Safety, Injury Prevention, and Emergency Care
Core concepts
Injury prevention is developmental: back-to-sleep and safe sleep for infants, car seat safety (rear-facing until at least 2 years or per guidelines, booster seats for older children), water safety, helmet use, poisoning prevention (locked storage, poison control number), and firearm safety. Recognize child maltreatment signs and mandatory reporting.
Emergency care: systematic approach (ABCs), pediatric assessment triangle (appearance, work of breathing, circulation), and early escalation. Know CPR ratios (30:2 for single rescuer, 15:2 for two rescuers in children), compression depth (~1/3 of chest diameter), and AED use. Manage choking, drowning, burns, and anaphylaxis (epinephrine IM to the vastus lateralis).
Triage: recognize the sick child quickly and prioritize. Use a calm, organized approach and involve family when safe.
Traps
- Using adult CPR ratios and depth for children.
- Delaying epinephrine in anaphylaxis while giving antihistamines.
- Forgetting to report suspected abuse-mandatory reporting is not optional.
- Assuming a child who is quiet is stable-quiet can mean deterioration.
- Overlooking prevention counseling at every visit.
Rule of thumb
In an emergency, appearance is the most sensitive indicator of serious illness. If the child looks unwell (limp, pale, unresponsive), act first and gather details later.
Worked example
A child with known peanut allergy develops hives, wheezing, and hypotension after eating a cookie. Give IM epinephrine in the vastus lateralis immediately, call for help, provide oxygen, and monitor-antihistamines are adjuncts, not first-line.