Acute Illness and Emergency Care
Core content
Acute care questions reward rapid recognition and prioritized action. Use the pediatric assessment triangle-appearance, work of breathing, circulation-then ABCDE. Recognize shock before hypotension, because children compensate by increasing heart rate and vascular tone; hypotension is a late sign. Know emergency doses: epinephrine IM 0.01 mg/kg (max 0.5 mg) for anaphylaxis, fluid boluses of 20 mL/kg for shock, and oxygen for hypoxemia. Distinguish common respiratory patterns: croup (barking cough, stridor, stepladder), bronchiolitis (wheezing, viral, supportive care), asthma (reversible obstruction, bronchodilators and steroids), and epiglottitis (toxic, drooling, tripod-do not inspect the throat).
Traps
Do not treat bronchiolitis routinely with albuterol, steroids, or antibiotics. Do not give hypotonic fluids to a child with suspected DKA; use isotonic fluid and cautious rehydration. A febrile seizure is usually benign if the child returns to baseline, but consider meningitis if there is lethargy, neck stiffness, or prolonged altered mental status. In trauma, hypotension is late and indicates decompensation.
Worked example
A 6-month-old with bronchiolitis has respiratory rate 70, retractions, and oxygen saturation 88%. Give oxygen and supportive fluids, and monitor. Routine bronchodilators are not indicated. Rule of thumb: in pediatric emergencies, treat hypoxia and shock aggressively, but avoid interventions not supported for the specific condition.