ObjectiveKey components in the assessment of a child in the emergency department (ED) are their heart and respiratory rates. In order to interpret these signs, practitioners must know what is normal for a particular age. The aim of this paper is to develop age-specific centiles for these parameters and to compare centiles with the previously published work of Fleming and Bonafide, and the Advanced Paediatric Life Support (APLS) reference ranges.DesignA retrospective cross-sectional study.SettingThe ED of the Children's Hospital at Westmead, Australia.PatientsAfebrile, Triage Category 5 (low priority) patients aged 0–15 years attending the ED.InterventionsCentiles were developed using quantile regression analysis, with cubic B-splines to model the centiles.Main outcome measuresCentile charts were compared with previous studies by concurrently plotting the estimates.Results668 616 records were retrieved for ED attendances from 1995 to 2011, and 111 696 heart and respiratory rates were extracted for inclusion in the analysis. Graphical comparison demonstrates that with heart rate, our 50th centile agrees with the results of Bonafide, is considerably higher than the Fleming centiles and fits well between the APLS reference ranges. With respiratory rate, our 50th centile was considerably lower than the comparison centiles in infants, becomes higher with increasing age and crosses the lower APLS range in infants and upper range in teenagers.ConclusionsClinicians should consider adopting these centiles when assessing acutely unwell children. APLS should review their normal values for respiratory rate in infants and teenagers.

During standardised paediatric simulations multiple incidents of suboptimal care have been identified and multiple causation factors attributed to these. Educators should use this information to adapt current training programs to encompass these factors.

High-quality, published CDRs exist for head CT use after paediatric head injury. Physician-reported CT triggers differ from CDR-recommended triggers. The major published head injury CDRs should be prospectively validated in the Australasian setting before incorporating them into local practice and CPGs.

Intubation of children outside of the operating room is performed infrequently and is often associated with life‐threatening adverse events. This review aims to clarify the contributors to adverse events encountered during intubations outside of the operating room and provide preventative strategies. The primary contributors to adverse events during non‐operating room intubations are physiologically and situationally difficult airways; anatomically difficult airways are rare. Systems‐based changes, including a shared mental model, standardization in equipment and its location, checklist use, physiological resuscitation prior to resuscitation, dose titration of induction agent, multi‐disciplinary team training in the technical and nontechnical aspects of non‐operating room intubation, debrief post–real and simulated events, and regular audit of performance all reduce life‐threatening intubation‐related adverse events in children. Intubation of children outside of the operating room may be performed safely through engagement of all critical care specialties, shared learning, and focus on patient‐centered care delivery.

The cover image is based on the Original Article Emergency intubation of children outside of the operating room by Elliot Long, Francis D Lockie, Michael Barrett et al., https://doi.org/10.1111/pan.13784.