27 - Pediatric Emergencies

Question 1

Neonatal fever

Answer 1

• IF temp 100.4 (38) or higher and no focus of infection
• 1. History, VS, Physical (start with ABC’s— appearance, airway, breathing, circulation)
• 2. CBC, BC, UA, UC, LP
• 3. Admit to hospital if 28 days of age or younger
• 4. Antibiotics to cover E. Coli, Listeria, Group B strep—Ampicillin, Cefotaxime

Question 2

Fever in infant 29 days to 2 months

Answer 2

• 1. History, VS, Physical (ABC’s)
• 2. CBC, BC, UA, UC and maybe LP
• 3. If PMH is negative, lab studies normal and close follow up can be attained then discharge to home is acceptable
• Normal WBC 5-15,000
• Normal Bands

Question 3

Seizure

Answer 3

• History, VS, Physical (may be limited if unstable), AVPU
• Oxygen
• IV: obtain CBC, BC, Na, BUN, Cr, Ca, Mg, Phos, Bedside Glu,
• Give Benzodiazepine
• Reassess after any intervention or change in status

Question 4

Asthma

Answer 4

• History, VS, Physical (ABC’s)
• Oxygen as needed
• Albuterol for bronchospasm
• Steroids for inflammation
• Ensure Proper hydration
• Reassess after any intervention or change in status

Question 5

Laryngotracheobronchitis (Croup)

Answer 5

• Typically follows a few days of viral cold symptoms.
• Abrupt daytime onset of stridor think FB
• History, VS, Physical (ABC’s)
• If significant stridor: Nebulized Racemic Epinephrine, Dexamethasone
• Avoid separating from parents, keep calm (you and patient)
• If not responding consider other causes: Foreign Body, Bacterial Tracheitis, Epiglottitis
• Reassess after any intervention or change in status

Question 6

Dehydration

Answer 6

• History, VS, Physical (ABC’s)
• If stable may rehydrate orally
• If tachycardia, prolonged capillary refill, or decreased blood pressure consider IV bolus
• Bolus 20ml/kg of NS or LR
• Electrolytes are indicated for moderate to severe dehydration but does not change the initial bolus fluid
• Reassess after any bolus and give a second if still CV instability