Pediatrics
Pediatric Emergencies: Assessment and Resuscitation
Paediatric emergency assessment for NEET-PG: cardiorespiratory arrest, shock, status epilepticus, poisoning and ETAT triage, mapped to NMC PE27 codes.
MedNext Academy | 3 min read
Pediatric Emergencies: Assessment and Resuscitation
Paediatric emergency assessment for NEET-PG: cardiorespiratory arrest, shock, status epilepticus, poisoning and ETAT triage, mapped to NMC PE27 codes.
This chapter covers the assessment and resuscitation of the critically ill child, from the pathways of preventable under-five mortality through cardiorespiratory arrest, respiratory distress, shock, status epilepticus, the unconscious child and poisoning. It builds the ETAT ABCD triage framework and oxygen-delivery choices.
High-yield: Pediatric Emergencies: Assessment and Resuscitation
- Most preventable under-five deaths occur through common pathways of hypoxaemia, dehydration, sepsis, hypoglycaemia, hypothermia and delayed transport, which are teachable and treatable.
- The two most common correctable causes of paediatric arrest are hypoxia and hypovolaemia, and the arrest drug to memorise is adrenaline 0.01 mg/kg intravenous or intraosseous.
- Adrenaline in cardiac arrest is repeated every 3 to 5 minutes during cardiopulmonary resuscitation.
- In children, bradycardia with poor perfusion is often a pre-arrest rhythm from hypoxia, so ventilate first and start compressions if the heart rate stays below 60 per minute despite oxygenation.
- Children decompensate early because oxygen consumption is high, functional residual capacity is low and the small airway radius means little oedema causes a large rise in resistance.
- The initial isotonic crystalloid bolus is 20 mL/kg with reassessment, and repeated unexamined boluses are dangerous in dengue, myocarditis, renal failure, severe malnutrition and pulmonary oedema.
- In status epilepticus, give a benzodiazepine promptly, a second dose if still convulsing after 5 minutes, then load a second-line drug, avoiding repeated benzodiazepines that cause respiratory depression.
- Check glucose in every unconscious child, and treat first with oxygen, airway support, dextrose if low, an anticonvulsant if seizing and antibiotics if sepsis or meningitis is possible.
- In poisoning, do not induce vomiting, and activated charcoal is time-sensitive and contraindicated when the airway is unprotected or the substance is caustic, hydrocarbon or metal.
- Blood pressure is a late sign of shock in children, whereas tachycardia, pulse volume, capillary refill, mental status and urine output identify shock earlier.
- Oxygen corrects hypoxaemia but not ventilation failure, so a drowsy child with shallow breathing may need bag-mask ventilation even while oxygen is flowing.
- Nasal prongs are low-flow comfortable devices, non-rebreather masks are high-concentration rescue devices, and bag-mask ventilation is for inadequate breathing, not merely low saturation.
- The longer a seizure continues, the more receptors internalise and the less it responds to benzodiazepines, so status epilepticus is treated by the clock, not by hope.
- The ETAT assessment structure is ABCD: airway, breathing, circulation with coma and convulsion, and dehydration, and emergency signs go straight to the treatment area.
- Triage is neither diagnosis nor registration; it is a safety decision about how fast a child must be seen and what lifesaving treatment must start immediately.
Resuscitation anchors
- **Adrenaline in arrest:** 0.01 mg/kg intravenous or intraosseous, repeated every 3 to 5 minutes during CPR.
- **Fluid bolus:** 20 mL/kg isotonic crystalloid, then reassess; cautious in dengue, myocarditis and malnutrition.
- **Bradycardia in children:** Ventilate first; start compressions if heart rate stays below 60 per minute with poor perfusion.
- **ETAT structure:** ABCD: airway, breathing, circulation with coma and convulsion, and dehydration.
NMC competencies in this chapter
- **PE27.2:** Cardiorespiratory Arrest in Children
- **PE27.4:** Clinical Approach and Management of Respiratory Distress in Children
- **PE27.5:** Shock in Children
- **PE27.6:** Status Epilepticus
- **PE27.8:** Poisoning in Children
- **PE27.11:** Need and Process of Triage of Sick Children
Frequently Asked Questions
What is the adrenaline dose in paediatric cardiac arrest?
Adrenaline is given at 0.01 mg/kg intravenously or intraosseously, repeated every 3 to 5 minutes during cardiopulmonary resuscitation. The most common correctable causes of arrest are hypoxia and hypovolaemia.
How is paediatric shock recognised early?
Blood pressure is a late sign in children. Tachycardia, pulse volume, capillary refill, mental status and urine output identify shock earlier, and an initial 20 mL/kg isotonic bolus is given with careful reassessment.
Why treat status epilepticus by the clock?
The longer a seizure continues, the more receptors internalise, making it less responsive to benzodiazepines. A benzodiazepine is given promptly, a second dose after 5 minutes if needed, then a second-line drug, avoiding repeated benzodiazepines.
What is the ETAT ABCD structure?
It stands for airway, breathing, circulation with coma and convulsion, and dehydration. Emergency signs identified in this sequence go straight to the treatment area rather than waiting in the queue.
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