Different emergency situations for the child

Emergencies involving children are manifold and require different measures to alleviate or prevent the situation from deteriorating. Some of these situations are explained below. Childhood emergencies caused by unconsciousness or even fainting are among the disorders of consciousness in the sense of a reduction in consciousness.

In this situation, the child is restricted in its reactions and in its information processing. The extent of such a loss of consciousness ranges from simple dazedness to drowsiness (somnolence) to coma. It is important to find out what causes the unconsciousness.

The main mechanisms that lead to unconsciousness in childhood are an insufficient blood supply, a lack of oxygen or nutrients in the brain, toxic effects or disorders in the brain itself. The causes of these mechanisms can again be quite different. For example, unconsciousness can be caused by a severe fall on the head (craniocerebral trauma).

Inflammatory or infectious processes in the brain, such as meningitis in children, can also lead to unconsciousness in severe cases and without initiating therapy. In the case of childhood diabetes (Diabetes mellitus type 1), unconsciousness can also occur as a result of a derailment or excessive external insulin intake, with subsequent hypoglycaemia. In any case, if the child is unconscious, he or she should be placed in a stable lateral position (roll onto his or her side, with the mouth pointing towards the floor and head stretched backwards) and the emergency services should be informed.

If there is no breathing activity, resuscitation must be started immediately. Children from the age of 1 should be given 5 resuscitations first. After that, compression of the thorax and the respirations should be started in a ratio of 30:2, in children better 15:2.

This must be continued until the child is relieved by the rescue service or awakened.A febrile convulsion is a seizure that occurs in the context of a febrile infection. Most febrile convulsions occur in the phase of temperature rise and are independent of the actual temperature level. Therefore, antipyretic drugs cannot prevent a febrile convulsion.

Up to 4% of all children suffer from febrile convulsions. Febrile convulsions are very worrying and impressive for parents, but in most cases they do not represent an emergency situation. Most febrile convulsions are therefore uncomplicated attacks that are harmless.

However, there are also complicated febrile convulsions with a focal course (i.e. only one area of the brain is affected), with a duration of more than 15 minutes, a recurrence within a day or at an untypical age (below the 6th month of life or above the 5th year of age). The complicated febrile convulsions always require further diagnostic clarification in order to rule out a possible serious cause, such as meningitis. This usually requires a lumbar puncture with examination of the nerve fluid.

With every complicated febrile convulsion and with every first febrile convulsion, a measurement of the brain waves (EEG) is also initiated to clarify possible causes. If a febrile spasm occurs, the child should first be kept calm and placed in such a way that it cannot be injured. Holding the child or protecting the teeth or tongue should be urgently avoided.

The cramp usually ends on its own. However, after a seizure lasts for more than 5 minutes, parents can administer a diazepam suppository. If the seizures last longer and cannot be stopped, it is essential to inform the emergency services.

The optimal body temperature, which keeps all metabolic processes in the body going, is between 36 and 37°C. If the body is exposed to strong external cold, e.g. due to frosty outside temperatures or wetness from damp clothing, the body temperature may drop. Children are particularly at risk if they stay in the water for a long time.

Despite these adverse conditions, the body can maintain the temperature for a long time through various mechanisms. For example, the children then start to shiver. However, the possibilities of compensation are often quickly exhausted in children and hypothermia with a body temperature below 35°C occurs.

Severe hypothermia is an emergency situation, not only for children. Depending on the temperature, hypothermia can be divided into different degrees of severity with corresponding symptoms. In the beginning, children feel cold, have bluish lips and the heart beats faster.

Below 34°C the children become increasingly sleepy, the heart beats too slowly and the muscles become rigid. Below 30°C body temperature coma-like states occur. A danger of hypothermia is also the occurrence of cardiac arrhythmia.

In case of hypothermia, the child should be warmed up again as soon as possible. Acute respiratory distress in children represents a childhood emergency. There are many possible causes.

A sudden shortness of breath during sports lessons or in the case of known allergies can be an indication of an acute asthma attack. If the child does not have an emergency spray and cannot be calmed down, the rescue service should be informed. The asthma attack is a cause of acute shortness of breath that can be easily remedied and rarely goes into a state that is difficult to interrupt.

In infancy, the most common cause of sudden shortness of breath is the accidental inhalation of small toys or nuts (foreign body aspiration). Depending on the position within the airways, the shortness of breath is correspondingly severe. The child can be supported by a strong blow on the back when coughing.

Infants can also be placed upside down over the lap while being strongly patted on the back. If the inhaled piece gets stuck, an ambulance should again be alerted. Slim and tall boys in puberty are particularly at risk for the so-called spontaneous pneumothorax, a pathological accumulation of air in the thorax.

It is characterized by sudden shortness of breath and pain when breathing. However, respiratory pain and shortness of breath can also be an indication of pulmonary embolism. The typical risk group includes above all pubescent girls who take the pill and are smoking or overweight at the same time.

Burns in children refer to tissue damage due to enormous heat exposure. Depending on the depth of the damaged skin layers, burns are divided into four grades.

Grade 1: here the pain, redness and swelling are in the foreground, as known from sunburn
Grade 2a: is also accompanied by pain and shows blistering of the skin
Grade 2b: from here on, the pain fibers are also damaged, so that hardly any pain is complained about. Healing takes place here with scarring.
Grade 3: is characterized by tissue death (necrosis)
Grade 4: here, deeper layers with muscles or bones can already be damaged

The extent of the burn is also determined by the affected body surface.

The weighting here differs depending on age between infants, toddlers and children from the age of 9. For example, infants have a large head compared to the rest of the body, so that the head takes up a larger part of the body surface and must be assessed more severely in the case of burns than in adults. Death from burns is to be expected in children from an affected body surface of 60-80%.

Serious complications occur at a rate of 10%. In an emergency situation, the burned clothing must first be removed and the affected areas cooled with water. In case of larger burns, cooling is not allowed due to the danger of cooling.

In case of severe burns, the rescue service must be informed immediately. An allergic emergency in childhood is anaphylactic shock. This is the strongest form of a hypersensitivity reaction of the immune system and is potentially life-threatening.

Triggers include bee and wasp venom, food such as nuts, eggs or seafood, as well as airborne allergens such as pollen, house dust, mold or animal scales. An allergic reaction occurs naturally only if the child actually has an allergy against the described triggers, which are normally harmless. With the first contact with the allergen the body forms defense substances (antibodies) in the context of the sensitization.

On renewed contact with the same allergen, the antibodies formed trigger the typical allergic reaction, which can culminate in anaphylactic shock. This is due to a severe loss of fluid in the child. Therefore, in an emergency situation, the child should be placed in the so-called shock position, i.e. lying on his or her back with slightly elevated legs, and the emergency services should be called.

Children who have experienced this before always carry an allergy emergency set with them. This contains an antiallergic (H1 antihistamine), cortisone and an adrenaline pen, which is injected into the thigh in an emergency. For poisoning in childhood, a vast number of substances such as plants, medicines or chemicals in the household can be considered.

If the child has inadvertently swallowed something, it should first be kept calm. If the child shows no acute symptoms, it is advisable to contact the poison control center (different telephone numbers depending on the federal state). Here you can obtain information 24 hours a day on whether the substance or quantity swallowed is dangerous, what measures should be taken and whether a presentation in the children’s emergency room is necessary.

For many poisonings there are appropriate remedies or very simple symptomatic measures, such as plenty of fluids. With children, for example, prussic acid poisoning through the consumption of bitter almonds is more frequent. Five to 10 almonds are already sufficient with children.

Thus headache and difficulty in breathing can develop with children. The rescue service must then be informed immediately. With small children, who put everything into their mouth, cigarette butts lying on the ground can also be swallowed.

This is often harmless. When eating a whole cigarette, symptoms of nicotine poisoning with vomiting and rapid heartbeat occur. Here the pediatrician can administer activated carbon as a countermeasure.