PE24.1-23 | Pediatric Emergencies — Glossary

Glucose solution used for emergency hypoglycaemia treatment in children at 5 mL/kg IV; 50% dextrose is contraindicated in paediatrics due to vein sclerosis risk.

The preferred 2-rescuer infant CPR compression method: both thumbs are placed over the mid-sternum while the hands encircle the chest; generates higher peak aortic pressure than the 2-finger technique.

A catecholamine used in cardiac arrest at 0.01 mg/kg IV/IO every 3–5 minutes; increases coronary and cerebral perfusion pressure through alpha-1 mediated vasoconstriction.

Mnemonic for aetiology of coma: Alcohol/Acidosis, Epilepsy, Insulin/Hypoglycaemia, Overdose/Opiates, Uraemia, Trauma/Temperature, Infection, Psychogenic, Stroke/Structural.

An antiarrhythmic drug used for shock-refractory VF/pVT at 5 mg/kg IV/IO; acts by prolonging the action potential and refractory period in ventricular myocardium.

IgE-mediated massive histamine and mediator release causing profound vasodilation and airway oedema; first-line treatment is adrenaline IM 0.01 mg/kg (max 0.5 mg).

The front-to-back diameter of the chest; correct compression depth is one-third of this measurement — approximately 4 cm in infants and 5 cm in children.

A child's agreement to a proposed medical procedure; ethically important and sought from children approximately ≥7 years; not legally binding, but morally significant; distinct from consent.

Complete absence of electrical activity on ECG ('flat line'); a non-shockable cardiac arrest rhythm requiring CPR and adrenaline.

Positive end-expiratory pressure generated by the patient's own respiratory mechanics; in grunting infants, partially closed glottis generates auto-PEEP preventing alveolar collapse — analogous to ventilator PEEP.

A rapid 4-point qualitative consciousness scale: Alert, responds to Voice, responds to Pain, Unresponsive; AVPU P/U approximates GCS ≤8 (coma threshold).

A hand-held device consisting of a self-inflating bag, one-way valve, and face mask used to deliver positive-pressure ventilation with room air or supplemental oxygen during resuscitation.

The foundational resuscitation skills of chest compressions and rescue breathing that maintain minimal perfusion and oxygenation until advanced help arrives.

Specialised fat in neonates (neck, axillae, perirenal region) generating heat via uncoupling oxidative phosphorylation; stimulated by noradrenaline in response to cold stress.

An EEG pattern of alternating bursts of epileptiform activity and periods of flat/suppressed trace; the target pattern for anaesthetic management of refractory SE, indicating adequate cortical suppression.

The PALS-recommended order for CPR: Compressions first, then Airway opening, then Breathing; prioritises restoration of cardiac output over airway management.

The ability to understand relevant information, retain it, weigh it in making a decision, and communicate that decision; assessed at the time of each decision, not as a permanent trait.

The time taken for blanched skin (pressed for 5 seconds on the sternum or forehead) to return to its baseline colour after release; normal <2 seconds; prolonged >2 seconds indicates reduced peripheral perfusion.

Shock caused by primary myocardial pump failure; distinguished by raised JVP, hepatomegaly, gallop rhythm, and pulmonary crepitations; fluid resuscitation must be cautious (5–10 mL/kg).

The cessation of effective respiratory effort and cardiac output, resulting in absent delivery of oxygenated blood to vital organs; recognised by unresponsiveness, apnoea, and absent central pulse.

Suboptimal thermal environment causing increased metabolic rate and oxygen consumption in neonates attempting to maintain core temperature; precedes frank hypothermia and depletes glucose.

State of unarousable unconsciousness defined as GCS ≤8 (or AVPU P/U); requires immediate airway protection and systematic emergency evaluation.

The phase of shock in which sympathetic compensatory mechanisms (tachycardia, vasoconstriction) maintain a normal blood pressure despite reduced cardiac output; identifiable by tachycardia, prolonged CRT, and cold extremities.

The number of chest compressions delivered before each set of rescue breaths; 30:2 for a single rescuer (child or infant), 15:2 for two rescuers (child or infant).

Two parallel randomised controlled trials published in 2019 in New Zealand/Australia (ConSEPT) and the United Kingdom (EcLiPSE) that compared levetiracetam vs phenytoin as second-line treatment for paediatric SE; both found levetiracetam non-inferior, supporting its use as a preferred second-line agent.

SE with continuous or intermittent tonic-clonic, tonic, or clonic motor activity; the most recognisable and clinically obvious form.

Abnormal posture with extension and pronation of arms and leg extension; indicates lower midbrain or pontine lesion; ominous sign of severe structural injury.

The phase of shock in which compensatory mechanisms fail and blood pressure falls below the 5th percentile for age; indicates impending cardiac arrest without immediate intervention.

Abnormal posture with arm flexion and leg extension; indicates lesion at the level of the midbrain–diencephalon junction; less ominous than decerebrate.

Delivery of a synchronised or unsynchronised electrical shock to the myocardium to terminate a shockable arrhythmia; dose 2 J/kg initial, escalating to 4 J/kg in children.

WHO recommendation to defer the first bath until at least 24 hours after birth; prevents evaporative heat loss and allows the protective vernix caseosa to provide some insulation.

First-line benzodiazepine for acute seizure control; dose 0.3 mg/kg IV (max 10 mg) slow injection over 2–3 minutes; causes respiratory depression.

Rectal route for diazepam at 0.5 mg/kg when IV access is unavailable; can be administered by trained community health workers; onset 5–10 minutes.

Shock caused by maldistribution of blood flow due to abnormal vasodilation; includes septic (most common), anaphylactic, and neurogenic shock; early septic shock may present with warm peripheries and bounding pulses.

The two-handed technique for bag-valve-mask ventilation: three fingers (ring, middle, index) lift the mandible (E), while thumb and forefinger seal the mask against the face (C); lifts the face into the mask to maintain airway patency.

Legal and ethical principle permitting treatment without prior consent when delay would cause irreversible harm and the proxy decision-maker is unavailable; requires immediate documentation and retrospective consent.

Third-generation cephalosporin given immediately at 100 mg/kg/day IV (max 4 g/day) when bacterial meningitis/meningococcal disease is clinically suspected, before LP confirmation.

The concentration of CO₂ in exhaled breath at end-expiration; a rise to >35–40 mmHg during CPR signifies ROSC as it reflects resumption of pulmonary perfusion.

Heat loss from the conversion of liquid water to vapour at the skin surface; the dominant route of heat loss in the immediate postnatal period; prevented by immediate drying after delivery.

Neuronal injury caused by excessive glutamate activation of NMDA receptors leading to calcium influx, mitochondrial dysfunction, and apoptosis; the primary mechanism of neuronal death in prolonged SE.

In many Indian family structures, a senior family member (often a male elder) who acts as the communication intermediary; the clinician must still ensure the legal proxies (parents) are directly informed and consulted.

Fluid Expansion as Supportive Therapy trial (East Africa, 2011); demonstrated increased 48-hour mortality with 20 mL/kg fluid boluses vs no bolus in febrile African children with predominantly malaria and severe anaemia; informs caution with boluses in this specific population.

Seizure occurring with fever (>38°C) in children aged 6 months to 5 years without CNS infection or metabolic cause; simple febrile seizures are self-limited and benign.

SE occurring in the context of fever in a child aged 1-5 years without underlying structural brain disease; the most common cause of SE in children; a prolonged febrile seizure >15 min meets the SE definition.

Fraction of inspired oxygen — the proportion of the inspired gas mixture that is oxygen, expressed as a decimal (0.21 for room air) or percentage (21% for room air).

A rare form of new-onset refractory SE occurring in a previously neurologically normal child, typically within 2 weeks of a febrile illness; associated with prolonged PICU stay and significant neurological sequelae; requires specialist management.

A defined volume of IV/IO fluid given rapidly to restore intravascular volume in shock; standard paediatric dose 20 mL/kg isotonic crystalloid; 10 mL/kg for neonates, DKA, and cardiogenic shock.

Persistent haemodynamic instability despite 60 mL/kg of fluid resuscitation; requires vasopressor/inotrope therapy and PICU support.

A water-soluble prodrug of phenytoin; dose 18-20 mg PE/kg (phenytoin equivalents); can be given IV or IM; does not precipitate; given at ≤150 mg PE/min IV; preferred over phenytoin when IM route needed.

The volume of air remaining in the lungs at the end of a normal passive expiration; reduced FRC in infants predisposes to airway closure and V/Q mismatch, contributing to rapid desaturation during respiratory illness.

The molecular mechanism of benzodiazepine resistance in prolonged SE: sustained seizure activity causes endocytosis of synaptic GABA-A receptors, removing benzodiazepine binding sites from the synapse and reducing drug efficacy.

An expiratory sound produced by partial closure of the glottis, generating auto-PEEP to prevent alveolar collapse; a sign of severe respiratory distress and impending failure if it disappears as the child tires.

Indian legislation governing the appointment and duties of guardians of minors; the parent is the natural guardian and primary proxy decision-maker for a child's medical care.

A mnemonic for the reversible causes of cardiac arrest: Hypoxia, Hypovolaemia, Hydrogen ion (acidosis), Hypo/hyperkalaemia, Hypoglycaemia, Hypothermia; Tension pneumothorax, Tamponade, Toxins, Thrombosis.

Life-threatening hyperthermia (core >40°C) with CNS dysfunction (confusion, seizures, loss of consciousness) from environmental heat overload; treated by emergency cooling, not antipyretics.

Standard paediatric daily maintenance fluid calculation: 100 mL/kg for the first 10 kg + 50 mL/kg for the next 10 kg + 20 mL/kg for each kg above 20 kg; separate from dehydration replacement volumes.

Metabolic acidosis caused by excess chloride load from large-volume normal saline infusion; a reason to prefer Ringer's lactate over normal saline for diarrhoeal dehydration.

Core temperature >40°C; indicates heat stroke or severe infection; associated with high risk of neurological damage if not rapidly treated with cooling or fever management.

Blood glucose <45 mg/dL associated with neurological symptoms; neonatal threshold is <2.6 mmol/L (47 mg/dL). Treated with 10% dextrose 5 mL/kg IV.

Axillary temperature <36.5°C in a neonate; classified as mild (36.0–36.4°C), moderate (32–35.9°C), or severe (<32°C); a leading preventable cause of neonatal mortality.

Shock caused by reduced intravascular volume (diarrhoeal dehydration, haemorrhage, burns); characterised by cold peripheries, prolonged CRT, poor pulse volume, and fluid responsiveness.

WHO Integrated Management of Neonatal and Childhood Illness criteria indicating severe respiratory illness: central cyanosis, severe chest indrawing, grunting at rest, inability to drink/breastfeed, stridor at rest, altered consciousness.

WHO/UNICEF Integrated Management of Neonatal and Childhood Illness framework classifying dehydration into no, some, or severe based on two or more of four clinical signs (consciousness, eye appearance, drinking ability, skin turgor).

Legal and ethical authorisation for a medical procedure, requiring disclosure, understanding, voluntariness, capacity, and explicit authorisation from the patient or proxy.

Insertion of a needle into the medullary cavity of a bone (most commonly proximal tibia in children) to deliver drugs and fluids; equivalent to IV access in bioavailability and onset.

An IV fluid with an osmolality approximating plasma (280–310 mOsm/kg); expands extracellular and intravascular volume; 0.9% normal saline and Ringer's/Hartmann's lactate are the standard choices for shock resuscitation.

Airway-opening technique for suspected cervical spine injury: hands behind the mandibular angles lifting the jaw anteriorly without extending the neck.

Skin-to-skin contact with infant placed prone and upright on the mother's bare chest; effective for warming stable neonates, promoting breastfeeding, and reducing infection and mortality.

Descriptive model of grief responses: denial, anger, bargaining, depression, acceptance; not strictly sequential; used to understand and respond to family emotional states in crisis communication.

A second-line antiepileptic (SV2A modulator) for SE; dose 40-60 mg/kg IV (max 3000 mg); ConSEPT/EcLiPSE trials (2019) showed non-inferiority to phenytoin; no cardiac monitoring required; compatible with dextrose.

Coordinated manoeuvre to turn a patient while maintaining spinal alignment, requiring one person at the head controlling neck and three along the body; essential when cervical injury is possible.

First-line benzodiazepine for IV/IO treatment of SE in children; dose 0.1 mg/kg IV (max 4 mg); onset 2-5 min; longer anticonvulsant duration than diazepam due to slower redistribution.

Invasive Neisseria meningitidis infection presenting with fever, petechial/purpuric non-blanching rash, and rapid haemodynamic collapse; requires immediate ceftriaxone IV.

First-line benzodiazepine when IV access is unavailable; dose 0.2-0.3 mg/kg (max 10 mg) into the buccal mucosa; equivalent efficacy to IV diazepam for out-of-hospital or ward SE management.

A low-flow oxygen delivery device delivering 24–44% FiO₂ at 1–6 L/min via two nasal prongs; preferred for mild hypoxaemia in stable, cooperative patients.

SE in which electrographic seizure activity continues on EEG without prominent motor manifestations; presents as persistent altered consciousness, staring, automatisms; requires EEG for diagnosis.

A high-flow oxygen mask with a reservoir bag and one-way valve delivering 60–90% FiO₂ at 10–15 L/min; indicated for severe hypoxaemia with SpO₂ <90%.

Heat generation in neonates through brown adipose tissue (BAT) metabolism via uncoupling protein-1; the primary thermogenic mechanism in newborns who cannot shiver effectively.

Shock caused by physical obstruction to cardiac filling or outflow (tension pneumothorax, cardiac tamponade, massive PE); requires cause-directed treatment — fluid alone is insufficient.

Modified Glasgow Coma Scale (total 3–15) with a developmentally adapted verbal component for pre-verbal children; coma is defined as GCS ≤8.

First-line antipyretic in children; dose 10–15 mg/kg every 4–6 hours; acts by reducing hypothalamic set point; ineffective for heat stroke (where the set point is not elevated).

Latin for 'parent of the nation'; the state's legal authority to act in the best interests of a minor or incapacitated person, including overriding parental refusal of life-saving treatment.

First component of Plan C: 30 mL/kg Ringer's lactate given over 1 hour (infants <12 months) or 30 minutes (children ≥12 months) to rapidly restore circulating volume.

Second component of Plan C: 70 mL/kg Ringer's lactate given over 5 hours (infants <12 months) or 2.5 hours (children ≥12 months) after Phase 1 reassessment confirms improvement.

Third-line antiepileptic in most paediatric SE algorithms; dose 15-20 mg/kg IV over 20-30 min; remains first-line in neonates due to immature sodium channel expression that limits phenytoin efficacy in the newborn period.

A sodium-channel blocker used as second-line antiepileptic in SE; dose 18-20 mg/kg IV (in 0.9% saline) at ≤1 mg/kg/min; requires ECG monitoring; cannot be given IM or in dextrose solutions.

IMNCI home management for no dehydration: ORS after each loose stool (50–100 mL for under 2; 100–200 mL for 2–10 years), continue feeding, return signs listed.

IMNCI protocol for some dehydration: supervised ORS 75 mL/kg over 4 hours in a health facility, with reassessment at 4 hours to reclassify.

IMNCI intravenous rehydration protocol for severe dehydration: Ringer's lactate 100 mL/kg total in two phases (30 mL/kg rapid + 70 mL/kg maintenance), with timing based on age (<12 months vs ≥12 months).

The complex systemic response following resuscitation from cardiac arrest, comprising myocardial dysfunction, systemic ischaemia-reperfusion injury, brain injury, and persistence of the precipitating cause.

Consent given by a parent or legal guardian on behalf of a child under 18 years who lacks the legal capacity to consent independently; the proxy must act in the child's best interests.

Non-invasive measurement of haemoglobin oxygen saturation by photoplethysmography; target ≥94% in paediatric respiratory distress; unreliable in poor perfusion states and does not measure CO₂.

An organised cardiac electrical rhythm on ECG without a palpable pulse; a non-shockable rhythm requiring CPR, adrenaline, and search for reversible causes.

A rapid, organised ventricular rhythm (>100/min) with no palpable pulse; a shockable rhythm treated with defibrillation.

The antidote for isoniazid-induced status epilepticus; isoniazid inhibits pyridoxal phosphate → reduces GABA synthesis → refractory SE; antidote dose 70 mg/kg IV (up to 5 g); especially relevant in India where TB treatment is common.

Left lateral decubitus position with upper limbs positioned for stability; prevents airway obstruction and aspiration in an unconscious child without suspected spinal injury.

WHO-recommended oral rehydration salt solution with osmolarity 245 mOsm/L (Na 75, Cl 65, glucose 75, K 20 mmol/L); reduces stool output and vomiting compared to the original formula.

SE persisting despite adequate doses of a benzodiazepine and a second-line antiepileptic (>30 min); requires intensive care, rapid sequence intubation, and continuous anaesthetic infusion under EEG monitoring.

The clinical state in which increased work of breathing is required to maintain adequate gas exchange, manifested by tachypnoea, retractions, nasal flaring, grunting, and use of accessory muscles.

Inability to maintain adequate gas exchange despite maximal respiratory effort; characterised by hypoxaemia (SpO₂ <85%, PaO₂ <60 mmHg) and/or hypercapnia (PaCO₂ >50 mmHg); requires assisted ventilation.

Ascending network in the brainstem and diencephalon that maintains wakefulness; bilateral disruption produces coma regardless of cortical integrity.

Inward movement of the skin over the chest wall during inspiration due to increased negative intrathoracic pressure; sites (subcostal, intercostal, suprasternal, supraclavicular) indicate increasing severity of respiratory distress.

Consent obtained from a parent after an emergency procedure has been performed under the emergency exception; requires explanation of what was done and why; documented fully.

The resumption of coordinated cardiac activity producing a palpable pulse, typically detected by carotid/brachial pulse, rise in end-tidal CO₂, or spontaneous movement.

Isotonic IV fluid containing sodium chloride, potassium chloride, calcium chloride, and sodium lactate; preferred for Plan C because lactate is metabolised to bicarbonate, correcting metabolic acidosis.

Nutritional state defined as weight-for-height <−3 SD, MUAC <11.5 cm, or bilateral pedal oedema; skin pinch unreliable for dehydration assessment; slower IV rehydration rates required.

Paradoxical respiratory movement in which the chest wall retracts while the abdomen protrudes during inspiration, indicating severe upper airway obstruction or neuromuscular respiratory failure with loss of coordinated breathing.

The most common distributive shock in children; caused by systemic infection → cytokine release → vasodilation; biphasic (warm phase: bounding pulses, high CO; cold phase: poor perfusion, low CO).

A state of acute circulatory failure resulting in inadequate oxygen delivery to meet cellular metabolic demands; characterised by tachycardia, poor perfusion, and eventually hypotension and organ dysfunction.

Assessment of skin elasticity by lifting a fold of abdominal skin and timing recoil: <1 second = normal; 1–2 seconds = some dehydration; >2 seconds = severe dehydration.

The optimal airway-opening position for infants: slight neck flexion ('sniffing the morning air'), achieved by placing a folded towel under the shoulders to counteract the large occiput.

Six-step structured framework for breaking bad news: Setting, Perception, Invitation, Knowledge, Emotions, Strategy/Summary; developed by Buckman; widely adapted for paediatric emergency communication.

Seizure lasting >5 minutes or repeated seizures without recovery of consciousness; treated with timed benzodiazepine doses followed by phenobarbitone or phenytoin if refractory.

A prolonged seizure or repeated seizures without recovery between them; operational definition: ≥5 minutes of continuous seizure activity (ILAE 2015 t1 threshold for treatment); physiological definition: >30 minutes (t2, risk of long-term neurological consequences).

A high-pitched monophonic respiratory sound due to turbulent airflow through a narrowed upper airway; inspiratory stridor indicates supraglottic/glottic obstruction (croup, epiglottitis, foreign body).

Clinical sign of dehydration indicating reduced intra-ocular pressure and depleted orbital fat; present in both 'some' and 'severe' dehydration per IMNCI classification.

Respiratory rate above the normal range for age; the earliest and most sensitive clinical sign of respiratory distress in children (thresholds vary by age: >60/min newborn, >50/min 2-12 months, >40/min 1-5 years).

Controlled maintenance of core body temperature at 32–36°C in post-arrest comatose patients to limit cerebral reperfusion injury; fever (≥38°C) is actively prevented.

Fever and heat-reduction technique using lukewarm (not cold) water applied to skin; works via evaporative cooling; cold water is contraindicated (causes vasoconstriction and shivering).

The practice of withholding medical information from a patient/family to prevent distress; generally considered unethical in modern medical ethics; the default duty is to disclose.

The bony prominence on the anterior tibia, distal to the patella; the landmark for IO needle insertion, which is placed 1–2 cm distal and medial to this point on the flat anteromedial tibial surface.

Transient focal neurological weakness (hemiplegia, monoplegia) following a focal seizure; typically resolves within minutes to hours; important to distinguish from structural stroke, which it can mimic.

A rapid 30-second visual assessment tool comprising three elements: Appearance (tone, responsiveness), Work of Breathing (retractions, grunting, stridor), and Circulation to Skin (cyanosis, pallor, mottling); used to immediately categorise a child's severity.

A vasoactive agent that increases systemic vascular resistance and/or cardiac output; examples: dopamine, noradrenaline, adrenaline, dobutamine; administered by continuous IV infusion via central or IO line.

Chaotic, disorganised electrical activity of the ventricular myocardium producing no effective cardiac output; a shockable cardiac arrest rhythm treated with defibrillation.

The only oxygen delivery device providing a fixed, controlled FiO₂ (24–60%) regardless of patient breathing pattern, using the Venturi principle to entrain room air in a fixed ratio; essential when precise FiO₂ control is required.

Consent given freely, without coercion, manipulation, or undue influence; a parent who signs under implicit threat of abandonment has not given valid voluntary consent.

WHO framework of 10 interlinked actions to prevent neonatal hypothermia from delivery through discharge; includes warm room, immediate drying, KMC, breastfeeding, and delayed bathing.

A preparatory phrase used before delivering bad news, e.g., 'I'm afraid the news is serious'; gives the listener a moment of psychological preparation and reduces the shock of the subsequent disclosure.