The Child Has Stopped Wheezing
The strongest risk factor for fatal pediatric asthma.
A previous ICU admission or prior intubation for asthma
The earliest clinical sign of pediatric shock.
Tachycardia
The primary cause of metabolic acidosis in DKA.
Ketone bodies (beta-hydroxybutyrate and acetoacetate)
Seizure activity lasting longer than this duration is treated as status epilepticus.
≥30 minutes of either continuous seizure activity or two or more sequential seizures without full recovery of consciousness between seizures
Most common preventable cause of death after pediatric trauma
Unrecognized hemorrhage
An asthmatic patient whose wheezing suddenly disappears while respiratory distress worsens demonstrates this finding.
Silent chest
Initial fluid bolus recommended by current pediatric sepsis guidelines.
10–20 mL/kg isotonic crystalloid with reassessment
Insulin infusion should begin only after this intervention.
Initial fluid resuscitation
First-line medication class for status epilepticus.
Benzodiazepines
Initial cervical spine imaging recommended in an alert child with concerning trauma.
Cervical spine radiography (or CT when indicated)
This laboratory abnormality may be seen after prolonged continuous albuterol therapy and can worsen respiratory muscle weakness.
Hypokalemia
This laboratory test is commonly trended to assess tissue hypoperfusion and response to therapy.
Lactate
New onset headache, altered mental status, and bradycardia in DKA should be assumed to represent this complication.
Cerebral edema
Common second-line agent recommended after benzodiazepine failure.
Levetiracetam, fosphenytoin, valproate
The most sensitive bedside tool for detecting free intraperitoneal fluid in unstable trauma patients.
FAST examination
A rising PaCO₂ in a child with severe asthma is concerning for this.
Impending respiratory failure
A child with septic shock initially improves after fluid resuscitation. Several hours later, he develops increasing oxygen requirements, hepatomegaly, and diffuse crackles on lung examination.
Fluid overload from aggressive resuscitation
First-line treatment for suspected cerebral edema in DKA.
Hypertonic saline or mannitol
Most common life-threatening complication during prolonged seizures.
Respiratory failure
A child with blunt abdominal trauma and hypotension should be assumed to have this until proven otherwise.
Hemorrhagic shock due to spleen rupture
Ventilator strategy preferred in intubated status asthmaticus.
Permissive hypercapnia with prolonged expiratory time
A child remains hypotensive despite 60 mL/kg of crystalloid and epinephrine infusion. This condition should be considered and treated if clinically suspected.
Adrenal insufficiency
Despite a pH of 6.85, this medication is usually avoided in pediatric DKA because it may increase the risk of cerebral edema.
Sodium bicarbonate
A previously healthy 12-year-old develops fever, psychiatric symptoms, dyskinesias, and recurrent seizures. CSF demonstrates lymphocytic pleocytosis.
Anti-NMDA receptor encephalitis
This type of injury is the most common cause of death overall, responsible for 66% of fatalities, and the majority of these deaths occur within 24 hours
Traumatic Brain injury (TBI)