Pediatric Emergencies: Fever & Resuscitation

Resuscitation Quick Ribbon (First 2 Minutes)

PALS Epinephrine:0.01 mg/kg IV/IO (0.1 mL/kg of 1:10,000 solution) q3–5min

Fluid Bolus (Shock):10–20 mL/kg balanced crystalloid over 10–20 min; re-evaluate liver edge and lung crackles

Dextrose (Hypoglycemia):D10W 5 mL/kg IV bolus (or D25W 2 mL/kg for children > 1 year)

Croup (Moderate/Severe):Dexamethasone 0.6 mg/kg PO/IM (max 16 mg) + Nebulized Racemic Epinephrine 0.5 mL in 3 mL saline

Neonatal Empiric Abx:Ampicillin 50 mg/kg IV q8h + Gentamicin 2.5 mg/kg IV q12h (or Cefotaxime 50 mg/kg)

Bottom-Line Clinical Pearl

Children are not small adults: bradycardia is the primary cardiac response to hypoxia and shock. The febrile infant under 28 days old requires a full sepsis workup (blood cultures, catheterized UA, and lumbar puncture) and empiric admission on IV ampicillin and ceftazidime/gentamicin. In infants 29–60 days, validated criteria (Rochester/Philadelphia) guide selective workup. In pediatric cardiac arrest, prioritize ventilation (1 breath q2–3s) and deliver Epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000).

1. Febrile Infant Algorithm by Age Group

Age Window	Risk Level	Mandatory Diagnostic Workup	Empiric Management
0–28 days (Neonate)	Extreme high risk (Listeria, GBS, E. coli, HSV)	CBC, blood cultures x2, catheter UA/culture, Lumbar Puncture, chest X-ray	Admit to PICU/Peds; Ampicillin 50 mg/kg + Ceftazidime 50 mg/kg (add Acyclovir if vesicles/seizures)
29–60 days	Intermediate risk	Catheter UA, blood cultures, inflammatory markers (procalcitonin/CRP), LP if high risk	If low-risk criteria met: Ceftriaxone 50 mg/kg IM and 24h follow-up; if high-risk: LP + admit
61–90 days	Low risk if immunized	Catheter UA and urine culture; clinical assessment	Outpatient management if well-appearing and urine negative