The sick child and paediatric resuscitation

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Target exams

Red flags

• Hypotension is a late and pre-terminal sign in a child — recognise the tachycardia, the mottled skin, the prolonged capillary refill and the altered conscious level first; a normal blood pressure does not exclude decompensated shock
• Bradycardia in a sick child is pre-terminal — it reflects hypoxia, and the response is ventilation and oxygenation, not atropine or cardiac pacing
• Estimate the weight before any drug: Broselow tape, or weight in kilograms equals age plus four times two for the child aged one to ten — every dose, fluid and shock is weight-based
• An intra-osseous needle is placed after two failed intravenous attempts or 90 seconds — do not let difficult veins delay resuscitation
• Paediatric arrest is asphyxial in origin — ventilations matter: use 15 to 2 for two rescuers, never compression-only as a routine
• Defibrillate at 4 joules per kilogram, adrenaline 10 micrograms per kilogram, amiodarone 5 milligrams per kilogram — the adult doses are wrong and dangerous
• Check the bedside glucose in every sick or arrested child — hypoglycaemia is common, dangerous and easily corrected
• A child desaturates within 30 to 60 seconds of apnoea and bradycardia during intubation is hypoxia — pre-oxygenate, move fast, and ventilate before any drug; the adult two minutes of apnoea does not apply
• The standard APLS fluid bolus is 20 mL/kg reassessed, but use cautious 10 mL/kg aliquots in septic shock and 5 mL/kg in suspected cardiogenic shock — a full bolus into the failing heart causes pulmonary oedema
• The cuffed endotracheal tube is now standard over 3 kg only if cuff pressure is monitored under 25 cmH2O — an unmonitored cuff risks subglottic stenosis, the harm the old uncuffed rule protected against