Pediatric Critical Care, Resuscitation, and Patient Safety
Resuscitation
Pediatric resuscitation follows PALS principles: high-quality CPR with a compression-to-ventilation ratio of 15:2 for two rescuers, rate 100–120/min, depth about one-third of chest diameter, and early defibrillation for shockable rhythms. Epinephrine 0.01 mg/kg IV/IO (0.1 mL/kg of 1:10,000) every 3–5 min; amiodarone for refractory VF/pVT. Oxygen and ventilation are prioritized in asphyxial arrest.
Critical care concepts
- Shock: recognize compensated shock (tachycardia, prolonged capillary refill, narrow pulse pressure) before hypotension, which is a late sign in children.
- Fluid resuscitation: 10–20 mL/kg isotonic crystalloid boluses, reassess; avoid over-resuscitation in cardiac or DKA patients.
- Respiratory failure: escalating support from nasal cannula to HFNC to NIV to intubation; watch for fatigue.
- Sepsis: early antibiotics, fluids, and vasoactive support.
Patient safety
- Medication errors: weight-based dosing requires double-check; use standardized concentrations and smart pumps.
- Wrong-site and retained items: time-outs and counts.
- Handoffs and monitoring: capnography, pulse oximetry, and alarms.
Traps
A frequent trap is waiting for hypotension before treating shock - in children, tachycardia and poor perfusion come first. Another is using adult compression ratios or epinephrine doses. Questions may test that bradycardia in a child is often hypoxic in origin.
Rule of thumb
In a child, treat tachycardia and poor perfusion as shock; give 10–20 mL/kg boluses and reassess after each.
Worked example
A 2-year-old (12 kg) with septic shock: tachycardia, mottled skin, capillary refill 4 s. Give 20 mL/kg (240 mL) isotonic crystalloid, reassess, repeat as needed, start antibiotics, and add vasoactive support if hypotension persists. Epinephrine for arrest: 0.12 mg IV (0.01 mg/kg).