From the Guidelines
A crash course in pediatric emergency medicine should focus on the ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure) with pediatric-specific considerations, as outlined in the 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1.
Key Considerations
- Begin by assessing airway patency, noting that children have anatomical differences including larger tongues, narrower airways, and more compliant chest walls.
- For respiratory distress, provide oxygen targeting SpO2 >94%, and consider nebulized epinephrine (0.5 mL/kg of 1:1000 solution, max 5 mL) for croup or albuterol (2.5-5 mg) for wheezing.
- Fluid resuscitation for shock requires 20 mL/kg boluses of isotonic crystalloid, reassessing after each bolus.
- Pediatric medication dosing is weight-based: use the Broselow tape or calculate doses carefully.
- For seizures, administer lorazepam 0.1 mg/kg IV/IO or midazolam 0.2 mg/kg intranasally.
- Hypoglycemia should be treated with D10W at 5 mL/kg.
Additional Recommendations
- Remember that children compensate well until sudden decompensation occurs, so tachycardia and poor perfusion are critical early warning signs.
- Temperature management is essential as children are prone to heat loss.
- Always involve parents when possible to reduce anxiety and gather information, while maintaining a systematic approach to avoid missing critical diagnoses in these vulnerable patients.
- Regular training and practice in pediatric emergency care, such as mock codes and simulation exercises, are crucial for healthcare professionals to maintain their skills and knowledge 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Overview of Pediatric Emergency Medicine
- Pediatric emergency medicine involves the assessment and management of children in emergency situations, with priorities similar to those for adults, including airway, breathing, and circulation 2
- Children have unique anatomic, physiologic, developmental, and social considerations that must be taken into account during evaluation and treatment 2
Assessment and Management of Pediatric Patients
- The initial approach to pediatric patients involves assessing airway, breathing, and circulation, with consideration of the child's age, size, and developmental stage 3
- Pediatric patients may present with different injuries and react to trauma differently than adults, requiring specialized care 3
- A systematic approach to assessment, such as the pediatric assessment triangle, can help emergency physicians evaluate pediatric patients in respiratory distress 4
Common Pediatric Emergencies
- Respiratory emergencies are a common reason for pediatric emergency department visits, with conditions such as foreign body aspiration, asthma exacerbation, epiglottitis, bronchiolitis, community-acquired pneumonia, and pertussis requiring prompt diagnosis and management 5
- Pediatric airway emergencies, although rare, can be anxiety-provoking and require evidence-based management, including preoxygenation, anticipation and prevention of intubation-related complications, and selection of induction and paralytic agents 4
Equipment and Resuscitation
- A working knowledge of resuscitation equipment is fundamental to assessing and treating children in emergency situations, with an emphasis on checking and preparing equipment using a structured approach such as the (A) Airway, (B) Breathing, and (C) Circulation framework 6
- Emergency clinicians must be prepared to use specialized equipment and techniques, such as rapid sequence intubation and alternative airway devices, to manage pediatric emergencies 4