2nd Edition
of
Principles of Pediatric and
Neonatal Emergencies
Editors
HPS Sachdev
Division of Clinical Epidemiology,
Department of Pediatrics
Maulana Azad Medical College
New Delhi-110 002 and
Visiting Professor
University of Southampton, UK
Arvind Bagga
Additional Professor and
Incharge
Division of Pediatric Nephrology
All India Institute of Medical Sciences
New Delhi-110 029
Siddarth Ramji
Professor and
Head of Neonatology
Department of Pediatrics
Maulana Azad Medical College
New Delhi-110 002
Panna Choudhury
Consultant Pediatrician
Department of Pediatrics
Maulana Azad Medical College and
Associated Lok Nayak Hospital
New Delhi-110 002
Krishan Chugh
Head of Pulmonology and
Pediatric Intensive Care Unit
Department of Pediatrics
Sir Ganga Ram Hospital
New Delhi-110 060
Ramesh K Puri
Senior Consultant in Pediatrics and
Teenage Health
Indraprastha Apollo Hospital
New Delhi-110 044
Section I
Organization of Emergency Department 1. Approach to a Patient in the Emergency Department 3 Krishan Chugh
2. Ethical and Legal Issues in Emergency Care 8 Krishan Chugh
3. Organization of Pediatric Emergency Services 13 Krishan Chugh
Section II
Resuscitation and Life-threatening Emergencies 4. Emergency Airway Management and Cardiopulmonary Resuscitation 23 S Krishnan
5. Oxygen Therapy 42 Soonu Udani
6. Shock 46 Sunit Singhi
7. Respiratory Failure 63 Praveen Khilnani
8. Anaphylaxis 70 Anil Sachdev, Arun Soni
Section III
Pediatric Medical Emergencies
9. Acute Asthma 77 GR Sethi
10. Stridor 93 Meenu Singh, Lata Kumar
11. Lower Respiratory Tract Infection 102 D Vijayasekaran
12. Congestive Heart Failure 108 Anita Khalil, Jitender Nagpal
13. Cardiac Arrhythmias 116 Anita Khalil, Jyotsna K Vaswani
14. Hypertensive Emergencies 129 Pankaj Hari
15. Acute Renal Failure 133 Arvind Bagga, Mukta Mantan
16. Fluid and Electrolyte Disturbances 141 Rakesh Lodha, Arvind Bagga
17. Acid-base Disturbances 154 Rakesh Lodha, UC Mouli Natchu, Arvind Bagga
18. Hematuria 163 Sanjeev Gulati
19. Acute Seizure 167 Tarun Dua, Piyush Gupta
20. Approach to a Comatose Patient 175 Suchitra Ranjit
21. Intracranial Hypertension 181 Pratibha Singhi
22. Acute Paralysis 191 RK Sabharwal
23. Acute Bacterial Meningitis 203 S Aneja, Anju Agarwal
24. Encephalitis 215 Sheffali Gulati
25. Acute Diarrhea and Dehydration 227 AK Patwari
26. Hepatic Failure and Encephalopathy 236 Neelam Mohan
27. Upper Gastrointestinal Bleeding 245 Narendra K Arora, Prashant Mathur, Anjali Ahuja, Anita Patwari
28. Hematological Emergencies 257 VP Choudhry, M Mahapatra, R Kashyap
29. Oncologic Emergencies 284
LS Arya, V Thavaraj
30. Blood Component Therapy 290 Anupam Sachdev
31. Diabetic Ketoacidosis 304 PSN Menon, Anju Virmani
32. Endocrine Emergencies 311 Anju Virmani
33. Calcium Metabolic Emergencies 315 Baldev S Prajapati
34. Initial Management of Life-threatening Problems in
Severely Malnourished Children 319
Tarun Gera, HPS Sachdev
35. Severe Falciparum Malaria 326 Niranjan Shendurnikar, Mukesh Agrawal
36. Dengue Hemorrhagic Fever and Dengue Shock Syndrome 333 SK Kabra, Rakesh Lodha
37. Fever Without a Focus 339 Y K Amdekar
38. Dermatologic Emergencies 343 Neena Khanna, Deepika Pandhi
39. Gynecologic Emergencies 350 Rewa Tripathi, Sapna Murthy
40. Psychiatric Emergencies 354 PSS Russell, Alice Cherian
41. Rheumatologic Emergencies 364 Sujata Sawhney
Section IV
Environmental Problems
42. Burns 373 Arun Goel, Urmila Jhamb
43. Drowning 383 Lalitha Janakiraman
44. Heat Illnesses 388 Dheeraj Shah, HPS Sachdev
45. Electric Shock 396 Piyush Gupta, Mily Ray
46. Snake Bite 402 Joseph L Mathew, Tarun Gera
47. Scorpion Sting 409 S Mahadevan
Section V
Toxicological Emergencies 48. General Management of a Poisoned Child 417 Suresh Gupta, Vikas Taneja
49. Management of Specific Toxicological Emergencies 426
49.1 Hydrocarbon (Kerosene) Poisoning 426
Vikas Taneja, Krishan Chugh
49.2 Dhatura 430 Sanjay Choudhary
49.3 Opioids 433 Sanjay Choudhary
49.4 Acetaminophen Poisoning 436 Utpal Kant Singh, Ramesh K Puri
49.5 Organophosphorus Poisoning 439 Puneet A Pooni, Daljit Singh
49.6 Lead Poisoning 446 Tarun Dua
49.7 Iron Poisoning 451 Utpal Kant Singh
49.8 Barbiturate Poisoning 456 Rajesh Mehta
49.9 Phenothiazine Toxicity 458 Rajesh Mehta
49.10 Corrosive Poisoning 460 S Gopalan, P Choudhury
49.11 Naphthalene Poisoning 462 S Gopalan, P Choudhury
Section VI
Neonatal Emergencies 50. Neonatal Emergencies in Delivery Room 467 Amit Upadhayaya, Ashok K Deorari
51. Approach to a Sick Newborn 477 Siddarth Ramji
52. Respiratory Failure in Newborn 483 Jaideep Singh, Sunil Sinha
53. Neonatal Shock 493 Rajiv Aggarwal
54. Neonatal Convulsions 501 Swarna Rekha
55. Neonatal Hypoglycemia 508 Sourabh Datta
56. Neonatal Jaundice 519 Anil Narang, M Sriniwas
57. Bleeding Neonate 530 Arun Kumar
58. Neonatal Cardiac Emergencies 541 Parvathi U Iyer
59. Acute Renal Failure in Newborn 553 Arvind Shenoi, S Kishore Babu
60. Disturbances in Temperature in Newborn 560 NB Mathur
61. Neonatal Surgical Emergencies 565 Yogesh Kumar Sarin, Arvind Sinha
62. Neonatal Transport 586 Neelam Kler, Arun Soni
Section VII
Pediatric Surgical Emergencies 63. Acute Abdomen 595 Shinjini Bhatnagar, Veereshwar Bhatnagar
64. Urological Emergencies 604 Anurag Krishna
65. Pediatric Trauma 608 Peeyush Jain, AP Dubey
66. Orthopedic Emergencies 617 Ramani Narasimhan
67. Ocular Emergencies 636 Supriyo Ghose, Sanjeev Nainiwal, Sarita Beri
68. Otolaryngological Emergencies 642 RC Deka, KK Handa
69. Oral and Dental Emergencies 646 H Parkash, S Kapoor, Mahesh Verma
Section VIII
Pediatric Emergency Procedures 70. Procedures in Emergency Room 657
70.1 Sedation, Analgesia, Anesthesia 657 S Ramesh
70.2 Pulse Oximetry 663 Dhiren Gupta, Krishan Chugh
70.3 Noninvasive Blood Pressure Measurement 667 Dhiren Gupta
70.4 Intramuscular Injections 668 Daljit Singh, Puneet A Pooni
70.5 Intravenous Infusion 669 Daljit Singh, Puneet A Pooni
70.6 Vascular Access 671 M Jayashree
70.7 Venous Cut Down 678 Anil Sachdev
70.8 Lumbar Puncture 679 Varinder Singh, Shishir Bhatnagar
70.9 Abdominal Paracentesis 679 Varinder Singh, Shishir Bhatnagar
70.10 Pericardiocentesis 680 Anil Sachdev
70.11 Thoracocentesis/Pleural Tap 681 Varinder Singh, Shishir Bhatnagar
70.12 Tube Thoracotomy and Needle Decompression 682 Varinder Singh, Shishir Bhatnagar
70.13 Cervical Spine Stabilization in Trauma 683 Sukhmeet Singh
70.14 Heimlich Maneuver 684 Sukhmeet Singh
70.15 Insertion of Nasogastric Tube 686 Daljit Singh, Puneet A Pooni
70.16 Urinary Bladder Catheterization 688 DK Gupta
70.17 Suprapubic Tap 688 Daljit Singh, Puneet A Pooni
70.18 Hydrostatic Reduction of Intussusception 689 DK Gupta
70.19 Tracheostomy 689 Tarun Gera, Anjali Seth Annexures
Annexure I: Drugs and Dosages 697 Ashok K Deorari, Rakesh Lodha
Annexure II: Reference Laboratory Values 721 Tarun Gera Index 729