatal injuries: premature infants, twins, handicapped,
developmentally delayed, uncommunicative are at higher risk
• Sexual abuse : step daughters by step fathers. Men are
responsible 95%sexual abuse in girls and 80% in boys
• Multiple injuries in various stages of healing, injuries on
boththe front, back, both sides
• Unusual wounds( circular burns) fearful child, injuries to the
genitals
• Injuries that do not match the mechanism of the injury
described by the parent or the patient
• Bruises found on the buttocks, thighs, ears, side of the
face,trunks and upper arms