Pediatric Medical Emergencies - NREMT: AEMT Level

Blood glucose $<60\ \text{mg/dL}$. This threshold identifies clinically significant hypoglycemia requiring intervention to prevent neurological sequelae in children exhibiting symptoms.

Hyperglycemia, dehydration, and Kussmaul respirations. Insulin deficiency leads to elevated blood sugar, osmotic diuresis causing dehydration, and metabolic acidosis prompting deep, rapid breathing for compensation.

Airway/ventilation support and isotonic fluid per protocol. Addressing hypoxia and hypovolemia stabilizes the patient, as aggressive fluid resuscitation corrects dehydration while avoiding cerebral edema risks.

Hypotension indicates decompensated shock. Children maintain blood pressure through compensatory mechanisms like tachycardia until late stages, where hypotension signifies failure of these mechanisms.

$20\ \text{mL/kg}$ isotonic crystalloid, reassess after each bolus. This volume restores intravascular fluid deficits in hypovolemia, with reassessment preventing overload and guiding further boluses based on response.

$300\ \text{mL}$. Multiplying the child's weight by the per-kilogram rate yields the appropriate bolus to improve perfusion without exceeding standard protocol limits.

Cholinergic poisoning (organophosphates/carbamates). Excessive acetylcholine from acetylcholinesterase inhibition produces muscarinic effects like pupil constriction, slowed heart rate, secretions, and bronchoconstriction.

Croup (laryngotracheobronchitis). Viral inflammation of the upper airway produces characteristic subglottic edema, leading to the seal-like cough and high-pitched stridor during inspiration.

Progressive respiratory failure (hypoxia) leading to arrest. In pediatric patients, untreated hypoxia from respiratory distress commonly progresses to complete respiratory arrest due to immature compensatory mechanisms.

Respiratory failure or shock resulting in hypoxia. Unlike adults, children's cardiac arrests typically result from systemic hypoxia secondary to respiratory or circulatory compromise rather than primary cardiac events.

Bradycardia. In children, initial tachycardia compensates for hypoxia, but bradycardia signals myocardial depression and imminent cardiorespiratory collapse.

Meningitis (possible sepsis). These symptoms indicate meningeal irritation and potential central nervous system infection, often progressing to sepsis if untreated.

Relatively larger tongue in a smaller oral cavity. This anatomical disproportion increases the likelihood of the tongue falling back and blocking the airway, particularly in unconscious or supine positions.

Neutral sniffing position (pad under shoulders if needed). Infants' larger occiputs cause natural neck flexion, so shoulder padding helps achieve optimal airway alignment without risking spinal injury.

Epiglottitis. Bacterial infection causes supraglottic swelling, resulting in painful swallowing, drooling to avoid irritation, and positional relief to maintain airway patency.

Avoid agitation; provide oxygen and prepare for airway failure. Minimizing stress prevents further airway swelling, while oxygen supports hypoxemia and readiness anticipates rapid deterioration requiring intervention.

Acute asthma exacerbation. Bronchospasm from triggers causes airway narrowing, manifesting as expiratory wheezing and extended expiratory phase in patients with known reactive airway disease.

Diffuse wheezing and/or crackles with increased work of breathing. Viral infection causes small airway inflammation and mucus production, leading to adventitious sounds and compensatory increased respiratory effort in young infants.

Foreign body airway obstruction. Sudden aspiration during activities involving small objects or food can partially or completely obstruct the airway, triggering immediate protective reflexes.

Alternate 5 back slaps and 5 chest thrusts. This sequence applies manual force to dislodge foreign bodies in infants under one year, alternating methods to maximize efficacy without abdominal injury risk.

Abdominal thrusts (Heimlich maneuver). For children over one year, subdiaphragmatic thrusts generate intra-abdominal pressure to expel obstructions from the airway effectively and safely.

Intramuscular epinephrine. It rapidly reverses life-threatening histamine-mediated effects like bronchospasm and hypotension by stimulating alpha and beta receptors.

$0.01\ \text{mg/kg IM}$ (maximum $0.3\ \text{mg}$ per dose). This weight-based dosing ensures effective alpha and beta adrenergic stimulation to counteract severe allergic reactions without exceeding safe limits in children.

$0.2\ \text{mL IM}$. For a 20 kg child, the 0.01 mg/kg dose calculates to 0.2 mg, which equates to 0.2 mL of the 1 mg/mL concentration for intramuscular administration.