E-Book Description
Principles of Pediatric & Neonatal Emergencies 3rd Edition PDF Free Download
We are happy to present the third edition of Principles of Pediatric and Neonatal Emergencies. The present edition
continues with its tradition of serving the needs of physicians involved in the immediate care of children and
neonates with life-threatening illnesses. The book has been extensively revised and updated, to reflect the
current standards of emergency care relevant to the needs of pediatricians working in developing countries.
This book continues to have the privilege of scholarly writings from illustrious authors, across the country.
We welcome several new colleagues and express gratitude for their contributions to this edition. A number
of chapters have been completely rewritten, including those on hematological disorders, upper gastrointestinal
bleeding, neonatal surgical disorders, and ophthalmologic emergencies. Inputs from consensus and expert
statements of the Academy have been incorporated for management of malaria and severe malnutrition. The
emphasis continues to be on presenting management of common and important emergencies affecting children.
Detailed discussions on pathophysiology have been avoided.
We hope that this text shall continue to serve the needs of pediatricians, physicians, resident doctors, other
trainees and be a part of all pediatric emergency units. As before, all the royalties generated from the sale of
the book shall pass onto the journal, Indian Pediatrics.
Finally, we thank Mr RG Bhardwaj and Ms Veena Arora for secretarial assistance and are grateful to
M/s Jaypee Brothers Medical Publishers (P) Ltd., New Delhi, India for their guidance and expeditious
publication.
E-Book Details
Table of Contents
Section 1: Organization of Emergency Department
1. Approach to Child in Emergency Department . 3
Krishan Chugh
Pediatrician’s Contact with the Sick Child 3
Age-related Approach 4
The Complete Physical Examination 4
Identification of an Acutely Ill Child 5
CPR in Emergency Department 6
The Death of a Child in the Emergency Department 6
2. Ethical and Legal Issues in Emergency Care 9
Krishan Chugh
Ethics 9
Legal Responsibilities 9
Types of Legal Risks 9
Legal Risk factors 10
Legal and Ethical Issues in Consent 10
Ethical and Legal Issues in Training and Research 11
Ethical and Legal Issues in CPR 11
Ethical and Legal Issues in withholding Life Support 12
Ethical and Legal Issues in Death 12
Hospital Ethics Committees 12
The Medical Record 12
Steps for Suit Prevention 12
3. Organization of Pediatric Emergency Services 14
Krishan Chugh
Pediatric Emergency Service in a General/Pediatric Hospital 14
Pediatric Emergency Services in the Clinic 15
Physical Design of Emergency Department 15
Computers in the Emergency Department 20
Cost of Emergency Care 20
Section 2: Resuscitation and Life-threatening Emergencies
4. Emergency Airway Management and Cardiopulmonary Resuscitation . 25
S Krishnan, Sunil Dutt Sharma
Pediatric Tachycardia with Pulses and Poor Perfusion 49
Pediatric Tachycardia with Pulses and Adequate Perfusion 49
5. Oxygen Therapy . 52
Soonu Udani
xx Principles of Pediatric and Neonatal Emergencies
6. Shock 57
Sunit Singhi, Puneet Jain
Correction of Metabolic Abnormalities 67
Newer Modalities for Sepsis and Septic Shock 70
7. Respiratory Failure 74
Praveen Khilnani, Nitesh Singhal
8. Anaphylaxis 84
Anil Sachdev
Section 3: Pediatric Medical Emergencies
9. Acute Asthma . 93
GR Sethi
Step 1: Initial Assessment of Severity 93
Step 2: Initiation of Therapy 94
Step 3: Assessment of Response to Initial Therapy 99
Step 4: Modification of Therapy for patients with Partial and Poor Response to Initial Therapy 99
10. Stridor 107
Meenu Singh, Sandeep Budhiraja, Lata Kumar
Pathophysiology 107
Assessment of a Child with Stridor 110
Treatment 111
Prognosis 113
11. Lower Respiratory Tract Infection 117
D Vijayasekaran
Acute Lower Respiratory Tract Infection 117
Laryngotracheobronchitis (Croup) 118
Bronchiolitis 118
Pneumonia 119
12. Heart Failure . 123
Vivek Chaturvedi, Anita Saxena
Introduction 123
Causes of Heart Failure in Infants and Children 123
Epidemiology of Heart Failure 125
Clinical Features 125
Investigations 127
Management of Heart Failure 130
13. Cardiac Arrhythmias . 140
Anita Khalil, Jyotsna K Vaswani
14. Hypertensive Emergencies. 152
Aditi Sinha, Pankaj Hari
15. Acute Renal Failure . 158
Arvind Bagga, Mukta Mantan
Nomenclature and Classification 158
Biomarkers 159
Neonatal ARF 159
Causes of ARF 159
Clinical Features 161
Diagnostic Approach to ARF 161
Management of ARF 162
Outcome 167
16. Fluid and Electrolyte Disturbances 169
Rakesh Lodha, Manjunatha Sarthi, Natchu UC Mouli
Physiology 169
Disorders of Sodium Homeostasis 172
Disorders of Potassium Homeostasis 177
17. Acid-Base Disturbance . 182
Rakesh Lodha, Manjunatha Sarthi, Arvind Bagga
Physiology 182
Acid Elimination and Compensation 183
Acid-base Disorders 183
18. Hematuria 192
Anil Vasudevan, Arpana Iyengar, Kishore Phadke
Categorizing the Patient with Hematuria 192
Evaluating a Child with Hematuria 193
Management 195
19. Acute Seizure 197
Tarun Dua, Piyush Gupta
20. Approach to a Comatose Patient . 205
Suchitra Ranjit
Guidelines for Differentiating Causes of Coma 205
Evaluation of a Child in Coma 205
Laboratory Evaluation 208
Management of a Comatose Patient 208
Prognosis 210
21. Intracranial Hypertension 211
Pratibha Singhi, Roosy Aulakh, Sunit Singhi
Pathophysiology 211
Management of Raised Intracranial Hypertension 215
22. Acute Flaccid Paralysis . 224
RK Sabharwal
Clinical Approach 224
23. Acute Bacterial Meningitis. 237
S Aneja, Anju Aggarwal
Epidemiology 237
Etiology 237
Pathogenesis and Pathology 237
Clinical Features 238
Complications 238
Differential Diagnosis 241
Treatment 241
Antibiotic Therapy 241
xxii Principles of Pediatric and Neonatal Emergencies
Prognosis 243
Prevention 244
24. Encephalitis. 248
Sheffali Gulati
Etiology 248
Epidemiology 248
Pathogenesis 248
25. Acute Diarrhea and Dehydration . 258
AK Patwari
Diarrheal Dehydration 258
Compensatory Mechanisms 258
Clinical Features 259
Case Management 259
Assessment of Dehydration 259
Oral Rehydration Therapy 261
ORS in Neonates 261
Intravenous Fluid Therapy 261
Rehydration of Severely Malnourished Children 262
Electrolyte Disturbances 262
26. Acute Liver Failure 266
Neelam Mohan, Rajeev Khanna
Introduction 266
Definitions 266
Etiology 266
Clinical Features 267
Orthotopic Liver Transplantation 272
27. Upper Gastrointestinal Bleeding 275
Anshu Srivastava, Surender K Yachha
Etiology 275
Clinical features 276
Endoscopic therapy 280
Treatment 282
28. Hematologic Emergencies 285
Tulika Seth
Bleeding Child 285
Disseminated Intravascular Coagulation 291
Depression of Bone Marrow Activity 294
Blood Transfusion Reactions 295
Hemolysis 296
Sickle Cell Disease 299
Thrombosis 301
29. Oncologic Emergencies. 305
LS Arya, V Thavaraj, KP Kulkarni
Oncological Emergencies Due to Structural or Local Effects of Tumor 305
Abnormalities of Blood and Blood Vessels 308
Metabolic Emergencies 309
Oncological Emergencies Secondary to Treatment Effects 311
30. Blood Component Therapy 314
Anupam Sachdeva, Satya P Yadav, Anand Prakash
Appropriate Use of Blood and Blood Products 314
Whole Blood 314
Red Blood Cells 315
Plasma 320
Platelets 322
Granulocytes 324
Cryoprecipitate 325
31. Diabetic Ketoacidosis . 329
Anju Virmani, PSN Menon
32. Other Endocrine Emergencies . 336
Anju Virmani
Adrenal Crisis 336
Thyroid Storm (Accelerated Hyperthyroidism) 338
Congenital Hypothyroidism 339
33. Calcium Metabolic Emergencies. 340
BS Prajapati, Anju Virmani
Hypocalcemia 340
Hypercalcemia 342
34. Management of Severely Malnourished Children 344
Shinjini Bhatnagar, Rakesh Lodha, Panna Choudhury, HPS Sachdev, Nitin Shah, Sushma Narayan
35. Malaria . 359
Ritabrata Kundu, Nupur Ganguly, Tapan Kumar Ghosh
Artemesinin Combination Therapy 359
Uncomplicated Malaria 359
Severe and Complicated Malaria 359
Supportive Management 360
Management of Complications of Malaria 363
36. Dengue Hemorrhagic Fever and Dengue Shock Syndrome 364
SK Kabra, Rakesh Lodha
Clinical Manifestations 364
Grading of DHF 365
Diagnosis 365
Laboratory Investigations 366
Treatment 366
Monitoring 368
Prognosis 368
37. Fever without a Focus 370
YK Amdekar
Rule Out Serious Illness 371
Agewise Diagnostic Approach 372
38. Dermatologic Emergencies 374
Neena Khanna, Seema B Rasool
Acute Urticaria and Angioedema 374
Epidermal Necrolysis 375
xxiv Principles of Pediatric and Neonatal Emergencies
Staphylococcal Scalded Skin Syndrome (SSSS) 377
Erythroderma 377
Collodion Baby 378
Drug Eruptions 379
Pemphigus 379
Epidermolysis Bullosa (EB) 380
Herpes Virus Simplex Infections 382
Erysipelas and Cellulitis 382
39. Gynecologic Emergencies 384
Reva Tripathi, Pooja Pundhir
Foreign Body in Genital Tract 384
Direct Trauma to Vagina—Tears and Lacerations 384
Puberty Menorrhagia 386
Imperforate Hymen, Transverse Vaginal Septum 387
Twisted Ovarian Cyst 388
Teenage Pregnancy Complications 388
40. Psychiatric Emergencies . 390
PSS Russell, Alice Cherian
Basic Principles and Decision Making in Emergency Psychiatry 390
Epidemiology 390
Classification of Psychiatric Emergencies in Infants and Toddlers, Children and Adolescents 390
41. Emergencies in Pediatric Rheumatology . 399
Sujata Sawhney, Manjari Agarwal
Introduction 399
Juvenile Idiopathic Arthritis (JIA) 399
Antiphospholipid Antibody Syndrome 401
Juvenile Dermatomyositis (JDM) 403
Section 4: Environmental Problems
42. Burns 409
Arun Goel, Urmila Jhamb
Mode of Injury 409
Prevention 410
First Aid 410
Hospital Management 410
43. Drowning 420
Lalitha Janakiraman
Pathophysiology 420
44. Heat Illnesses 426
Dheeraj Shah, HPS Sachdev
45. Electric Shock . 434
Piyush Gupta, Mily Ray
46. Snake Bite 439
Joseph L Mathew, Tarun Gera
Management of Ophitoxemia 442
47. Scorpion Envenomation . 445
S Mahadevan, Jhuma Shankar
Case Vignettes 445
The Problem 445
Distribution 445
Pathophysiology 445
Venom 445
Effect of the Venom on Various Tissues/Organs 446
Section 5: Toxicological Emergencies
48. General Management of a Poisoned Child . 457
Suresh Gupta, Vikas Taneja
49. Management of Specific Toxicological Emergencies 465
Vikas Taneja, Krishan Chugh, Sanjay Choudhary, Utpal Kant Singh, Rajniti Prasad, Puneet A Pooni,
Daljit Singh, Tarun Dua, Rajesh Mehta, S Gopalan, Panna Choudhury
49.1 Hydrocarbon (Kerosene) Poisoning 465
Vikas Taneja, Krishan Chugh
49.2 Dhatura . 469
Sanjay Choudhary
49.3 Opioids . 471
Sanjay Choudhary
49.4 Acetaminophen Poisoning 474
Utpal Kant Singh, Rajniti Prasad
49.5 Organophosphorus Poisoning . 478
Puneet A Pooni, Daljit Singh
49.6 Lead Poisoning 484
Tarun Dua
49.7 Iron Poisoning . 489
Utpal Kant Singh, Rajniti Prasad
49.8 Barbiturate Poisoning 494
Rajesh Mehta
49.9 Phenothiazine Toxicity 496
Rajesh Mehta
49.10 Corrosive Poisoning . 497
S Gopalan, Panna Choudhury
49.11 Naphthalene Poisoning . 500
S Gopalan, Panna Choudhury
Section 6: Neonatal Emergencies
50. Neonatal Emergencies in Delivery Room . 503
Amit Upadhyay, Ashok K Deorari
Neonatal Emergencies which can Present in Labor Room 503
Management of Neonatal Emergencies 504
xxvi Principles of Pediatric and Neonatal Emergencies
Baby not Breathing at Birth 504
Technique of Chest Compression 508
Use of Drugs 508
When to Stop Resuscitation withhold Resuscitation 509
Meconium Stained Liquor 509
Shock 510
Drug Depression 510
Hydrops Fetalis 510
Impaired Lung Function 511
Accidental Injection of Local Anesthetic 512
Airway Anomalies in Delivery Room Resuscitation 512
51. Approach to a Sick Newborn. 515
Siddharth Ramji
Initial Assessment 515
Emergency Triage 516
Differential Diagnosis 517
Breastfeeding Problems Presenting in the Emergency Room 518
52. Respiratory Failure in Newborn . 520
Jaideep Singh, Sunil Sinha
Causes of Respiratory Failure in the Newborn 520
Mechanisms of Respiratory Failure 521
Assessment of Respiratory Failure 521
Treatment of Respiratory Failure 522
Mechanical Ventilation 524
Management of Specific Respiratory Conditions 525
53. Shock in the Newborn 530
Rajiv Aggarwal
Definition 530
Tissue Perfusion and Shock 530
Blood Pressure and Shock 530
Etiology of Shock 531
Stages of Shock 532
Monitoring for Physical Signs 532
Initial Management of Shock 532
Issues in Fluid Resuscitation 533
Refractory Shock 534
Afterload Reduction 535
Management of Complications 535
54. Neonatal Convulsions . 538
Swarna Rekha
Incidence 538
Etiology of Neonatal Convulsions 538
Classification of Neonatal Convulsions 538
Clinical Approach 539
Management of Neonatal Convulsions 540
Why Should Seizures be Treated? 541
When to Treat Seizures? 541
Adequacy of treatment 541
Choice of Anticonvulsant 541
Refractory Seizures 542
Second Line Anticonvulsants 542
Newer Antiepileptic Drugs 543
Neonatal Status Epilepticus 543
Special Situations 543
Seizure Control—Clinical or EEG Control 543
Duration of Anticonvulsant Therapy 544
Prognosis 544
55. Neonatal Hypoglycemia . 546
Sourabh Dutta
Glucose Homeostasis and Metabolic Adaptation at Birth 546
Causes of Hypoglycemia 547
Hypoglycemia and the Brain 549
Definition of Hypoglycemia 550
Prevention of Hypoglycemia 552
Treatment of Hypoglycemia 553
Methods of Measuring Blood or Plasma Glucose 554
56. Neonatal Jaundice 557
Srinivas Murki, Anil Narang
Bilirubin Metabolism and Etiology of Jaundice 557
Clinical Evaluation of a Jaundiced Neonate 558
Prediction of Severe Jaundice 559
Investigations 561
Treatment of Severe Jaundice 561
Intravenous Immunoglobulin 564
57. Management of the Bleeding Neonate 569
Arun Kumar
Major Causes of Bleeding 569
Hemorrhage in the Perinatal Period 572
Iatrogenic 572
Sites of Major Hemorrhage 572
Gastrointestinal Hemorrhage 573
Intra-abdominal Bleeding 573
Subgaleal Hemorrhage 573
Intracranial Hemorrhage 573
Bleeding from the Umbilical Cord 574
Approach to a Child with Bleeding 574
Emergency Management 575
Subsequent Management 576
Prevention 576
58. Neonatal Cardiac Emergencies 579
Girish Kumar, Parvathi U Iyer
Magnitude of the Problem 579
Clinical Presentation 579
Emergency Management and Initial Stabilization 586
59. Acute Kidney Injury in Newborn . 591
Arvind Shenoi, S Kishore Babu
Introduction 591
Physiology 591
Definitions of AKI 591
xxviii Principles of Pediatric and Neonatal Emergencies
Definition 591
Incidence 592
Causes of Neonatal AKI 592
Pathophysiology of ATN 593
Clinical Approach 594
Management 595
Bioartificial Kidney and Bioengineered Membranes in AKI 597
Drugs in Renal Failure 597
Recent Trends in ARF Therapy 597
Stem cell therapy in AKI 597
Management of the Diuretic Phase 598
Prognosis 598
60. Disturbances in Temperature in Newborn . 600
NB Mathur
Mechanisms of Heat Loss 600
Response to Cold Stress 600
Risk Factors for Hypothermia 602
Severity of Hypothermia: WHO Classification 602
Measuring or Assessing the Newborn’s Temperature 602
Effects and Signs of Hypothermia 602
Management of Hypothermia in Hospital 603
Duration of Rewarming 603
Kangaroo Mother Care 604
Management at Home 604
Warm Chain 604
Hyperthermia 604
Physiological Response to Hyperthermia 604
Causes of Hyperthermia 605
Symptoms of Hyperthermia 605
Management 605
61. Neonatal Surgical Emergencies. 607
Satish Kumar Aggarwal
Introduction 607
Neonatal Intestinal Obstruction 607
Abdominal Wall Defects 620
Surgical Causes of Respiratory Distress in the Newborn 622
Posterior Urethral Valves (PUV) 628
Antenatal Hydronephrosis 629
62. Neonatal Transport 632
Neelam Kler, Arun Soni, Naveen Gupta
Introduction 632
Why is Transport of Sick Patients Necessary? 632
Clinical Presentation of Transported Babies 632
Types of Transport 633
Regionalization of Neonatal Health Care Facilities 633
Whom to Transport 634
Where to Transport 634
Mode of Transport 634
Transport Personnel 635
Leadership 635
Team members 635
Transport Equipment 636
Specific Equipment Items 636
CPAP Devices 636
Incubators 637
Principles of Transport 637
Modules for Transport 638
Complications of Transport 638
Family Counseling 640
Cost of Transport 640
Aviation Physiology in Neonatal Transport 640
Section 7: Pediatric Surgical Emergencies
63. Acute Abdomen . 645
Shinjini Bhatnagar, Veereshwar Bhatnagar, Vidyut Bhatia
Introduction 645
Evaluation of the Child with Acute Abdomen 645
Classification of Etiologies 647
Location of Underlying Cause 648
Emergency Investigations 652
Principles of Management 653
64. Urological Emergencies 655
Anurag Krishna
Urinary Tract Injuries 655
Retention of Urine 655
Urosepsis 656
Acute Scrotum 656
65. Pediatric Trauma 658
Peeyush Jain, AP Dubey
Major Trauma 658
Spectrum of Trauma 658
Trauma Scores 660
Head Trauma 661
Minor Trauma and Lacerations 662
66. Orthopedic Emergencies 666
Ramani Narasimhan
Immature Skeleton—Basic 666
Physes or ‘Growth Plate’ 666
General Approach 667
Pediatric Orthopedic Trauma 668
Fractures and Dislocations of Upper Limb 668
‘Pulled Elbow’ 670
67. Ocular Emergencies . 683
Radhika Tandon, Noopur Gupta
68. Ear, Nose and Throat Emergencies . 690
KK Handa
Ear 690
Nose 691
Throat 692
xxx Principles of Pediatric and Neonatal Emergencies
69. Oral and Dental Emergencies 693
H Parkash, S Kapoor, Mahesh Verma
Section 8: Pediatric Emergency Procedures
70. Procedures in Emergency Room . 703
Anil Sachdev, Dhiren Gupta, Daljit Singh, Puneet A Pooni, M Jayashree, Varinder Singh,
Shishir Bhatnagar, Sukhmeet Singh, DK Gupta, Tarun Gera, Anjali Seth
70.1 Sedation, Analgesia, Anesthesia . 703
Anil Sachdev
Introduction 703
Pre-evaluation 704
Assessment Tools 704
Monitoring 705
Specific Drugs 705
70.2 Pulse Oximetry 709
Dhiren Gupta
70.3 Non-invasive Blood Pressure Measurement . 713
Dhiren Gupta
70.4 Intramuscular Injections . 718
Daljit Singh, Puneet A Pooni
70.5 Intravenous Infusion . 719
Daljit Singh, Puneet A Pooni
70.6 Vascular Access . 720
M Jayashree
Cannulation of Peripheral Veins 720
Factors that Increase the Risk of Arterial Catheter Thrombosis 726
70.7 Venous Cut Down 727
Anil Sachdev
70.8 Lumbar Puncture 728
Varinder Singh, Shishir Bhatnagar
70.9 Abdominal Paracentesis 728
Varinder Singh, Shishir Bhatnagar
70.10 Pericardiocentesis . 729
Anil Sachdev
70.11 Thoracocentesis/Pleural Tap 730
Varinder Singh, Shishir Bhatnagar
70.12 Tube Thoracotomy and Needle Decompression 731
Varinder Singh, Shishir Bhatnagar
70.13 Cervical Spine Stabilization in Trauma . 732
Sukhmeet Singh
70.14 Heimlich Maneuver . 733
Sukhmeet Singh
70.15 Insertion of Nasogastric Tube 736
Daljit Singh, Puneet A Pooni
70.16 Urinary Bladder Catheterization . 737
DK Gupta
70.17 Suprapubic Tap. 737
Daljit Singh, Puneet A Pooni
70.18 Hydrostatic Reduction of Intussusception 738
DK Gupta
70.19 Tracheostomy 738
Tarun Gera, Anjali Seth
ANNEXURES 743
Annexure 1: Dosages of Some Common Drugs. 745
Ashok K Deorari, Rakesh Lodha
Annexure 2: Reference Laboratory Values . 769
Tarun Gera
Index . 775
Principles of Pediatric & Neonatal Emergencies 3rd Edition PDF Ebook
1. Approach to Child in Emergency Department . 3
Krishan Chugh
Pediatrician’s Contact with the Sick Child 3
Age-related Approach 4
The Complete Physical Examination 4
Identification of an Acutely Ill Child 5
CPR in Emergency Department 6
The Death of a Child in the Emergency Department 6
2. Ethical and Legal Issues in Emergency Care 9
Krishan Chugh
Ethics 9
Legal Responsibilities 9
Types of Legal Risks 9
Legal Risk factors 10
Legal and Ethical Issues in Consent 10
Ethical and Legal Issues in Training and Research 11
Ethical and Legal Issues in CPR 11
Ethical and Legal Issues in withholding Life Support 12
Ethical and Legal Issues in Death 12
Hospital Ethics Committees 12
The Medical Record 12
Steps for Suit Prevention 12
3. Organization of Pediatric Emergency Services 14
Krishan Chugh
Pediatric Emergency Service in a General/Pediatric Hospital 14
Pediatric Emergency Services in the Clinic 15
Physical Design of Emergency Department 15
Computers in the Emergency Department 20
Cost of Emergency Care 20
Section 2: Resuscitation and Life-threatening Emergencies
4. Emergency Airway Management and Cardiopulmonary Resuscitation . 25
S Krishnan, Sunil Dutt Sharma
Pediatric Tachycardia with Pulses and Poor Perfusion 49
Pediatric Tachycardia with Pulses and Adequate Perfusion 49
5. Oxygen Therapy . 52
Soonu Udani
xx Principles of Pediatric and Neonatal Emergencies
6. Shock 57
Sunit Singhi, Puneet Jain
Correction of Metabolic Abnormalities 67
Newer Modalities for Sepsis and Septic Shock 70
7. Respiratory Failure 74
Praveen Khilnani, Nitesh Singhal
8. Anaphylaxis 84
Anil Sachdev
Section 3: Pediatric Medical Emergencies
9. Acute Asthma . 93
GR Sethi
Step 1: Initial Assessment of Severity 93
Step 2: Initiation of Therapy 94
Step 3: Assessment of Response to Initial Therapy 99
Step 4: Modification of Therapy for patients with Partial and Poor Response to Initial Therapy 99
10. Stridor 107
Meenu Singh, Sandeep Budhiraja, Lata Kumar
Pathophysiology 107
Assessment of a Child with Stridor 110
Treatment 111
Prognosis 113
11. Lower Respiratory Tract Infection 117
D Vijayasekaran
Acute Lower Respiratory Tract Infection 117
Laryngotracheobronchitis (Croup) 118
Bronchiolitis 118
Pneumonia 119
12. Heart Failure . 123
Vivek Chaturvedi, Anita Saxena
Introduction 123
Causes of Heart Failure in Infants and Children 123
Epidemiology of Heart Failure 125
Clinical Features 125
Investigations 127
Management of Heart Failure 130
13. Cardiac Arrhythmias . 140
Anita Khalil, Jyotsna K Vaswani
14. Hypertensive Emergencies. 152
Aditi Sinha, Pankaj Hari
15. Acute Renal Failure . 158
Arvind Bagga, Mukta Mantan
Nomenclature and Classification 158
Biomarkers 159
Neonatal ARF 159
Causes of ARF 159
Clinical Features 161
Diagnostic Approach to ARF 161
Management of ARF 162
Outcome 167
16. Fluid and Electrolyte Disturbances 169
Rakesh Lodha, Manjunatha Sarthi, Natchu UC Mouli
Physiology 169
Disorders of Sodium Homeostasis 172
Disorders of Potassium Homeostasis 177
17. Acid-Base Disturbance . 182
Rakesh Lodha, Manjunatha Sarthi, Arvind Bagga
Physiology 182
Acid Elimination and Compensation 183
Acid-base Disorders 183
18. Hematuria 192
Anil Vasudevan, Arpana Iyengar, Kishore Phadke
Categorizing the Patient with Hematuria 192
Evaluating a Child with Hematuria 193
Management 195
19. Acute Seizure 197
Tarun Dua, Piyush Gupta
20. Approach to a Comatose Patient . 205
Suchitra Ranjit
Guidelines for Differentiating Causes of Coma 205
Evaluation of a Child in Coma 205
Laboratory Evaluation 208
Management of a Comatose Patient 208
Prognosis 210
21. Intracranial Hypertension 211
Pratibha Singhi, Roosy Aulakh, Sunit Singhi
Pathophysiology 211
Management of Raised Intracranial Hypertension 215
22. Acute Flaccid Paralysis . 224
RK Sabharwal
Clinical Approach 224
23. Acute Bacterial Meningitis. 237
S Aneja, Anju Aggarwal
Epidemiology 237
Etiology 237
Pathogenesis and Pathology 237
Clinical Features 238
Complications 238
Differential Diagnosis 241
Treatment 241
Antibiotic Therapy 241
xxii Principles of Pediatric and Neonatal Emergencies
Prognosis 243
Prevention 244
24. Encephalitis. 248
Sheffali Gulati
Etiology 248
Epidemiology 248
Pathogenesis 248
25. Acute Diarrhea and Dehydration . 258
AK Patwari
Diarrheal Dehydration 258
Compensatory Mechanisms 258
Clinical Features 259
Case Management 259
Assessment of Dehydration 259
Oral Rehydration Therapy 261
ORS in Neonates 261
Intravenous Fluid Therapy 261
Rehydration of Severely Malnourished Children 262
Electrolyte Disturbances 262
26. Acute Liver Failure 266
Neelam Mohan, Rajeev Khanna
Introduction 266
Definitions 266
Etiology 266
Clinical Features 267
Orthotopic Liver Transplantation 272
27. Upper Gastrointestinal Bleeding 275
Anshu Srivastava, Surender K Yachha
Etiology 275
Clinical features 276
Endoscopic therapy 280
Treatment 282
28. Hematologic Emergencies 285
Tulika Seth
Bleeding Child 285
Disseminated Intravascular Coagulation 291
Depression of Bone Marrow Activity 294
Blood Transfusion Reactions 295
Hemolysis 296
Sickle Cell Disease 299
Thrombosis 301
29. Oncologic Emergencies. 305
LS Arya, V Thavaraj, KP Kulkarni
Oncological Emergencies Due to Structural or Local Effects of Tumor 305
Abnormalities of Blood and Blood Vessels 308
Metabolic Emergencies 309
Oncological Emergencies Secondary to Treatment Effects 311
30. Blood Component Therapy 314
Anupam Sachdeva, Satya P Yadav, Anand Prakash
Appropriate Use of Blood and Blood Products 314
Whole Blood 314
Red Blood Cells 315
Plasma 320
Platelets 322
Granulocytes 324
Cryoprecipitate 325
31. Diabetic Ketoacidosis . 329
Anju Virmani, PSN Menon
32. Other Endocrine Emergencies . 336
Anju Virmani
Adrenal Crisis 336
Thyroid Storm (Accelerated Hyperthyroidism) 338
Congenital Hypothyroidism 339
33. Calcium Metabolic Emergencies. 340
BS Prajapati, Anju Virmani
Hypocalcemia 340
Hypercalcemia 342
34. Management of Severely Malnourished Children 344
Shinjini Bhatnagar, Rakesh Lodha, Panna Choudhury, HPS Sachdev, Nitin Shah, Sushma Narayan
35. Malaria . 359
Ritabrata Kundu, Nupur Ganguly, Tapan Kumar Ghosh
Artemesinin Combination Therapy 359
Uncomplicated Malaria 359
Severe and Complicated Malaria 359
Supportive Management 360
Management of Complications of Malaria 363
36. Dengue Hemorrhagic Fever and Dengue Shock Syndrome 364
SK Kabra, Rakesh Lodha
Clinical Manifestations 364
Grading of DHF 365
Diagnosis 365
Laboratory Investigations 366
Treatment 366
Monitoring 368
Prognosis 368
37. Fever without a Focus 370
YK Amdekar
Rule Out Serious Illness 371
Agewise Diagnostic Approach 372
38. Dermatologic Emergencies 374
Neena Khanna, Seema B Rasool
Acute Urticaria and Angioedema 374
Epidermal Necrolysis 375
xxiv Principles of Pediatric and Neonatal Emergencies
Staphylococcal Scalded Skin Syndrome (SSSS) 377
Erythroderma 377
Collodion Baby 378
Drug Eruptions 379
Pemphigus 379
Epidermolysis Bullosa (EB) 380
Herpes Virus Simplex Infections 382
Erysipelas and Cellulitis 382
39. Gynecologic Emergencies 384
Reva Tripathi, Pooja Pundhir
Foreign Body in Genital Tract 384
Direct Trauma to Vagina—Tears and Lacerations 384
Puberty Menorrhagia 386
Imperforate Hymen, Transverse Vaginal Septum 387
Twisted Ovarian Cyst 388
Teenage Pregnancy Complications 388
40. Psychiatric Emergencies . 390
PSS Russell, Alice Cherian
Basic Principles and Decision Making in Emergency Psychiatry 390
Epidemiology 390
Classification of Psychiatric Emergencies in Infants and Toddlers, Children and Adolescents 390
41. Emergencies in Pediatric Rheumatology . 399
Sujata Sawhney, Manjari Agarwal
Introduction 399
Juvenile Idiopathic Arthritis (JIA) 399
Antiphospholipid Antibody Syndrome 401
Juvenile Dermatomyositis (JDM) 403
Section 4: Environmental Problems
42. Burns 409
Arun Goel, Urmila Jhamb
Mode of Injury 409
Prevention 410
First Aid 410
Hospital Management 410
43. Drowning 420
Lalitha Janakiraman
Pathophysiology 420
44. Heat Illnesses 426
Dheeraj Shah, HPS Sachdev
45. Electric Shock . 434
Piyush Gupta, Mily Ray
46. Snake Bite 439
Joseph L Mathew, Tarun Gera
Management of Ophitoxemia 442
47. Scorpion Envenomation . 445
S Mahadevan, Jhuma Shankar
Case Vignettes 445
The Problem 445
Distribution 445
Pathophysiology 445
Venom 445
Effect of the Venom on Various Tissues/Organs 446
Section 5: Toxicological Emergencies
48. General Management of a Poisoned Child . 457
Suresh Gupta, Vikas Taneja
49. Management of Specific Toxicological Emergencies 465
Vikas Taneja, Krishan Chugh, Sanjay Choudhary, Utpal Kant Singh, Rajniti Prasad, Puneet A Pooni,
Daljit Singh, Tarun Dua, Rajesh Mehta, S Gopalan, Panna Choudhury
49.1 Hydrocarbon (Kerosene) Poisoning 465
Vikas Taneja, Krishan Chugh
49.2 Dhatura . 469
Sanjay Choudhary
49.3 Opioids . 471
Sanjay Choudhary
49.4 Acetaminophen Poisoning 474
Utpal Kant Singh, Rajniti Prasad
49.5 Organophosphorus Poisoning . 478
Puneet A Pooni, Daljit Singh
49.6 Lead Poisoning 484
Tarun Dua
49.7 Iron Poisoning . 489
Utpal Kant Singh, Rajniti Prasad
49.8 Barbiturate Poisoning 494
Rajesh Mehta
49.9 Phenothiazine Toxicity 496
Rajesh Mehta
49.10 Corrosive Poisoning . 497
S Gopalan, Panna Choudhury
49.11 Naphthalene Poisoning . 500
S Gopalan, Panna Choudhury
Section 6: Neonatal Emergencies
50. Neonatal Emergencies in Delivery Room . 503
Amit Upadhyay, Ashok K Deorari
Neonatal Emergencies which can Present in Labor Room 503
Management of Neonatal Emergencies 504
xxvi Principles of Pediatric and Neonatal Emergencies
Baby not Breathing at Birth 504
Technique of Chest Compression 508
Use of Drugs 508
When to Stop Resuscitation withhold Resuscitation 509
Meconium Stained Liquor 509
Shock 510
Drug Depression 510
Hydrops Fetalis 510
Impaired Lung Function 511
Accidental Injection of Local Anesthetic 512
Airway Anomalies in Delivery Room Resuscitation 512
51. Approach to a Sick Newborn. 515
Siddharth Ramji
Initial Assessment 515
Emergency Triage 516
Differential Diagnosis 517
Breastfeeding Problems Presenting in the Emergency Room 518
52. Respiratory Failure in Newborn . 520
Jaideep Singh, Sunil Sinha
Causes of Respiratory Failure in the Newborn 520
Mechanisms of Respiratory Failure 521
Assessment of Respiratory Failure 521
Treatment of Respiratory Failure 522
Mechanical Ventilation 524
Management of Specific Respiratory Conditions 525
53. Shock in the Newborn 530
Rajiv Aggarwal
Definition 530
Tissue Perfusion and Shock 530
Blood Pressure and Shock 530
Etiology of Shock 531
Stages of Shock 532
Monitoring for Physical Signs 532
Initial Management of Shock 532
Issues in Fluid Resuscitation 533
Refractory Shock 534
Afterload Reduction 535
Management of Complications 535
54. Neonatal Convulsions . 538
Swarna Rekha
Incidence 538
Etiology of Neonatal Convulsions 538
Classification of Neonatal Convulsions 538
Clinical Approach 539
Management of Neonatal Convulsions 540
Why Should Seizures be Treated? 541
When to Treat Seizures? 541
Adequacy of treatment 541
Choice of Anticonvulsant 541
Refractory Seizures 542
Second Line Anticonvulsants 542
Newer Antiepileptic Drugs 543
Neonatal Status Epilepticus 543
Special Situations 543
Seizure Control—Clinical or EEG Control 543
Duration of Anticonvulsant Therapy 544
Prognosis 544
55. Neonatal Hypoglycemia . 546
Sourabh Dutta
Glucose Homeostasis and Metabolic Adaptation at Birth 546
Causes of Hypoglycemia 547
Hypoglycemia and the Brain 549
Definition of Hypoglycemia 550
Prevention of Hypoglycemia 552
Treatment of Hypoglycemia 553
Methods of Measuring Blood or Plasma Glucose 554
56. Neonatal Jaundice 557
Srinivas Murki, Anil Narang
Bilirubin Metabolism and Etiology of Jaundice 557
Clinical Evaluation of a Jaundiced Neonate 558
Prediction of Severe Jaundice 559
Investigations 561
Treatment of Severe Jaundice 561
Intravenous Immunoglobulin 564
57. Management of the Bleeding Neonate 569
Arun Kumar
Major Causes of Bleeding 569
Hemorrhage in the Perinatal Period 572
Iatrogenic 572
Sites of Major Hemorrhage 572
Gastrointestinal Hemorrhage 573
Intra-abdominal Bleeding 573
Subgaleal Hemorrhage 573
Intracranial Hemorrhage 573
Bleeding from the Umbilical Cord 574
Approach to a Child with Bleeding 574
Emergency Management 575
Subsequent Management 576
Prevention 576
58. Neonatal Cardiac Emergencies 579
Girish Kumar, Parvathi U Iyer
Magnitude of the Problem 579
Clinical Presentation 579
Emergency Management and Initial Stabilization 586
59. Acute Kidney Injury in Newborn . 591
Arvind Shenoi, S Kishore Babu
Introduction 591
Physiology 591
Definitions of AKI 591
xxviii Principles of Pediatric and Neonatal Emergencies
Definition 591
Incidence 592
Causes of Neonatal AKI 592
Pathophysiology of ATN 593
Clinical Approach 594
Management 595
Bioartificial Kidney and Bioengineered Membranes in AKI 597
Drugs in Renal Failure 597
Recent Trends in ARF Therapy 597
Stem cell therapy in AKI 597
Management of the Diuretic Phase 598
Prognosis 598
60. Disturbances in Temperature in Newborn . 600
NB Mathur
Mechanisms of Heat Loss 600
Response to Cold Stress 600
Risk Factors for Hypothermia 602
Severity of Hypothermia: WHO Classification 602
Measuring or Assessing the Newborn’s Temperature 602
Effects and Signs of Hypothermia 602
Management of Hypothermia in Hospital 603
Duration of Rewarming 603
Kangaroo Mother Care 604
Management at Home 604
Warm Chain 604
Hyperthermia 604
Physiological Response to Hyperthermia 604
Causes of Hyperthermia 605
Symptoms of Hyperthermia 605
Management 605
61. Neonatal Surgical Emergencies. 607
Satish Kumar Aggarwal
Introduction 607
Neonatal Intestinal Obstruction 607
Abdominal Wall Defects 620
Surgical Causes of Respiratory Distress in the Newborn 622
Posterior Urethral Valves (PUV) 628
Antenatal Hydronephrosis 629
62. Neonatal Transport 632
Neelam Kler, Arun Soni, Naveen Gupta
Introduction 632
Why is Transport of Sick Patients Necessary? 632
Clinical Presentation of Transported Babies 632
Types of Transport 633
Regionalization of Neonatal Health Care Facilities 633
Whom to Transport 634
Where to Transport 634
Mode of Transport 634
Transport Personnel 635
Leadership 635
Team members 635
Transport Equipment 636
Specific Equipment Items 636
CPAP Devices 636
Incubators 637
Principles of Transport 637
Modules for Transport 638
Complications of Transport 638
Family Counseling 640
Cost of Transport 640
Aviation Physiology in Neonatal Transport 640
Section 7: Pediatric Surgical Emergencies
63. Acute Abdomen . 645
Shinjini Bhatnagar, Veereshwar Bhatnagar, Vidyut Bhatia
Introduction 645
Evaluation of the Child with Acute Abdomen 645
Classification of Etiologies 647
Location of Underlying Cause 648
Emergency Investigations 652
Principles of Management 653
64. Urological Emergencies 655
Anurag Krishna
Urinary Tract Injuries 655
Retention of Urine 655
Urosepsis 656
Acute Scrotum 656
65. Pediatric Trauma 658
Peeyush Jain, AP Dubey
Major Trauma 658
Spectrum of Trauma 658
Trauma Scores 660
Head Trauma 661
Minor Trauma and Lacerations 662
66. Orthopedic Emergencies 666
Ramani Narasimhan
Immature Skeleton—Basic 666
Physes or ‘Growth Plate’ 666
General Approach 667
Pediatric Orthopedic Trauma 668
Fractures and Dislocations of Upper Limb 668
‘Pulled Elbow’ 670
67. Ocular Emergencies . 683
Radhika Tandon, Noopur Gupta
68. Ear, Nose and Throat Emergencies . 690
KK Handa
Ear 690
Nose 691
Throat 692
xxx Principles of Pediatric and Neonatal Emergencies
69. Oral and Dental Emergencies 693
H Parkash, S Kapoor, Mahesh Verma
Section 8: Pediatric Emergency Procedures
70. Procedures in Emergency Room . 703
Anil Sachdev, Dhiren Gupta, Daljit Singh, Puneet A Pooni, M Jayashree, Varinder Singh,
Shishir Bhatnagar, Sukhmeet Singh, DK Gupta, Tarun Gera, Anjali Seth
70.1 Sedation, Analgesia, Anesthesia . 703
Anil Sachdev
Introduction 703
Pre-evaluation 704
Assessment Tools 704
Monitoring 705
Specific Drugs 705
70.2 Pulse Oximetry 709
Dhiren Gupta
70.3 Non-invasive Blood Pressure Measurement . 713
Dhiren Gupta
70.4 Intramuscular Injections . 718
Daljit Singh, Puneet A Pooni
70.5 Intravenous Infusion . 719
Daljit Singh, Puneet A Pooni
70.6 Vascular Access . 720
M Jayashree
Cannulation of Peripheral Veins 720
Factors that Increase the Risk of Arterial Catheter Thrombosis 726
70.7 Venous Cut Down 727
Anil Sachdev
70.8 Lumbar Puncture 728
Varinder Singh, Shishir Bhatnagar
70.9 Abdominal Paracentesis 728
Varinder Singh, Shishir Bhatnagar
70.10 Pericardiocentesis . 729
Anil Sachdev
70.11 Thoracocentesis/Pleural Tap 730
Varinder Singh, Shishir Bhatnagar
70.12 Tube Thoracotomy and Needle Decompression 731
Varinder Singh, Shishir Bhatnagar
70.13 Cervical Spine Stabilization in Trauma . 732
Sukhmeet Singh
70.14 Heimlich Maneuver . 733
Sukhmeet Singh
70.15 Insertion of Nasogastric Tube 736
Daljit Singh, Puneet A Pooni
70.16 Urinary Bladder Catheterization . 737
DK Gupta
70.17 Suprapubic Tap. 737
Daljit Singh, Puneet A Pooni
70.18 Hydrostatic Reduction of Intussusception 738
DK Gupta
70.19 Tracheostomy 738
Tarun Gera, Anjali Seth
ANNEXURES 743
Annexure 1: Dosages of Some Common Drugs. 745
Ashok K Deorari, Rakesh Lodha
Annexure 2: Reference Laboratory Values . 769
Tarun Gera
Index . 775
Principles of Pediatric & Neonatal Emergencies 3rd Edition PDF Ebook
About the Authors
Panna Choudhury
President IAP, 2009 and Former Senior Consultant
Department of Pediatrics, Lok Nayak Hospital
New Delhi, India
Arvind Bagga
Professor of Pediatrics
Division of Pediatric Nephrology
All India Institute of Medical Sciences
New Delhi, India
Krishan Chugh
Director
Center for Child Health, Sir Ganga Ram Hospital
Delhi, India
Siddharth Ramji
Professor and Head of Neonatology Unit
Department of Pediatrics, Maulana Azad Medical College
and Associated Lok Nayak Hospital
New Delhi, India
Piyush Gupta
Editor-in-Chief, Indian Pediatrics and Professor of Pediatrics
University College of Medical Sciences and GTB Hospital
Delhi, India
President IAP, 2009 and Former Senior Consultant
Department of Pediatrics, Lok Nayak Hospital
New Delhi, India
Arvind Bagga
Professor of Pediatrics
Division of Pediatric Nephrology
All India Institute of Medical Sciences
New Delhi, India
Krishan Chugh
Director
Center for Child Health, Sir Ganga Ram Hospital
Delhi, India
Siddharth Ramji
Professor and Head of Neonatology Unit
Department of Pediatrics, Maulana Azad Medical College
and Associated Lok Nayak Hospital
New Delhi, India
Piyush Gupta
Editor-in-Chief, Indian Pediatrics and Professor of Pediatrics
University College of Medical Sciences and GTB Hospital
Delhi, India
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