Emergency, Critical, and Perioperative Pediatric Care
Emergency and critical care items test rapid recognition, weight-based dosing under pressure, and the perioperative safety net.
Recognition and resuscitation
- Pediatric Assessment Triangle, then ABCDE.
- Estimate weight with a length-based tape; it beats guessing.
- Two-rescuer child CPR: 15:2, rate 100–120/min, depth one-third of the anteroposterior diameter.
- Epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000) IV/IO every 3–5 minutes; maximum 1 mg.
- Defibrillation: 2 J/kg first shock, 4 J/kg thereafter.
- Fluid bolus: 20 mL/kg isotonic crystalloid, reassess after each bolus.
- Anaphylaxis: epinephrine 0.01 mg/kg IM of 1:1000 (max 0.3–0.5 mg) into the vastus lateralis.
- Status epilepticus: benzodiazepine first line (midazolam IM/intranasal or lorazepam IV).
Shock and sepsis
- Recognize compensated shock by tachycardia, prolonged capillary refill, and narrow pulse pressure before hypotension appears.
- Cultures, antibiotics within 1 hour, and fluids.
Perioperative care
- NPO: clear liquids 2 h, breast milk 4 h, formula 6 h, light meal 8 h.
- Preop: child life preparation, distraction, parental presence at induction.
- Malignant hyperthermia: stop the triggering agent, cool, give dantrolene 2.5 mg/kg.
- Postop: distinguish emergence delirium from pain - treat pain first.
Worked example
A 10 kg, 18-month-old has hives, wheeze, and hypotension after an antibiotic. Give epinephrine 0.01 mg/kg × 10 kg = 0.1 mg = 0.1 mL of 1:1000 IM in the lateral thigh, call for help, position supine with legs elevated, give oxygen and a 20 mL/kg (200 mL) isotonic fluid bolus.
Traps
- Using an adult 0.3 mg autoinjector for a small child.
- Relying on blood pressure to diagnose pediatric shock.
- Stacking fluid boluses without reassessing.
- Forgetting the length-based tape when the weight is unknown.