Paeds emergency

The febrile, breathless, dehydrated or limping child in paeds ER.

• Sepsis in childrenA child with sepsis can look well until they suddenly collapse. Recognise it early, get access, give antibiotics within the hour, give fluid in 10 mL/kg steps with reassessment, and call senior help.
• The febrile childMost feverish children have a simple viral illness. Your job is to find the few with serious infection, using the traffic light signs, the age, and a urine test, and to treat the child, not the number.
• Fever in a well-looking childAssess from the doorway, use the traffic light, test the urine, and give parents clear advice on when to come back.
• Diarrhoea and dehydration in childrenWeigh the child, grade the dehydration, follow WHO Plan A, B or C, give ORS and zinc, keep feeding, and use antibiotics only for bloody diarrhoea or cholera.
• BronchiolitisA viral chest infection of babies. Supportive care only: oxygen if low, feeding support, gentle nasal suction. No salbutamol, steroids or antibiotics. Watch for apnoea and tiring.
• CroupBarking cough and stridor in a young child after a cold. Keep the child calm, give oral dexamethasone to every child, and nebulised adrenaline for stridor at rest. Think of epiglottitis, a foreign body and diphtheria.
• Rashes in childrenSort the urgency, ask seven questions, describe what you see, and always look in the mouth.
• The limping childFever and won't bear weight is septic arthritis until proven otherwise. Always examine the hip when a child has knee pain.
• Pulled elbowA toddler pulled by the hand who won't use the arm. No swelling? Reduce with hyperpronation; no X-ray needed.
• ChickenpoxUsually mild. Paracetamol, not ibuprofen. Watch for skin infection and pneumonia, and protect high-risk contacts.