ABP Pediatric Critical Care Medicine cheat sheet

Alveolar gas equation: PAO2 = FiO2 × (Patm − 47 mm Hg) − (PaCO2 / 0.8); at sea level Patm ≈ 760 mm Hg.

Arterial oxygen content: CaO2 = (1.34 × Hb × SaO2) + (0.003 × PaO2), expressed in mL O2 per dL blood.

Pediatric ARDS requires onset within 7 days of a known insult, pulmonary edema not fully explained by cardiac failure, and oxygenation impairment; severity is graded by oxygenation index or SpO2/FiO2.

Lung-protective ventilation targets tidal volume 4–8 mL/kg predicted body weight, plateau pressure ≤28 cm H2O, and driving pressure ≤15 cm H2O.

Compliance = tidal volume / (plateau pressure − PEEP); airway resistance = (peak inspiratory pressure − plateau pressure) / inspiratory flow.

Permissive hypercapnia may be tolerated with pH ≥7.20; it is avoided in raised intracranial pressure, severe pulmonary hypertension, and some metabolic disorders.

Type 1 respiratory failure is hypoxemia with normal or low PaCO2; type 2 is hypercapnia with PaCO2 >50 mm Hg, often from hypoventilation or fatigue.

Minute ventilation = respiratory rate × tidal volume; increased dead space or reduced compliance raises PaCO2 for a given minute ventilation.

High-frequency oscillatory ventilation variables include frequency in Hz, amplitude or power, mean airway pressure, and bias flow; mean airway pressure is often higher than during conventional ventilation.

Cardiac output = heart rate × stroke volume; cardiac index = cardiac output / body surface area.

Shock categories are hypovolemic, distributive, cardiogenic, and obstructive; mixed shock is common in sepsis.

PALS hypotension thresholds: term infants <60 mm Hg; 1–12 months <70 mm Hg; 1–10 years <70 + (2 × age) mm Hg; >10 years <90 mm Hg.

Septic shock fluid resuscitation uses 10–20 mL/kg balanced crystalloid boluses with reassessment; isotonic maintenance fluids are preferred after stabilization.

Cold septic shock is treated with epinephrine infusion; warm septic shock with norepinephrine; dobutamine or milrinone may add inotropy when myocardial dysfunction persists.

Central venous pressure alone does not reliably predict fluid responsiveness in spontaneously breathing children; dynamic measures and bedside ultrasound add information.

ScvO2 >70% and lactate clearance are used as resuscitation targets alongside capillary refill, mental status, and urine output.

ECMO is considered for refractory hypoxemia or shock when conventional ventilation and vasoactive support fail and a reversible cause is plausible.

Pulse pressure variation and inferior vena cava collapsibility are unreliable with spontaneous breathing, arrhythmia, or low tidal volume.

Pediatric sepsis is suspected infection with organ dysfunction; septic shock adds cardiovascular dysfunction such as hypotension, elevated lactate, or vasoactive requirement.

For septic shock, administer empiric broad-spectrum antibiotics within 1 hour; for possible sepsis without shock, within 3 hours, after blood cultures if this does not delay therapy.

Initial fluid boluses are 10–20 mL/kg balanced crystalloid; reassess perfusion, respiratory status, and hepatomegaly after each bolus.

Empiric neutropenic fever therapy is an antipseudomonal beta-lactam; add vancomycin for catheter infection, skin or soft tissue infection, or MRSA risk.

Hydrocortisone is considered for fluid- and vasoactive-refractory septic shock with suspected adrenal insufficiency, not routinely for all sepsis.

DIC produces prolonged PT/INR, low fibrinogen, thrombocytopenia, and elevated D-dimer; treat the cause and replace platelets or factors for active bleeding.

Blood cultures, lactate, complete blood count, coagulation panel, and organ function tests guide sepsis management; cultures should not delay antibiotics in shock.

In immunocompromised children, fever may be blunted; maintain a low threshold for cultures and empiric antibiotics.

Source control through drainage, debridement, or catheter removal is part of sepsis treatment.

CPP = MAP − ICP; target CPP approximately ≥40–50 mm Hg in infants and ≥50–60 mm Hg in older children, individualized to injury.

ICP >20 mm Hg sustained warrants treatment: head elevation 30°, sedation, normocapnia, temperature control, and hyperosmolar therapy.

Impending herniation: brief hyperventilation to PaCO2 30–35 mm Hg and hypertonic saline 3% (3–5 mL/kg) or mannitol 0.5–1 g/kg.

Pediatric GCS: eye 1–4, verbal 1–5, motor 1–6; age-specific verbal responses are used for preverbal children.

Status epilepticus: benzodiazepine first; second-line levetiracetam, fosphenytoin, or phenobarbital; refractory cases need continuous infusion and EEG monitoring.

TBI management avoids hypotension and hypoxemia, maintains normoglycemia and normothermia, and avoids routine hyperventilation or therapeutic hypothermia.

Pupillary light reflex, corneal, gag, and oculocephalic responses guide brainstem evaluation; apnea testing requires adequate preoxygenation and PaCO2 rise.

Neurosurgical emergencies: fixed dilated pupil, deteriorating GCS, or Cushing triad of hypertension, bradycardia, and irregular respiration prompt decompression.

Parkland formula: 4 mL/kg/%TBSA lactated Ringer over 24 h; half in the first 8 h from burn time; children also need maintenance fluid with glucose.

Burn TBSA estimation in children uses Lund-Browder or age-adjusted charts; the rule of nines overestimates head and underestimates leg surface area in young children.

Trauma primary survey: airway with cervical spine protection, breathing, circulation with hemorrhage control, disability, and exposure.

Hemorrhagic shock: balanced blood products, tranexamic acid within 3 h, warming, and damage-control surgery.

Abdominal compartment syndrome: intra-abdominal pressure >20 mm Hg with new organ dysfunction; decompression, drainage, sedation, paralysis, and fluid avoidance.

Inhalation injury: suspect with facial burns, soot, hoarseness, stridor, or enclosed-space fire; early intubation if airway edema progresses.

Perioperative aspiration risk: follow fasting guidelines; in emergencies, rapid sequence intubation with cricoid pressure as indicated.

Traumatic brain injury in trauma: avoid hypotension (SBP <70 + 2 × age) and hypoxemia; head CT for altered mentation, vomiting, seizure, or skull fracture signs.

Burn resuscitation urine output target is approximately 1 mL/kg/h in children.

KDIGO AKI: creatinine rise ≥0.3 mg/dL in 48 h, ≥1.5× baseline in 7 days, or urine output <0.5 mL/kg/h for 6 h.

Hyperkalemia with ECG changes: IV calcium gluconate or chloride first; then insulin/glucose, albuterol, bicarbonate if acidotic; dialysis for refractory or renal failure.

Hyponatremia correction limit: ≤8–10 mEq/L per 24 h to avoid osmotic demyelination; hypertonic saline for seizures or symptomatic severe hyponatremia.

DKA: isotonic fluid resuscitation, insulin infusion 0.05–0.1 U/kg/h after initial stabilization, monitor potassium; treat cerebral edema with hyperosmolar therapy.

Adrenal crisis: hydrocortisone stress dose plus isotonic fluid and dextrose; do not delay treatment for cortisol results in an unstable child.

Renal replacement therapy indications: refractory acidosis, electrolyte imbalance, intoxication, volume overload, and uremia (AEIOU).

Hypoglycemia: treat with IV dextrose; children <60 mg/dL and neonates <45 mg/dL require prompt correction and glucose recheck.

Nutrition: initiate enteral nutrition within 24–48 h when hemodynamically stable; indirect calorimetry estimates energy needs in complex cases.

GI bleeding: resuscitate, acid suppression, endoscopic evaluation; variceal bleeding may need octreotide.

Two-rescuer pediatric CPR: 15:2 compression-to-ventilation ratio, rate 100–120/min, depth one-third anteroposterior chest diameter, full recoil.

Defibrillation: 2 J/kg first, 4 J/kg second, then ≥4 J/kg up to 10 J/kg or adult maximum.

IO access is indicated when IV access is unavailable; administer drugs and fluids; complications include extravasation, compartment syndrome, fracture, and infection.

RSI: preoxygenate, choose induction agent such as ketamine, etomidate, or propofol and paralytic such as rocuronium or vecuronium; avoid succinylcholine in hyperkalemia risk.

Transport readiness: secure airway with capnography, confirm IV/IO, stabilize cervical spine, check equipment, and communicate handoff with SBAR.

Capnography confirms endotracheal tube placement and monitors CPR quality; waveform loss suggests dislodgment or low pulmonary blood flow.

Central venous catheter complications include pneumothorax, arterial puncture, thrombosis, and infection; ultrasound guidance improves first-pass success.

Handoff should include illness severity, interventions, response, pending studies, and family communication.

Monitoring includes continuous ECG, pulse oximetry, capnography, and invasive arterial pressure when indicated.

Informed consent requires decision-making capacity, disclosure of risks, benefits, and alternatives, and voluntariness; minors provide assent proportional to development.

Withholding and withdrawing life-sustaining treatment are ethically equivalent when consistent with the child's best interests and informed family goals.

Brain death determination requires irreversible coma, absent brainstem reflexes, and an apnea test; confounding factors include hypothermia, drugs, and metabolic derangement.

Family-centered care includes shared decision-making, honest prognostic disclosure, and attention to sibling and caregiver needs.

Medical error disclosure: promptly inform family, explain known facts, apologize, describe prevention, and document the discussion.

Palliative care can be provided alongside curative treatment; it addresses pain, dyspnea, anxiety, and goals of care.

Organ donation is considered after death or in some jurisdictions after circulatory death; consent and allocation follow legal and institutional frameworks.

Resource allocation during disasters uses triage criteria and crisis standards of care; decisions are based on objective survival likelihood, not social worth.

Documentation of goals-of-care discussions and code status is essential.