Pediatric Emergencies and Acute Care
Recognize and act
Pediatric emergencies reward early recognition. Distinguish respiratory distress from respiratory failure (decreasing effort, cyanosis, altered mental status) and compensated from decompensated shock. Know the pediatric chain of survival, high-quality CPR ratios (30:2 for a single rescuer; 15:2 for two rescuers in infants and children), AED use, choking relief, and the immediate treatment of anaphylaxis, seizure, hypoglycemia, DKA, trauma, and poisoning. Triage by airway, breathing, circulation, and disability, and call for help early.
Traps
Waiting for hypotension before treating shock is dangerous because children compensate and then deteriorate abruptly. Do not delay intramuscular epinephrine for anaphylaxis while giving antihistamines. Do not give oral fluids or food to a child with altered mental status. Recheck glucose and temperature. In seizures, protect the airway and time the event; do not restrain the child or place objects in the mouth. Weight-based dosing errors are a major source of harm.
Worked example
A 20-kg child has anaphylaxis after a food exposure. Epinephrine 1 mg/mL is given IM at 0.01 mg/kg = 0.2 mg (0.2 mL) into the lateral thigh, repeated every 5 to 15 minutes as needed, with a maximum single dose of 0.5 mg. Simultaneously call for help, give oxygen, position the child, and start isotonic fluid. Rule of thumb: epinephrine first, then adjuncts.