Pediatric: Hypotension

 

History:

 

  • Blood
  • Fluid loss (vomiting/diarrhea/fever)
  • Infection
  • Congenital defects
  • Birth complications
  • Medications
  • Allergic reaction
  • History of poor oral intake

 

Significant Findings:

 

  • Restlessness
  • Confusion
  • Weakness
  • Dizziness
  • Weak, rapid pulse
  • Pale, cool, clammy skin
  • Delayed capillary refill
  • Decreased blood pressure

 

Differential:

 

  • Shock
  • Trauma
  • Infection
  • Dehydration
  • Congenital heart disease
  • Medication/toxin
  • Allergic reaction

 

  • Use age appropriate heart rate and blood pressure levels

 

 Treatment:

 

 

  • Oxygen

 

 

 

  • 12-Lead EKG

 

  • Obtain BGL

 

 

 

  • Initiate IV

 

Hypotension due to cardiogenic shock (tachycardia) ?

 

 

 

 

 

 

    • Push Dose Epi: 10 mcg (1 ml)

 

 

See appropriate cardiac protocol

 

Non-trauma Non-cardiac (no bradycardia) ?

 

 

 

  • Normal Saline 20 mL/kg IV; max 60 mL/kg or 1,000 mL

 

Improvement ?

 

  • Yes

 

    • Notify receiving facility or contact Medical Control

 

  • No

 

 

 

  • Request additional fluid (Medical Control)

 

Hypotension due to bradycardia ?

 

 

PEARLS:

 

  • Pediatric
    • 1 day to less than age 12, or
    • less than 55 kg in ages 13-18.
  • Use Broselow tape for drug dosages.
  • Consider all possible causes of shock and treat per appropriate protocol.
  • Consider possible allergic reaction or early anaphylaxis.
  • Decreasing heart rate and hypotension occur late in children and are signs of imminent cardiac arrest.
  • Work of breathing is a better indicator of oxygenation and ventilation than rate and lung sounds

 

 

  • Most maternal medications pass through breast milk to the infant. Consider Naloxone (Narcan) 0.1 mg/kg IV/IO; max 2 mg.
  • If the patient has a history of cardiac disease (e.g., prematurity), chronic lung disease, or renal disease, limit Normal Saline bolus to 10 mL/kg.

 

  • Age based SBP hypotension

 

    • less than 1 year:
      • less than 70
    • 1-10 years:
      • less than 70 + (2 x age)
    • greater than 11:
      • less than 90 + (2 x age)

 

  • Appearance
  • Often the first clue to a problem
  • Tone
  • Interactiveness
  • Consolability
  • Look/gaze (eye contact)
  • Speech/cry
  • Skin Circulation
  • Reflects overall adequacy of perfusion
  •  Abnormal audible breath sounds
  • Stridor - upper airway obstruction
  • Wheezing - partially blocked small airways
  • Grunting - lower airway (pneumonia)
  • Retractions - suprasternal, intercostal, or subcostal
  • Nasal flaring
  • Positioning

 

  • Abnormal appearance + Poor circulation

= SHOCK

 

  • Abnormal appearance + Change in work of breathing

= RESPIRATORY FAILURE

 

  • Normal appearance + Change in work of breathing

= RESPIRATORY DISTRESS

NREMR

National Registry Emergency Medical Responder

NREMT

National Registry Emergency Medical Technician

NREMT-I

National Registry EMT-Intermediate

NREMT-I

National Registry EMT-Intermediate

OLMC

Online Medical Control - Contact Medical Control

NREMT-I

National Registry EMT-Intermediate

OLMC

Online Medical Control - Contact Medical Control

OLMC

Online Medical Control - Contact Medical Control