Pediatric Emergency and Critical Care
Domain focus
Pediatric emergency and critical care tests rapid assessment, shock, anaphylaxis, resuscitation, trauma, and poisoning.
Core rules
- Use the Pediatric Assessment Triangle: appearance, work of breathing, circulation.
- Anaphylaxis: IM epinephrine 0.01 mg/kg of 1 mg/mL (maximum 0.5 mg) into the anterolateral thigh; repeat every 5–15 minutes if needed. Give oxygen, fluids, and adjuncts, but do not delay epinephrine.
- Septic shock: 10–20 mL/kg isotonic fluid boluses, reassess after each, and give antibiotics early. Start vasoactive support if shock persists.
- PALS: two-rescuer CPR 15:2, rate 100–120/min, depth one-third of the anteroposterior chest diameter. Defibrillate VF/pVT at 2 J/kg, then 4 J/kg.
- Trauma: primary survey, cervical spine precautions, and avoid hypoxia and hypotension.
Worked example
A 6-year-old develops hives, wheezing, and hypotension minutes after eating peanuts. Reasoning: this is anaphylaxis. Give IM epinephrine immediately, place the child supine with legs elevated, provide high-flow oxygen, and start a 20 mL/kg isotonic fluid bolus. Repeat epinephrine if symptoms persist. Antihistamines and steroids are adjuncts, not first-line.
Traps
- Giving IV epinephrine instead of IM epinephrine for anaphylaxis.
- Delaying epinephrine while waiting for IV access.
- Over-resuscitating DKA or trauma and causing cerebral edema or worsening hemorrhage.