Pediatric Emergency Protocols

SPECIALIZED

Age-specific assessment and treatment protocols for pediatric patients

Pediatric Considerations

Children are not small adults. They have unique anatomical and physiological differences that affect assessment and treatment. Use weight-based dosing, age-appropriate equipment, and remember that children compensate well until sudden decompensation.

Pediatric Assessment Triangle (PAT)

Rapid visual assessment from across the room

Appearance

Normal

✓Alert and responsive
✓Good muscle tone
✓Strong cry/voice
✓Appropriate interaction
✓Consolable

Abnormal

⚠Lethargy
⚠Poor muscle tone
⚠Weak cry
⚠Inconsolable
⚠Unresponsive

Work of Breathing

Normal

✓Normal respiratory rate
✓No retractions
✓No abnormal sounds
✓Normal positioning

Abnormal

⚠Tachypnea/bradypnea
⚠Retractions
⚠Grunting/stridor/wheezing
⚠Tripod positioning
⚠Nasal flaring

Circulation

Normal

✓Pink skin
✓Normal capillary refill
✓No bleeding
✓Warm extremities

Abnormal

⚠Pallor/cyanosis/mottling
⚠Delayed cap refill >2 sec
⚠Petechiae/purpura
⚠Cool extremities

Normal Vital Signs by Age

Age Group	Heart Rate	Resp Rate	Systolic BP	Weight Range
Newborn (0-1 month)	100-180 bpm	30-60 /min	60-90 mmHg	2-4 kg
Infant (1-12 months)	100-160 bpm	30-60 /min	70-100 mmHg	4-10 kg
Toddler (1-3 years)	90-150 bpm	24-40 /min	80-110 mmHg	10-14 kg
Preschool (3-5 years)	80-140 bpm	22-34 /min	80-110 mmHg	14-18 kg
School Age (6-12 years)	70-120 bpm	18-30 /min	90-120 mmHg	18-36 kg
Adolescent (>12 years)	60-100 bpm	12-20 /min	100-130 mmHg	>36 kg

Weight-Based Drug Dosing

Patient Weight (kg)

Equipment Sizing Guide

3-5 kg

ETT: 3.0-3.5 mmBlade: #0-1OPA: 40-50mmNG: 5-8 Fr

6-7 kg

ETT: 3.5 mmBlade: #1OPA: 50mmNG: 8 Fr

8-9 kg

ETT: 3.5-4.0 mmBlade: #1OPA: 60mmNG: 10 Fr

10-11 kg

ETT: 4.0 mmBlade: #1OPA: 60mmNG: 10 Fr

12-14 kg

ETT: 4.5 mmBlade: #1-2OPA: 70mmNG: 10-12 Fr

15-18 kg

ETT: 5.0 mmBlade: #2OPA: 70mmNG: 12 Fr

19-23 kg

ETT: 5.5 mmBlade: #2OPA: 80mmNG: 12-14 Fr

24-29 kg

ETT: 6.0 mmBlade: #2-3OPA: 80mmNG: 14 Fr

30-36 kg

ETT: 6.5 mmBlade: #3OPA: 90mmNG: 14-16 Fr

Common Pediatric Emergencies

Respiratory Distress

Recognition

•Increased work of breathing
•Abnormal breath sounds
•Cyanosis
•Altered mental status

Interventions

→Position of comfort
→High-flow oxygen
→Nebulized medications
→BVM if needed
→Consider transport position

Shock

Recognition

•Tachycardia
•Delayed cap refill
•Weak pulses
•Altered mental status
•Cool extremities

Interventions

→Oxygen therapy
→IV/IO access
→20 mL/kg fluid bolus
→Repeat bolus as needed
→Keep warm

Seizures

Recognition

•Tonic-clonic movements
•Loss of consciousness
•Post-ictal state
•Possible fever

Interventions

→Protect from injury
→Oxygen therapy
→Check blood glucose
→Benzodiazepines if >5 min
→Cool if febrile

Anaphylaxis

Recognition

•Urticaria/angioedema
•Respiratory distress
•Hypotension
•GI symptoms

Interventions

→IM epinephrine 0.01 mg/kg
→High-flow oxygen
→IV fluids
→Antihistamines
→Steroids

Pediatric Medication Quick Reference

Medication	Dose	Max Dose	Indication	Route
Epinephrine (1:1000)	0.01 mg/kg IM	0.5 mg	Anaphylaxis, severe asthma	IM (anterolateral thigh)
Epinephrine (1:10,000)	0.01 mg/kg IV/IO	1 mg	Cardiac arrest	IV/IO
Albuterol	2.5-5 mg nebulized	5 mg	Bronchospasm	Nebulized
Midazolam	0.1-0.2 mg/kg	10 mg	Seizures	IV/IO/IM/IN
Dextrose 25%	2-4 mL/kg	As needed	Hypoglycemia	IV/IO
Normal Saline	20 mL/kg bolus	Repeat as needed	Shock, dehydration	IV/IO

PALS Quick Reference

CPR Guidelines

• Compression depth: 1/3 AP diameter
• Rate: 100-120/min
• Ratio: 30:2 (single), 15:2 (two rescuers)
• Minimize interruptions

Defibrillation

• Initial: 2 J/kg
• Subsequent: 4 J/kg
• Maximum: 10 J/kg or adult dose
• Use pediatric pads if available

Special Pediatric Considerations

Anatomical Differences

• Large head and tongue
• Anterior larynx
• Flexible trachea
• Higher metabolic rate

Communication Tips

• Get down to child's eye level
• Use simple language
• Include parents when possible
• Use distraction techniques