Acute and Chronic Illness Management
Domain 4 tests assessment and management of common acute and chronic pediatric conditions, including asthma, diabetes, sickle cell disease, seizures, dehydration, and infection. You need to recognize severity, start safe initial care, and coordinate the chronic plan.
Core rules
- Assess ABCs and severity first; respiratory distress can worsen quickly in children.
- Asthma: assess work of breathing, speech, oxygen saturation, and response to short-acting beta-agonist; give oxygen and systemic corticosteroids for moderate-to-severe exacerbation and reassess.
- Diabetes: know sick-day rules, never stop basal insulin, monitor glucose/ketones, and treat hypoglycemia with fast sugar followed by complex carbohydrate.
- Sickle cell: fever is an emergency; give antibiotics after cultures per protocol; treat pain promptly.
- Seizures: protect the airway, do not restrain, time the event, and give rescue medication per plan if prolonged.
Worked example
A 6-year-old with asthma has wheezing, speaks in short phrases, and has retractions. Give supplemental oxygen, a short-acting beta-agonist by nebulizer or spacer, and systemic corticosteroid early. Reassess work of breathing and oxygen saturation. If there is poor response, fatigue, or silent chest, escalate to emergency care. Document peak flow if able, but do not delay treatment for it.
Traps
Underestimating retractions or a “quiet” chest, delaying steroids, and treating fever in sickle cell as routine. Also avoid stopping insulin during illness and giving oral fluids to a child who is lethargic or unable to swallow.