Outline the principles of management of this child.

I. Initial Assessment & Stabilization (The Primary Survey)

The primary survey follows the ABCDE approach:

• Airway: Assess airway patency. In children, airway obstruction is often due to foreign bodies or swelling. Techniques like head tilt-chin lift (avoid in suspected cervical spine injury) and jaw thrust are used. Oropharyngeal or nasopharyngeal airways may be needed.
• Breathing: Evaluate respiratory rate, effort, and oxygen saturation. Look for signs of respiratory distress (nasal flaring, retractions). Provide supplemental oxygen. Consider assisted ventilation if necessary.
• Circulation: Assess heart rate, peripheral perfusion, and capillary refill. Control any bleeding. Establish intravenous (IV) access. Fluid resuscitation is often required, guided by age-appropriate volumes (e.g., 20ml/kg for initial bolus).
• Disability: Briefly assess neurological status using the AVPU scale (Alert, Verbal, Painful, Unresponsive) and Glasgow Coma Scale (GCS) adapted for pediatric age.
• Exposure: Completely expose the child to identify any hidden injuries or abnormalities while maintaining warmth.

II. History & Physical Examination (The Secondary Survey)

Once the child is stabilized, a detailed history and physical examination are performed. The history should include:

• Chief Complaint: The primary reason for seeking medical attention.
• History of Present Illness: A chronological account of the symptoms.
• Past Medical History: Previous illnesses, surgeries, allergies, and medications.
• Developmental History: Age-appropriate milestones.
• Family History: Relevant medical conditions in the family.
• Social History: Immunization status, exposure to toxins, and living conditions.

The physical examination should be a systematic head-to-toe assessment, paying attention to vital signs, growth parameters, and any specific findings related to the chief complaint.

III. Diagnostic Investigations

Investigations are guided by the clinical presentation and may include:

• Blood Tests: Complete blood count (CBC), electrolytes, blood glucose, renal function tests, liver function tests, inflammatory markers (CRP, ESR).
• Urine Analysis: To assess for infection or kidney problems.
• Imaging Studies: Chest X-ray, abdominal X-ray, CT scan, MRI, ultrasound. Minimize radiation exposure in children.
• Microbiological Studies: Blood cultures, urine cultures, CSF analysis (if meningitis is suspected).

IV. Specific Management Considerations

Management varies depending on the underlying condition. Some common pediatric emergencies and their management include:

Condition	Management
Dehydration	Oral rehydration therapy (ORT) is preferred for mild to moderate dehydration. IV fluids are used for severe dehydration. Monitor electrolytes closely.
Febrile Seizures	Ensure airway, breathing, and circulation. Administer antipyretics. Consider anti-seizure medication if seizures are prolonged or recurrent.
Asthma Exacerbation	Oxygen therapy, bronchodilators (beta-agonists, anticholinergics), and corticosteroids. Monitor respiratory status closely.
Meningitis	Prompt antibiotic therapy, supportive care, and monitoring for complications.

V. Psychosocial Support

Pediatric emergencies are stressful for both the child and their family. Providing emotional support and clear communication is crucial. Involve parents in the decision-making process and explain procedures in age-appropriate terms. Consider the need for child life specialists to help children cope with the hospital experience.