Paediatric Emergencies
This domain tests paediatric assessment, respiratory distress, bronchiolitis, croup, sepsis, dehydration, seizures, and congenital heart emergencies. The exam expects weight-based dosing and age-specific physiology.
Core rules
- Use a structured ABCDE approach and recognise respiratory distress from grunting, recession, and head bobbing.
- Bronchiolitis is usually supportive: oxygen if hypoxic, hydration, and nasal suction. Do not routinely give bronchodilators or corticosteroids.
- Croup: dexamethasone for all severities; nebulised adrenaline for moderate-to-severe stridor at rest. Do not use steam or antibiotics routinely.
- Paediatric sepsis: give antibiotics early and fluid boluses cautiously, reassessing for overload.
- Febrile seizures: most are benign; investigate according to age, duration, and focal features. Treat hypoglycaemia and electrolyte disturbance.
Worked example
A 6-month-old with bronchiolitis has feeding difficulty and saturations of 88%. Give oxygen and ensure hydration; admit for supportive care. Avoid routine salbutamol, which is not indicated in bronchiolitis.
Traps
- Do not use adult fluid boluses without weight-based calculation.
- Do not miss non-accidental injury when the history is inconsistent.
- Do not give aspirin to children with fever.
- Do not over-investigate a typical simple febrile seizure in an otherwise well child.