Pediatric Medical Emergencies :Pediatric Medical Emergencies


Fever :Fever Not a disease, it’s a sign of disease Severity is not indication of severity of underlying disease Usually good


Fever :Fever Treat child, not thermometer How do you know he has a fever? How sick does he look? How long has he been listless, weak? Will he tolerate being held on mom’s shoulder? Does he cry even when consoled?


Fever :Fever Educate parents Tempra, Tylenol Avoid aspirin Sponge with water at 96 - 970F Do not say “tepid”, “lukewarm” Do not leave kid unattended


Fever :Fever Educate parents Do not Use ice water “Bundle” Use alcohol rubs Use tap water enemas


Fever :Fever Emergency if: >1040F in any child >1010F in infant < 3months old


Septic Shock :Septic Shock Peripheral hypoperfusion due to septicemia (blood infection) Most common in young infants, debilitated children


Septic Shock :Septic Shock Pathophysiology Severe peripheral vasodilation Fluid loss from vessels to interstitial space


Septic Shock :Septic Shock Signs/Symptoms “Warm” shock Tachycardia, full pulses Slow capillary refill Fever Flushed skin


Septic Shock :Septic Shock Signs/Symptoms “Cold” shock Tachycardia, weak pulses Slow capillary refill Cool, pale, mottled skin “Cold” shock has 90% mortality


Febrile infant + Won’t tolerate being held to shoulder =Septic Shock :Febrile infant + Won’t tolerate being held to shoulder =Septic Shock


Septic Shock :Septic Shock Management 100% oxygen LR in 20cc/kg boluses Fill dilated vascular space Prevent onset of “cold” shock


Meningitis :Meningitis Inflammation of meninges Increased CSF production Cerebral /meningeal edema Increased intracranial pressure


Meningitis :Meningitis Signs/Symptoms: Older Children Fever Headache Stiff neck (can’t touch chin to chest) Decreased LOC Seizures


Meningitis :Meningitis Signs/Symptoms: Infants Difficulty feeding Irritability High-pitched cry Bulging fontanelle Classic meningeal signs possibly absent


Meningitis :Meningitis Meningococcemia Petechial rash Septic shock DIC


Reyes’ Syndrome :Reyes’ Syndrome Non-communicable Affects ages 2 -19 Mostly toddlers, pre-schoolers


Reyes’ Syndrome :Reyes’ Syndrome Pathophysiology Dysfunction of hepatic urea cycle enzymes Increased protein breakdown leading to rise in blood ammonia levels Diffuse cerebral edema


Reyes’ Syndrome :Reyes’ Syndrome History Previously healthy child Recovering from viral illness Frequently chicken pox or influenza Frequently received aspirin during illness


Reyes’ Syndrome :Reyes’ Syndrome Signs/Symptoms Prolonged, violent vomiting Varying degrees of personality change Unusual behavior Irritability, drowsiness


History of vomiting + Altered LOC + Recovering from virus = Reyes’ Syndrome :History of vomiting + Altered LOC + Recovering from virus = Reyes’ Syndrome


Crankiness in infant + Recovering from virus = Reye’s Syndrome :Crankiness in infant + Recovering from virus = Reye’s Syndrome


Reyes’ Syndrome :Reyes’ Syndrome Management Avoid overstimulation IV’s at tko Decrease ICP by controlled hyperventilation


Seizures :Seizures Second most common pediatric complaint after fever Can result from same causes as adult seizures


Seizures :Seizures Pedi seizures can also result from fever Most common from 6 months to 3 years Caused by rapid rise in body temperature Short-lived Does not recur during that illness


Seizures :Seizures Potential dangers Aspiration Trauma Missed diagnosis


Seizures :Seizures “Febrile seizure” diagnosis risky in field


Seizures :Seizures History Previous seizures? Previous febrile seizures? Number of seizures this episode? What did seizure look like?


Seizures :Seizures History Remote, recent head trauma? Diabetes? Headache, stiff neck? Petechial rash?


Seizures :Seizures History Possible ingestion? Medications?


Seizures :Seizures Physical exam ABC’s Neurological exam Signs of injury? Signs of dehydration? Rash, stiff neck? Bulging, depressed anterior fontanelle?


Seizures :Seizures Management--if actively seizing: Place on floor away from furniture Position on side Prevent injury Do not restrain Do not force anything between teeth


Seizures :Seizures Management--following seizure Check ABC’s, suction prn Assure good oxygenation, ventilation Vascular access Check blood glucose, if < 70, give D25W If febrile, remove excess clothing, sponge with water to cool patient.


Status Epilepticus :Status Epilepticus Diazepam: 0.3 mg/kg to 5mg if 5 years old


Status Epilepticus :Status Epilepticus Administer diazepam slowly Anticipate respiratory arrest, hypotension Rectal route is alternative when vascular access cannot be obtained


Most Common Cause of Seizure Deaths = Anoxia :Most Common Cause of Seizure Deaths = Anoxia


Hypoglycemia :Hypoglycemia More common than in adults, especially in newborns Signs/symptoms may mimic hypoxia


Hypoglycemia :Hypoglycemia Check blood glucose in any child with: Seizures Decreased LOC Severe dehydration Known hypoglycemia or diabetes Pallor, sweating, tachycardia, tremors


Hypoglycemia :Hypoglycemia Management Oral sugar if tolerated 2cc/kg D25W, if oral sugar not possible ? Glucagon 1 mg IV or IM Reassess every 20 - 30 minutes


Diabetes Mellitus :Diabetes Mellitus Typically insulin-dependent Complications Hypoglycemia Hyperglycemia, DKA


Diabetes Mellitus :Diabetes Mellitus DKA therapy same as for severe dehydration Not every diabetic is known diabetic Every diabetic must have first hyperglycemic episode


Coma :Coma Disturbance in consciousness; patient unresponsive to stimuli Causes Metabolic Structural


Coma :Coma Metabolic causes: Anoxia Drug Toxicity Hypoglycemia Epilepsy DKA Reyes’ Syndrome Infections Increased ICP (Edema)


Coma :Coma Structural causes: Trauma Tumor CVA


Coma Control ABC’s before worrying about cause!! :Coma Control ABC’s before worrying about cause!!


Coma :Coma Airway/Breathing All patients with decreased LOC receive oxygen!! Evaluate for ineffective breathing patterns Controlled hyperventilation if increased ICP suspected


Coma :Coma Circulation Control bleeding Give fluid boluses for hypovolemia Disability AVPU, pupils Check blood glucose


Coma :Coma Management Support ABC’s 2 cc/kg D25W glucose < 70 mg% Narcan 0.1 mg/kg IV/IM/SQ/ET Elevate head 300 if C-spine injury not suspected and patient not in shock Rapid transport Reassess, Reassess, Reassess


Poisoning :Poisoning Incidence Accidental: 75% children < 5 years old Overdose: School-age, adolescents


Poisoning :Poisoning Assessment Remove to safe environment Control airway Support breathing: 100% O2 Circulation - vasodilation, decreasing myocardial tone, hypoxia Blood glucose


Poisoning :Poisoning History What? When? How much? Vomiting? Coughing? Seizures? Altered LOC? Ipecac?


Poisoning :Poisoning Management Support ABC’s Consider D25W, Narcan Ipecac?/Charcoal? Transport samples Consult poison control Treat patient, not poison!!


Near-Drowning :Near-Drowning A leading cause of childhood death Two major groups Toddlers Adolescents


Near-Drowning :Near-Drowning Pathophysiology Hypoxia Acidosis Hypothermia Aspiration, pulmonary edema, atelectasis


Near-Drowning :Near-Drowning Management Protect rescuers Assume C-spine injury 100% oxygen Decompress stomach early with gastric tube


Near-Drowning :Near-Drowning Management Remember mammalian diving reflex!! Think about underlying causes-- ? Child abuse All near-drownings are transported regardless of how good they look!!