CHILDHOOD EMERGENCIES

Chocking - Near Drowning - Aspiration

Adapted from : EMERGENCY MEDICINE .

PRINCIPLE AND PRACTICE .Gordian W.O.
Fulde McLennan+Petty. London
By Purnomo Suryantoro
Gadjah Mada Medical School.

General
Important: history taking and
examination.
Rapidly clinical deterioration
prehospital care are most important
Any doubt call children emergencies
hospital for advice or admittance
Special care for Childhood emergencies (
children are not small adult !)
Caring and sympathetic approach are
essential

Topics

1. Unconscious or acutely ill child

2. Fever
3. Head injury
4. Convulsions
5. Stridor
6. Acute abdominal pai
7. Acute Gastroenteritis
8. Child abuse
9. Purpura
10. Near-drowning
11. Burns
12. Poisonings

Bre

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General feature :
the PAT

Circulation to Skin

Tonus
Interactiveness
Consolability
Look/Gaze
Speech/Cry

Ap
pe
ar a
nc
e

Appearance
(Tickles =TICLS)

Work of Breathings
rk
Wo
of
ing
ath
Bre
s

Abnormal airway
sounds
Abnormal positioning
Retractions
Nasal flaring

Circulation to Skin
Pallor
Mottling
Cyanosis
Circulation to Skin

Shoc
k

Respiratory distress

N
Primary CNS
dysfunction/
metabolic
abnormality
N

Cardiopulmonary
failure
N

Specific
feature

Respiratory status
Ventilation / respiratory abnormalities
Adequate airway
1. Unconscious
Semi prone position in case of vomiting
Oxygen
or acutely ill
Circulatory status
child
Establish i.v access crystalloids or expander
Look for
rash ( purpuric meningococcal septicemias )
Fever or hypothermia
Evidence of head injury
High or low glucose levels
Blood pressure low or high
Hydration
Intracranial pressure ( retinal hemorrhages without trauma child
abuse )
Neurological signs
Accidental ingestion ( alcohol, diabetes )

Management
-

Insert airway or ETT

Prepare ventilation
Check blood sugar and Blood Gas analysis
Immediate treatment

Investigation
- depend on history taking and examination
include
blood count, blood glucose, blood culture,
electrolyte and urea, urine, ketones and drug
assay
- Lumbar puncture if intracranial pressure not high

2. Fever

5% of 6 mo-5yr old prone to febrile

convulsions symptomatic
treatment
Take off blanket and extra clothes
Paracetamol 10 mg/Kg BW. (not
aspirin) every 4-6 hour.
Cool by tepid bath ( don't use cold
water)

Cause of fever

Viral illness
Bacterial Septicemias
Meningitis
UTI
Pneumonia
Otitis media
Tonsillitis

3. Head injury

Rapid deterioration airway

obstruction, poor ventilation priority
ASSESS
1.Severity of injury
2. Level of consciousness ( AVPU )
3. Respiratory state
4.Ear,nose, throat for blood leakage and
CNS
5. Blood pressure
6. Reassess and reassess

Hospital admittance

Loss of consciousness
Neurological signs
Repeated vomiting
Severe headache
Skull fracture
Any worrying feature ( history and or
physical)

4. CONVULSSIONS

Febrile convulsions, Meningitis,

Metabolic, Electrolyte imbalance,
Dehydration, brain anomalies ,
epilepsy.
Masquerade as convulsion : syncope,
breath holding history taking.

Priorities for convulsion

Prevent hypoxia clear airway, lie
on right side, give 100% Oxygens.
Stop convulsion Diazepam 0.2
mg/Kg repeat if necessary. IV or
rectal

5. STRIDOR
Partial obstruction of airways croup ( viral )
epiglotitis, foreign body.
Acute epiglottitis complete obstruction fatal.
Give oxygen, dont attempt to visualize epiglottis
trauma to total obstruction If necessary call
operation theatre to insert ETT Cefotaxime 150
mg/kg 4devided doses
Croup humidified include oxygen observed,
may need ETT.
Inhaled foreign body; history taking ( sudden
choking or cough ), asymmetrical chest moving,
decreased air entry or localize ronchi), do chest Xray, bronchscopy for removal material

6. Acute Abdominal pain

Under 3 years the origin of pain are not

at abdomen may acute tonsillitis, lower
pneumonia, testicular torsion, hernia.
Observed symptoms : vomiting,
diarrhea, fever, rash, bleeding.
Difficult below 2 years : Appendicitis
with or without perforation abdominal
tenderness peritonitis (?).

7. Intussusceptions

High incidence for 2 mo 2 yr old

complete gut obstruction.
Severe pain screaming, drawing up
leg and pallor. Blood stain mucus
rectal. Banana-shape mass right
upper quadrant intraabdominal.
Barium enema for X-ray may reduce
the lesion but call the operation
theatre in the case of perforation.

8. Caused of abdominal pains

Appendicitis,
Urinary track infection, Cystitis
Trauma e.c splenic rupture, duodenal
rupture
Diarrhea : Amube, Shigella
Helicobacter Pylori Gastritis
Frequents vomiting

9. Acute Gastroenteritis

Can be a trap that make symptoms

abdominal pain and or vomiting and
dehydration
Includes: appendicitis, intussusceptions,
diabetic ketoacidosis UTI, septicemia
and meningitis history taking and
physical examination.
Diagnosis , criteria and treatment
referred to Gastroenterology
department !

10. Child Abuse

Common problems in Westerners, only some in

Easters .
Clinical shows injuries, burns and or poisonings.
Suspect :
discrepancies between physical findings with those of
anamnesis.
Delayed of seeking medical aid
Anamnesis varies
Multiple injury in different stage
Spiral fractures (twisting, shearing force), metacarpal
chip fracture
Two black eyes, hematoma of the ear
Retinal hemorrhages
Finger print bruising ( shows violent gripping )
Abnormal injured in play
Burns on buttock, perineum , cigarette burns

Management
Hospitalized for protection and treatment
Skeletal survey by X-ray different stage of
healing
Obtain clinical photographs
Take full social history
Record accurately may required in court
later
Access childs development and behavior
Consult pediatrician and experienced social
worker
Notify the local statutory authority which has
mandatory notification laws.

11. PURPURA

Hemorrhage in skin
Possible cause :

Meningococcal septicemia
ITP
Henoch-schoenlein purpura
Leukemia
Mechanical

Blood culture Cefotaxime 100

mg /kg /day

12. NEAR-DROWNING
Cardiopulmonary resuscitation should be
given on site correlated with survival.
Aids :

Clear airway
External cardiac massage
Ventilate
Obtain I.V access
Take Arterial Blood Gas
Check electrolyte balance and hemoglobin
Assess and reassess.

13. BURNS

Assess the degree of burns

Different calculation in children than
adult

0 - 3 years
> 3 years
Head and neck
Trunk
38%
Both arms
20%
Both leg

18 %

12%
32 %
20 %

30 %

30%

Clinics of burn
Smoke inhalation swelling and obstruction
of airway, damage of lower respiratory tract
Carbon monoxide poisoning leads to
impairment of oxygen carrying capacity.
Needs :
Assessment include accurate weight, area of
burn and respiratory status
Analgesia and sedation
Fluid replacement ( 10% of body surface I.V.
Volume of fluid : BW(kg) x 2 x % body surface
burnt area

 Common in Indonesia 14. POISONING

Suspect will suffer from drowsiness, coma, unexplained
tachycardia, flushing, bizarre behavior or hyperventilation
anamnesis i.e. empty or missing tablet container .
If the child unconscious :
Maintain airway
Need for ventilator support
Look for evidence of poisoning ( tablet in vomits, burns in
mouth, kerosene/alcohol in breath, dilated pupil
organophosphates poisoning, constricted pupil opiates
or barbiturate
Gastric aspiration only after intubations.
Hypoglycemia ( aspirin or alcohol )
Antidote must be specific, chelating agent when
appropriate ( naloxone for narcotics, desferrioxamine for
iron, atropine and PAM for organophosphates.)
Induced vomiting unless contraindicated. Activated
Charcoal if fail to vomit
Ipecac contraindication : petroleum ingestion, corrosive
agent, drowsiness and unconscious.

SUHU BIPHASIK