Pediatric Emergencies
Children explore the world with their mouths — and sometimes, that curiosity lands them in the emergency room. From household cleaners to grandma’s pills, accidental poisoning remains a major preventable cause of childhood morbidity and mortality.
🧠 Why It Happens
Children's Vulnerability
Children are naturally:
- Curious: they love to taste, smell, and touch.
- Active: they move fast and reach unexpected places.
- Unaware: they can’t distinguish between medicine and candy.
Most cases occur in children aged 1–5 years, often at home, during unsupervised moments.
🧴 Common Poisons and Their Sources
| Category | Examples | Common Sources |
|---|---|---|
| Medications | Paracetamol, iron, antihypertensives, benzodiazepines, oral hypoglycemics | Medicine cabinets, relatives’ handbags |
| Household agents | Kerosene, bleach, detergents, disinfectants | Kitchen, bathroom |
| Agricultural chemicals | Organophosphates, herbicides | Farms, storage sheds |
| Food/plant toxins | Cassava (cyanide), poisonous berries, mushrooms | Local foods, gardens |
| Gases | Carbon monoxide | Faulty generators, closed garages |
💡 Remember: “Kerosene kills kids quietly.” It’s one of the most common and deadly poisons in developing countries.
⚠️ Recognition of Poisoning
Suspicion and Signs
Always suspect poisoning when a child:
- Suddenly becomes drowsy, confused, or unresponsive
- Vomits repeatedly without a clear cause
- Has unusual breath odor (kerosene, alcohol, garlic in organophosphate)
- Develops pinpoint or dilated pupils
- Has respiratory depression or seizures
Look for empty bottles, chemical stains, or unusual smells nearby.
🚨 Initial Management: The “ABC” Rule
| Step | Action | Details |
|---|---|---|
| A – Airway | Ensure patency | Remove obstructions; intubate if needed |
| B – Breathing | Give oxygen | Support ventilation if shallow or irregular |
| C – Circulation | IV fluids for hypotension |
➡️ Stabilization always comes before decontamination.
🧴 Decontamination Techniques
| Method | When Used | Avoid When |
|---|---|---|
| Activated charcoal (1 g/kg PO or via NG tube) | Within 1 hour of ingestion; for most drugs and chemicals | If ingestion of corrosives, hydrocarbons, or if airway unprotected |
| Gastric lavage | Within 1 hour, if life-threatening ingestion | If ingestion of acids, alkalis, kerosene |
| Skin decontamination | For dermal exposure | Avoid excessive rubbing |
| Remove clothes | For dermal/gaseous toxins | Prevents ongoing absorption |
💡 Never induce vomiting (e.g., with salt water or syrup of ipecac). It can worsen damage, especially with corrosives or hydrocarbons.
💊 Specific Antidotes (High-Yield Table)
| Toxin | Antidote / Treatment | Key Notes |
|---|---|---|
| Paracetamol | N-acetylcysteine (NAC) | Start within 8–10 hrs; prevents liver failure |
| Organophosphates | Atropine + Pralidoxime | Watch for bronchorrhea, miosis, bradycardia |
| Iron | Deferoxamine | Red urine (“vin rose” color) |
| Opiates | Naloxone | Rapid reversal of respiratory depression |
| Benzodiazepines | Flumazenil | Use cautiously; may induce seizures |
| Methemoglobinemia (e.g., nitrites) | Methylene blue | Restores Hb function |
| Hydrofluoric acid | Calcium gluconate gel | Neutralizes fluoride ions |
🩺 Supportive Care
Essential Support
- Monitor vital signs, urine output, and neurological status.
- Maintain hydration and electrolyte balance.
- Treat seizures with IV diazepam or midazolam.
- Correct hypoglycemia with 10% dextrose.
- Manage arrhythmias if present (especially with tricyclic antidepressants).
🧴 Special Note on Kerosene Poisoning
Very common in Africa and Asia — often mistaken for water or juice.
Presentation:
- Cough, vomiting, respiratory distress (from aspiration).
- Drowsiness, fever (secondary chemical pneumonitis).
Management:
- No gastric lavage (risk of aspiration).
- Supportive care only — oxygen, fluids, antibiotics if secondary infection.
- Observe for 24–48 hours for respiratory complications.
🧠 Mnemonic for Approach to Poisoning — “ABC F E”
- A – Assess the poison and exposure time
- B – Breathing
- C – Circulation
- F – Formulate treatment (specific + supportive)
- E – Educate caregivers for prevention
🧬 Prevention — Because It’s Always Better
Safety Measures
- Keep all medicines and chemicals out of reach (locked cupboards).
- Avoid transferring kerosene or chemicals into drink bottles.
- Use child-resistant containers.
- Educate caregivers, especially in rural areas.
- Strengthen community awareness campaigns.
💭 Key Takeaways
- Airway first, antidote second.
- Never induce vomiting in suspected kerosene or corrosive ingestion.
- Activated charcoal within 1 hour can save lives in many poisonings.
- Always look around — the scene gives clues (smells, bottles, stains).
- Prevention is the ultimate cure — lock it, label it, and lift it high.