INDEX

Pediatric

Critically Ill

What do I do if a critically ill child presents to our UAB ED?

Immediately stabilize the patient; then call the Center for Patient Flow to assist with an emergent transfer to Children’s of Alabama through the One Stop Placement hotline at 205-638-7200 or the nearest available bed in the area. 

 

Radiology Limitations

In the event a child requires imaging and you are at a location that does not have imaging available, please proceed to arrange for an emergent transfer to an alternate facility.

 

Common Presentations

Fever (of 5 or more days with unknown origin)

  • CXR 

  • CBC 

  • BMP

  • CRP/ESR

  • UA/culture

  • Blood cultures

  • Viral testing

 

Fever in neonate (less than 3 months)

  • All of the above plus…

  • Blood cultures

  • LP

    • Automatic LP for age less than 21

    • Possible LP for age greater than 21 based on apearance and labs

  • Antibiotics

    • Age 0-29 days: ampicillin and gentamycin (add vancomycin for suspected soft tissue infection, extended coverage cephalosporin for suspected meningitis)

    • Age 29-90 days: ceftriaxone/cefotaxime, ampicillin, vancomycin

    • Add acyclovir for patients with vesicular rash or concerning findings for HSV (eg history of seizures, positive exposure, or elevated LFTs)

  • Should be admitted to COA

Viral Respiratory

  • VRP

  • Covid/flu

  • Rapid strep (if sore throat/concerning exam)

  • Consider CXR

  • RSV

  • Supportive care for well appearing patients (no tachypnea, apnea, increased WOB)

  • Consider transfer to COA for toxic appearing patients or high risk patients (tachypnea/increased WOB, age < 6 months, immunocompromised)

  • Provide/recommend suctioning and frequent feeds of small amounts

  • If hypoxic less than 90% of RA, start NC, or HFNC if with increased WOB

Croup

  • Mild symptoms: supportive care, single dose of oral dexamthesone 0.6 mg/kg (max dose of 16mg/dose. Use IV concentration for PO)

  • Moderate/severe symptoms:

    • Retractions, agitation, cyanosis, audible stridor

    • Oral dexamethasone 0.6 mg/kg

    • Racemic epinephrine

    • Observe 2-3 hours after administration of epi

    • Discharge home if: no stridor at rest, no hypoxia, normal color, normal level of consciousness, tolerating PO

    • Admit/transfer to COA for: altered level of consciousness, persistent stridor/symptoms despite treatment, toxic appearing, need for supplmental O2, (consider admission if recurrent ED visit within 24 hours, age less than 6 months)

  • Consider foreign body if no improvement after recommended treatments and obtain airway films

Orthopaedic Injuries

  • XR of affected long bone/joint

  • Consider XR imaging of joint above/below injury

  • Most pediatric orthopaedic injuries can be splinted and followed up with COA fracture clinic (205-638-9146)

  • Consider CT imaging if normal XR but unable to bear weight in hip/knee

  • Consider intranasal fentanyl for pain control (1.5mcg/kg, max dose of 50mcg)

  • Keep NPO if transferring to COA for ortho eval

Abdominal Pain

  • CBC

  • BMP

  • LFTs and lipase

  • UA/culture

  • Pregnancy test in females of childbearing age

  • CRP

  • Testicular exam in males

  • Consider urine GC/chlamydia in sexually active patients

  • Consider IVFs if clinically indicated

  • Imaging

    • Consider US imaging for suspected:

      • Ovarian/testicular torsion

      • Intussuception

      • Appendicitis (site specific)

    • Consider CT imaging for suspected

      • Acute appendicitis

      • Blunt or penetrating trauma

      • Intraabdominal mass

      • Obstruction

Head injury/concussion

  • Calculate risk with PECARN

  • Low risk, observe for 2-4 hours in ED with repeat exam, if stable then DC with return precautions and concussion precautions (avoid contact sports, etc)

  • High risk, CT imaging

  • Followup at the COA concussion clinic: https://www.childrensal.org/services/concussion

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