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The Critically Ill Or Comatose Infant: An Organized Approach

October 2002

 Abstract
The crashing infant is a challenge in any setting. From the largest specialty children's center to the smallest rural ED, a dying baby creates havoc. Even when you think you're prepared, things appear chaotic. Procedures go wrong; rarely used equipment seems to disappear. IV access becomes impossible for even the most experienced hands; your mind freezes when trying to calculate drug doses. The right decisions must come quickly or a baby will die.

Even if a children's center is down the street, parents might panic and bring an ill infant to the closest facility; therefore, every emergency physician and every ED must prepare for this scenario. Critically ill children arrive in all kinds of EDs, at all times throughout the day and night.1 

This article will help the emergency physician stay organized and minimize the chaos that can ensue when caring for critically ill infants (up to about 18 months of age). Emergencies pertaining to full cardiopulmonary arrest (e.g., sudden infant death syndrome), precipitous deliveries, known trauma, or emergencies occurring in otherwise well infants (e.g., the management of fever in the well-appearing infant, generalized [tonic-clonic] status epilepticus, and apparent life-threatening events) are beyond the scope of this article.
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