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Chapter 51. Pediatric Considerations

Fernando L. Soto

Pediatric visits account for 20–25% of visits to emergency departments in the United States. Most of these encounters will occur in general emergency departments, which may have limited capabilities to care for the critically ill child.1,2 The priorities in the assessment and management of the pediatric patient are similar to those of the adult patient. The quoted ABCs of airway, breathing, and circulation still apply and are first and foremost in the evaluation of the young infant and child. There are certain anatomic, physiologic, developmental, and social considerations that are unique to this population and must be taken into account during the evaluation and treatment. This chapter will focus on the key differences in the treatment of the critically ill child. A complete discussion of the many procedures, as well as the presentation of every critical condition in pediatric patients, is well outside the scope of this text. See Table 51-1 for a list of medications used in pediatric resuscitation.

Table 51-1. Common Medications Used in Pediatric Resuscitation
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Table 51-1. Common Medications Used in Pediatric Resuscitation
Epinephrine0.01 mg/kg (0.1 mL/kg) IV every 3–5 min (1:10,000) in active resuscitation
Atropine0.02 mg/kg IV every 5 min (minimum dose 0.1 mg, maximum dose 1.0 mg)
Adenosine0.1 mg/kg IV (maximum dose 6 mg). May double to 0.2 (maximum dose 12 mg)
Amiodarone5 mg/kg bolus for pulseless VT and over 20–60 min if perfusing arrhythmia—expert consultation advised
Narcan0.1 mg/kg/dose IM/ET/IV/IO every 2–3 min (maximum dose 2 mg/dose)
Glucose
  • 5–10 mL/kg of D10W in neonates and infants
  • 2–4 mL/kg of D25W in young children
  • 1–2 mL/kg of D50W in older children and adults
Calcium100 mg/kg 10% calcium gluconate or 20 mg/kg of 10% calcium chloride
Lidocaine1 mg/kg IV, and then infusion
Bicarbonate1 mEq/kg, may repeat every 10 min
Prostaglandin E10.5 μg/kg/min IV (at lowest effective dose)

Recognition of Respiratory Distress

Compared with adults, infants and children have anatomic and physiologic characteristics that make them more susceptible to respiratory emergencies. During the first 6 months of life, they are obligate nose breathers, and their nasal passages can easily become occluded with a simple upper respiratory illness that will lead to obstruction. They have weak abdominal muscles and diaphragm, which tire easily during respiratory conditions. In addition, they have faster metabolic rates, which require a higher oxygen demand. This higher oxygen demand, coupled with a decreased functional residual capacity, makes them more vulnerable to decreases in their oxygen levels compared with those of adults.3 It is based on these differences that children tend to have higher respiratory rates, even at rest. One must be familiar with the normal vital signs according to the age (see Table 51-2). Associated fatigue or sweating while feeding and weight changes will prompt the examiner to think of congestive heart failure or hereditary conditions such as ...

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