CPEN cheat sheet

Hypotension threshold: term neonate systolic BP <60 mm Hg, infant <70 mm Hg, child 1–10 years <70 + (2 × age in years) mm Hg.

Compensated shock: tachycardia, cool extremities, capillary refill >2 seconds, and weak pulses with normal blood pressure; hypotension is a late sign.

Cardiac arrest epinephrine: 0.01 mg/kg IV/IO of 1:10,000 (0.1 mL/kg), maximum 1 mg; repeat every 3–5 minutes.

Defibrillation: 2 J/kg first shock, 4 J/kg second shock, then at least 4 J/kg up to 10 J/kg or the adult dose.

SVT: vagal maneuvers first if stable; adenosine 0.1 mg/kg rapid IV push (max 6 mg), then 0.2 mg/kg (max 12 mg).

Bradycardia with poor perfusion: provide oxygen and ventilation; start CPR if heart rate remains <60/min despite adequate oxygenation and ventilation.

Ductal-dependent lesions: start prostaglandin E1 infusion and monitor for apnea, hypotension, and fever.

Tet spell: knee-chest position, oxygen, IV fluids, morphine, and phenylephrine; avoid procedures that provoke crying.

Respiratory rates: infant 30–60, toddler 24–40, preschool 22–34, school-age 18–30, adolescent 12–20 breaths/min.

Stridor is inspiratory and suggests upper airway obstruction; expiratory wheeze suggests lower airway obstruction; grunting and retractions indicate distress.

Croup: dexamethasone 0.6 mg/kg PO/IM/IV (max 10 mg); add nebulized epinephrine for stridor at rest or severe distress.

Asthma: albuterol 2.5 mg nebulized or 4–8 puffs MDI with spacer; give ipratropium and systemic corticosteroids for severe exacerbation.

Severe asthma: magnesium sulfate 25–50 mg/kg IV (max 2 g) over 20 minutes; monitor blood pressure.

Choking infant <1 year: 5 back blows then 5 chest thrusts; child >1 year: abdominal thrusts; start CPR if unresponsive.

Epiglottitis: keep child calm, avoid examining the throat, and prepare for emergent airway management.

Tension pneumothorax: needle decompression at second intercostal space midclavicular line or fourth/fifth anterior axillary line, then chest tube.

Pediatric GCS: eye 1–4, verbal 1–5 (age-specific), motor 1–6; total 3–15.

Status epilepticus: lorazepam 0.1 mg/kg IV (max 4 mg); if no IV access, midazolam 0.2 mg/kg IM/intranasal (max 10 mg) or diazepam 0.5 mg/kg rectal.

Check bedside glucose in any child with new seizure or altered mental status; treat hypoglycemia immediately.

Simple febrile seizure: age 6 months–5 years, generalized, <15 minutes, once in 24 hours, no CNS infection.

Cushing triad (hypertension, bradycardia, irregular respirations) is a late sign of increased ICP.

Increased ICP: keep head midline, elevate head of bed 30°, avoid hypoxia and hypercapnia, and prepare hypertonic saline or mannitol.

Meningitis: do not delay antibiotics for lumbar puncture; avoid LP if unstable, focal deficit, or signs of raised ICP.

PECARN head injury rules help identify low-risk children for whom CT can be avoided.

Bilious vomiting in a neonate is malrotation with volvulus until proven otherwise; obtain urgent surgical consultation.

Intussusception: 6–36 months, colicky pain, sausage mass, currant-jelly stool; air or contrast enema is diagnostic and therapeutic.

Pyloric stenosis: 3–6 weeks, projectile nonbilious vomiting, olive mass, hypochloremic hypokalemic metabolic alkalosis.

Appendicitis: periumbilical pain migrating to right lower quadrant, guarding, rebound, fever; analgesia does not mask diagnosis.

Oral rehydration: 50 mL/kg over 3–4 hours for mild dehydration, 100 mL/kg for moderate; replace ongoing losses.

Button battery in esophagus: emergent endoscopic removal; do not induce vomiting.

Gastroenteritis with severe dehydration or shock: give isotonic IV bolus 20 mL/kg and reassess.

GI bleed: stabilize airway and circulation, obtain IV access, and check hemoglobin/coagulation before endoscopy.

Testicular torsion: acute scrotal pain, high-riding testicle, absent cremasteric reflex; surgical detorsion within 6 hours.

Febrile infant UTI: obtain catheterized or suprapubic urine culture; bag specimens are unreliable.

Nephrotic syndrome: edema, proteinuria, hypoalbuminemia, hyperlipidemia; corticosteroids are first-line.

Normal urine output: 1–2 mL/kg/hour in children, 2–3 mL/kg/hour in infants; oliguria <1 mL/kg/hour.

Post-streptococcal glomerulonephritis: cola-colored urine, hypertension, edema, recent strep infection.

Priapism in sickle cell disease is an emergency; treat with hydration, analgesia, and urology consultation.

Hypospadias: avoid circumcision before surgical repair.

Acute kidney injury: correct dehydration, avoid nephrotoxins, and monitor electrolytes and urine output.

Fracture neurovascular checks: pain, pallor, pulselessness, paresthesia, paralysis, and pressure; document before and after splinting.

Compartment syndrome: pain out of proportion and pain with passive stretch are early; remove constrictive cast/dressing and call orthopedics.

Supracondylar humerus fracture: assess radial pulse and median nerve; urgent orthopedic evaluation for displaced fractures.

SCFE: obese adolescent with hip or knee pain and decreased internal rotation; make non-weight-bearing and obtain ortho consult.

Septic arthritis: fever, joint swelling, refusal to bear weight; arthrocentesis and IV antibiotics are needed.

Nursemaid's elbow: radial head subluxation from traction; reduction is accomplished by flexion and supination.

Salter-Harris: I physis, II physis+metaphysis, III physis+epiphysis, IV all three, V physeal crush.

Open fracture: cover wound, immobilize, give tetanus prophylaxis and antibiotics, and obtain urgent orthopedic consult.

Parkland burn formula: 4 mL/kg × %TBSA lactated Ringer over 24 hours, half in first 8 hours from burn time; add maintenance in children.

Pediatric TBSA: head about 18%, each leg about 14%, trunk 36%, each arm 9%, perineum 1%; Lund-Browder is more accurate.

Superficial partial burn: painful, moist, blisters; deep partial: less painful, white/mottled; full thickness: insensate, leathery.

Circumferential full-thickness burns can cause compartment syndrome; monitor pulses and prepare for escharotomy.

Necrotizing fasciitis: pain out of proportion, spreading erythema, crepitus, bullae, toxicity; surgical debridement is urgent.

Stevens-Johnson syndrome/TEN: stop culprit drug, support fluids, provide wound care, and monitor for sepsis.

Burn infection signs: increasing pain, fever, wound discoloration, purulent drainage, and systemic toxicity.

Pressure injury staging: stage 1 intact skin with nonblanchable erythema; stage 2 partial-thickness loss; stage 3 full-thickness; stage 4 exposed bone/tendon.

Neutropenic fever: ANC <500 and single temp ≥38.3°C or ≥38.0°C sustained 1 hour; give empiric broad-spectrum antibiotics within 60 minutes.

Sickle cell vaso-occlusive crisis: hydration, prompt analgesia, and oxygen only for hypoxemia; avoid acidosis and dehydration.

Acute chest syndrome: fever, chest pain, hypoxemia, new infiltrate; antibiotics, hydration, analgesia, and transfusion for severe cases.

ITP: isolated thrombocytopenia with petechiae; avoid aspirin/IM injections; treat with IVIG or steroids if significant bleeding.

Hemophilia bleeding: replace missing factor promptly; avoid IM injections and aspirin-containing drugs.

Tumor lysis syndrome: hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia; hydrate and use allopurinol or rasburicase.

Transfusion reaction: stop transfusion, keep IV open with normal saline, notify blood bank/provider, and monitor vitals.

Leukemia presentation: pallor, bruising, bone pain, fever, hepatosplenomegaly, and lymphadenopathy.

Pediatric DKA: glucose >250 mg/dL, pH <7.3, bicarbonate <15, ketonemia/ketonuria; give isotonic bolus for shock then insulin 0.05–0.1 units/kg/hour.

DKA cerebral edema: headache, altered mental status, bradycardia, hypertension; reduce fluid rate, give hypertonic saline or mannitol, and elevate head of bed.

Hypoglycemia: treat with dextrose 0.5–1 g/kg IV; D10 5 mL/kg = 0.5 g/kg; recheck glucose.

Congenital adrenal hyperplasia salt-wasting crisis: hypotension, hyponatremia, hyperkalemia, hypoglycemia; give hydrocortisone and isotonic fluids.

Diabetes insipidus: polyuria, dilute urine, hypernatremia; give desmopressin and correct free water deficit slowly.

SIADH: hyponatremia, concentrated urine, euvolemia; treat with fluid restriction and monitor sodium.

Inborn error of metabolism crisis: avoid fasting, provide glucose, and check ammonia, lactate, and blood gas.

Thyroid storm: fever, tachycardia, agitation, altered mental status; supportive care and antithyroid drugs.

Suicide risk assessment: ask directly about ideation, plan, intent, and access to means; high risk requires continuous observation and emergency mental health evaluation.

Mandatory reporting: report suspected child abuse to the designated agency; document objective findings and do not investigate independently.

Physical restraint: use only for imminent danger after less restrictive measures fail; obtain order, monitor vitals, circulation, and airway, and reassess frequently.

Developmental stages: infant stranger anxiety 6–12 months; toddler separation anxiety; preschool magical thinking; school-age concrete thinking; adolescent identity formation.

Sexual assault: preserve evidence, maintain chain of custody, offer STI prophylaxis and emergency contraception, and provide trauma-informed care.

De-escalation: use calm voice, maintain safe distance, offer choices, and avoid arguing; restraint is a last resort.

Family-centered care: keep caregivers present when safe, explain procedures honestly, and support attachment.

Munchausen by proxy: unexplained recurrent illnesses and inconsistent history; report suspected factitious disorder imposed on another.