Pediatric Emergency Medicine, Critical Care and Toxicology
Core concepts
Master the ABCDE approach to the critically ill child, the recognition of shock (hypovolemic, distributive, cardiogenic, obstructive), and the principles of fluid resuscitation and vasoactive support. Know the approach to respiratory distress, status epilepticus, and altered consciousness. Understand common poisonings (acetaminophen, salicylates, iron, organophosphates, hydrocarbons) and the role of antidotes and decontamination. Know the basics of trauma assessment and the recognition of child abuse.
Traps
Questions test whether you can distinguish septic shock from cardiogenic shock and choose the right initial therapy. Another trap is missing a toxic ingestion in a child with unexplained altered mental status or metabolic acidosis. Do not forget that fluid boluses are not always appropriate - in cardiogenic shock, they can worsen the picture.
Worked example
A child with a salicylate overdose presents with tachypnea, tinnitus, and a mixed respiratory alkalosis and metabolic acidosis; treatment includes urinary alkalinization and, in severe cases, hemodialysis. The trap is giving only supportive care without recognizing the need for alkalinization.
Rule of thumb
In any poisoned or altered child, check a glucose and an arterial blood gas early; the acid-base pattern often points to the toxin.