Chapter 29: Nursing Care During a Pediatric Emergency

Nursing Care During a Pediatric Emergency on pediatric emergency nursing emphasizes the unique vulnerability of infants and children to life-threatening crises such as submersion injuries, accidental poisonings, and traumatic accidents, noting that most pediatric cardiopulmonary arrests stem secondarily from respiratory failure or shock, rather than primary cardiac events. Therefore, the nurse must possess advanced clinical knowledge, integrating Pediatric Advanced Life Support (PALS) and American Heart Association (AHA) guidelines that prioritize prevention and rapid intervention. The nursing process during an emergency mandates an immediate, focused primary survey—evaluating Airway, Breathing, and Circulation (ABCs)—followed by intervention before moving to the secondary survey, with a more comprehensive history obtained only after stabilization. Critical procedures include securing a patent airway using techniques like the head tilt-chin lift or jaw-thrust maneuver (if cervical spine injury is suspected), providing 100% supplemental oxygen, and assisting ventilation via Bag-Valve-Mask (BVM) or definitive airway management through endotracheal intubation. In circulation crises like shock (hypovolemic being the most common type), prompt fluid resuscitation using isotonic solutions (e.g., 20 mL/kg normal saline bolus) and the establishment of rapid vascular access, often via the intraosseous (IO) route, are paramount, as hypotension (decompensated shock) is a late and ominous sign. For cardiac arrests, high-quality chest compressions and early application of electrical therapies like defibrillation or synchronized cardioversion are necessary, guided by protocols for bradyarrhythmias, tachyarrhythmias (like SVT), and collapsed rhythms (asystole or PEA). Medications, including emergency drugs recalled by the LEAN mnemonic, are accurately dosed using the child’s weight or estimated by tools such as the Broselow tape. Specific management strategies are detailed for respiratory compromise, various forms of shock, near drowning (where immediate hypoxia treatment is key), poisoning (requiring toxin identification and supportive care, like activated charcoal or antidotes), and trauma (using the ABCs, Disability, Exposure survey structure, and ensuring C-spine stabilization). Throughout acute management, the nurse plays a vital role in providing nonjudgmental, empathetic support and clear, simple explanations to the child and family members who are experiencing intense fear and anxiety.