Pediatric Emergency, Critical Care and Toxicology
Domain focus
Pediatric Emergency, Critical Care and Toxicology tests resuscitation, shock, sepsis, anaphylaxis, trauma and poisoning. Prioritise ABCDE and time-critical interventions.
Core rules
- Use the paediatric assessment triangle: appearance, work of breathing and circulation.
- Shock: give 20 mL/kg isotonic crystalloid bolus and reassess; in septic shock start antibiotics within 1 hour.
- Anaphylaxis: intramuscular adrenaline first; fluids and bronchodilators are adjuncts.
- Poisoning: identify toxidrome, support airway and breathing, check glucose, and use naloxone for opioid toxicity. Activated charcoal only if ingestion was recent and the airway is protected. Do not perform routine gastric lavage.
- Paracetamol overdose needs N-acetylcysteine according to nomogram; organophosphate poisoning needs atropine.
Worked example
A 3-year-old is drowsy with pinpoint pupils and slow breathing after finding tablets. This is opioid toxicity. Open the airway, assist ventilation, check glucose and give naloxone 0.01 mg/kg IV or IM, repeated as needed. Observe for recurrent toxicity because naloxone is shorter-acting than many opioids.
Traps
Giving activated charcoal to a drowsy child; delaying epinephrine in anaphylaxis; using adult drug doses; forgetting glucose in a collapsed child; sending home a poisoned child too early.