Pediatric Emergency, Critical Care and Toxicology
Core concepts
Master the ABCDE approach and pediatric assessment triangle (appearance, work of breathing, circulation). Know shock recognition and management (fluid boluses, reassessment, vasopressors when indicated) and the difference between compensated and decompensated shock. Understand respiratory failure and cardiopulmonary resuscitation principles (high-quality compressions, ventilation, reversible causes). Know common poisonings (acetaminophen, iron, salicylates, organophosphates, opioids) and the role of activated charcoal (within 1 hour, protected airway) and antidotes (N-acetylcysteine, naloxone, atropine/pralidoxime). Recognize anaphylaxis (epinephrine first), drowning, trauma (primary and secondary survey), and status epilepticus. Understand DKA and sepsis management in the emergency setting.
Traps
- Delaying epinephrine in anaphylaxis while giving antihistamines or steroids.
- Giving activated charcoal to a patient with altered consciousness or unprotected airway.
- Under-resuscitating shock because the child looks "stable" - reassess after each bolus.
- Missing hypoglycemia as a cause of altered mental status.
- Forgetting to consider nonaccidental trauma in the injured infant.
Worked example / rule of thumb
A 3-year-old with hives, stridor, and hypotension after a bee sting: give intramuscular epinephrine immediately, then fluids and adjuncts. Rule of thumb: epinephrine is first-line for anaphylaxis; activated charcoal only within 1 hour with a protected airway; reassess after every fluid bolus in shock.