Prehospital Academy Lesson 40.7
Other Pediatric Emergencies Part 1 of 2
This lesson covers a range of pediatric emergencies beyond the cardiovascular, neurological, and respiratory systems. EMTs must be prepared to identify and manage these diverse conditions, which often require unique considerations due to the anatomical and physiological differences in children.
Gastrointestinal Emergencies
Gastrointestinal issues are common in pediatric patients and can range from benign to life-threatening.
Biliary Atresia: A rare congenital condition where the bile ducts are malformed, preventing bile excretion. This leads to liver damage and eventually liver failure.
Prehospital role: Recognize the signs of severe liver dysfunction and transport to a facility capable of managing complex pediatric conditions.
Massive GI Bleeds: Can lead to rapid hypovolemic shock in children.
Signs: Hematemesis (bloody vomit), melena (black, tarry stools), hematochezia (bright red blood in stool), signs of shock (tachycardia, pallor, poor perfusion).
Management: Ensure airway, breathing, circulation. Obtain IV access if possible (for advanced providers) and administer fluid boluses (20 mL/kg isotonic crystalloids). Rapid transport.
Viral Gastroenteritis: Common infection causing nausea, vomiting, and diarrhea. Leads to dehydration.
Signs: Vomiting, diarrhea, poor oral intake, lethargy, sunken fontanelle (infants), dry mucous membranes, decreased urine output.
Management: Assess hydration status. If signs of dehydration, administer oral rehydration solutions if tolerated, or IV fluids for severe dehydration (per protocol). Supportive care.
Appendicitis: Inflammation of the appendix. Can lead to peritonitis and shock if untreated.
Signs: Periumbilical pain migrating to the right lower quadrant, fever, nausea, vomiting, guarding, rebound tenderness (though not always reliable in children).
Management: Transport immediately to emergency department. Monitor for signs of shock.
Ingestion of Foreign Bodies: Common in young children. Can lead to airway obstruction or gastrointestinal issues.
Signs: Gagging, choking, difficulty swallowing, vomiting, drooling (esophageal obstruction).
Management: If airway obstructed, perform age-appropriate foreign body removal maneuvers. If no airway compromise, keep child calm and transport to facility for removal.
Diabetic Emergencies
Children with diabetes can experience both hyperglycemia and hypoglycemia.
Hypoglycemia (Low Blood Sugar): A critical emergency that can rapidly lead to neurological damage.
Signs: Altered mental status, irritability, confusion, seizure, diaphoresis, tachycardia.
Management: If conscious and able to swallow, administer oral glucose. If unconscious or unable to swallow, administer IV dextrose (D10 for children, per protocol; avoid D50 in young children).
Diabetic Ketoacidosis (DKA) (High Blood Sugar): Occurs due to severe insulin deficiency.
Signs: Polydipsia (increased thirst), polyuria (increased urination), polyphagia (increased hunger), Kussmaul respirations (deep, rapid breathing), fruity breath odor, altered mental status, dehydration.
Management: Airway, breathing, circulation support. Administer fluids cautiously. Rapid transport.
Allergic Reactions and Anaphylaxis
Children can have severe allergic reactions to food, insect stings, medications, or other allergens.
Anaphylaxis: A severe, life-threatening allergic reaction.
Signs: Urticaria (hives), angioedema (swelling, especially of face/airway), respiratory distress (wheezing, stridor), hypotension, gastrointestinal symptoms.
Management: Remove allergen if possible. Maintain airway. Administer epinephrine (IM, age/weight-appropriate dose). Supplemental oxygen. Antihistamines and corticosteroids (per protocol/ALS). Rapid transport.
Critical Thinking Questions
You are called for an 18-month-old infant with sudden onset of severe abdominal pain, drawing their knees to their chest, and passing currant-jelly stools. What serious gastrointestinal emergency might you suspect, and what is your priority?
A 5-year-old child with a history of Type 1 Diabetes is found unresponsive, pale, and diaphoretic. What is the most likely cause, and what immediate intervention should you consider if within your scope of practice?
A child has ingested a small button battery. What are the potential immediate and long-term dangers, and what is your transport recommendation?
You encounter a child experiencing a severe allergic reaction with widespread hives, wheezing, and hypotension. What is the single most important medication to administer, and why is prompt administration critical?
Discuss the importance of recognizing the subtle signs of dehydration in infants and young children, and how it differs from assessing dehydration in adults.