USMLE Guide: Pediatric Emergencies

Introduction

Pediatric emergencies refer to medical conditions in children that require immediate intervention to prevent further complications or even death. As a medical student preparing for the USMLE exam, it is crucial to have a strong understanding of common pediatric emergencies, their presentation, diagnosis, and initial management. This guide aims to provide you with a comprehensive overview of important pediatric emergencies to help you succeed in your exam and future medical practice.

Table of Contents

1. Respiratory Emergencies
2. Cardiovascular Emergencies
3. Neurologic Emergencies
4. Gastrointestinal Emergencies
5. Infectious Emergencies
6. Toxicologic Emergencies

Respiratory Emergencies

• Epiglottitis: A potentially life-threatening condition characterized by severe sore throat, dysphagia, high fever, drooling, and respiratory distress. Immediate management includes securing the airway and providing intravenous antibiotics.
• Croup: Common viral infection causing barking cough, stridor, and respiratory distress. Supportive care with humidified oxygen and nebulized epinephrine is the mainstay of treatment.
• Bronchiolitis: Often caused by respiratory syncytial virus (RSV) infection, bronchiolitis presents with wheezing, cough, and respiratory distress. Management includes supportive care, oxygen therapy, and nebulized bronchodilators if indicated.

Cardiovascular Emergencies

• Congenital Heart Disease (CHD): Various CHDs may present as emergencies, such as cyanotic spells in Tetralogy of Fallot or hypoplastic left heart syndrome. Prompt referral to a pediatric cardiologist is essential for further evaluation and management.
• Myocarditis: Inflammation of the heart muscle leading to congestive heart failure, arrhythmias, and cardiogenic shock. Management includes supportive care, diuretics, inotropes, and antiviral therapy if indicated.
• Kawasaki Disease: A systemic vasculitis primarily affecting children, presenting with fever, conjunctivitis, strawberry tongue, rash, and coronary artery aneurysms. Treatment involves intravenous immunoglobulin and aspirin.

Neurologic Emergencies

• Seizures: Children may experience febrile seizures or non-febrile seizures requiring immediate management with antiepileptic drugs and addressing the underlying cause.
• Meningitis: Bacterial or viral infection causing meningeal inflammation. Symptoms include fever, headache, neck stiffness, and altered mental status. Lumbar puncture for cerebrospinal fluid analysis and initiation of appropriate antibiotics are crucial.
• Head Trauma: Prompt evaluation and management of head trauma, including assessment of the Glasgow Coma Scale, imaging studies, and neurosurgical consultation if necessary.

Gastrointestinal Emergencies

• Intussusception: Telescoping of one part of the intestine into another, causing abdominal pain, currant jelly-like stools, and a palpable abdominal mass. Air enema or surgical intervention is necessary for reduction.
• Malrotation with Volvulus: Abnormal rotation of the intestines leading to obstruction and compromised blood supply. Surgical intervention is urgent to prevent bowel necrosis.
• Acute Appendicitis: Inflammation of the appendix requiring surgical removal. Clinical presentation includes periumbilical pain migrating to the right lower quadrant, fever, and leukocytosis.

Infectious Emergencies

• Sepsis: Systemic inflammatory response to infection, often caused by bacteria. Early recognition, initiation of broad-spectrum antibiotics, fluid resuscitation, and management of septic shock are vital.
• Pneumonia: Infection of the lungs presenting with fever, cough, tachypnea, and respiratory distress. Treatment includes appropriate antibiotics, oxygen therapy, and supportive care.
• Urinary Tract Infections (UTIs): Commonly caused by bacteria, UTIs may present with fever, dysuria, and abdominal pain. Early diagnosis and appropriate antibiotic therapy are crucial to prevent renal complications.

Toxicologic Emergencies

• Accidental Poisoning: Ingestion of