ABEM Peds EM cheat sheet

Weight-based dosing uses length-based tapes or age formulas: (age in years × 2) + 8 kg approximates weight for children 1–10 years.

Pediatric assessment triangle: appearance, work of breathing, circulation to skin - forms a rapid first impression within seconds of arrival.

Hypotension in children is a late sign; systolic BP below 70 + (2 × age in years) defines hypotension for ages 1–10.

Normal pediatric vitals trend: heart rate falls and blood pressure rises with age; infants normally breathe 30–60/min and have heart rates of 100–160/min.

IV fluid resuscitation for septic or hypovolemic shock: 20 mL/kg isotonic crystalloid boluses, reassessing after each bolus for hepatomegaly and rales.

For weight-based resuscitation medication quick reference: epinephrine 0.01 mg/kg IV (0.1 mL/kg of 1:10,000); defibrillation 2 J/kg, then 4 J/kg.

Fever in infants under 28 days warrants full sepsis evaluation including lumbar puncture, blood and urine cultures, and empiric antibiotics.

Children compensate for shock with tachycardia and increased systemic vascular resistance; bradycardia in a hypoxic child is treated first with oxygenation and ventilation.

Adult ACLS: epinephrine 1 mg IV every 3–5 minutes; amiodarone 300 mg first dose then 150 mg for refractory VF/VT.

Acute ischemic stroke: IV thrombolysis window is up to 4.5 hours from last known well; door-to-CT target is 20 minutes and door-to-needle 60 minutes.

Sepsis bundle: measure lactate, obtain cultures before antibiotics, give broad-spectrum antibiotics and 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L.

Anion gap = Na − (Cl + HCO3); normal is 8–12 mEq/L; elevated gap with acidosis suggests ketoacidosis, lactate, toxins, or renal failure.

Hyperkalemia with ECG changes: give IV calcium first for membrane stabilization, then insulin with glucose, beta-agonist, and dialysis if refractory.

Trauma: permissive hypotension targets systolic BP 80–90 mmHg in penetrating trauma without TBI; avoid hypotension in traumatic brain injury to maintain cerebral perfusion.

NEXUS criteria for cervical spine imaging: no posterior midline tenderness, no intoxication, normal alertness, no focal deficit, no distracting injury.

Acetaminophen toxicity: Rumack-Matthew nomogram guides N-acetylcysteine; salicylate toxicity presents with mixed respiratory alkalosis and metabolic acidosis and is treated with urine alkalinization.

Developmental milestones: sits unsupported by 6–8 months, walks by 12–15 months, two-word phrases by 18–24 months.

Kawasaki disease: fever ≥5 days plus 4 of 5 criteria (conjunctivitis, mucosal changes, rash, extremity changes, cervical adenopathy); treat with IVIG and aspirin.

Bronchiolitis is most often RSV; management is supportive with oxygen and hydration; routine bronchodilators, steroids, and antibiotics are not indicated.

Croup: barking cough and inspiratory stridor; treat with dexamethasone and nebulized epinephrine for moderate to severe symptoms.

Pyloric stenosis presents at 3–6 weeks with projectile nonbilious vomiting and hypochloremic hypokalemic metabolic alkalosis; olive-shaped mass may be palpable.

Intussusception: colicky pain, currant-jelly stool, and target sign on ultrasound; air or contrast enema is both diagnostic and therapeutic if no peritonitis.

Neonatal jaundice: phototherapy thresholds depend on age in hours, gestational age, and risk factors; check total and direct bilirubin and assess for hemolysis.

Febrile seizure: simple if generalized, under 15 minutes, and once in 24 hours; no routine labs, imaging, or anticonvulsants are needed for a simple febrile seizure.