General paediatrics emergencies

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1. General Paediatrics
1. Abdominal pain (general paediatrics)
2. Growth and nutritional concerns
3. Learning, developmental and behavioural difficulties
4. Neonatal and infant concerns
5. Respiratory concerns
6. Seizures
7. Urinary tract infections

General paediatrics for paediatric patients (aged 0 to 15 years)

Abdominal pain (general paediatrics)

• Acute, severe abdominal pain with any of the following features:
• Acute gastrointestinal bleeding
• Appendicitis
• Bowel obstruction (i.e. bilious vomiting, significant distention, lack of passage of flatus)
• Intussusception
• Irreducible hernia
• Peritonism
• Pregnancy complications, ectopic pregnancy or ovarian torsion
• Testicular torsion
• Dehydration, shock or suspected sepsis

Note: a child with diabetic ketoacidosis and pneumonia often presents with abdominal pain as their presenting symptom

Growth and nutritional concerns

• > 10% unexplained weight loss in the neonatal period
• Acute gastrointestinal bleeding (i.e. haematemesis, melena)
• Clinical rickets
• Concerns about child abuse or neglect
• Concerning features on physical examination including,
  but not limited to, malnutrition with features of medical instability as indicated by:
• Bradycardia, postural heart rate or blood pressure changes
• Hypoglycaemia
• Hyperglycaemia or diabetic ketoacidosis
• Jaundice
• Onset of vomiting and/or diarrhoea in the context of dehydration unable to be managed with oral hydration at home and/or electrolyte disturbances
• Severely deranged investigations (e.g. hypocalcaemia, hypophosphateaemia)
• Suspected pyloric stenosis

Learning, developmental and behavioural difficulties

• Acute, severe mental health symptoms, including psychosis, mania, deliberate self-harm and suicidal intent or plan
  Note: these symptoms require urgent review by a psychiatrist
• Aggressive behaviour with immediate threatening risk to others
  Note: these symptoms require urgent review by a psychiatrist
• Non-speaking with acute distress and unable to examine adequately for medical conditions causing pain (e.g. tooth abscess, bone infections or osteopaenic fractures)
• Signs of physical abuse (i.e. inflicted injury) or at imminent risk of harm
• Symptoms suggestive of serious underlying medical condition

Neonatal and infant concerns

• Acute medical or surgical concerns such as, but not limited to:
• Acute injury
• Acutely unsettled and inconsolable over a prolonged period
• Anaphylaxis
• Apnoeas, episodes of pallor, cyanosis, respiratory distress or stridor
• Bilious or projectile vomiting and/or haematemesis
• Hair tourniquet
• Hypoglycaemia
• Inguinal hernia that cannot be reduced
• Jaundice with dark urine and pale stool or bruising or poor weight gain
• New bulging fontanelle, acute increase in head circumference and/or suspected raised intracranial pressure
• Newly noted murmur with any of the following features:
• Poor feeding
• Post ductal (foot) oxygen saturation < 95%
• Slow weight gain
• Weak or absent femoral pulses
• Possible infantile spasms or other infantile seizures
  Note: this may be frequent brief episodes of head bobbing (with or without arm extension) in an infant < 12 months
• Respiratory signs (wheeze, recession or tachypnoea)
• Severe diarrhoea
• Signs of dehydration, abnormal tone and vital signs, and/or malnourishment with or without weight gain
• Sudden onset of change in neurological function
• Suspected intussusception
• Suspected neglect, harm or non-accidental injury, including oronasal bleeding Suspected sepsis and/or fever or hypothermia aged < 3 months
• Unconsolable over a prolonged period
• Weak cry or change in usual pitch of cry
• Weak or absent femoral pulses

Respiratory concerns

• Abscess or haematoma (e.g., peritonsillar, parapharyngeal, salivary, retropharyngeal)
• Acute airway obstruction (e.g. sudden voice change, drooling, stridor, odynophagia)
• Acute respiratory illness failing to respond to treatment
• Acute, severe asthma
• Acutely enlarging neck mass with airway symptoms
• Apnoea or cyanosis, with or without cough
• Frank haemoptysis
• Inhaled or ingested button battery
• Moderate to severe respiratory distress, unable to feed and/or apnoea
• Post-tonsillectomy haemorrhage
• Stridor with respiratory distress
• Suspected anaphylaxis
• Suspected bacterial epiglottitis (particularly if unimmunised)
• Suspected inhaled foreign body and/or history of choking with persistent cough, wheeze or recurrent pneumonia (particularly if aged between 6 months and 4 years)

Seizures

• Seizures with acute clinical concerns,
  as indicated by:
• Developmental, cognitive, psychiatric regression accompanying new onset, or ongoing epileptic seizures
• New onset of abnormalities on neurological examination (e.g. increasing head circumference centile, focal weakness, gait disturbance, papilloedema, diplopia)
• New onset of confusion or altered level of consciousness
• Significant change in seizure frequency, type or duration for established epilepsy
• Suspected infantile spasms (West syndrome)
  Note: may be frequent brief episodes of head bobbing (with or without arm extension in an infant aged < 1 year)
• Suspected raised intracranial pressure (e.g. bradycardia, hypertension, severe headache)
• Status epilepticus (i.e. seizure > 5 minutes in duration)

Urinary tract infections

• Aged < 6 months with suspected febrile urinary tract infection (UTI)
• Febrile UTI with underlying genitourinary abnormalities
• Possible sepsis or seriously unwell (e.g. persistent tachycardia and/or lethargy)
• UTI with any of the following features:
• Abdominal, flank or bladder mass
• Acutely raised creatinine
• Acute urinary retention
• Hypertension
• Frequent vomiting with consequent poor hydration and/or inability to tolerate oral antibiotics
• Immunocompromised
• Poor urine stream suggestive of obstruction