Chapter 89: Emergencies in children

INTRODUCTION

Important serious emergencies in children include:

• trauma, especially head injuries and intra-abdominal injuries

• painful conditions

• swallowed foreign bodies (FB)

• respiratory problems:

  • – bronchial asthma

  • – epiglottitis

  • – croup

  • – inhaled FB

  • – acute bronchiolitis

• severe gastroenteritis

• septicaemia (e.g. meningococcal septicaemia)

• myocarditis

• immersion

• poisoning

• bites and stings

• seizures

• febrile convulsions

• sudden infant death syndrome (SIDS) and apparent life-threatening episode (ALTE)

• child abuse:

  • – emotional

  • – physical

  • – sexual

  • – neglect

  • – potential

• psychogenic disturbances

• anxiety/hyperventilation

• suicide/parasuicide

SURVEY BY AGE GROUP

The author’s study analysed emergencies into three groups:¹ preschool (0–5 years), primary school (6–12), adolescence (13–17).

The commonest emergency calls in the 0–5 years group were poisoning, accidents and violence, dyspnoea, fever/rigors, convulsions, abdominal pain, earache, vomiting.

In the 6–12 years age group: accidents and violence, dyspnoea, abdominal pain, vomiting, acute allergy, bites and stings, earache.

In the 13–17 years age group: accidents and violence, abdominal pain, psychogenic disorders, acute allergy, bites and stings, epistaxis.

THE SIGNS AND SYMPTOMS OF A SERIOUS ILLNESS

The busy GP will see many sick children in a day’s work, especially in the winter months with the epidemic of URTIs. It is vital to be able to recognise the very sick child who requires special attention, including admission to hospital. It is unlikely that the commonplace robust, lustily crying, hot, red-faced child is seriously ill but the pale, quiet, whimpering child spells danger. These rules are particularly helpful in the assessment of babies under six months of age.^2,3 The presence of a fever in itself is not necessarily an indication of serious illness but rather that the baby has an infection.²

A Melbourne study⁴ of the sensitivity of clinical signs in detecting serious illness in infants identified five key signs or markers:

If sepsis suspected, investigate with:

• blood culture

• FBE/ESR/CRP

• lumbar puncture

• urine culture

• chest X-ray

Serious infectious illnesses to consider include:

• Haemophilus influenzae type B ...