Pediatricians must be prepared to handle pediatric office emergencies. Unfortunately, many pediatricians and pediatric offices are not equipped to manage common pediatric office emergencies. Reference one below in the resources is a very short book which will help every pediatric practitioner develop the resources to adequately care for any emergency that may arise in his or her office.
Pediatric office emergencies are relatively common. And one preventable complication or one preventable death is too much.
We can’t count on the emergency medical services (the EMTs or Paramedics) to get to our offices rapidly enough to make a difference. It can take at least 7 to 10 min. in an urban area for the EMS ambulance to arrive (and often longer). It can take a lot longer if you practice in a suburban or especially in a rural area.
Resuscitation equipment, although not inexpensive, is worth every penny. See reference blank for suggested equipment list.
Experts recommend that every physician and every nurse working in a pediatric office [including pediatric family practitioners, pediatric internists, pediatric nurse practitioners, and pediatric physicians assistants] should maintain current certification in pediatric advanced life support.
Everyone who works in an office that cares for sick children should maintain expertise in current certification in basic life support.
Here is a list of common pediatric office emergencies:
- Respiratory distress due to:
- Asthma
- bronchiolitis
- croup
- pneumonia
- Shock due to:
- Hypovolemia due to:
- Dehydration
- sepsis
- anaphylaxis
- Hypovolemia due to:
- Diabetic ketoacidosis
- Seizures
- head injury
- child abuse
- domestic violence in whom
- depression with risk factors for suicide
- rare causes of office emergencies include:
- Trauma
- choking
- apnea
- cardiac arrest
Reference (1) At the office, the front desk personnel are often the first people to assess a child. They, as well as the nursing staff should be taught how to rapidly recognize the critically ill patient this rapid assessment can easily be taught by the physician and should include the following:
- Skin:
- How does the child look? (Pale, bluish or dusky, model or petechiae/rash)
- Breathing:
- What is the rate? (Rapid or slow)
- What is the [respiratory] effort? (Chest retractions, nasal flaring, head bobbing)
- Appearance:
- How is the child responding to the environment? (Somnolent, poorly aroused, agitated)
Resources:
(1) The Complete Resource on Pediatric Office Emergency Preparedness. 2013. Springer. This excellent book is brief and to the point. The authors are from Texas Children’s Hospital and Texas Children’s Pediatrics.
(2) The Harriet Lane Handbook, Twentieth Edition, Elsevier Saunders, 2015. No one should practice pediatrics without this great resource.
(3) Preparation for Emergencies in the Offices of Pediatricians and Pediatric Primary Care Providers [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Pediatrics
July 2007, VOLUME 120 / ISSUE 1.
(4) Are you ready for an office code blue?: online video to prepare for office emergencies. [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Canadian Family Physician January 2015 vol. 61 no. 1
(5) Is your office ready for a medical emergency? www.officeemergencies.ca
(6) Pediatric Office Emergencies – Needed Office Equipment and Supplies
