- Fluid loss (vomiting/diarrhea/fever)
- Congenital defects
- Birth complications
- Allergic reaction
- History of poor oral intake
- Weak, rapid pulse
- Pale, cool, clammy skin
- Delayed capillary refill
- Decreased blood pressure
- Congenital heart disease
- Allergic reaction
- Use age appropriate heart rate and blood pressure levels
Hypotension due to cardiogenic shock (tachycardia) ?
- OLMC: Push Dose Epi: 10 mcg (1 ml) q 3-5 mins
See appropriate cardiac protocol
Non-trauma Non-cardiac (no bradycardia) ?
- Normal Saline 20 mL/kg IV; max 60 mL/kg or 1,000 mL
- Notify receiving facility or contact Medical Control
- OLMC: Request additional fluid (Medical Control)
Hypotension due to bradycardia ?
- 1 day to less than age 12, or
- less than 55 kg in ages 12-18.
- Use Handtevy 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:
greater than 11:
- Often the first clue to a problem
- Look/gaze (eye contact)
- 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
- Abnormal appearance + Poor circulation
- Abnormal appearance + Change in work of breathing
- Normal appearance + Change in work of breathing