Pediatrics

Special Considerations in Pediatric Emergency Medicine

  • Anatomical and Physiological Differences
    • Children differ from adults:
    • Anatomical: Proportionately larger heads.
    • Physiological: Higher metabolic rate, larger surface area to body volume ratio.
    • Emotional Responses: Varied reactions to illness and injury.

Glasgow Coma Scale Modifications for Infants

  • Verbal Response:
    • Happy, coos = 5
    • Irritable crying, consolable = 4
    • Cries to pain, weak cry = 3
    • Moans to pain = 2
    • None = 1
  • Motor Response:
    • Spontaneous movement = 6
    • Withdraws to touch = 5
    • Withdraws to pain = 4
    • Abnormal flexion = 3
    • Abnormal extension = 2
    • None = 1
  • Eye Opening:
    • Spontaneous = 4
    • To speech = 3
    • To pain = 2
    • None = 1

Pediatric Vital Signs

  • Normal Ranges (PALS 2020):
    • Infant:
    • Heart Rate: 100-180 bpm
    • Respiratory Rate: 30-53 bpm
    • Systolic BP: 70
    • Toddler:
    • Heart Rate: 98-140 bpm
    • Respiratory Rate: 22-37 bpm
    • Systolic BP: 70 + (age in yrs x 2)
    • Preschooler:
    • Heart Rate: 80-120 bpm
    • Respiratory Rate: 20-28 bpm
    • Systolic BP: 70 + (age in yrs x 2)
    • School Age:
    • Heart Rate: 75-118 bpm
    • Respiratory Rate: 18-25 bpm
    • Systolic BP: 70 + (age in yrs x 2)
    • Adolescent:
    • Heart Rate: 60-100 bpm
    • Respiratory Rate: 12-20 bpm
    • Systolic BP: >90
  • Important Considerations:
    • High pulse rates may not be as concerning as low pulse rates.
    • Caution with blood pressure readings in children under 3.

Respiratory Emergencies in Pediatrics

  • Signs of Respiratory Failure:
    • Irritability or anxiety → lethargy
    • Tachypnea → bradypnea
    • Retractions → agonal respirations
    • Poor muscle tone
    • Tachycardia → bradycardia
    • Central cyanosis
  • Common Respiratory Emergencies:
    • Upper Airway: Croup, Epiglottitis, Foreign body aspiration.
    • Lower Airway: Asthma, Bronchiolitis, Pneumonia.

Specific Respiratory Emergencies

  • Croup:
    • Viral infection, hallmark sign is stridor, characterized by a “barking seal” cough.
  • Epiglottitis:
    • Bacterial infection causing rapid onset inflammation, manage quickly.

Cardiovascular Emergencies

  • Pediatric Assessment Triangle (PAT):
    • Appearance
    • Work of Breathing
    • Circulation to Skin

Shock in Pediatrics

  • Compensated Shock:
    • Body compensates via increased heart and respiration rates.
  • Decompensated Shock:
    • Body unable to maintain perfusion, late sign is hypotension.

Toxicology Emergencies

  • Common Ingested Poisons:
    • Household cleaners, medications, plants, toiletries.
  • Management:
    • Decontamination, possibly activated charcoal (1-2 g/kg).

Burns in Pediatrics

  • Rule of Nines must be adjusted for children.
  • Burn Severity by Area:
    • Head and neck: 9%
    • Each upper extremity: 9%
    • Each lower extremity: 18%
    • Anterior and posterior trunk: 18% each
    • External genitalia: 1%

Sudden Infant Death Syndrome (SIDS)

  • Leading cause of unexplained death in infants 1 month to 1 year old.
  • Risk Factors:
    • Male gender, preterm birth, safe sleep practices not followed.

Child Maltreatment and Neglect

  • Forms: Physical, sexual, emotional abuse, and neglect.
  • Signs: Bruises in unusual locations, malnutrition.
  • Assessment: Trust your instincts, gather careful documentation, suspect maltreatment in case of unusual injuries.