This document discusses several pediatric emergency cases seen by Dr. Altaf Ahmad Bhat including: 1. A 7-year-old with seizure disorder, fever, and fast breathing who went into status epilepticus. 2. A 5-year-old who had anaphylaxis after vaccination who presented with rash, breathing difficulty, and blue lips. 3. A 2-year-old with Down syndrome, CHD, cough, fast breathing, and fever who was lethargic and in respiratory failure. 4. An 8-year-old with asthma who had sudden onset cough and breathing difficulty in an asthma exacerbation. 5. A 15-month-old who choked

1. Department of Emergency Pediatrics
Dr.Altaf Ahmad Bhat
Consultant pediatrics

2.  7 Year old child known case of seizure
disorder and developmental delay
 Fever 3 days
 Fast breathing 3 days
 Status epileptics

4. 

6.  Blood Gas
1. Ph 7.1
2. PCO2 85mmhg
3. PO2 30
4. HCO3 10
Intervention :-
1.Intubation MV
2.I v Fluids
3.Iv Antibiotics

7.  5 years old child brought to ER After
Vaccination from General pediatric OPD with
complaints of :-
 Rash over body
 Breathing difficulty
 Bluish discoloration of lips
Initial impression:-
 Appearance:- Frightened/Anxious
 Breathing:- work of breathing was Increased
 Circulation:- Red And flushed

8.  Primary Assessment:-
Maintainable Airway
increase rate and effort of breathing
circulation status normal
Neurologically Anxious, Alert
 Secondary Assessment
Vaccination Received MMR
Egg protein and peanut Allergy
Identify:-
Anaphylaxsis
Intervene:-
1. Oxygen via mask
2. Inj Epinephrine 0.01mg/kg max 0.5mg(1in 10000)
3. Inj Diphenhydramine
4. Inj hydrocortisone
5. I v fluids

9.  2 year old male child known case of downs
syndrome with CHD
 Cough 3 days
 Fast breathing 3 days
 Fever 3 days
Initial Impression:-
Appearance :-lethargic, unresponsive
Breathing:- WOB increased
Circulation:- cyanosis and visible mottling

10.  Evaluate :-
Primary Assessment:-
Non Maintainable Airway
Increase rate and effort of breathing, spo2 low
circulation status- tachy, BP low, PP feeble, Cold peripheries
Neurologically unresponsive to pain and pupils reactive
Secondary Assessment
on heart failure medication, Case of single ventricle.
Diagnostic:- Blood Gas Revealed Metabolic Acidosis, X ray, Routine
lAbs
 Identify :-
1.Hypotensive Shock, Cardiogenic,
2.Respiratory Failure:-Lung tissue disease super imposed infection
 Intervene:-
1. Air way was secured with intubation
2. Iv Fluids and inotropes started.
3. Ist Dose Of AntiBiotics.

11.  8 years old male child known case of Asthma
brought with complaints of
 Sudden onset cough since yesterday
 Breathing Difficulty
Initial Impression :-
Appearance :- Anxious, Alert, Responsive
Breathing:- work of breathing increased .
Circulation:- color Appears Normal.

12. 15 months old female brought with choking attack breathing difficulty after inhalation
of fus seed
Initial impression
Anxious , Increased WOB, Stable circulation
 Evaluate :-
Primary Assessment:-
Maintainable Airway, Audible stridor Increase rate and effort of breathing,
circulation status- tachy, BP, PP , peripheries
Neurologically responsive and alert and pupils reactive
Secondary Assessment
witnessed chocking spell, foreign body inhalation
Diagnostic:-X ray, Routine lAbs
 Identify :-
Foreign body inhalation
 Intervene:-
1. Back slaps and Chest Thrust
2. Foreign body retrieved by Bronchscopy

13.  Primary Assessment:-
Maintainable Airway
increase rate and effort of breathing
circulation status normal
Neurologically Anxious, Alert
 Secondary Assessment
know asthmatic
Salbutamol MDI
Identify:-
Asthma Acute excerbation
Intervene:-
1. Step wise Beta 2 agonist nebulization, Ipratropium
bromide nebulization
2. Iv steriods, Fluids
Reassesment:-

14.  Children account for only a small percentage
of pre-hospital emergency (2% to 10%)
 A mastery of basic emergency techniques
including clinical evaluation of the child,
establishment of venous access, airway
management, resuscitation, and drug dosing
is essential for the successful emergency
treatment of children.

15.  Aside from physical examination, the initial
evaluation includes an ECG, pulse oximetry, and non-
invasive manual measurement of blood pressure.
 Measurement of the vital signs should not delay any
urgent therapeutic interventions
● Is the child ill, or seriously ill?
● Are the airways obstructed? Is the child short of
breath?
● Is the skin unusually pale, mottled, or cyanotic?
● What is the child’s state of consciousness?
● Does the child make eye contact?
(Tables of age-specific normal values for the most
important parameters)

16.  Obtaining venous access in a child can be a
challenge, as well-nourished infants and
toddlers often have no visible peripheral
veins under the skin, even on a second look.
 Commonly used veni puncture sites are the
dorsum of the hand or foot, the medial
surface of the ankle, the forehead, and the
scalp. A distal vein should be punctured first
with a small venous catheter
 (“small is better than nothing”), preferably
26 Gauge.

17.  If no suitable veins can be localized, the next
option is a vein with a fixed anatomical
relationship.
 In the treatment of pediatric emergencies, it
is recommended that vascular access should
be obtained by the intraosseous route after a
maximum of three unsuccessful puncture
attempts or 90 to 120 seconds of trying.

18.  High position of the larynx
• Large tongue
• Infants and toddlers should be positioned
in minimal extension
 School age and preschool children are best
intubated with the aid of a straight Miller-
type laryngoscope.
 If intubation is unexpectedly difficult, revert
to mask ventilation to prevent hypoxia.

19.  Chest compression for ventilation
 – One rescuer: 30:2
 – Two rescuers: 15:2

20.  The child’s body weight can be estimated by
the formula, “body weight (kg) = 2 × age
(years) + 8.”
 The e-Table provides an overview dosages of
medications that are currently given in the
treatment of pediatric emergencies.

21.  Aside from trauma, most pediatric
emergencies can be categorized by their
main clinical manifestations as belonging to
one of four types:
 ● Respiratory distress
 ● Altered consciousness
 ● Seizure
 ● Shock.

22.  Respiratory emergencies in childhood are
characterized by two cardinal
manifestations, dyspnea and stridor.
 The triad of a barking, cough, hoarseness,
and inspiratory stridor characteristically
arises in a small child in the aftermath of an
upper respiratory infection.
 Epiglottitis is characterized by inspiratory
stridor, marked dysphagia, and high fever in
a very sick child,
 Treatment with steroids (systemic and
inhaled) and inhaled epinephrine leads to
rapid resolution of mucosal swelling

23.  Wheez bronchial asthma or bronchiolitis. Dyspnea
and obstruction dominate the clinical picture;
hypoxia and hypercapnia arise late in its course.
 Impending decompensation include silent obstruction
and neurological signs (agitation or somnolence).
 Oxygen administration and medical stabilization of
the patient with inhaled beta2-mimetics,
epinephrine, steroids.
 Similar therapeutic principles apply to bronchiolitis,
epinephrine is usually the most effective drug,
 An important differential diagnosis of either
inspiratory or expiratory stridor is foreign-body
aspiration.
 The actual aspiration event is seldom observed
clinical signs are coughing and/or shortness of
breath, in the absence of fever or a history of asthma

24.  Altered consciousness in children
1.Fever (sepsis, meningitis,
heatstroke),
2.Circulatory centralization (shock), and
3.Trauma.
4.Hypoglycemia,
insulin treatment for diabetes mellitus,
After a prolonged period without food
intake,
congenital metabolic disturbances.
5.Poisoning

25.  Most cases are of febrile seizures.
 Meningitis, traumatic brain injury, and severe
dehydration
 Rectal administration of diazepam (5 mg for
children weighing less than 15 kg, 10 mg for
children weighing more than 15 kg)
 Seizure does not stop within 5 minutes, rectal
diazepam should be repeated before lorazepam
is given intravenously
 Administration of antipyretic drugs (ibuprofen,
paracetamol) should not be forgotten in
practice.
 The dehydration that accompanies severe febrile
illnesses requires effective treatment.
 The new occurrence of a focal epileptic seizure
in a child calls for prompt diagnostic imaging.

26.  Trauma,burns, infection, gastroenteritis, and
anaphylactic reactions
 Most common type of shock in childhood is
hypovolemic shock—persistent fluid loss
Gastroenteritis
 Each 1% of dehydration corresponds to a fluid
loss of about 10 mL per kilogram of body
weight.
 Septic shock in children takes a variable
course. Hypodynamic, “cold” shock with
elevated peripheral resistance and a low
cardiac output is much more common than in
adults.

27.  Classifying the common non-traumatic
pediatric emergencies by four cardinal
manifestations: respiratory distress, altered
consciousness, seizure, and shock
Classifying these rare emergency situations
in this way helps assure that their treatment
will be goal-oriented and appropriate to the
special needs of sick children

28. THANKS