Paediatric Emergencies 351BREATHLESS CHILD(a) afebrile but mildly unwell with signs of pneumonia, cover for
Bordetella pertussis. Give azithromycin 10 mg/kg orally, daily
for 5 days
(b) febrile, give benzylpenicillin 30 mg/kg i.v. 6-hourly for up to
7 days
(c) severe, give cefotaxime 25 mg/kg i.v. 8-hourly.
(iii) 4 months to <5 years
(a) non-severe, give amoxycillin 25 mg/kg orally, 8-hourly for
3 days, or benzylpenicillin 30 mg/kg i.v. 6-hourly for up to 7
days, if oral treatment not tolerated
(b) severe, give cefotaxime 25 mg/kg i.v. 8-hourly, or a
combination of ceftriaxone 25 mg/kg i.v. daily plus
flucloxacillin 50 mg/kg i.v. 6-hourly.
(iv) 5–15 years
(a) non-severe, give amoxycillin 25 mg/kg up to 1 g orally,
8-hourly for 5 to 7 days, or if Mycoplasma pneumoniae is
suspected, roxithromycin 4 mg/kg up to 150 mg orally,
12-hourly for 5 to 7 days
(b) more severe, give benzylpenicillin 30 mg/kg i.v. 6-hourly for
up to 7 days plus roxithromycin 4 mg/kg up to 150 mg orally,
12-hourly for 7 days.4 Admit any child with severe respiratory compromise, altered level of
consciousness, lethargy, difficulty feeding, cyanosis, or oxygen saturation
<90% for i.v. antibiotics, and supportive care.
Anaphylaxis
DIAGNOSIS
1 Anaphylaxis is an immediate-type hypersensitivity reaction to an ingested,
inhaled, topical or injected substance. The most common agents include
foods such as nuts, fish, milk, egg and food additives. Less frequent are
medications, and hymenopteran stings.
2 Determine any history of atopy, the rapidity of symptom progression, previ-
ous reactions and prior response to medical management.
3 Look for an urticarial rash, conjunctival injection, erythema, pallor, wheeze
and cough.
4 Symptoms and signs may rapidly progress to become potentially life-threat-
ening, including stridor, severe wheeze and an altered conscious level. Shock
is less common t han in adult presentations.
MANAGEMENT1 Stop or remove a precipitating agent such as an antibiotic or radiocontrast
contrast dye.