Contents -- Preface -- Acknowledgements -- UNCRC standards -- Life-threatening emergencies -- Essential knowledge -- Fluid management -- Normal fluid requirements -- Electrolyte contents of body fluids -- Normal water, electrolyte, energy and protein requirements (provided excessive loss is not present) -- Essential drug doses -- Disability -- Normal values for paediatric vital signs in patients who are not crying -- Triage -- Seeing the sickest first: triage -- Emergency signs, assessment and treatment (adapted from WHO) -- Resuscitation at birth -- Drugs: IV, UVC -- Paediatric life support -- Drug therapy -- Epinephrine (adrenaline) -- Sodium bicarbonate -- Recognition of the sick child -- Primary assessment of airway -- Primary assessment of breathing -- Effort of breathing -- Exceptions -- Efficacy of breathing -- Effects of respiratory failure on other physiology -- Primary assessment of the circulation -- Circulatory status -- Effects of circulatory inadequacy on other organs/physiology -- Primary assessment of disability -- Neurological function -- Respiratory effects -- Circulatory effects -- The shocked child -- Key features from a focused history -- Specific examination of cardiovascular status -- Heart rate -- Pulse volume -- Capillary refill -- Blood pressure -- Treatment of shock -- The unconscious child -- Coma -- Focused history -- Examination -- Airway and breathing - look, listen, feel -- Circulation - HR, capillary refill time (CRT), BP -- Neurological disability - AVPU, pupils, lateralising signs and posturing, followed by specific coma score assessment and full neurological examination -- Further focused examination to identify cause -- Further detailed neurological evaluation -- Investigations -- Management -- Immediate (ABC) -- Treat RICP (see below for more details) -- Intermediate.

Presenting features of raised intracranial pressure (RICP) -- Infants and young children -- Older children -- Features of a supratentorial mass lesion -- Management -- Emergency and temporary relief of RICP -- Allergic reactions and anaphylactic shock -- Management ABC -- Reassess ABC and continue 100% oxygen -- Status epilepticus -- During a seizure -- Investigations -- Management -- Poisoning -- Symptoms and signs -- Management of poisoning -- Questions to be asked -- Commonly ingested drugs -- Local medicines in disadvantaged countries -- Iron -- Paracetamol -- Alcohol -- Benzodiazepines -- Salicylates -- Tricyclic antidepressants -- Poisonous household and natural products -- Bleach: 3-6% sodium hypochlorite -- Corrosive agents -- Petroleum compounds such as kerosene, turpentine, and petrol -- Organophosphorus compounds -- Lead poisoning -- Carbon monoxide poisoning -- Neonatal emergencies -- Fluid and electrolyte balance in the ill neonate -- Water requirements -- Electrolyte requirements -- Hypoglycaemia in the neonate -- Hypoglycaemia in the ill neonate -- When to test -- Management -- Infants at risk but appearing well: -- Infants with symptomatic hypoglycaemia, or unable to feed, or who failed correction of glucose levels with enteral feeding -- Treatment of hypocalcaemia in the neonate -- Jaundice in the ill neonate -- Jaundice in the neonate -- "Physiological jaundice" -- Pathological jaundice -- Investigation of jaundice -- Treatment -- Respiratory problems in the neonate -- Evaluate work, effectiveness, and adequacy of breathing -- Causes of early < 12 hours respiratory distress -- Principles of treatment -- Causes of neonatal apnoea -- Neonatal infections -- Maternal risk factors for early onset sepsis -- Laboratory tests -- Management -- Meningitis -- Presenting features -- Investigations -- Treatment -- Necrotising enterocolitis.

Neonatal seizures -- Differential diagnosis -- Investigations -- Treatment -- Neonatal Hypoxic Ischaemic Encephalopathy (HIE) -- Treatment -- Specific emergencies -- Respiratory and cardiovascular -- Upper airway problems -- Emergency treatment of croup -- Acute epiglottitis -- Management -- Contrasting features of croup and epiglottitis -- Acute asthma -- For moderate asthma -- Severe or life-threatening asthma -- Features include -- Management -- Heart failure -- Management -- Endocarditis prophylaxis -- Management of acute rheumatic fever -- Features suggesting cause of central cyanosis in an infant -- The hyperoxia test -- Features that help to distinguish the three types of cyanotic heart defect -- Gastrointestinal/liver/renal -- Acute gastroenteritis -- Management -- Fluid deficit -- Mild dehydration (3-5% fluid deficit) -- Moderate dehydration (6-9% fluid deficit) -- Severe dehydration ( =10% fluid deficit, shock) -- Hypernatraemia (Na >150 mmol/L) -- Hyponatraemia (Na <130 mmol/L) -- Hypokalaemia (K <3 mmol/L) -- Replacement of ongoing fluid losses -- Severe malnutrition -- Principles of treatment -- General points -- Dehydration with severe malnutrition -- Children with watery diarrhoea in an adequate clinical state: -- Children with watery diarrhoea in a poor clinical state: -- Emergency treatment of severe dehydration by IV infusion -- Electrolyte problems in severe malnutrition -- Infection in severe malnutrition -- No specific infection and no suspected septic shock -- Septic shock: emergency treatment -- If circulatory collapse -- Hypothermia: prevention and treatment -- Prevention -- Emergency treatment -- Hypoglycaemia: prevention and treatment -- Prevention -- Emergency treatment -- Congestive heart failure (see page 70) -- Usually caused by -- Signs -- Emergency treatment -- Measles: prevention and treatment in severe malnutrition.

Micro-nutrient deficiencies in severe malnutrition -- Vitamin A deficiency: prevention and treatment -- Routine preventive treatment -- Treatment of xerophthalmia or measles -- Iron deficiency and anaemia treatment -- Emergency treatment of very severe anaemia -- Intestinal parasites -- Dermatosis of kwashiokor -- Continuing diarrhoea -- Osmotic diarrhoea -- Malaria: treatment and prevention -- Tuberculosis -- Dietary treatment in phase 1 -- Principles -- Home made phase 1 diet -- Acute liver failure -- Grades of hepatic encephalopathy -- Acute renal failure (ARF) -- Prerenal (shock induced) -- Treatment -- Established ARF -- Management of persistent ARF -- Hyperkalaemia -- Neurological -- Bacterial meningitis -- Typical findings in CSF -- Supportive care -- Endocrine and metabolic -- Diabetic ketoacidosis (DKA) -- Emergency management of children > 5% dehydrated and clinically unwell -- Assess and record -- Management -- Cerebral oedema in DKA -- Signs and symptoms -- Management -- Adrenal crisis -- Diagnosis -- Management -- Hypoglycaemia -- Treatment of hypoglycaemia -- Hypokalaemia -- Treatment of severe hypokalaemia -- Infectious diseases -- Diphtheria -- Antitoxin -- Desensitisation -- Meningococcal disease -- Dengue haemorrhagic shock -- Tetanus -- Typhoid fever -- Treatment -- Measles -- Clinical features -- Clinical features of severe measles -- Management -- Rabies -- Risk of exposure to rabies -- Post-exposure treatment (very urgent) -- Postexposure treatment for previously vaccinated patients -- Malaria -- Clinical features -- Diagnosis -- Severe malaria -- Cerebral malaria -- Investigations -- Management of severe malaria -- First line - quinine IV -- Second line antimalarials -- Always check local guidelines on drug sensitivities -- Helminth infections - "worms" -- Adult worms in intestine.

Illness due to "larvae" rather than adult worms -- Investigation for migrating larvae -- Treatment -- Environmental emergencies -- Envenoming -- Snakebite -- Local effects -- Systemic effects -- First aid -- Diagnosis and initial assessment (think of envenoming in unusual cases) -- Antivenom -- Other therapy -- Scorpion stings -- Clinical features -- Management -- Spider bites -- Widow spiders (Latrodectus spp.) -- Recluse spiders (Loxosceles spp.) -- Banana spiders (Phoneutria spp.) -- Marine envenoming: venomous fish -- Jellyfish -- Near drowning -- Problems which may be present -- Assessment and resuscitation -- Hyper- and hypothermia -- Heat stroke -- Clinical signs -- Treatment -- Hypothermia in infants -- Trauma and surgical -- Acute abdomen -- Appendicitis -- Clinical presentation -- Intussusception -- Clinical presentation -- Intestinal obstruction -- Clinical presentation -- Treatment -- Life-threatening trauma -- Airway with cervical spine control -- Signs of airway obstruction: -- If still obstructed: orotracheal intubation under direct vision with manual in-line stabilisation of the cervical spine -- Confirmation of correct placement of the tube -- Breathing - assessment of adequacy of respiration -- Circulatory assessment -- Disability -- Exposure -- Secondary survey -- Management of spinal cord injuries (SCI) -- Emergency treatment of traumatic amputation -- Gunshot wounds -- Initial measures -- Wound excision -- Management of burns -- First aid - cold water -- ABC -- Intravenous fluids -- Enteral fluids -- Dressings -- Procedures and equipment -- AIRWAY -- Intubation -- Aids to intubation -- Predicting difficulty -- Procedure -- Position -- Oxygenate child -- Recognise glottis -- Confirm correct placement -- Secure tube -- Emergency surgical airway -- Needle cricothyroidotomy (sterile technique) -- Important notes.

Surgical cricothyroidotomy.