Acutely Ill Child

Acute abdomen
Burn
Diabetic ketoacidosis / Diabetes mellitus
Meningococcemia
Poisoning / intoxication
Shock
Trauma

  • List toxic agents that can cause altered level of consciousness and describe their mechanisms of action
  • Describe common toxidromes
  • Explain the effect of hyperglycemia on fluid, electrolyte and acid-base status
  • Describe the basic principles of pharmacology used in the management of diabetic ketoacidosis
  • Describe the pathophysiology of glucose homeostasis and the consequences of hyperglycemia
  • Describe how the physiology of the cardiopulmonary systems impacts the vital signs in different age groups
  • Describe the anatomic differences between the pediatric and adult airway
  • Recognize that a primary respiratory event can lead to cardiac arrest in the pediatric population
  • Define shock and describe the pathophysiology of four broad categories of shock: hypovolemic, distributive, cardiogenic and neurogenic
  • Recognize that body surface area and degree of burn injury impact fluid management in the pediatric population
  • Recognize that acute illness may lead to multisystem organ dysfunction

Overview & Foundational Knowledge

Brayer AF & Humiston SG. Invasive meningococcal disease in childhood.  Pediatrics in Review, 2011; 32(4): 152-160.

Review of meningococcal disease. Clinical features, treatment guidelines and complications.

The medical assessment of bruising in suspected child maltreatment cases: A clinical perspective.

http://www.cps.ca/documents/position/medical-assessment-of-bruising

http://www.cps.ca/fr/documents/position/evaluation-medicale-des-ecchymoses

Canadian Pediatric Society Practice Guideline (2013). Good tables, differential diagnoses.

Avner JR.  Altered States of Consciousness. Pediatrics in Review 2006; 27 (9): 331-338. 

Approach to altered level of consciousness. Common causes, differential diagnosis, table on herniation syndromes and management.

Yager P & Noviski N. Shock. Pediatrics in Review 2010; 31(8): 311-319.

Excellent overview, including pathophysiology of shock, types of shock and management.

Pope J & McBride J. Consultation with the Specialist: Respiratory Failure in Children. Pediatrics in Review 2004; 25(5): 160-167.

Review article on pathophysiology of respiratory insufficiency, and covers both acute and chronic respiratory failure and management.

Clinical Resources

Meningococcal vaccines in Canada: An update

http://www.cps.ca/en/documents/position/invasive-meningococcal-vaccination

http://www.cps.ca/fr/documents/position/vaccination-contre-la-meningococcie-invasive

Canadian Paediatric Society Position Statement (2017).

Wolfsdorf et al. Diabetic ketoacidosis in children and adolescents with diabetes. Pediatric Diabetes 2009; 10 (Suppl 12): 118-133.

International Society for Pediatric and Adolescent Diabetes (ISPAD) Clinical Practice Consensus Guidelines 2009 Compendium. Comprehensive article on diabetic ketoacidosis (DKA).

Pediatric Vital Signs. pedscases.com

http://www.pedscases.com/pediatric-vital-signs-reference-chart

Pedscases podcast on pediatric vital signs and link to pediatric vital signs reference chart.

Krishnamoorthy et al. Pediatric burn injuries. International Journal of Critical Illness & Injury Science (2012); 2(3): 128-134.

Overview of pediatric burns, including classification of burn, systemic effects, and goals of management.

Management of the paediatric patient with acute head trauma.

http://www.cps.ca/en/documents/position/paediatric-patient-with-acute-head-trauma

http://www.cps.ca/fr/documents/position/patient-age-pediatrique-victime-traumatisme-cranien-aigu

Canadian Paediatric Society Position Statement (2016).

Clinical Presentations