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Pediatric visits account for 20–25% of visits to emergency departments in the United States. Most of these encounters will occur in general emergency departments, which may have limited capabilities to care for the critically ill child.1,2 The priorities in the assessment and management of the pediatric patient are similar to those of the adult patient. The quoted ABCs of airway, breathing, and circulation still apply and are first and foremost in the evaluation of the young infant and child. There are certain anatomic, physiologic, developmental, and social considerations that are unique to this population and must be taken into account during the evaluation and treatment. This chapter will focus on the key differences in the treatment of the critically ill child. A complete discussion of the many procedures, as well as the presentation of every critical condition in pediatric patients, is well outside the scope of this text. See Table 51-1 for a list of medications used in pediatric resuscitation.
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Recognition of Respiratory Distress
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Compared with adults, infants and children have anatomic and physiologic characteristics that make them more susceptible to respiratory emergencies. During the first 6 months of life, they are obligate nose breathers, and their nasal passages can easily become occluded with a simple upper respiratory illness that will lead to obstruction. They have weak abdominal muscles and diaphragm, which tire easily during respiratory conditions. In addition, they have faster metabolic rates, which require a higher oxygen demand. This higher oxygen demand, coupled with a decreased functional residual capacity, makes them more vulnerable to decreases in their oxygen levels compared with those of adults.3 It is based on these differences that children tend to have higher respiratory rates, even at rest. One must be familiar with the normal vital signs according to the age (see Table 51-2). Associated fatigue or sweating while feeding and weight changes will prompt the examiner to think of congestive heart failure or hereditary conditions such ...