Pediatrics
Pediatric Emergencies: Emergency and Priority Signs
Paediatric emergency triage for NEET-PG: emergency and priority signs, bag-mask ventilation, shock and convulsion doses under ETAT and F-IMNCI, mapped to NMC PE27 codes.
MedNext Academy | 3 min read
Clinically reviewed by Dr Shameer Deen, MBBS, MS, MRCS
Pediatric Emergencies: Emergency and Priority Signs
Paediatric emergency triage for NEET-PG: emergency and priority signs, bag-mask ventilation, shock and convulsion doses under ETAT and F-IMNCI, mapped to NMC PE27 codes.
This chapter operationalises paediatric emergency triage: distinguishing emergency, priority and non-urgent signs, and performing the specific ABCD interventions of airway positioning, oxygen delivery, assisted ventilation, shock recognition, fluid boluses and convulsion control. It follows the ETAT and F-IMNCI sequence.
High-yield: Pediatric Emergencies: Emergency and Priority Signs
- Emergency signs need immediate treatment, priority signs need rapid assessment without queue delay, and non-urgent means no emergency or priority sign at that moment, not safe forever.
- Sequential assessment is a doorway look, then ABCD emergency signs with immediate treatment, then priority signs only if no emergency sign is present.
- Emergency signs are ABCD threats: airway or breathing failure, circulation failure, coma or convulsion, and severe dehydration in a child with diarrhoea.
- Look at the tongue for central cyanosis, the lower chest wall for indrawing, and the whole child for exhaustion, feeding difficulty and altered mental status.
- Infants need a neutral or slightly extended airway position, not adult-style hyperextension, because a large occiput flexes the neck when the infant lies flat.
- For assisted ventilation, use an EC clamp, open the airway, attach oxygen, deliver one breath over about 1 second with visible chest rise, then reassess heart rate and air leak.
- Oxygen device flows are prescribed: simple masks need at least 5 L/min and non-rebreather masks need 10 to 15 L/min with an inflated reservoir.
- Capillary refill is measured in a warm environment by pressing for 5 seconds and counting the time to colour return, and more than 3 seconds is abnormal in ETAT-style triage.
- The shock fluid is isotonic crystalloid such as normal saline or Ringer lactate at 20 mL/kg where appropriate, with reassessment after every bolus.
- Repeated boluses without checking crepitations, hepatomegaly, worsening distress or perfusion can kill a child with cardiogenic shock, dengue recovery or severe malnutrition.
- Convulsion doses to know are diazepam 0.3 mg/kg intravenous, diazepam 0.5 mg/kg per rectum and midazolam 0.2 mg/kg buccal, always with airway and glucose management.
- Convulsive status epilepticus is treated at 5 minutes, and after two adequate benzodiazepine doses further benzodiazepines without escalation cause respiratory depression.
- F-IMNCI severe dehydration is diarrhoea plus two or more of lethargy or unconsciousness, sunken eyes, drinking poorly or being unable to drink, and a very slow skin pinch.
- In a crashing child, about two quick intravenous attempts or 90 seconds is enough before moving to intraosseous access rather than repeatedly traumatising the child.
- A quiet, exhausted child with poor air entry may be closer to respiratory arrest than a noisy child with strong effort, so improvement means better air entry and mental status.
Convulsion and dehydration anchors
- Diazepam doses: 0.3 mg/kg intravenous or 0.5 mg/kg per rectum; midazolam 0.2 mg/kg buccal.
- Shock bolus: Isotonic crystalloid 20 mL/kg where appropriate, reassessing after each bolus.
- Capillary refill: Press for 5 seconds in a warm setting; more than 3 seconds is abnormal.
- F-IMNCI severe dehydration: Diarrhoea plus two or more of lethargy, sunken eyes, drinks poorly, very slow skin pinch.
NMC competencies in this chapter
- PE27.12: Emergency Signs and Priority Signs
- PE27.18: Assisted Ventilation by Bag and Mask
- PE27.19: Signs of Shock: Pulse, Blood Pressure and Capillary Refill Time
- PE27.21: Fluid Type and Fluid Requirement in Shock
- PE27.22: Consciousness, Convulsions and Coma: Positioning and Diazepam
- PE27.23: Assess for Signs of Severe Dehydration
Frequently Asked Questions
How do emergency, priority and non-urgent signs differ?
Emergency signs need immediate treatment, priority signs need rapid assessment without queue delay, and non-urgent means no emergency or priority sign is present right now. Non-urgent children still need reassessment and caregiver warning signs.
What convulsion drug doses should be known?
Diazepam is 0.3 mg/kg intravenous or 0.5 mg/kg per rectum, and midazolam is 0.2 mg/kg buccal. Airway and glucose are always managed alongside, and status is treated at 5 minutes.
How is capillary refill assessed correctly?
Press for 5 seconds in a warm environment, release, and count the time to colour return. A refill time of more than 3 seconds is abnormal in ETAT-style triage and points to circulatory compromise.
Why is a quiet child sometimes more worrying than a noisy one?
A quiet, exhausted child with poor air entry may be closer to respiratory arrest than a noisy child with strong effort. Genuine improvement means better air entry and mental status, not simply less noise.
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