From the Guidelines
Immediate interventions for common pediatric emergencies require prompt recognition and appropriate action, with the most recent guidelines from the American Heart Association in 2020 1 emphasizing the importance of timely and effective care. For respiratory distress, establishing airway patency, positioning the child upright, administering oxygen to maintain saturation above 94%, and considering nebulized albuterol 2.5-5mg for wheezing or croup are crucial steps.
- For status epilepticus, protecting the airway, administering lorazepam 0.1mg/kg IV/IO (maximum 4mg) or midazolam 0.2mg/kg intranasally/buccally, and preparing for second-line therapy with fosphenytoin or levetiracetam if seizures persist beyond 5 minutes are essential interventions.
- For anaphylaxis, giving epinephrine 0.01mg/kg (1:1000 solution) IM in the mid-outer thigh (maximum 0.3mg for children, 0.5mg for adolescents), establishing IV access, administering fluid boluses of 20mL/kg for hypotension, and considering adjunctive therapies like diphenhydramine (1mg/kg, max 50mg) and methylprednisolone (1-2mg/kg) are critical.
- For severe dehydration, securing IV/IO access and administering 20mL/kg isotonic fluid boluses, reassessing after each bolus, are vital steps.
- For hypoglycemia, giving dextrose (0.5-1g/kg) as D10W for infants or D25W for older children, or glucagon 0.03mg/kg IM/SC (maximum 1mg) if IV access is unavailable, are necessary interventions. These interventions are time-sensitive and should be initiated while simultaneously assessing vital signs, obtaining relevant history, and arranging appropriate definitive care or transfer to higher levels of care when needed, as emphasized by the preparation for emergencies in the offices of pediatricians and pediatric primary care providers 1.
From the Research
Common Pediatric Emergencies
- Respiratory distress or insufficiency, respiratory arrest, hemodynamic instability, and/or cardiopulmonary arrest are common pediatric emergencies 2
- Sepsis, trauma, and respiratory illnesses are high-priority areas of research in pediatric emergency medicine 3
- Pediatric Assessment Triangle (PAT) is a valid tool for identifying critical cases, particularly in recognition of pediatric respiratory emergencies and neonatal emergencies 4
Immediate Interventions
- Assessment of airway and breathing should be initiated immediately, with a median time of 1.3 minutes 2
- Administration of oxygen should be done promptly, with a median time of 2.0 minutes 2
- Cardiopulmonary resuscitation (CPR) should be initiated immediately in cases of cardiac arrest, with a median time to initiation of compressions of 1.5 minutes 2
- PAT can be used to triage pediatric patients and identify those who require immediate attention 4
Organ-Specific Emergencies
- Respiratory emergencies, such as acute respiratory distress syndrome (ARDS), require prompt diagnosis and management, including mechanical ventilation and supportive care 5
- Cardiac emergencies, such as cardiopulmonary arrest, require immediate initiation of CPR and other resuscitative measures 2
- Neurological emergencies, such as seizures or stroke, require prompt diagnosis and management, including administration of medications and supportive care 6
Special Considerations
- Pediatric patients have unique anatomy, physiology, and pathophysiology that require special consideration in emergency situations 6
- Neonatal patients are at high risk for critical cases and require prompt identification and management 4
- Communication errors and deviations from American Heart Association guidelines are common in pediatric resuscitation and can be improved with simulation-based training and educational interventions 2