Paediatric Emergency Guide

Overview – Paediatric Emergency Guide

The paediatric emergency guide outlines the critical differences in anatomy, physiology, and clinical response when managing acutely unwell neonates, infants, and children. Paediatric patients require age-appropriate assessments, drug doses, and resuscitation strategies. Early recognition of airway, breathing, or circulatory compromise is vital for timely, life-saving interventions.

Definition

  • Neonate: Birth to 4 weeks
  • Infant: 4 weeks to 1 year
  • Child: 1 year to adolescence

Weight Estimation

Weight is central to:

Estimation Methods

  • Broselow Tape: Colour-coded by height/weight zones
  • Formula:
    • Weight (kg) = 2 × (Age + 4)
  • Experience-based guessing (least accurate)

Limitations

  • Access to Broselow tape not universal
  • Stress may impair accurate recall or calculation
  • Estimates may not account for malnutrition or obesity
  • Cultural variability in average body size
PAEDIATRIC CONSIDERATIONS IN AN EMERGENCY SETTING

Airway Differences in Children

  • Head: Larger and floppier
  • Neck: Shorter
  • Nose: Obligatory nasal breathers → prefer nasal oxygen
  • Teeth: Easily dislodged
  • Tongue: Proportionally large
  • Tonsils: Frequently inflamed and obstructive
  • Epiglottis: Long and floppy – must be lifted during intubation
  • Larynx: More anterior
  • Cricoid ring: Narrowest part of airway (important MCQ point)
  • Trachea: Short → Avoid deep instrumentation

Breathing Differences in Children

  • Smaller respiratory surface area
  • Flat diaphragm limits tidal volume
  • In hypoxia, they increase respiratory rate – not volume
    • → Tachypnoea is an early warning sign
    • → Always provide supplemental oxygen

Circulatory Differences in Children

  • Higher circulating volume per kg
  • Lower stroke volume → must increase heart rate to maintain cardiac output
    • CO = Stroke Volume × Heart Rate
    • Tachycardia = clue to hypovolaemia
    • Treat with fluid boluses (10 mL/kg)

Primary Paediatric Assessment (ABC)

  • Observe from a distance first
  • Remain calm, use parental support
  • Prioritise airway (A) before breathing (B) before circulation (C)
    • Always give oxygen before attempting IV access

Airway

  • Assess speech → patent airway
  • Observe chest movement
  • Listen for breath sounds
  • Feel for air movement

Breathing

  • RR decreases by ~10 every 2 years until age 8
  • Look for:
    • Recession
    • Use of accessory muscles
    • Abnormal rate
    • Stridor, grunting, nasal flaring
    • Oxygen saturations
    • Mental state and skin colour
Primary Paediatric Assessment

Circulation

  • HR decreases ~20 bpm every 2 years
  • BP less useful in young children
  • Clinical signs of dehydration:
    • Tachycardia
    • Dry mucosa
    • ↓ Urine output
  • If in doubt: Give fluid bolus (10 mL/kg)
Primary Paediatric Assessment

Secondary Paediatric Assessment

  • Focused history and examination
  • Bedside glucose
  • Continuous monitoring
  • Trust parental concerns
  • Assess interaction, behaviour, play
  • Be gentle, respectful, and observant

Paediatric Radiology Pearls

  • Ribs are more horizontal
  • Large thymus → widened mediastinum
  • Gas bubble under diaphragm more common
  • Right ventricle is proportionally larger → different silhouette
Paediatric Radiology

Paediatric ECG Features

  • Right heart dominance in infancy
  • Higher heart rates
  • T-wave inversion is often normal in early childhood

Summary – Paediatric Emergency Guide

This paediatric emergency guide provides a concise, clinically oriented approach to managing neonates, infants, and children in acute settings. It highlights anatomical and physiological differences, assessment priorities, and safe intervention strategies. For a broader context, see our Emergency Medicine Overview page.

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