ABP Pediatric Emergency Medicine cheat sheet

Pediatric assessment triangle: appearance, work of breathing, circulation to skin - completed in seconds before any equipment.

Weight-based dosing uses length-based tape or measured weight; 1 kg of body weight approximates 10 mL/kg fluid bolus in children.

Normal pediatric vital signs vary by age: infants have higher heart and respiratory rates; systolic BP lower limit ≈ 70 + (2 × age in years) for ages 1–10.

PALS compression-to-ventilation ratio: 30:2 single rescuer, 15:2 two rescuers; rate 100–120/min with depth one-third AP chest diameter.

Hypoglycemia in children is treated at 0.5–1 g/kg dextrose (D10 at 5–10 mL/kg in infants, D25 at 2–4 mL/kg in children).

Fever in infants ≤28 days warrants full sepsis evaluation including lumbar puncture regardless of appearance.

Pediatric hypotension is a late sign; compensated shock presents with tachycardia, delayed capillary refill, and narrowed pulse pressure.

Broselow-style length-based resuscitation tapes reduce dosing error when weight is unknown.

Pediatric cardiac arrest is most often respiratory in origin; ventilation and oxygenation are prioritized over early defibrillation except in shockable rhythms.

Epinephrine dose in pediatric arrest: 0.01 mg/kg IV/IO of 1:10,000 (0.1 mL/kg); repeat every 3–5 minutes.

Defibrillation energy for pediatric VF/pVT: 2 J/kg first shock, 4 J/kg second, then ≥4 J/kg up to 10 J/kg or adult dose.

Fluid bolus for pediatric shock: 10–20 mL/kg isotonic crystalloid, reassessing after each bolus for hepatomegaly and rales.

Post-arrest targeted temperature management: 32–34°C for comatose patients after ROSC, or 36–37.5°C; avoid fever.

Septic shock in children: obtain cultures, give broad-spectrum antibiotics within 60 minutes, and begin 10–20 mL/kg boluses with reassessment.

Hypotension formula: systolic BP < 70 + (2 × age) mm Hg in children 1–10 years defines decompensated shock.

Rapid sequence intubation in children: preoxygenate, weight-based sedative plus paralytic, and anticipate bradycardia from hypoxia.

Pediatric trauma is the leading cause of death in children older than 1 year; head injury predominates in younger children.

Glasgow Coma Scale modified for children scores eye, verbal, and motor responses; score ≤8 generally indicates need for airway protection.

Focused Assessment with Sonography for Trauma (FAST) detects free fluid but is less sensitive in children than adults.

Cervical spine clearance uses NEXUS or Canadian C-Spine criteria when age and cooperation permit; young children often need imaging.

Non-accidental trauma red flags: injury inconsistent with developmental stage, delayed presentation, and patterned bruising.

Prevention counseling: rear-facing car seats until age 2 or seat limit, booster seats until 4 ft 9 in, and helmet use for bicycles.

Splint long-bone fractures and reassess neurovascular status; femoral shaft fractures in young children may need traction or spica casting.

Massive transfusion in children: 10–20 mL/kg packed red cells with balanced ratios; permissive hypotension is avoided in head injury.

Acetaminophen toxicity: N-acetylcysteine is most effective within 8 hours; use Rumack-Matthew nomogram for timed levels.

Salicylate toxicity causes mixed respiratory alkalosis and metabolic acidosis; urinary alkalinization enhances elimination.

Iron poisoning stages: GI irritation, latent phase, shock/metabolic acidosis, hepatic failure, and late pyloric scarring.

Opioid overdose: naloxone 0.1 mg/kg IV/IO (max 2 mg) titrated to respiratory effort; repeat as needed.

Carbon monoxide poisoning: treat with 100% oxygen; hyperbaric oxygen considered for severe neurologic symptoms or syncope.

Hydrocarbon ingestion risks aspiration pneumonitis; avoid gastric lavage and emesis.

Toxic alcohol (methanol, ethylene glycol) toxicity: fomepizole or ethanol therapy plus hemodialysis for severe cases.

Heat stroke in children: rapid evaporative cooling and rehydration; core temperature goal below 40°C within 30 minutes.

Febrile infants ≤28 days: full sepsis workup including blood, urine, and CSF cultures with empiric antibiotics and admission.

Meningitis in children: empiric ceftriaxone plus vancomycin; add ampicillin for neonates to cover Listeria and enterococcus.

Kawasaki disease: fever ≥5 days plus 4 of 5 criteria; treat with IVIG 2 g/kg and aspirin; obtain echocardiogram.

Toxic shock syndrome: hypotension, rash, and multi-organ involvement; give clindamycin plus anti-staphylococcal coverage and remove source.

Epiglottitis presents with drooling, tripod positioning, and muffled voice; avoid agitating the child and prepare for airway management.

Necrotizing fasciitis: pain out of proportion, rapid spread, and systemic toxicity; requires urgent surgical debridement.

Lyme disease prophylaxis after tick bite: single-dose doxycycline 4 mg/kg (max 200 mg) if high-risk endemic exposure.

Measles post-exposure prophylaxis: MMR within 72 hours or immunoglobulin within 6 days for susceptible contacts.

Asthma severity: mild-moderate uses albuterol plus ipratropium and steroids; severe adds magnesium sulfate 25–50 mg/kg IV.

Croup: single dose dexamethasone 0.15–0.6 mg/kg; nebulized epinephrine (1:1000, 5 mL) for stridor at rest.

Bronchiolitis: supportive care with oxygen and hydration; routine bronchodilators, steroids, and antibiotics are not recommended.

Foreign body aspiration: sudden onset cough and unilateral wheeze; rigid bronchoscopy is definitive.

Epinephrine racemic or 1:1000 nebulized provides 2-hour relief in croup; observe for rebound after treatment.

Pulse oximetry target in bronchiolitis: maintain SpO2 ≥90%; discharge criteria include adequate oral intake and stable respiratory status.

Tension pneumothorax: needle decompression at second intercostal space midclavicular line or fourth space anterior axillary line.

High-flow nasal cannula in bronchiolitis reduces work of breathing and may decrease intubation rates in moderate-severe disease.

Supraventricular tachycardia in infants: rate typically >220 bpm; vagal maneuvers then adenosine 0.1 mg/kg IV (max 6 mg) rapid push.

Synchronized cardioversion for unstable SVT: 0.5–1 J/kg, then 2 J/kg.

Congenital heart disease with ductal-dependent lesions: start prostaglandin E1 at 0.01–0.05 mcg/kg/min and prepare for apnea.

Myocarditis: presents with tachycardia out of proportion, gallop, and cardiogenic shock; treat with inotropes and avoid fluid overload.

Hypertrophic cardiomyopathy: avoid dehydration and vasodilators; syncope with exertion warrants cardiology evaluation.

Long QT syndrome: avoid QT-prolonging drugs; torsades treated with magnesium sulfate.

Cardiac tamponade: Beck triad of hypotension, muffled heart sounds, and distended neck veins; treat with pericardiocentesis.

Kawasaki coronary aneurysms increase thrombosis risk; giant aneurysms may require anticoagulation.

Status epilepticus: benzodiazepine first-line (lorazepam 0.1 mg/kg IV or midazolam 0.2 mg/kg IM), then second-line antiepileptic.

Pediatric stroke: consider arterial ischemic stroke with acute focal deficit; obtain urgent MRI and consult neurology.

Head trauma with suspected elevated intracranial pressure: elevate head 30°, maintain normocapnia, and give hypertonic saline or mannitol.

Bacterial meningitis: dexamethasone before or with first antibiotic dose reduces hearing loss in Hib meningitis.

Febrile seizure: simple febrile seizures last <15 minutes and occur once in 24 hours; no routine EEG or imaging.

Hydrocephalus shunt malfunction: headache, vomiting, lethargy; obtain shunt series and head CT.

Intracranial hemorrhage: sudden headache with altered mental status; CT is first-line imaging.

Cerebral edema in diabetic ketoacidosis: treat with mannitol 0.5–1 g/kg or hypertonic saline and slow fluid correction.

Intussusception: colicky pain, currant-jelly stool, and sausage-shaped mass; air or contrast enema is diagnostic and therapeutic.

Malrotation with volvulus: bilious emesis in a neonate is a surgical emergency; obtain upper GI series.

Pyloric stenosis: nonbilious projectile vomiting at 3–6 weeks; ultrasound shows thickened pyloric muscle.

Testicular torsion: acute scrotal pain with high-riding testis; surgical exploration within 6 hours preserves viability.

Appendicitis: migration of pain to right lower quadrant, anorexia, and rebound tenderness; ultrasound or CT confirms.

Ovarian torsion: sudden unilateral pelvic pain with nausea; urgent surgical detorsion.

Henoch-Schönlein purpura: palpable purpura on dependent areas, abdominal pain, and renal involvement; monitor urinalysis.

Dehydration assessment: capillary refill, mucous membranes, tears, and urine output guide oral versus IV rehydration.

Suicide risk screening in adolescents: ask directly about ideation, plan, and access to lethal means; a prior attempt is the strongest risk factor.

Agitation management: verbal de-escalation first; if medication needed, use weight-based antipsychotic or benzodiazepine with monitoring.

Serotonin syndrome: clonus, hyperreflexia, and hyperthermia after serotonergic drugs; treat with cyproheptadine and supportive care.

Neuroleptic malignant syndrome: rigidity, hyperthermia, and autonomic instability; stop antipsychotics and use dantrolene or bromocriptine.

Delirium versus psychosis: acute onset with fluctuating attention suggests delirium and requires medical workup.

Eating disorder emergencies: refeeding syndrome risk with hypophosphatemia; correct electrolytes slowly.

Autism spectrum: use calm environment and visual supports; sensory overload may mimic agitation.

Involuntary hold criteria vary by jurisdiction; document dangerousness to self or others and notify guardians.

Pediatric readiness: weight-based equipment, trained staff, and pediatric-specific protocols improve outcomes in general EDs.

Triage uses ESI or similar 5-level system; children under 3 months with fever are high acuity regardless of appearance.

Quality metrics: door-to-antibiotic time in sepsis, time to analgesia in fractures, and ED length of stay.

Handoff communication: use SBAR or I-PASS to reduce errors at shift change.

Medication safety: weight-based dosing with independent double-check for high-alert drugs such as insulin and opioids.

Disaster preparedness: pediatric surge capacity requires age-appropriate supplies and family reunification plans.

Documentation: record reassessments after interventions and shared decision-making discussions.

Boarding of psychiatric patients: maintain safety observation and appropriate staffing ratios.

Informed consent for minors: guardian consent required except emergencies under implied consent doctrine.

Mandated reporting: suspected child abuse or neglect must be reported to child protective services.

Family-centered care: explain in plain language, use teach-back, and allow family presence during resuscitation when feasible.

Disclosure of medical error: honest, timely disclosure with apology and explanation is an ethical duty.

Cultural humility: use interpreters for limited English proficiency and respect family decision-making norms.

Advocacy: promote injury prevention, vaccine access, and safe firearm storage counseling.

Confidentiality: adolescent care may require confidential discussion of sexual health and mental health within legal limits.

Burnout and wellness: recognize impairment and use peer support; impaired colleagues require patient-safety-focused intervention.