Pediatric emergencies in the Outpatient Setting

Clinic, Clinic A/P, Peds

Pediatric Emergencies in the Clinic Setting

  • Respiratory emergencies,
  • Seizures, infections (especially in young infants), and
  • Shock/dehydration are reported most often, and
  • Serious traumatic injuries have also been noted.

In a survey of 1000 randomly selected, nonhospital-based pediatricians, the percentage of pediatricians who had encountered children with the following conditions in the office setting in the previous year was as follows:

  • Meningitis: 71 percent
  • Severe asthma: 66 percent
  • Severe hypovolemia: 58 percent
  • Ongoing seizure activity: 45 percent
  • Head trauma: 40 percent
  • Anaphylaxis: 14 percent
  • Cardiopulmonary arrest: 8 percent

Dr. Gill’s help:

“The key thing in the office is assessing the patient so that you don’t miss anything.” Dr. Jeff Gill, Peds.

To the list above, add:

  • New Onset Leukemia in a pediatric patient – Send to the ED to prevent tumor lysis syndrome
  • Suicidal ideation
  • Bronchiolitis
  • Severe Croup
  • Foreign Body Aspiration

What is included in the following table is from discussion with Dr. Gill, verify as part of creating handouts.

*Dr. Gill has not had to intubate in his own clinic but did that during residency.

Bronchiolitis Suction + saline
Severe Croup Shot of Dexamethasone + airway management and transfer
Shock First aid: Lie down to perfuse the brain. Elevate the legs (Trendelenburg); Blood Sugar
Severe Asthma Oxygen; Albuterol treatments; Steroids; Manage airway; Assess for shock and hypovolemia. Call Ambulance/911 per clinic protocol.
Give Epinephrine shot: Give epinephrine shot to asthmatics who are not moving air. Some of these patients are so broncho-constricted that they giving a breathing treatment wouldn’t really go in. In such cases, give epinephrine first. You may use an Epi-pen, however, they are so expensive. Epinephrine from a vial given with a needle in the clinic works just as well and is very inexpensive. Not everybody needs epinephrine, only those with severe constriction that they are not moving air.
 Status Epilepticus First Aid: ABC; Secure airway; lie on side / sit upright/lean forward if vomiting; Oxygen; suction in case they vomit. Treatment vs. transfer?
Most likely try to transfer without treatment per Dr. Gill.
Tx will be benzos (Ativan); Dilantin (Phenytoin). Look into this.
 Anaphylaxis E.g. from something we do to them like vaccines. Patients are supposed to wait and be observed for about 30 mins (verify) after vaccines or as recommended by the manufacturer on the cover of the vaccine. Ask MA’s in our clinic if we are doing that.
DKA can show up as respiratory problems Check BS when:
Heavy breathing + Normal breath sounds; could be Kussmaul
Heavy breathing + No breath sounds.
 Mengingitis Young: Usually look sick and toxic, send to ED for r/o sepsis
Older kids: Purpura, stiff neck, etc. > Urgent Transfer. Staff that worked with patient may need to be treated. Check.

 

Capillary refill (Per Dr. Gill – Verify)
≤2 seconds = Normal
3 seconds = Maybe normal.
4 seconds and up (i.e. >3 seconds ) = shock

 

Ped Emergencies, password protected

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