Paediatric emergencies

Abstract

SummaryThe care of sick children can be challenging for the anaesthetist who is only involved in the occasional care of paediatric patients. This paper outlines the care of medical and surgical paediatric emergencies for which an anaesthetist working at a district general hospital or equivalent may encounter. Conditions discussed include paediatric respiratory emergencies, sepsis, status epilepticus, the acute abdomen in the newborn, intussusception, the bleeding tonsil, trauma and the child with burns.

Pediatric Anesthesia Management for Post-Tonsillectomy Bleed: Current Status and Future Directions

“…The literature on anesthesia management of posttonsillectomy hemorrhage is relatively sparse. Aside from short papers or sections in manuscripts on otolaryngologic emergencies [10][11][12][13]18 and a single center study from 1973, 14 only three recent papers have examined PTH and anesthesia. In particular, an anesthesiology education article on simulation training 15 and two single center retrospective studies have focused on the anesthetic management of PTH patients.…”

“…Endotracheal tubes of varying sizes to accommodate airway edema and two suction systems should be available in cases of heavy bleeding in case one suction catheter becomes obstructed with blood clot. 10 While inhalation induction in the lateral decubitus position has been described, 13,14,18 contemporary practice of pediatric anesthesia usually endorses intravenous induction. We will first explore the choice of classical (apneic) rapid sequence induction and intubation (RSII) versus controlled RSII with gentle bag-mask ventilation.…”

“…Endotracheal tubes of varying sizes to accommodate airway edema and two suction systems should be available in cases of heavy bleeding in case one suction catheter becomes obstructed with blood clot. 10 …”

Classical versus controlled rapid sequence induction and intubation in children with bleeding tonsils (a retrospective audit)

“…Anaesthesia for children with surgical revision of bleeding tonsils is one of the most challenging situations in paediatric anaesthesia. In these situations, a classical rapid sequence induction using muscle paralysis with succinylcholine, cricoid pressure and apnoea until the airway has been secured by a tracheal tube is the most common approach . There has so far been only one published retrospective study reporting on 575 anaesthetic managements in children scheduled for surgical revision of bleeding tonsils .…”

The evolving roles of the anaesthetist during emergency medical care

“…To end, after expert guidance on the latest in paediatric, vascular and medical emergency management [7][8][9][10], Wong and Irwin demonstrate just how much fun they must be at parties with their fascinating insight into the world of acute toxicology [11].…”