Pediatric emergency medicine trisk 3031 3031

Level of consciousness, neuromuscular tone, reflexes
Eyes—pupil size/reactivity, extraocular movements, fundi, nystagmus
Mouth—corrosive lesions, odors
Cardiovascular—rate, rhythm, perfusion
Respiratory—rate, chest excursion, air entry
GI—motility, corrosive effects
Skin—color, bullae or burns, diaphoresis, piloerection
Odors
Laboratory (individualize)
CBC, co-oximetry
ABG, serum osmolarity
EKG/cardiac monitor
Chest radiograph, abdominal radiograph
Electrolytes, BUN/creatinine, glucose, calcium, liver function panel
Urinalysis
Urine screen for common drugs (amphetamine, benzodiazepines,
barbiturates, cocaine, marijuana, opiates, phencyclidine)
Quantitative toxicology tests (including acetaminophen, aspirin, ethanol)
Assessment of severity/diagnosis
Clinical findings
Laboratory abnormalities (with consideration of anion, osmolar gaps)
Toxidromes ( Table 102.6 )
Specific detoxification
Reassess ABCDs
Institute appropriate GI decontamination (if not already under way)
Urgent antidotal therapy
Consider excretion enhancement
Continue supportive care
ABG, arterial blood gas; ETCO2 , end-tidal carbon dioxide; AVPU, A lert, V erbal, P ain, U nresponsive;
GCS, Glasgow Coma Scale; ALS, advanced life support; GI, gastrointestinal; CBC, complete blood cell
count; EKG, electrocardiogram; BUN, blood urea nitrogen.

Empiric drug treatment is warranted for most symptomatic poisoned children
with altered mental status. Administer humidified oxygen and monitor blood
oxyhemoglobin saturation by pulse oximetry. Assess ventilatory effort by
auscultation and continuously by end-tidal CO2 , if available. If rapid bedside