Paediatric emergencies
The seriously ill child: resuscitation, airway problems, seizures, anaphylaxis, poisoning and injuries.
High-yield points
Paediatric anaphylaxis: IM adrenaline 0.01 mg/kg; autoinjector 150 ug for children 7.5-20 kg and 300 ug for over 20 kg.
Status epilepticus: midazolam (buccal or intranasal 0.3 mg/kg, or IM) first line, then a second-line agent if still seizing.
Button battery ingestion is a time-critical emergency: urgent X-ray and removal from the oesophagus within 2 hours.
Paediatric DKA: slower fluid replacement than adults and watch for cerebral oedema (headache, bradycardia, falling GCS).
Intussusception: episodic inconsolable crying, drawing up of legs, 'redcurrant jelly' stool; ultrasound and air enema.
Foreign body aspiration: sudden choking then unilateral wheeze; bronchoscopy.
Dehydration signs: prolonged capillary refill, reduced skin turgor and abnormal breathing are the most useful.
Always consider non-accidental injury when the history does not match the injury.
India vs Australia
Where the answer the AMC marks correct differs from what’s usually taught in Indian MBBS.
| Aspect | India (MBBS)What you learn in MBBS | Australia (AMC)What the exam marks as correct |
|---|---|---|
| Drowning | Ponds and open water. | Leading cause of toddler death; pool fencing is law, active supervision emphasised. |
| Resuscitation | AHA or IAP algorithms. | ANZCOR guidelines and DRSABCD. |
| Poisoning | Kerosene and pesticides. | Medicines, household products and button batteries (an emergency). Poisons Information Centre 13 11 26. |
| Anaphylaxis | Hospital adrenaline; autoinjectors uncommon. | IM adrenaline 0.01 mg/kg; children at risk carry autoinjectors and ASCIA action plans at school. |
Drowning
India (MBBS)
Ponds and open water.
Australia (AMC): what the exam expects
Leading cause of toddler death; pool fencing is law, active supervision emphasised.
Resuscitation
India (MBBS)
AHA or IAP algorithms.
Australia (AMC): what the exam expects
ANZCOR guidelines and DRSABCD.
Poisoning
India (MBBS)
Kerosene and pesticides.
Australia (AMC): what the exam expects
Medicines, household products and button batteries (an emergency). Poisons Information Centre 13 11 26.
Anaphylaxis
India (MBBS)
Hospital adrenaline; autoinjectors uncommon.
Australia (AMC): what the exam expects
IM adrenaline 0.01 mg/kg; children at risk carry autoinjectors and ASCIA action plans at school.
The Australian context
Drowning is a leading cause of death in Australian toddlers, which is why pool fencing is law and supervision is emphasised. Childhood poisoning calls go to the Poisons Information Centre on 13 11 26.