Recognize early. Respond rapidly. Resuscitate effectively. Save lives.
Every year, critically ill children are presented to hospitals where emergency care must be delivered despite limited resources, variable staffing, and restricted access to sophisticated technology.
PREM provides a practical solution.
Developed in Tamil Nadu, India, and shaped by experience from resource-constrained health care settings, this book presents a simple, structured, physiological approach to pediatric emergency care. It helps health care professionals recognize children at risk, prioritize interventions, work cohesively as a team, and deliver timely, effective resuscitation.
This updated edition provides a practical, evidence-based approach to pediatric emergency care, covering rapid assessment, resuscitation, emergency management, essential procedures, and medication guidance. It serves as an indispensable resource for undergraduates, trainees, and health care professionals working in both tertiary and resource-limited setting
Key Features:
- Enhanced illustrations and algorithms for clear understanding (NEW).
- Thoroughly revised content with updated guidelines and clinical case scenarios to reinforce evidence-based approach (NEW).
- Introduction to the app (in development) in Chapter 63, which will act as a ready reference tool for all professionals (NEW).
- Links to YouTube videos in suggested readings for quick reference (NEW).
- Rapid assessment and recognition of the critically ill child.
- Step-by-step approaches to pediatric resuscitation.
- Practical management of common and life-threatening emergencies.
- Essential procedures and medication guidance.
- QR-linked videos for practical learning.
- Guidance on teamwork, communication, and organization of emergency care.
- Approaches suitable for district hospitals and other resource-limited settings.
PREM is more than a textbook. It is an approach to making pediatric emergency care safer, simpler, and more accessible.
When resources are limited, clinical excellence matters even more. PREM—bringing the right care to the right child at the right time.
About the Author:
Indumathy Santhanam, MD, DCH, is Professor and Project Director, Regional Collaborative Center, Pediatric Resuscitation and Emergency Medicine Skill Laboratory, National Health Mission, Chennai, Tamil Nadu, India.
Baljit Cheema, MBBS, BSc, MRCPCH, DTM&H, MPhil (Emergency Medicine), MPP (Public Policy), is Honorary Senior Lecturer, Department of Pediatrics & Child Health, University of Cape Town, Cape Town, South Africa.
Anjali Ponni Rajkumar, MSc (Biotechnology, University of Pennsylvania), is a Partner at Photo Emporium, Artist Aswatha, Chennai, Tamil Nadu, India.
Simon Craig, MBBS (Hons), FACEM, MHPE, MPH, is Professor and Pediatric Emergency Physician, Monash Medical Centre, and Adjunct Clinical Professor, Department of Pediatrics, Monash University, Melbourne, Victoria, Australia.
Online at MedOne
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Section 1: Foundation
1. PREM Triangle
Indumathy Santhanam
Editors: Baljit Cheema, Simon Craig
2. PREM Team Approach to Unresponsiveness
Indumathy Santhanam, Baljit Cheema
Editor: Simon Craig
3. Recognition of Early Signs of Organ Dysfunction in the Outpatient Department
Indumathy Santhanam, Haiko Jahn, Prinetha Moodley
Editor: Simon Craig
Section 2: Oxygen Delivery Devices and Intubation
4. Bag Valve Mask Ventilation
Indumathy Santhanam, Ross Hofmeyr, Chandan Kumar Mahalingam, Poornisha Rajendran
Editor: Simon Craig
5. Frugal Innovation to Provide CPAP: Jackson Rees/Paediatric Bain’s Circuit
Indumathy Santhanam
Editor: Simon Craig
6. Approach to Intubating the Physiologically Difficult Airway
Indumathy Santhanam
Editor: Simon Craig
7. Approach to Intubating the Structurally Difficult Airway
Krishnan Narasimhan, Indumathy Santhanam
Editor: Simon Craig
Section 3: Airway and Breathing Emergencies
8. Approach to Stridor
Indumathy Santhanam, Deepa Raja, Prinetha Moodley
Editor: Simon Craig
9. Approach to Respiratory Distress
John Recardie (Jaco) Murray, Indumathy Santhanam, Shiji K. Jacob, Gundas Srinivas, Heloise Buys
Editor: Simon Craig
10. Pneumonia
John Recardie (Jaco) Murray, Shiji K. Jacob, Indumathy Santhanam
Editor: Simon Craig
11. Asthma
Tecwyn Davies, Indumathy Santhanam
Editor: Simon Craig
12. Bronchiolitis
Peter van Kooy, Indumathy Santhanam
Editor: Simon Craig
13. Recognizing Cardiac Failure in a Child Presenting with Respiratory Distress
Ritchie Sharon Solomon, Indumathy Santhanam
Editor: Simon Craig
Section 4: Circulation
14. General Approach to Shock
Indumathy Santhanam, Beyra Rossouw, Baljit Cheema
Editor: Simon Craig
15. Vasoactive Medications
Shanthi Sangareddi, Indumathy Santhanam, Beyra Rossouw
Editor: Baljit Cheema
16. Approach to Septic Shock
Indumathy Santhanam
Editor: Baljit Cheema and Simon Craig
17. Hypovolaemic Shock
Indumathy Santhanam, Beyra Rossouw
Editor: Baljit Cheema
18. Anaphylaxis
Pradeepa Venkatesan, Beyra Rossouw, Indumathy Santhanam
Editor: Baljit Cheema
19. Cardiogenic Shock in the ED
Ritchie Sharon Solomon, Indumathy Santhanam
Editor: Baljit Cheema
20. Dengue Shock
Indumathy Santhanam, Shu-Ling Chong, Deepa Raja
Editor: Baljit Cheema
21. COVID and Multisystem Inflammatory Syndrome
Sharada Satishkumar, Vidya Krishna, Brendan McMullan, Asha Bowen
Editor: Simon Craig
22. Cyanotic Spell
Rajeshwari Sridharan, Indumathy Santhanam
Editor: Baljit Cheema
23. Acute Severe Hypertension
Rajeshwari Sridharan, Beyra Rossouw, Indumathy Santhanam
Editor: Baljit Cheema
24. Arrhythmias
Beyra Rossouw, Ritchie Sharon Solomon, Thangavelu Sankaralingam
Editor: Baljit Cheema
25. Cardiopulmonary Arrest
Indumathy Santhanam, Murali Thandavarayan, Chandan Kumar Mahalingam
Editor: Baljit Cheema
Section 5: Disability
26. Approach to Decreased Level of Consciousness
Indumathy Santhanam, Andrew Redfern
Editor: Simon Craig
27. Status Epilepticus
Indumathy Santhanam, Sangeetha Yoganathan, Andrew Redfern
Editor: Simon Craig
28. Raised Intracranial Pressure
Leema Pauline, Indumathy Santhanam, Andrew Redfern
Editor: Simon Craig
29. CSF Shunt Complications
Leema Pauline, Indumathy Santhanam, Andrew Redfern
Editor: Simon Craig
30. Acute Weakness
Leema Pauline, Indumathy Santhanam, Andrew Redfern
Editor: Simon Craig
Section 6: Metabolic and Electrolyte Emergencies
31. Diabetic Ketoacidosis
Hemchand K. Prasad, Philip Bergman, Indumathy Santhanam, Anand Kumar
Editor: Simon Craig
32. Non-diabetic Hypoglycaemia
Sidney Sunwoo, Hemchand K. Prasad
Editor: Simon Craig
33. Inborn Errors of Metabolism
Sidney Sunwoo, Hemchand K. Prasad
Editor: Simon Craig
34. Hypernatraemia and Hyponatraemia
Sidney Sunwoo, Sharada Sathishkumar
Editor: Simon Craig
35. Hyperkalaemia and Hypokalaemia
Sidney Sunwoo, Sharada Sathishkumar
Editor: Simon Craig
36. Electrolyte Emergencies: Hypercalcaemia and Hypocalcaemia
Sidney Sunwoo, Sharada Sathishkumar
Editor: Simon Craig
Section 7: Envenomation and Toxicology
37. Envenomation: Scorpion
Balaji Jayaraman, Shanthi Sangareddi, Akila Sivakumar
Editor: Baljit Cheema, Andis Graudins, Indumathy Santhanam
38. Snake Envenomation
Balaji Jayaraman, Akila Sivakumar, Shanthi Sangareddi, Cindy Stephen, Kate Balme
Editors: Baljit Cheema, Andis Graudins, Indumathy Santhanam
39. Poisoning—General Approach
Thangavelu Sankaralingam, Shanthi Sangareddi, Indumathy Santhanam, Cindy Stephen, Kate Balme
Editor: Baljit Cheema, Andis Graudins
40. Common Household Poisons and Pesticides
Indumathy Santhanam, Balaji Jayaraman, Sharada Sathiskumar, Cindy Stephen, Kate Balme
Editor: Baljit Cheema, Andis Graudins
41. Medication Ingestion
Sharada Sathishkumar, Cindy Stephen, Suresh Gupta
Editor: Baljit Cheema, Andis Graudins
Section 8: Trauma, Burns, Submersion, and Electrical Injury
42. Principles of Initial Trauma Care
Poornisha Rajendran, A. Padmavathy, Indumathy Santhanam
Editor: Simon Craig
43. Head Injury
Rhiannon Palmer, Franz Babl, Indumathy Santhanam
Editor: Simon Craig
44. Cervical Spine Injury
Heather Deane, Indumathy Santhanam
Editor: Simon Craig
45. Maxillofacial Injuries
Harith Al Rawi, Indumathy Santhanam
Editor: Simon Craig
46. Chest Trauma
Claire Wilkin, Indumathy Santhanam
Editor: Simon Craig
47. Abdominal Trauma
Neha Jain, Indumathy Santhanam
Editor: Simon Craig
48. Genitourinary Trauma
Patricia Holliday, Justin Howlett
Editor: Simon Craig
49. Orthopaedic Injuries: Upper Limb, Pelvis, and Lower Limb
Terry Carroll, Melanie Turner, Indumathy Santhanam
Editor: Simon Craig
50. Burn Injuries
Katherine Franklin, Gary Dos Passos, Indumathy Santhanam, Bronwyn Griffin
Editor: Simon Craig
51. Electrical Injury
Michael Coman, Gary Dos Passos, Indumathy Santhanam, Jayanthi Ramesh
Editor: Simon Craig
52. Submersion Injury
Natalie Hood, Jonathon Webber, Jayanthi Ramesh, Indumathy Santhanam
Editor: Simon Craig
Section 9: Abuse and Mental Health
53. Child Abuse
Neil McKerrow, Bindu Bali, Hima Bindu Vipparthi
Editor: Simon Craig
54. Childhood Sexual Abuse
Neil McKerrow, Bindu Bali, Hima Bindu Vipparthi
Editor: Simon Craig
55. Behavioural Emergencies
Ed Sixsmith
Editor: Simon Craig
Section 10: Neonatal Emergencies
56. The Collapsed Newborn
Padmesh Vadakepat, Sandi Lee Holgate, Haseena Hassan
Editor: Baljit Cheema
Section 11: Paediatric Surgery: Gastrointestinal Emergencies
57. Acute Abdomen
Maurizio Pacilli, Marion Arnold, G. Nandhini
Editor: Simon Craig
58. Bilious Vomiting
Marion Arnold, Maurizio Pacilli, G. Nandhini
Editor: Simon Craig
59. Pyloric Stenosis
Marion Arnold, Ramesh Nataraja, G. Nandhini
Editor: Simon Craig
60. Intussusception
Ramesh Nataraja, Marion Arnold, G. Nandhini
Editor: Simon Craig
61. Gastrointestinal Bleeding
Marion Arnold, Liz Goddard, G. Nandhini, Rupert Hinds
Editor: Simon Craig
Section 12: Emergency Systems
62. Patient Safety and Quality Improvement
Erin Mills
Editor: Baljit Cheema
63. Setting Up PREM Units
Darez Ahmad, Indumathy Santhanam, Venkatesh Balasubramanian, S. Uma
Editor: Simon Craig
64. Disaster Management
Wayne Smith
Editor: Baljit Cheema
Section 13: Otolaryngology, Skin, Haemato-oncology
65. Ear, Nose, and Throat Emergencies
Tecwyn Davies
Editor: Simon Craig
66. The Skin in Emergencies
Keir Shiels, Poornisha Rajendran
Editor: Simon Craig
67. Haematological Emergencies
Julie Cayrol, Elizabeth Molyneux, Indira Jayakumar, Kottayam Radhakrishnan, Peter Downie
Editor: Simon Craig
68. Oncology Emergencies
Julie Cayrol, Elizabeth Molyneux, Indira Jayakumar, Peter Downie
Editor: Simon Criag
Section 14: Radiology, Ultrasound, Sedation and Procedures in the ED
69. Chest X-Ray Interpretation
Thangavelu Sankaralingam, Shanthi Sangareddi, Indumathy Santhanam
Editor: Simon Craig
70. Incorporating Point of Care Ultrasound during Paediatric Resuscitation
Vigil James, Adnan Bilgrami
Editor: Baljit Cheema
71. Sedation
Ben Lawton, Sathishkumar Kandath, Jess Archibald
Editor: Simon Craig
72. Peripheral Venous Access
Priyavarthini Venkatachalapathy, Joyce Tan
Editors: Baljit Cheema
73. Intraosseous Access
Indumathy Santhanam, Priyavarthini Venkatachalapathy
Editor: Baljit Cheema
74. External Jugular Vein Cannulation
Priyavarthini Venkatachalapathy, Joyce Tan
Editor: Baljit Cheema
75. Urinary Catheterization
Priyavarthini Venkatachalapathy, Joyce Tan
Editors: Baljit Cheema
76. Nebulizer Therapy
Priyavarthini Venkatachalapathy, Junaidah Badron
Editors: Baljit Cheema
77. Needle Thoracocentesis
Priyavarthini Venkatachalapathy, Murali Thandavarayan, Junaidah Badron
Editors: Baljit Cheema
78. Chest Drain Insertion
Priyavarthini Venkatachalapathy, Murali Thandavarayan, Junaidah Badron
Editor: Baljit Cheema
79. Pericardiocentesis
Priyavarthini Venkatachalapathy, Murali Thandavarayan, Sashikumar Ganapathy
Editor: Baljit Cheema
80. Defibrillation and Synchronized Cardioversion
Priyavarthini Venkatachalapathy, Sashikumar Ganapathy
Editor: Baljit Cheema