Pediatric acute emergencies

Pediatric acute stems compress time: a seizing febrile toddler, a quiet toxic ingestion, or a drooling child who will not lie flat. Adult respiratory crisis algorithms live in Acute respiratory emergencies; this chapter owns the child-specific febrile seizure, poisoning, and upper-airway infection map.

Febrile seizures

A febrile seizure is a convulsion driven by a rapid temperature rise in a predisposed young child, usually lasting minutes. Your job during the event is mechanical safety — clear hard objects, ease to the side when able so saliva drains, time the seizure, give oxygen if ordered, and never force a tongue blade or pin the limbs. Afterward, assess breathing and color, then treat the fever and find the infection source as ordered.

1. Protect and time — do not restrain or pry the mouth open.
2. After the seizure: recovery position, antipyretic as ordered, evaluate the cause.
3. Prolonged or repeated seizures: escalate as status pathway.

Parent teaching is reassurance plus honesty: most simple febrile seizures do not mean epilepsy, but any first seizure and any atypical or prolonged event needs medical evaluation. Avoid aspirin in viral illness patterns (Reye risk) — that teaching also sits in Paediatric neurology. Ice-water immersion of a seizing or post-ictal child is a distractor that looks decisive and causes harm.

Poisoning and overdose

Children explore with their mouths. The first nursing moves are remove ongoing exposure, support ABCs, and get expert dosing advice — poison control or the ordered toxicology pathway — rather than inventing home remedies. Inducing vomiting is almost never the blind default on modern stems; corrosives and hydrocarbons can worsen injury if vomited.

Bring the container or a photo when possible. Activated charcoal and antidotes appear only when the stem and orders support them within the time window. Decontamination of skin/eyes with copious water for topical exposures is fair game when the stem describes splash injury.

Pediatric respiratory emergencies

Kids obstruct high in the airway more often than adults. Epiglottitis (bacterial inflammation of the epiglottis) presents toxic: high fever, drooling, muffled voice, tripoding, and refusal to lie flat because the airway is happier open and forward. Do not inspect with a tongue blade in the exam room — that can precipitate complete obstruction. Keep the child with the caregiver, allow preferred position, give oxygen gently if tolerated, and move toward controlled airway management with a team ready.

Foreign-body aspiration is sudden in a previously well toddler — cough, choke, asymmetric findings, or silent complete obstruction. Use age-appropriate BLS maneuvers; never blind finger sweeps that push the object deeper. Bronchiolitis and asthma patterns may appear as work-of-breathing stems — support oxygen, suction gently in infants as ordered, and escalate for apnea or exhaustion. Quieter breath sounds with fatigue is worsening, not improvement — the same trap as adult asthma.

• Keep parents present when it calms the child and does not block care.
• NPO when airway surgery or scope is likely.
• Stridor at rest and drooling both raise urgency — do not send home on vibes.

Priority map