GUIDES TO MANAGEMENT OF

C O M M O N P E D I AT R I C
EMERGENCIES
dr. Yogi Prawira, Sp.A(K)

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 Sequences in Recognizing Critically Ill Children

01 02 03 04 05
Quick Primary Secondary Tertiary Re-assessment
look assessment assessment assessment

PAT ABCDE • History Taking Diagnosis

• Focused PE
• Detailed PE

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2
PAT
3
Pediatric Assessment Triangle (PAT)

B
e
nc

Bre
ara

ath
pe

ing
Ap
4

Circulation

C
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A

5
5
 B
Work of Breathing Assessment

6
 C

Mottling

Cyanosed
7
C

8 8
Respiratory Distress

N ↑

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Shock

≠N N

≠N
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CNS/Metabolic Disorders

≠N N

N
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Cardiopulmonary Failure

≠N ↑/↓

≠N
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❑ First Observational Assesment (PAT) à ABC
❑ Primary Assessment à ABCDE

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PALS
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 Shockable Rhythm Protocol

European Resuscitation Council Guidelines for Resuscitation 2021

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 Non Shockable Rhythm Protocol
Asystole / PEA

CPR 2 min
Minimize interuption

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European Resuscitation Council Guidelines for Resuscitation 2021
Epinephrine
Cardiac arrest
• IV/IO 10 mcg/kgbb ~ 0.1 mL/kgbb Epinephrine 1:10,000
• ETT 0.1 mL/kgbb Epinephrine 1:1,000

Anaphylaxis
• IM 0.01 mg/kgbb ~ 0.01 mL/kgbb Epinephrine 1:1,000
• IV 0.05-0.1 mL/kgbb Epinephrine 1:10,000

Bronchiolitis/Croup
• Inhalation (<2 yr 10L/min gas flow) 0.2 mL/kgbb (max 6 mL) Epinephrine
1:1,000 diluted to 6 mL

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Epinephrine
Vasoactive medications
• Low dose (<0.1 mcg/kg/min)
• Venoconstriction
• Mixed effect on systemic arterial resistance vessels with net reduction in SVR
• Pulmonary arterial vasodilation
• Significant inotropy and increase in heart rate
• Moderate to high dose (0.1-0.5 mcg/kg/min)
• Venoconstriction
• No appreciable effect on SVR to systemic arterial vasoconstriction
• Dose-dependant inotropy and further increase in heart rate
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Amiodarone
Mechanism of Action
• Inhibits adrenergic stimulation and possesses alpha and beta-adrenergic blocking properties
• Affects sodium, potassium, and calcium channels
• Prolongs the action potential and refractory period in myocardial tissue
• Decreases AV conduction and sinus mode function
• Possesses vasodilatory and negative inotropic effects

Pharmacokinetics
• t ½ in children for single IV dose is 9-36 days; single PO dose is 58 days; chronic PO therapy is 4-55 days
• Metabolized in the liver via P450 enzymes and possibly the GI tract

Clinical Indication
• Supraventricular or ventricular tachyarrhythmias; junctional ectopic tachycardia, VF or VT

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Amiodarone
Dosing
• Pulseless VT (refracter to DC shock): IV loading dose 5mg/kg (max
300mg/dose), may repeat twice
• IV infusion: 25 mcg/kgbb/min over 4 hours, continue 5-15 mcg/kg/min (max
1.2g/day)

Side effects
• Rapid administration of the loading dose may precipitate circulatory collapse
(consider calcium administration when giving amiodarone)
• Acute side effects: hypotension, torsade de pointes, bradycardia, AV block
• Long-term side effects: may cause thyroid abnormalities and/or optic
neuropathy

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NARROW COMPLEX
TACHYCARDIA
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 Supra Ventricular Tachycardia
Protocol

Establishing
vascular access
quicker than
obtain
defibrillator?

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Adenosine
Mechanism of Action
• Class V antiarrhytmic: slows conduction time through the AV node, interrupting
the reentry pathways through the AV node and restoring normal sinus rhythm

Pharmacokinetics
• Rapid onset and metabolized intracellularly with a t ½ of < 10 seconds

Clinical Indication
• Reentrant SVT involving the AV node

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Adenosine
Dosing
• IV: initial dose 0.1 mg/kg (max 6mg/dose), if not effective, increase
dose by 0.1 mg/kg up to 0.3-0.5 mg/kg (max 12 mg/dose)
• Must be given by rapid IV push

Side effects
• Hypotension, sinus arrest, bronchospasm
• Should not be used in patient with 2ndor 3rd degree AV block, SN
dysfunction, symptomatic bradycardia, or with wide complex
tachycardia
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CONVULSION IN
PAEDIATRICS
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KEY POINTS

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Key Points
➢ Quick Look using Pediatric Assessment Triangle (PAT)
is a rapid assessment to decide whether a child is
critically ill or not; immediate intervention needed or
not
➢ Increased work of breathing with normal appearance
and perfusion indicates respiratory distress
➢ Decreased perfusion with appearance deterioration
without increased work of breathing indicates shock

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➢ Appearance deterioration without increased work of
breathing or decreased perfusion indicates
CNS/Metabolic problems or intoxication
➢ PAT à ABCDE
➢ Once potential life threatening condition was
identified, intervene immediately before going
through the next step à Treat as you go!
➢ Assess and Reassess

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THANK YOU