Pediatrics

Question 1

Traumatic Shock: Hypovolemia

Answer 1

*If class 4 w/ no IV go to IO

Class 2: NS IV 10 ml/kg bolus, repeat to max 20 ml/kg.
Class 3 or 4: NS IV 20 ml/kg.

Question 2

Adrenal Crisis

Answer 2

Assist with Pt’s provided Tx Plan.

<OR>
Hydrocortisone IM/IV
<3 yo: 25 mg
3 - <10 yo: 50 mg
NS IV 20 ml/kg repeat to max 60 ml/kg.
</OR>

Question 3

Bradycardia w/ a Pulse

Answer 3

If no improvement w/ assisted ventilation start CPR.
Epinephrine IV 0.01 mg/kg (0.1 ml/kg 1:10 000) Q4.
If no improvement w/ Epinephrine:
Atropine IV 0.02 mg/kg (min 0.1 mg, max 0.5 mg)
If improvement w/ Atropine, repeat 1X Q4.
If no improvement w/ Atropine or max given, start pacing.

For discomfort during pacing consider if >95% and SBP >70+(2X age in years):
Fentanyl IV 0.5 mcg/kg (max 25 mcg) Q5 X3 then Q10.
Midazolam IV 0.05 mg/kg (max 1mg) Q10 (total max 6mg)

Question 4

Wide Complex Tach w/ a Pulse

Answer 4

Confirm signs of poor perfusion, QRS >0.09 sec.
*Infants usually >220
* Children usually >180

Sync Cardiovert 1 J/kg. Repeat doses at 2 J/kg.

If rhythm persists:
Lidocaine IV 1 mg/kg repeat 1X Q10.

Question 5

Cardiac Arrest: ? Opioid Ingestion

Answer 5

Treat as per PALS and:
Naloxone IM/IV 0.1 mg/kg (max 2 mg) Q4 PRN

Question 6

Anaphylaxis

Answer 6

Confirm significant or multisystem involvement.

Epinephrine (1:1000)
<1 yo: 0.1 mg IM
1-4 yo: 0.2 mg IM
5-9 yo: 0.3 mg IM
*Repeat PRN if Sx persist/reoccur after 5-10 min.

If mod/sev brochospasm present:
Salbutamol MDI 400 mcg Q15 (max 1200 mcg)

Question 7

Non-Traumatic Shock

Answer 7

*If no IV and Class 4, go to IO.

Class 2: NS IV 10 ml/kg
Class 3 & 4: NS IV 20 ml/kg

*If Class 2, 3, or 4 and ?DKA: 20 ml/kg over 20 min.
* Repeat bolus PRN as per Class.