Emergency Medicine

Paediatric Emergencies 355

Abdominal Pain, Diarrhoea and Vomiting

4 Request an anteroposterior and lateral CXR only in the stable child with
lower respiratory tract features.
(i) Although an organic foreign body such as a peanut will not show,
the secondary effects of compensatory hyperinflation on an
expiratory film, collapse and consolidation will gradually appear.

MANAGEMENT

1 Complete airway obstruction
(i) Hold an infant or small child head down and deliver up to five
blows to the back between the shoulder blades, followed by up to
five chest thrusts.
(ii) Perform abdominal thrusts after the back blows in an older child,
but not in infants <1 year.
(iii) Attempt removal of the impacted object under direct vision using
a laryngoscope and a pair of long-handled forceps if the above
measures fail, and the patient is unconscious, or
(iv) Proceed directly to emergency cricothyroid puncture (see
p. 470).

2 Stable airway obstruction
(i) Summon urgent anaesthetic and ENT help.

3 Disappearance of the symptoms of obstruction
(i) Consider the possibility that the foreign body has passed into the
lower airways.
(ii) Refer the child to the paediatric team if the history is convincing,
for consideration of rigid bronchoscopy even if the CXR appears
normal.

ABDOMINAL PAIN, DIARRHOEA AND VOMITING

Abdominal pain may present acutely, or may become chronic and recurrent.
Diarrhoea and vomiting are common problems that lead to dehydration.

Acute abdominal pain

DIAGNOSIS

1 Abdominal pain is a common paediatric presentation with an extensive
differential diagnosis including intra- and extra-abdominal pathology.

2 An accurate histor y is essentia l. Ask about:
(i) Onset, nature, duration and radiation of the pain
(a) a child >2 years should be able to indicate the site of the pain