Pediatric Emergencies and Critical Care
Emergency items test resuscitation numbers, drug doses, and the human side of a crisis - family presence, team roles, and debriefing.
Core rules
- High-quality CPR for children: two-rescuer compression-to-ventilation ratio of 15:2, rate 100–120 per minute, depth one-third of the anterior-posterior chest diameter, full recoil, minimal interruptions.
- Epinephrine for cardiac arrest: 0.01 mg/kg of 1:10,000 IV/IO every 3–5 minutes. Defibrillation at 2 J/kg, escalating to 4 J/kg.
- Anaphylaxis: intramuscular epinephrine 0.01 mg/kg of 1:1,000, maximum 0.5 mg, into the vastus lateralis, repeated in 5–15 minutes if needed. Antihistamines and steroids are adjuncts only.
- Septic shock: 20 mL/kg isotonic boluses with reassessment, early antibiotics, and vasoactive support if fluid-refractory.
- Status epilepticus: a benzodiazepine first, lorazepam 0.1 mg/kg IV, then a second-line antiepileptic.
- Offer family presence during resuscitation with a staff guide, and debrief the team afterward.
Worked example
A 15 kg child develops stridor, hives, and hypotension minutes after an antibiotic. Intramuscular epinephrine dose is 0.01 × 15 = 0.15 mg of 1:1,000, given immediately into the thigh. This equals 0.15 mL of 1:1,000; using 1:10,000 would deliver one-tenth the dose. Then provide oxygen, a fluid bolus of 20 mL/kg (300 mL), and continuous monitoring, since biphasic reactions can occur hours later.
Traps
- Giving an antihistamine before epinephrine in anaphylaxis.
- Confusing 1:1,000 and 1:10,000 concentrations.
- Using adult compression ratios or depths.
- Delaying defibrillation to complete an IV attempt.