The care for critically ill children begins with early recognition, and aggressive resuscitation and stabilisation. Critically ill children present particular challenges, as there are many unique features, anatomically and physiologically, that differ significantly to adults.
Typically, sick children will present with an inability to drink, respiratory distress and altered consciousness. Although they have a great ability for compensation (e.g. increased heart rate, increased respiratory rate), they can also deteriorate very quickly.
A carefully performed clinical assessment, including observation, medical history and physical examination, will detect serious illness with a high sensitivity (90 percent)
Some of the most common Paediatric Emergencies are:
1. Respiratory Distress
Respiratory emergencies in childhood are characterised by three cardinal manifestations: dyspnoea, wheezing and stridor. The type of stridor can provide an important clue to the differential diagnosis. An obstruction in the extra-thoracic portion of the trachea causes inspiratory stridor, while an obstruction in its intrathoracic portion causes expiratory or combined stridor.
The most common cause of inspiratory stridor of sudden onset is croup which characteristically arises in a small child as a triad of a barking cough, hoarseness and inspiratory stridor in the aftermath of an upper respiratory infection. Treatment with steroids (systemic and inhaled) and inhaled epinephrine leads to rapid resolution of mucosal swelling.
High-grade obstruction of the smaller air-ways with expiratory stridor is usually an expression of bronchial asthma or bronchiolitis. An important differential diagnosis of either inspiratory or expiratory stridor is foreign body aspiration.
Wheeze, on the other hand, is an acute, high-pitched sound that results from air movement across partially blocked small airways. More commonly, wheezing tends to occur during exhalation and secondary to viral lower respiratory infections such as bronchiolitis. The most common cause of wheezing is asthma; however, in younger children, bronchiolitis or lower-airway foreign body aspiration should be considered.
2. Respiratory Shock
Shock results from an acute failure of circulatory function. Children, like adults, can go into shock as a result of a number of common conditions including trauma, burns, infection, gastroenteritis and anaphylactic reactions. If too much time elapses before shock is correctly diagnosed and effectively treated, the body’s compensatory mechanisms can fail, bringing the child into acute danger.
The cardiac output falls before arterial hypotension occurs. It follows that shock in a child must always be treated before the child becomes hypotensive. The most common type of shock in childhood is hypovolemic shock, caused, for example, by persistent fluid loss in diarrhoea. Septic shock in children takes a variable course. Hypo-dynamic, ‘cold’ shock with elevated peripheral resistance and a low cardiac output is much more common than in adults.
Therefore, counselling for parents is an important aspect to ensure care for critically ill children. Only a well-aware network of doctors, nurses and health workers can improve this situation in our country.
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