Paediatric Emergencies
Assessment
Use the paediatric assessment triangle - appearance, work of breathing, circulation to skin - from the end of the bed before touching the child. Weight: (age in years + 4) × 2 kg; a length-based tape is faster in an arrest.
In children, bradycardia is hypoxia until proven otherwise: oxygenate and ventilate before considering atropine or adrenaline. Compressions are 15:2 with two rescuers, at least one third of chest depth (4 cm infant, 5 cm child), with a 4 J/kg defibrillation dose (up to 10 J/kg).
Fluid boluses are 10–20 mL/kg, and 10 mL/kg with reassessment in trauma, cardiac disease and diabetic ketoacidosis. In paediatric DKA, rapid fluid and insulin cause cerebral oedema: give 10 mL/kg for shock, start insulin at 0.05–0.1 units/kg/h after one hour, and never give bicarbonate.
Croup: dexamethasone for all, nebulised adrenaline 1:1000 5 mL for stridor at rest. Bronchiolitis: supportive care, no bronchodilators or steroids, with high-flow nasal oxygen for moderate distress.
Febrile infants under 28 days need a full sepsis screen including lumbar puncture and empirical antibiotics regardless of appearance. Consider non-accidental injury when the history does not fit the injury, and examine the whole child including perineum, ears and fundi.
Rule of thumb: respiratory and heart rates fall late in a sick child - a normal heart rate in a child who looks unwell is an ominous sign.