Airway & Breathing
This finding—stridor—most strongly suggests obstruction in this portion of the pediatric airway.
What is the upper airway?
Tachycardia, cool extremities, delayed capillary refill, and weak peripheral pulses with a normal blood pressure characterize this stage of pediatric shock.
What is compensated shock?
A child has a pulse but a heart rate <60/min with signs of poor perfusion despite adequate oxygenation and ventilation. This intervention should be started immediately.
What is CPR?
This medication is first-line for pediatric anaphylaxis and should be administered IM in the lateral thigh.
What is epinephrine?
Appearance, work of breathing, and circulation to the skin make up this rapid, hands-off pediatric assessment tool.
What is the Pediatric Assessment Triangle (PAT)?
A child has tachypnea, retractions, nasal flaring, and grunting but remains alert with adequate oxygenation. PALS classifies this respiratory condition as this.
What is respiratory distress?
Hypotension in a child with signs of poor perfusion indicates this late and ominous stage of shock.
What is hypotensive/decompensated shock?
A child has a regular narrow-complex tachycardia at 220/min with no identifiable P waves and little beat-to-beat variability. This rhythm is most consistent with this diagnosis.
What is SVT?
This medication is given by rapid IV/IO push followed immediately by a flush for stable SVT that persists despite vagal maneuvers.
What is adenosine?
Appearance, work of breathing, and circulation to the skin make up this rapid, hands-off pediatric assessment tool.
What is the Pediatric Assessment Triangle (PAT)?
A 2-year-old with a barking cough and stridor at rest receives dexamethasone. This inhaled medication should be given next.
What is nebulized racemic epinephrine?
A child with suspected hypovolemic shock should generally receive this initial volume of isotonic crystalloid, followed by reassessment.
What is 20 mL/kg?
A stable child with SVT does not respond to vagal maneuvers. This medication is given as a rapid IV/IO push followed immediately by a flush.
What is adenosine? (0.1 mg/kg first dose; max 6 mg)
During pediatric cardiac arrest, this is the IV/IO dose of epinephrine using the 0.1 mg/mL (1:10,000) concentration.
What is 0.01 mg/kg? (0.1 mL/kg; max 1 mg)
A toddler is alert, interactive, has good tone, normal work of breathing, and normal skin color. Before obtaining vital signs, the PAT would categorize this child this way.
What is physiologically stable / not obviously critically ill?
A 6-year-old with severe asthma becomes increasingly somnolent. His respiratory rate falls from 42 to 18/min, breath sounds become nearly absent, and SpO₂ is 88% despite oxygen. This change in respiratory status should trigger assisted ventilation and preparation for a definitive airway.
What is respiratory failure?
A child with septic shock receives cautious isotonic crystalloid boluses but remains poorly perfused. Further fluid is limited by new rales and hepatomegaly. This treatment should now be prioritized.
What is initiation of vasoactive support?
A child with SVT develops hypotension and altered mental status. This electrical treatment is indicated, beginning at this energy dose.
What is synchronized cardioversion at 0.5–1 J/kg? (Increase to 2 J/kg if needed.)
A 20-kg child remains in refractory VF/pulseless VT after defibrillation and epinephrine. This antiarrhythmic can be given at 5 mg/kg IV/IO.
What is amiodarone? (100 mg for this patient)
A child with severe respiratory distress was initially tachypneic and agitated. He is now sleepy, breathing more slowly, and has decreasing retractions with poor air movement. This seemingly “improved” respiratory effort actually indicates this.
What is appearance?
A 4-year-old in respiratory failure is being ventilated by BVM. Despite 100% oxygen, SpO₂ remains 78%. There is minimal chest rise and no improvement after repositioning the airway. This is the next immediate step before assuming the child requires an advanced airway.
What is reassessing/improving BVM ventilation—open the airway, obtain a tight mask seal, suction as needed, and use a two-person technique?
A child with fever and septic shock remains hypotensive with cool extremities, weak pulses, prolonged capillary refill, and low cardiac output despite appropriate initial resuscitation. This vasoactive infusion is commonly favored when myocardial dysfunction/low cardiac output predominates.
What is epinephrine?
A pulseless child is in VF. After the second shock, CPR resumes immediately. During this cycle, this medication should be administered.
What is epinephrine? (0.01 mg/kg IV/IO of 0.1 mg/mL [1:10,000], max 1 mg; repeat every 3–5 min.)
A 15-kg child with symptomatic bradycardia from suspected increased vagal tone requires this medication at this weight-based dose.
What is atropine 0.02 mg/kg IV/IO? (0.3 mg for this patient)
A child has altered mental status, weak central pulses, cool mottled extremities, capillary refill of 5 seconds, and hypotension. The presence of hypotension distinguishes this condition from compensated shock.
What is hypotensive/decompensated shock?