Child emergencies
General
Childhood emergencies present a particular medical challenge.
Last but not least, the reason is that the patients are often not yet able to speak and express their complaints, but the emergency situation requires urgent, quick action.
The most common emergencies in the Paediatrics are caused by road accidents Cranial brain injuries, Bleeding, and neurological sequelae.
Cloudiness and impaired consciousness can, in addition to an accident, also be caused by numerous metabolic diseases, such as Lack of sugar, decreased levels of sodium in the blood, infections, Seizure disorders, diabetic ketoacidosis, and bleeding.
It is important that every cloudiness and unconsciousness unite absolute emergency and must be treated immediately.
Initial measures
The first measure in child emergencies is always to secure vital functions, such as breathing and cardiovascular function.
It is important to check the breathing of an unconscious child. If the children are still breathing, they should be placed on their side in a stable position. If there is no more breathing, chest compressions should be started immediately. It is also important to alert the emergency services as soon as possible.
Read more on the subject at: resuscitation
As soon as the ambulance service arrives, questioning the parents should find out whether the unconsciousness or clouding occurred gradually or suddenly, occurred the first or repeatedly and was combined with nausea, dizziness or headache.
Symptoms
Most of the time, the symptoms will have subsided when you arrive at the clinic.
However, one should be careful about it Febrile seizures mostly repeat or even one epilepsy can result from this.
A large area of child emergencies represent disorders of the breathing in childhood.
A Asthma attack is due to dry breathing sounds (Wheezing, humming) caused by viruses Pseudo croup Inspiratory stridor seizure, dyspnoea, and barking cough caused by Haemophilus influenza B. Epiglottitis by Shortness of breath, Hotness and missing voice marked.
A cough that keeps coming back indicates that the airway has been blocked by a foreign body.
A sudden, acute shortness of breath with wheezing and pulling for an acute obstruction of the airway by a foreign body that must always be removed by bronchoscopy.
In consequence of diarrhea, reduced amount of drink and profuse sweating It can lead to dehydration symptoms with dry mucous membranes and standing skin folds as well as confusion and coma come.
An urgent need to restore the fluid balance is imperative here.
Various emergency situations in the child
Emergencies in children are diverse and require different measures to alleviate or prevent the situation from deteriorating. Some of these situations are explained below.
Unconsciousness in children
Childhood emergencies due to unconsciousness or fainting belong to the disorders of consciousness in the sense of a decrease in consciousness. In this situation, the child is limited in his reactions and in his information processing. The extent of such a decrease in consciousness ranges from simple drowsiness to drowsiness (Somnolence) to a coma.
It is important to find out what is causing the unconsciousness. Essential mechanisms that lead to unconsciousness in childhood are an insufficient blood supply, a lack of oxygen or nutrients in the brain, toxic effects or disorders in the brain itself. The causes of these mechanisms can in turn be very different. Loss of consciousness can be caused, for example, by a serious fall on the head (traumatic brain injury).
Inflammatory or infectious processes in the brain, such as meningitis in children (meningitis) can also lead to unconsciousness if the course is severe and if therapy is not initiated. In the case of diabetes in childhood (type 1 diabetes mellitus), unconsciousness can also occur as part of a derailment or due to too much insulin supply from outside, with subsequent hypoglycaemia.
In any case, if the child is unconscious, they should be brought into the stable side position (roll on their side, with their mouth pointing towards the floor and head tilted backwards) and the emergency services should be informed. If there is no breathing activity, resuscitation must be started immediately. For children from the age of 1, 5 ventilations should initially be given. Thereafter, compression of the chest and ventilation is started in a ratio of 30: 2, or 15: 2 for children. This must be continued until the rescue service is replaced or the child wakes up.
Read more on the subject at: Resuscitation in the infant
Febrile convulsions in the child
A febrile seizure is a seizure that occurs as part of a febrile infection. Most febrile seizures occur when the temperature rises and are independent of the actual temperature. Therefore, antipyretic agents cannot prevent febrile seizures. Up to 4% of all children have a febrile seizure. Febrile seizures are very worrying and impressive for the parents, but in most cases they are not an emergency situation. Most febrile seizures are therefore uncomplicated attacks that are harmless.
However, there are also complicated febrile seizures with focal Course (i.e. only one area of the brain is affected), lasting more than 15 minutes, repeating within a day or at an atypical age (under 6 months of age or over 5 years of age). The complicated febrile seizures always require further diagnostic work-up in order to identify a possible serious cause, e.g. meningitis, to rule out. A lumbar puncture with examination of the nerve water is usually necessary for this. With every complicated febrile seizure and every first febrile seizure, a measurement of the brain waves (EEG) is initiated in order to clarify possible causes.
If a febrile seizure occurs, you should initially remain calm and lay the child so that it cannot be injured. Holding the child or protecting the teeth or tongue should be avoided as a matter of urgency. The cramp usually ends on its own. However, if the seizure has lasted more than 5 minutes, the parents can give a diazepam suppository. In the event of persistent, uninterrupted seizures, it is essential to inform the emergency services.
Read more on the subject at: Febrile seizure
Child hypothermia
The optimal body temperature, which keeps all metabolic processes in the body running, is between 36 and 37 ° C. With strong external exposure to cold e.g. Freezing outside temperatures or moisture from damp clothing can lead to a drop in body temperature. Children are particularly at risk if they stay in the water for a long time. Despite these adverse conditions, the body can maintain the temperature for a long time through various mechanisms. The children then start to tremble, for example. However, the possibilities of compensation are often quickly exhausted in children and hypothermia with a body temperature below 35 ° C occurs.
Severe hypothermia is an emergency situation, and not just for children. Depending on the temperature, hypothermia can be divided into different degrees of severity with corresponding symptoms. At first the children are cold, have bluish lips and the heart beats faster. Below 34 ° C, the children become increasingly sleepy, the heart beats too slowly and the muscles become rigid. Coma-like conditions occur below 30 ° C body temperature. There is also a risk of hypothermia when cardiac arrhythmias occur. In the event of hypothermia, the child should be warmed up again as soon as possible.
Read more on the subject at: Hypothermia
Difficulty breathing in children
An acute shortness of breath in children is a child's emergency. There are many possible causes. An attack-like breathlessness during physical education or in the case of known allergies can be an indication of an acute asthma attack. If the child does not have an emergency spray and cannot be reassured, the emergency services should be informed. The asthma attack is a cause of acute shortness of breath that can be easily remedied and rarely turns into a difficult-to-interrupt state.
The most common cause of sudden shortness of breath in small children is when small parts of toys or nuts are accidentally inhaled (Foreign body aspiration). Depending on the position within the airways, the shortness of breath is correspondingly severe. The child can be supported by strong blows on the back when coughing out. Toddlers can also be placed upside down on their laps with heavy patting on the back. If the inhaled piece sticks, an ambulance should be alerted again.
Slender and tall boys in puberty are primarily at risk for so-called spontaneous pneumothorax, a pathological accumulation of air in the chest. It is characterized by sudden shortness of breath and pain when breathing. Breath-dependent pain when breathing and shortness of breath can, however, also indicate a pulmonary embolism. The typical risk group is mainly pubescent girls who take the pill and smoke or are overweight at the same time.
Read more on the subject at: Difficulty breathing in children
Burns in children
Burns in children refer to damage to the tissue due to the effects of enormous heat. Depending on the depth of the damaged skin layers, burns are divided into four degrees.
- Grade 1: here the pain, redness and swelling are in the foreground, as we know it from a sunburn
- Grade 2a: is also associated with pain and shows blistering of the skin
- Grade 2b: from here on the pain fibers are also damaged so that hardly any pain is complained about. Healing takes place here with scarring.
- Grade 3: is due to tissue death (necrosis) marked
- Grade 4: Here, deeper layers with muscles or bones can be damaged
Read more on the subject at: Degrees of combustion
The extent of the burn is also determined by means of the affected body surface. The weighting is different depending on the age between infants, toddlers and children from the age of 9. For example, infants have a large head compared to the rest of the body, so that the head takes up a larger part of the body surface and is more difficult to assess in burns than in adults. Death by burns is to be expected in children with an affected body surface of 60-80%. Serious complications occur with an involvement of 10%.
In an emergency situation, the burned clothing must first be removed and the affected areas cooled with water. In the case of larger burns, it must not be cooled because of the risk of cooling down. In the event of severe burns, the emergency services must be informed immediately.
Read more on the subject at: Burns in children
Allergy / allergic shock in the child
Anaphylactic shock is an allergic emergency in childhood. This represents the strongest form of hypersensitivity reaction of the immune system and is potentially life-threatening. Bee and wasp venom, food such as nuts, eggs or seafood, as well as allergens from the air such as pollen, house dust, mold or animal dander are possible triggers.
Of course, an allergic reaction only occurs if the child actually has an allergy to the triggers described, which are usually harmless. Upon first contact with the allergen, the body forms antibodies (antibody) in the context of raising awareness. Upon renewed contact with the same allergen, the antibodies formed trigger the typical allergic reaction, which can culminate in an anaphylactic shock. This is due to a severe loss of fluid in the child.
Therefore, in an emergency situation, the child should be placed in the so-called shock position, i.e. lying on their back with slightly raised legs, and the emergency services should be called. Children who have already experienced this always carry an allergy emergency kit with them. This contains an antiallergic (H1 antihistamine), cortisone and an adrenaline pen, which is injected into the thigh in an emergency.
Read more on the subject at: Allergies in children
Poisoning in children
For Childhood poisoning come a plethora of substances like Plants, medicines or chemicals in the household in question. If the child accidentally swallowed something, you should initially remain calm. If the child shows no acute symptoms, it is recommended Consultation with the poison control center (different phone numbers depending on the state). Here you can get information 24 hours a day as to whether the substance or amount swallowed is dangerous, which measures should be taken and whether a presentation to the child's emergency room is necessary.
There is a corresponding one for many types of poisoning Antidote or very simple symptomatic measures, such as plenty of fluids. In children, for example, hydrogen cyanide poisoning is more common Consumption of bitter almonds in front. Five to 10 almonds are enough for children. This allows Headache and shortness of breath in children arise. The rescue service must then be informed immediately. Small children who put everything in their mouths can also lie on the floor Swallowed cigarette butts become. This is often harmless. When eating a whole cigarette, symptoms of nicotine poisoning were accompanied by vomiting and rapid heartbeat.Here, the pediatrician can administer activated charcoal as a countermeasure.
therapy
Both scalds (only the top layer of skin is affected) as well as combustion (deeper layers of the skin are affected) are a common disease in emergency therapy for children.
The therapeutic measures of choice here are:
- cooling
- Removal of hot clothing
- sterile covering of the wounds
- Hydration
- Pain relief
Children who fall in water must be treated immediately if they suspect drowning. Airways blocked by water can lead to an oxygen deficiency and excessive cooling of the body can lead to hypothermic syndromes.
Drowning accidents are often fatal or the children suffer neurological damage.
Allergic reaction can be triggered by all sorts of substances introduced into the body and are usually caused by reddening of the skin, shortness of breath, facial swelling and even coma Cardiac arrest noticeable.
The children need intensive medical care immediately and with cortisone, H1 / H2 blockers and possibly adrenaline be treated.
Also one sepsis, by Meningococci can be triggered is an urgent treatment indication.
In many cases this disease, which is characterized by bleeding in the skin, fever and expresses unconsciousness, even with fatal treatment.
Children who have gotten to their parents' medicine or household cupboard often experience symptoms of poisoning, such as stomach pain, Vomit, a headache and Impaired consciousness taken to the hospital.
Here the treatment depends on which substance has been consumed and how much time has passed since then.
Medicines that have recently been taken can pass through induced vomiting be promoted to the outside world.
Corrosive substances or substances that have remained in the body for a long time should be taken with coal trying to bind.
Foaming agents should not be vomited under any circumstances.
Children who have been admitted to the hospital with symptoms of intoxication must be monitored in an emergency until symptoms can no longer be detected.
In extreme cases, the blood wash provides through the dialysis the only treatment option.
