C-NPT cheat sheet

Pediatric hypotension: systolic <70 mmHg in term neonates, <70 + (2 × age in years) for children 1–10 years, and <90 mmHg for children over 10 years.

Tachycardia is the earliest compensated sign of shock in children; hypotension is a late finding because vasoconstriction preserves blood pressure until decompensation.

Shock index = heart rate ÷ systolic blood pressure; a value >1.0 in a child suggests occult or decompensated shock (normal ≈0.7–0.8).

Uncuffed ETT internal diameter = (age in years ÷ 4) + 4; cuffed = (age ÷ 4) + 3.5; oral insertion depth (cm) ≈ 3 × tube size.

Estimated weight for ages 1–10 years = (age × 2) + 8 kg; a length-based tape is used for children under 12 years when age is unknown.

Infants are obligate nasal breathers for the first months of life, and the narrowest point of the pediatric airway is the subglottic cricoid ring.

Pediatric trauma scene time target is under 10 minutes; airway, hemorrhage control, and spinal motion restriction take priority over on-scene procedures.

Pre-transport stabilization bundle: airway secured and confirmed, vascular access, glucose and temperature checked, monitors attached, and referring records plus imaging copied.

Transport risk is judged on patient physiology, the referring team's capability, and time/distance to definitive care; a deteriorating patient is diverted to the nearest appropriate facility.

Tidal volume targets: 4–6 mL/kg predicted body weight in neonatal and pediatric ARDS, 6–8 mL/kg when lung mechanics are normal; keep plateau pressure below about 28–32 cmH2O in PARDS.

PEEP is typically 5 cmH2O and may be raised to 8–10 cmH2O in PARDS with escalating FiO2; high PEEP can reduce venous return and cause hypotension.

Time constant = compliance × resistance; allow at least three time constants of expiratory time to prevent air trapping and auto-PEEP.

Target SpO2 90–95% in preterm infants at risk of retinopathy of prematurity and 92–97% for most other neonates and children.

High-frequency oscillatory ventilation: amplitude (power) adjusts PaCO2 while mean airway pressure and FiO2 adjust oxygenation; the expiratory phase is active.

Inhaled nitric oxide for PPHN starts at 20 ppm; wean FiO2 before weaning nitric oxide to avoid rebound pulmonary hypertension.

Surfactant volumes: poractant alfa 2.5 mL/kg initially (1.25 mL/kg for repeat doses), beractant 4 mL/kg; give early in RDS by INSURE or LISA technique.

Sudden desaturation with asymmetric chest expansion and unilateral decreased breath sounds suggests pneumothorax; needle decompression is at the 2nd intercostal space, midclavicular line.

Permissive hypercapnia (PaCO2 45–60 mmHg with pH >7.20) is acceptable in selected ventilated infants to limit ventilator-induced lung injury.

Neonatal cardiac output is about 200–250 mL/kg/min; CO = HR × SV, and neonates depend heavily on heart rate because stroke volume is relatively fixed.

Hypotension thresholds: mean arterial pressure below gestational age in weeks for neonates; systolic <60 (term neonate), <70 (infant), <70 + 2×age (1–10 years), <90 (>10 years).

Fluid bolus is 10–20 mL/kg isotonic crystalloid with reassessment after each bolus; 40–60 mL/kg may be required in septic shock, but give cautiously with cardiac dysfunction or DIC.

Epinephrine 0.05–0.3 mcg/kg/min for fluid-refractory shock; norepinephrine 0.05–0.3 mcg/kg/min for warm, vasodilated shock.

Prostaglandin E1 at 0.05 mcg/kg/min maintains ductal patency in ductal-dependent lesions; apnea occurs in roughly 10–12%, so airway readiness is mandatory.

Cyanotic ductal-dependent lesions (pulmonary atresia, critical tetralogy) require PGE1; ductal-dependent systemic lesions (HLHS, interrupted aortic arch, critical coarctation) present in shock with weak or absent femoral pulses.

Resuscitation endpoints include central venous oxygen saturation >70%, falling lactate, and restored perfusion; lactate >2 mmol/L indicates hypoperfusion.

Capillary refill >2 seconds, mottling, and cool extremities are early markers of compensated shock and are treated before hypotension appears.

Pediatric GCS: eye 4, verbal 5, motor 6; a modified verbal scale is used for children under 2 years.

Cerebral perfusion pressure = mean arterial pressure − intracranial pressure; preventing hypoxia and hypotension preserves CPP in traumatic brain injury.

Therapeutic hypothermia for HIE: 33.5°C for 72 hours started within 6 hours of birth in infants ≥36 weeks with moderate-to-severe encephalopathy, then rewarm at about 0.5°C/hour.

Neonatal seizures are often subtle (apnea, eye deviation, cycling movements) or electrographic only; phenobarbital 20 mg/kg IV is first-line.

Sarnat stages I (mild), II (moderate), and III (severe) classify HIE by level of consciousness, tone, primitive reflexes, and autonomic function.

Pain in neonates and nonverbal children is scored with PIPP, N-PASS, or FLACC; physiologic signs alone are unreliable indicators of pain.

Spinal motion restriction: correctly sized rigid collar, log-roll with in-line stabilization, and padding under the torso to neutralize the prominent occiput in young children.

Signs of raised intracranial pressure in infants include a bulging fontanelle, split sutures, sunsetting eyes, and irritability progressing to lethargy; avoid hip flexion and neck rotation during transport.

Holliday-Segar maintenance: 4 mL/kg/h for the first 10 kg, plus 2 mL/kg/h for the next 10 kg, plus 1 mL/kg/h for each kilogram above 20.

Term neonates begin at 60–80 mL/kg/day on day 1 and advance 10–20 mL/kg/day; preterm infants often start near 80 mL/kg/day with careful sodium restriction.

Hypoglycemia thresholds: <45 mg/dL in neonates and <60 mg/dL in children; treat with D10W 2 mL/kg (0.2 g/kg) IV and recheck glucose in 30 minutes.

Glucose infusion rate (mg/kg/min) = (% dextrose × mL/h) ÷ (6 × weight in kg); typical neonatal target is 4–8 mg/kg/min.

Daily electrolytes: sodium 2–4 mEq/kg, potassium 1–3 mEq/kg; correct potassium no faster than 0.5–1 mEq/kg/h with continuous cardiac monitoring.

Suspected NEC: stop feeds, nasogastric decompression, cultures, and broad-spectrum antibiotics; pneumatosis intestinalis is the radiographic hallmark.

Parenteral nutrition is not stopped abruptly; taper the rate or provide dextrose to prevent rebound hypoglycemia.

Jaundice appearing within the first 24 hours is pathologic and requires urgent bilirubin measurement; physiologic jaundice appears after 24 hours.

Epinephrine IV/IO 0.01 mg/kg (0.1 mL/kg of 1:10,000) every 3–5 minutes; the endotracheal dose is 0.1 mg/kg of 1:1,000.

Adenosine 0.1 mg/kg rapid IV push (maximum 6 mg), then 0.2 mg/kg (maximum 12 mg), each followed by an immediate saline flush for SVT.

Amiodarone 5 mg/kg IV/IO (maximum 300 mg) for VF or pulseless VT; infuse over 20–60 minutes when a pulse is present.

Dexamethasone 0.6 mg/kg (maximum 10 mg) once for croup; nebulized racemic epinephrine 0.05 mL/kg of 2.25% solution (maximum 0.5 mL).

Sedation and paralysis doses: fentanyl 1–2 mcg/kg, midazolam 0.05–0.1 mg/kg, ketamine 1–2 mg/kg, rocuronium 0.6–1.2 mg/kg.

Naloxone 0.1 mg/kg IV/IM (maximum 2 mg) reverses opioid-induced respiratory depression; monitor for re-narcotization as its duration is shorter than most opioids.

High-alert medications (opioids, insulin, heparin, concentrated potassium, inotropes) require an independent second check and smart-pump limits.

Caffeine citrate 20 mg/kg loading dose with 5–10 mg/kg/day maintenance reduces apnea of prematurity.

The neutral thermal environment minimizes oxygen consumption; target axillary temperature is 36.5–37.5°C.

Heat is lost by evaporation, conduction, convection, and radiation; preterm infants lose heat fastest because of a large surface-area-to-mass ratio and thin skin.

Hypothermia raises oxygen consumption and causes hypoglycemia and metabolic acidosis; counter with plastic wrap, a hat, warm blankets, warm IV fluids, and heated humidified gases.

Transmission precautions: contact for MRSA, VRE, and C. difficile; droplet for influenza and pertussis; airborne for tuberculosis, measles, and varicella with an N95 respirator.

Early-onset neonatal sepsis is most often group B Streptococcus or E. coli; empiric therapy is ampicillin plus gentamicin, with cefotaxime added for meningitis.

As altitude rises, barometric pressure and alveolar oxygen tension fall; increase FiO2 and flow, and remember that trapped gas expands, overinflating ETT cuffs and pneumothoraces.

Therapeutic hypothermia at 33.5°C is the only planned exception to normothermia; all other transported infants are kept strictly normothermic.

Cylinder duration (min) = (gauge pressure in psi − 200) × cylinder factor ÷ flow in L/min; cylinder factors are 0.28 for an E cylinder and 3.14 for an M cylinder.

The isolette or stretcher is secured with four-point straps, and every monitor, pump, and cylinder is strapped down because unrestrained items become projectiles at roughly 10 G deceleration.

Pre-transport equipment check: two oxygen sources, two suction devices, bag-valve-masks in neonate/infant/child sizes, and a charged defibrillator.

All occupants are restrained whenever the vehicle is moving; no provider stands or rides unsecured in the patient compartment.

Motor vehicle crashes are the leading cause of injury during medical transport; driver fatigue and excessive speed are major contributors, so lights and sirens are used only when clinically justified.

Structured communication with medical control and the receiving team uses SBAR: Situation, Background, Assessment, Recommendation.

Air medical operations require a safety briefing, rotor clearance discipline for hot loading, ear and eye protection, and adjustment of oxygen delivery for altitude.

EMTALA requires stabilizing treatment and an appropriate transfer, documented by physician certification of benefit and acceptance from the receiving facility.

Informed consent is obtained from a parent or guardian; an emergency exception applies when delay would risk life or limb.

Core ethical principles - beneficence, nonmaleficence, autonomy, and justice - guide allocation of scarce transport resources and decisions about futile transfer.

Family-centered care includes offering family presence, developmentally supportive care with reduced light and noise and clustered handling, and shared decision-making.

Transport documentation records dispatch, arrival, departure, and handoff times, vital sign trends, interventions, medications, and receiving-team acceptance.

Closed-loop communication and explicit role assignment (crew resource management) reduce error during high-stress transports.

Use trained interpreters and health-literate materials; children are never used as interpreters for consent or clinical discussions.

Critical events and near misses are debriefed and reported through the quality and safety system for morbidity and mortality review.