Reassess after each weight-based fluid bolus and obtain base direction for pediatric push-dose epinephrine.
OCEMS source summary · Updated 2026-09-16
Key cautions & base contact
Pediatric push-dose epinephrine still requires a base order; the adult PR-230 authorization change does not apply.
Do not automatically give fluid to a child with cardiogenic shock and pulmonary edema.
Recognize and monitor
Assess mental status, pulses, skin signs, BP, respiratory effort, and possible hemorrhage, dehydration, infection, or cardiac disease. Monitor and document the rhythm.
For room-air SpO₂ below 95%, provide high-flow mask oxygen or nasal cannula/direct blow-by at 6 L/min as tolerated. Use the pediatric bradycardia pathway when indicated.
Initial resuscitation
Establish IV; if unresponsive and peripheral IV cannot be obtained, consider IO. Give normal saline 20 mL/kg IV/IO, maximum 250 mL per bolus, and make base contact.
The order allows two repeats for three total boluses. Reassess BP and perfusion after each bolus. If BP fails to improve after the first bolus, continue indicated fluids and request a base order for pediatric push-dose epinephrine.
Pediatric push-dose epinephrine
PR-205 requires base contact and an order before administration. Its dose is 1 mcg/kg IV/IO of the 10 mcg/mL mixture, maximum 10 mcg (1 mL), repeatable every 3 minutes as ordered.
If cardiogenic shock presents with pulmonary edema, PR-205 directs base contact without giving a fluid bolus. Exclusions include uncorrected hypovolemic shock and suspected stimulant intoxication.
Glucose & transport
At glucose 60 mg/dL or less, use oral glucose if tolerated with intact airway reflexes, D10 5 mL/kg IV (maximum 250 mL), or glucagon 0.5 mg IM when IV is unavailable. Respect the source-specific IO dextrose conditions.
Provide ALS escort and report the suspected cause, weight, cumulative fluids, BP response, glucose, medication dose/concentration, and base orders.