Pediatrics
Pediatric Emergencies: Procedures and Special Situations
Paediatric emergency procedures for NEET-PG: hypothermia, basic life support, child abuse reporting, breaking bad news and consent, mapped to NMC PE27 codes.
MedNext Academy | 3 min read
Pediatric Emergencies: Procedures and Special Situations
Paediatric emergency procedures for NEET-PG: hypothermia, basic life support, child abuse reporting, breaking bad news and consent, mapped to NMC PE27 codes.
This chapter covers paediatric emergency procedures and the ethical and organisational special situations around them: hypothermia and the warm chain, basic life support, recognition and reporting of child abuse, breaking bad news, informed consent and emergency teamwork. It blends procedural skill with medicolegal duty.
High-yield: Pediatric Emergencies: Procedures and Special Situations
- Neonatal hypothermia is an axillary temperature below 36.5 degrees Celsius, with moderate hypothermia 32.0 to 35.9 degrees and severe hypothermia below 32.0 degrees Celsius.
- A cold baby or severely malnourished child may be septic or hypoglycaemic even without fever, so always check glucose and infection in hypothermia.
- The warm chain is a warm room, immediate drying, skin-to-skin care, breastfeeding, delayed bath, warm clothing, warm procedures and warm transport.
- Skin-to-skin care is a structured intervention with bare chest to bare chest contact, an upright position, visible airway, cap and socks, and ongoing temperature monitoring.
- Paediatric basic life support quality means 100 to 120 compressions per minute, one-third chest depth, full recoil, 30:2 for a single rescuer, 15:2 for two trained rescuers, and early AED use.
- Do not spend more than 10 seconds checking for a pulse, because pulse checks are unreliable and delay worsens survival.
- Begin chest compressions if an infant or child has no pulse, or a heart rate below 60 per minute with poor perfusion despite effective ventilation.
- In suspected child abuse, suspicion is enough to report and proof is not required from the treating paediatrician; document facts, treat injuries and protect the child.
- A bruise in a non-mobile infant is a sentinel injury until proven otherwise, and abuse is suspected from a pattern rather than one sign alone.
- Never promise secrecy in abuse; the correct promise is privacy shared only with people who need to help keep the child safe.
- Do not remove hope when cure is impossible; redefine it honestly toward comfort, dignity, time with family and relief of suffering.
- Valid paediatric consent requires the correct guardian, adequate information, understanding, voluntariness and documentation, and emergency necessity allows lifesaving treatment when delay would seriously harm the child.
- Do not delay airway rescue, haemorrhage control, seizure treatment, dextrose for hypoglycaemia or shock resuscitation solely because a guardian is not immediately available.
- Emergency teamwork uses named roles, an announced weight, read-back drug orders, visible documentation and clear handover, and unlabelled or unchecked doses are never given.
- Do not place a newborn on a cold metal surface or under a fan, because even short exposure causes clinically important heat loss.
BLS and thermal anchors
- **Compression quality:** 100 to 120 per minute, one-third chest depth, full recoil, with early AED use.
- **Rescuer ratios:** 30:2 for a single rescuer and 15:2 for two trained rescuers.
- **Neonatal hypothermia:** Below 36.5 degrees Celsius; severe below 32.0 degrees Celsius.
- **Pulse check limit:** No more than 10 seconds; start compressions if heart rate stays below 60 with poor perfusion.
NMC competencies in this chapter
- **PE27.24:** Hypothermia: Definition, Features, Complications and Management
- **PE27.28:** Basic Life Support for Children on a Manikin
- **PE27.29:** Child Abuse: Causes, Presentation and Medico-Legal Implications
- **PE27.32:** Counselling Parents of a Dangerously Ill or Terminally Ill Child
- **PE27.33:** Obtain Informed Consent in Pediatric Emergencies
Frequently Asked Questions
What are the quality targets for paediatric basic life support?
Compressions should be 100 to 120 per minute at one-third chest depth with full recoil, using 30:2 for a single rescuer and 15:2 for two trained rescuers, with early AED use and pulse checks limited to 10 seconds.
How is neonatal hypothermia classified?
It is an axillary temperature below 36.5 degrees Celsius, with cold stress at 36.0 to 36.4 degrees, moderate hypothermia at 32.0 to 35.9 degrees and severe hypothermia below 32.0 degrees Celsius. Always check glucose and infection in a cold baby.
What should a doctor promise a child disclosing abuse?
Never promise secrecy. The correct promise is to keep the information as private as possible and share it only with those who need to help keep the child safe. Suspicion is enough to report, and proof is not required.
Can lifesaving treatment proceed without a guardian present?
Yes. Emergency necessity allows lifesaving treatment when delay would seriously harm the child. Airway rescue, haemorrhage control, seizure treatment, dextrose and shock resuscitation must not be delayed for paperwork, with the guardian informed as soon as possible.
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