Objectives

•Group reviews common pediatric illnesses and

emergencies such as fever acute gastroenteritis,
hypoglycemia, hyperglycemia, diabetic
ketoacidosis, status epileptics, Septic shock,
respiratory failure and pediatric surgical
emergencies.

• Group identifies patient requiring emergency

management in relation to specific conditions
mentioned above.

•Group discuss diagnosis requiring emergent

evaluation and management in relation to specific
conditions mentioned above.
A Pediatric Emergency care is
the care

of children and

teens who are acutely ill or

injured
Objectives of Management of Pediatric
Emergencies

To preserve life
To promote health
To restore health
To alleviate suffering
To prevent further complication
To decrease Mortality and Morbidity.

‘Provide Healthy citizen for nation’

Definition of Fever :

It is an elevation of body temperature above

normal.
 Fever
 Not a disease, it’s a sign of disease.
 Severity is not indication of severity of
underlying disease.

 Emergency if:
 >1040F in any child
 >1010F in infant < 3months old
Anatomical and Physiologic
Characteristics

-Increased metabolic rate

-Large body surface
-Immature kidneys
-Rapid fluid loss
Causes:
- Infection
- Inflammatory disease
- Dehydration
- Tumors
- Disturbances in temperature
regulating center
- Extravasations of blood in tissue
- Effect of drugs or toxins
Assessment:
1. Basic principles to be kept in mind
*Newborns temperature varies with environment
*Degree of fever does not always reflect severity
of the disease.
* Febrile seizures due to rapid rise in temperature

2. History
-physical examination
- laboratory test

3. Attempt to identify the pattern of fever

Principles of Management
- Monitor vitals

- Maintain hydration

- Prevent hypothermia

- Administration of antipyretic

- Dietary management
Management of fever
- Use traditional cooling methods
- Minimum clothing's
- Expose skin to air
- Reduce room temperature
- Increase air circulation
- Apply cool moist compress
- Tepid sponging
- -Cold sponging

‘Take care that temperature should not

increase more than set points’.

 Diarrhea
Definition:
It is alteration in consistency and /or frequency of
stool resulting in a net loss of fluid and electrolyte
from the body.

According to W.H.O/ UNICEF :

Acute diarrhea is an attack of sudden onset , which
lasts usually for three to seven days but may lasts up
to ten to fourteen days caused by infection of the
bowel.
Signs and Symptoms
1 History
- loose stool

- frequency and consistency, color ,mucus and blood

- vomiting, frequency, vomits nature

- fever

- altered sensorium

- oliguria

- tachypnea

- distention of abdomen
2. Grades of dehydration
characteristics Mild - Gr.1 Moderate- Gr.2 Severe- Gr.3

% of loss of 0.5% 5-10% >10%

fluid

Loss in 50ml/kg 50-100ml/kg. >100ml/kg

ml/kg.

General Thirsty Irritable/ Drowsy

appearance
Lethargic
Feeble/not
Pulse
Normal Rapid /normal palpable
 Grades of dehydration cont…
B.P. Normal decrease Unrecordable

Respiration Normal Normal /rapid Acidotic

Eyeballs Normal Soft Deeply

sunken

Anterior Normal Slightly Markedly

fontanels depressed depressed
Grades of dehydration cont…
Skin turgor Normal Normal to Complete
decrease loss

Mucous Moist dry Very dry

membrane

Tears Present Reduced Absent

Urine Normal Decreased Severe

output oliguria to
anuria
3. Investigation

stool Urine

blood
 Assessment
Collect information
- Normal body weight prior to illness

- Number and description of stool patient

usually has each day, when well .

- The description of stool (fluidity ,volume,

color and the presence of blood or mucus)

- Fever, abdominal pain ,weight loss.

- Fluid intake

- Frequency of urination

- Degree of dehydration/skin turgor

- State of consciousness
Principles of management
Correction and restoration of fluid

Use of drugs

Symptomatic treatment

Dietetic management

Treatment of complications

preventive measures
Correction of dehydration

Grade 1-
ORS solution
Plenty of oral fluids and
Continue to breast feed
Take the child to health worker
Treatment of grade 2
Hospital based treatment 100ml/kg ORS in 4
hours.
Reassure the client and family members
Monitor vitals
Check skin turgor
Maintain intake output
Observe the fluidity and frequency of stool
Maintain personal hygiene
Continue breast milk
Provide coconut water
Treatment of grade 3-
I.V.Rehydration therapy (Ringer lactate )
Shock
Unable to drink
Severely dehydrated
Fluid management
Fluid till 10kg -100ml/kg/day
10-20kg -50ml/kg/day
>20kg - add 20ml/kg/day

Sodium 3meq./kg/day

potassium 2meq./kg/day
Status Epilepticus
Status epilepticus is defined as
recurrent or continuous seizure
activity lasting longer than 30 minutes
in which the patient does not regain
baseline mental.
Investigations
Specimen Investigation
Blood Complete blood count
Electrolyte, Glucose, Calcium, Magnesium,
Creatinine, Liver function test,
Lactate , Arterial blood gas analysis
Anticonvulsant levels
CSF Biochemistry, Cytology, Bacteriology,
viral studies
Urine Routine, microscopy, myoglobin
CT Scan/MRI Brain
EEG
Management of Status Epilepticus
At: zero minutes
Initiate general systemic support of the airway (insert nasal airway
or intubate if needed)
Check blood pressure / Begin nasal oxygen / Monitor ECG and
respiration./ Check temperature/ Obtain history.

Perform neurologic examination.

Send sample serum for evaluation of electrolytes, blood urea
nitrogen, glucose level, complete blood cell count, toxic drug
screen, and anticonvulsant levels; check arterial blood gas
values
.
Start IV line containing isotonic saline at a low infusion rate.

Inject 50 mL of 50 percent glucose IV and 100 mg of thiamine IV

or IM.

Administer lorazepam (Ativan) at 0.1 to 0.15 mg per kg IV (2 mg

per minute); if seizures persist, administer phenytoin at 18 mg
per kg IV (150 mg per minute, with an additional 7 mg per kg if
seizures continue).
 Nursing Diagnosis

1.Risk for injury related to type of seizure

2.Risk for injury related to impaired

consciousness.

3.Interrupted family process related to

child with a chronic illness
Status Asthmaticus
Severe attack of bronchial asthma with extensive
bronchial obstruction from the beginning or during the
course of episode
Causes
 Signs and symptoms
Severe persistent dysponea
Respiratory rate over 30per/minute
Prolonged expiration [wheezing]
Hyperactivity of accessory muscles
Inability to speak without pause
Cyanosis
Altered consciousness
Respiratory muscle fatigue
Pneumothorax
 MANAGEMENT

Humidified oxygen

Hydration

Correction of metabolic acidosis

Maintain electrolyte

Antibiotics
 Nursing management
Emotional support
Positioning
Assessment of respiratory status
Administration of oxygen
Aerosol therapy
Postural drainage
I.V. Medication
Restrict overeating
Provide rest
Aspiration of foreign bodies
Aspiration of foreign bodies occurs in infants and toddlers
between the of 6 months to 3years of age

Laryngeal –
hoarseness of voice,
cough,
aphonia
hemoptysis
dyspnea ,
wheezing &
inflammation
Tracheal –
Cough ,
hoarseness, dyspnea
Bronchial –
Cough, wheeze, blood streaked sputum
atelectasis ,
gagging cough
 Management

Removal of foreign body

Bronchoscopy
Antibiotics
Abdominal thrust
 Poisoning
Definition: It is an ingestion or inhalation
of toxic substances which ,when taken into
the body or exposed to the body produce
serious and harmful effect on the body.
Types of poisoning
- Corrosive poisoning
Acid and Alkali
Hydrocarbons
kerosene
Lamp oil
Turpentine
Paint thinner and remover
Over dose of medicine e.g. aspirin, syrups
cleaning agents (phenol/Lysol)
Principles of emergency management

- Observe the victim

- Preserve the poison
- Treat the child first and not poison

Home approach to child

- Calm and quite environment
- Psychological support
- Prompt care
- Termination of exposure to poison
- Remove remaining poisonous material, from
mouth
CONT….
Eyes should be flushed with water
Skin should be cleaned
Induce vomiting
Prevent aspiration

Hospital approach

- Removal of poison
- Observe for symptoms of complications
- Emotional support to child & parents
Non corrosive substance
Decreased amount or activity of substance in G.I.T.
- Gastric lavage
- Administration of charcoal
- Administration of cathartics
- Forced diuresis for excretion of waste
 Corrosive substances
- NOT to remove by lavage / emesis
- Neutralization is not advised
- Provide patent airway
- Analgesics

Hydrocarbon
- induce vomiting
- assess vitals
- symptomatic management
- observation
- emotional support
- counselling
Endocrine Disorders

-DKA

-Hypoglycemia

-Hyperglycemia
 Hypoglycemia
Causes: (Neonatal hypoglycemia)
-Hyperinsulinism, or PHHI
-Limited glycogen stores
-Depleted glycogen stores
-Increased glucose utilization
-Decreased glycogenolysis,
gluconeogenesis, or utilization of
alternate fuels
 Hypoglycemia

Causes : (in older children)

Poisonings/drugs
Liver disease
Amino acid & organic acid disorders
Systemic disease
 Hypoglycemia
CNS and cardiopulmonary
disturbances.
Hypotonia
Lethargy, apathy
Poor feeding
Jitteriness, seizures
Congestive heart failure
Cyanosis
Apnea
Hypothermia
 Hypoglycemia

Clinical manifestations associated

with activation of the autonomic
nervous system
Anxiety, tremulousness
Diaphoresis
Tachycardia
Pallor
Hunger, nausea, and vomiting
Clinical manifestations of hypoglycorrhachia or
neuroglycopenia

Headache
Mental confusion, staring, behavioral
changes, difficulty concentrating
Visual disturbances (eg, decreased
acuity, diplopia)
Dysarthria
Seizures
Ataxia, somnolence, coma
Stroke (hemiplegia, aphasia),
paresthesias, dizziness, amnesia,
decerebrate or decorticate posturing
Treatment of hypoglycemia

Anti hypoglycemic agent:

Dextrose
Diazoxide
Octreotide
Glucagon
Signs and symptoms DKA

Abdominal Pain
Nausea/vomiting
Dehydration
LOC
DKA Treatment

Fluids
Insulin
Electrolyte imbalances
DKA Treatment Cont…

Infusion Rates of Potassium

Chloride:-
Septic Shock

Peripheral hypoperfusion due to

septicemia (blood infection)
Most common in young infants,
debilitated children
PATHOPHYSIOLOGY

Severe peripheral vasodilation

Fluid loss from vessels to interstitial
space
Signs/Symptoms

“Warm” shock
Tachycardia, full pulses

Slow capillary refill

Fever

Flushed skin
Signs/Symptoms

“Cold” shock
Tachycardia, weak pulses

Slow capillary refill

Cool, pale, mottled skin

 Management

100% oxygen

RL in 20cc/kg boluses

Fill dilated vascular space

Prevent onset of “cold” shock

 Respiratory failure

Clinical manifestations
“Cardinal signs”:
Restlessness
Tachypnea
Tachycardia
Flaring nares
Chest wall retractions
Expiratory grunt
Wheezing or prolonged expiration
 
 Clinical manifestations

More Sever Hypoxia”

Hypotension or hypertension
Dimness of vision
Stupor
Coma
Dyspnea
Depressed respirations
Bradycardia
Cyanosis (peripheral or central)
Principles of management:

Maintain ventilation and maximize

oxygen delivery
Correct hypoxia and hypercapnea
Treat the underlying cause
Minimize extrapulmonary organ
failure