PEDIATRIC EMERGENCY
The ABCD
The A
 Arousal
 Alertness
 Activity
 Apathy
The B
 Breathing difficulties
The C
 Poor Color (pale)
 Circulation (Cold peripheries)
The D
 Decreased fluids intake (fewer than half a normal intake) and
 Decreased urine output (fewer than 4 wet nappies a day)
Level of Awareness (AVPU)
 A - Alert
 V - Responds to Voice
 P - Responds to Pain
 U - Unresponsive
Neonatal Resuscitation
Adrenaline IV: 10 – 30 mcg / kg
Apgar Score
 Appearance
 Pulse
 Grimace
 Activity
 Respiration
Shock
Definition:
Inadequate circulation to meet the tissues’ demands
Etiology:
 Hypervolemia
 Viral gastroenteritis
 Maldistribution of fluid:
o Sepsis
o Anaphylaxis
Symptoms:
 EARLY (Compensated shock)
o Tachypnea and tachycardia
o Sunken eyes and fontanels
o Mottled, pale, cold skin
o Decreased skin turgor
o Decreased capillary refill (> 2 sec)
o Decreased urinary output (< 1 ml/kg/h)
 LATE (Decompensated shock)
o Confusion / depressed cerebral state
o Bradycardia
o Hypotension
o Blue peripheries
o Absent urine output
Hypervolemia (Treatment)
 0.9 % saline IV
 Blood if trauma
Septicemia (Meningococcal Purpura)
Poor State
 Fever
 Rash
 Negative Glass Test
Severe State
 Positive Glass Test
 Fever
 Poor feeding
 Irritability, lethargy
 Tachycardia
 Tachypnea
 Hypotension
 Shock, multi organ failure
 Purple rash
Seizures
Definition:
Uncontrolled electrical activity in the brain, which may produce a
physical convulsion.
Status epileptics:
Seizure lasting 30 min
Successive frequent seizures with unconsciousness
Febrile seizures:
Seizure accompanied by a fever in absence of intracranial infection
Etiology:
 Febrile seizures – any infections & fever
 Metabolic:
o Hypoglycemia,
o Hypocalcaemia
o Hypomagnesaemia
o Hypo/hypernatremia
 Meningitis and encephalitis
 Cerebral trauma or tumor
 Toxins (poison, metabolic disorders)
 Epilepsy and others
Dyspnea – Croup
Definition:
The degree of subcostal, intercostal and sternal recession is a more
useful indicator of severity of upper airways obstruction than the
respiratory rate.
Symptoms:
 Viral
 6 months to 6 years
 Harsh
 Loud stridor
 Cold
 Mild fever
Dyspnea – Asthma
Examination:
History of allergy or asthma
Symptoms:
Too breathless to eat or talk
Use of accessory muscles
Distended chest
Wheeze or silent chest
Cyanosis and alter level of consciousness
Anaphylaxis
Definition:
Severe, whole – body reaction to an allergen, after being previously
exposed to this allergen (sensitization to it). This reaction happen
very quickly.
Examination:
• History of allergy / anaphylaxis
• Food or insect sting venom allergy
Symptoms:
 Airways:
o Swelling
o Hoarseness
o Stridor
 Breathing:
o Tachypnea
o Wheeze
o Cyanosis (SpO2< 92 %)
 Circulation:
o Pale
o Clammy
o Hypotension
o Drowsy
o Coma