Emergency and Critical Care
Domain 5 tests rapid recognition and stabilization of the critically ill or injured child: respiratory failure, shock, sepsis, anaphylaxis, seizures, trauma, and resuscitation. The exam emphasizes ABCDE, weight-based interventions, and escalation.
Core rules
- Use the pediatric assessment triangle: appearance, work of breathing, circulation to skin.
- Assess ABCDE; provide oxygen, positioning, suction, and bag-mask ventilation as needed.
- Shock: tachycardia, poor perfusion, altered mental status; give isotonic fluid bolus 20 mL/kg and reassess, watching for overload.
- Anaphylaxis: intramuscular epinephrine 0.01 mg/kg (max 0.5 mg) into the anterolateral thigh, repeat every 5–15 minutes as needed; oxygen and fluids are adjuncts.
- In DKA or cardiac disease, fluid boluses require caution and close reassessment.
Worked example
A 12-kg child has hives, stridor, and hypotension after an antibiotic. Give IM epinephrine 0.01 mg/kg = 0.12 mg. Using 1 mg/mL, that is 0.12 mL in the anterolateral thigh. Call for help, give oxygen, place supine with legs elevated if tolerated, and start isotonic fluid. Repeat epinephrine in 5–15 minutes if symptoms persist. Do not wait for antihistamines or steroids.
Traps
Delaying epinephrine, giving it subcutaneously or orally, and using the wrong concentration. Also avoid over-fluid resuscitation in DKA, missing hypoglycemia, and failing to reassess after each intervention.