Management of Medical Emergencies In Pediatric Patients

Management of Medical Emergencies In Paediatric PatientsAllergic Reactions (mild or delayed)Allergic reactions (sudden onset): anaphylaxis

Allergic reaction (mild or delayed) Signs and symptomsHives; itching; edema; erythemaskin, mucosa conjuctiva Treatment1. Discontinue all sources of allergy-causing substances 2. Administer diphenhydramine Drug dosageDiphenhydramine 1 mg/kg Child: 10-25 mg qid Adult: 25-50 mg qidDrug delivery*Oral

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Allergic Reaction (Sudden Onset): Anaphylaxis Anaphylaxis: a symptom complex accompanying the acute reaction to a foreign substance to which the patient has been previously sensitized Anaphylatoid: same reaction but the reaction is non-immunological or unknown. Cameron, Widmer,Handbook of Pediatric Dentistry, 4th ed Mosby, 2013, pg 484-485.Incidence: Anesthesia- 1:5000 to 1:30000 (mortality rate of 4% with reactions)Radiographic contrast -2%Antibiotics- 1:5000Latex allergy- 0.13%Local anesthesia- rare (usually to preservatives)Foods, insects Timing:Some 98% occur within 5 min of drug administration, but may occur up to hours later

Angioedema of the face such that the boy cannot open his eyes. This reaction was caused by an allergen exposure.

Prodrome Cutaneous Cardiovascular Respiratory Gastrointestinal Others - Metallic taste-Apprehension-Coughing-Choking sensation-Paraesthesia Arthralgia -Blushing-Urticaria-Angio-oedema -Pallor and cyanosis -Tachycardia -Hypotension-Shock Bronchospam -Laryngeal obstruction-Pulmonary oedema -Nausea, vomiting, diarrhoea -Abdominal cramps -Disseminated intravascular coagulation -Fitting Signs and symptomsUrticaria-itching, flushing, hives; rhinitis; wheezing/difficulty breathing; bronchi-spasm; laryngeal edema; weak pulse; marked fall in blood pressure; loss of consciousness Clinical presentation: TreatmentThis is a true, life-threatening emergency Call for emergency medical services Administer epinephrine Administer oxygen Monitor vital signs Transport to emergency medical facility by advanced medical responders Drug dosageEpinephrine 1:1000 0.01 mg/kg every 5 min until recovery or until help arrives1,2 Drug delivery*IM or SubQ

Ref: Cameron, Widmer,Handbook of Pediatric Dentistry, 4th ed Mosby, 2013, pg 484-485.6