FIELD REFERENCE
Full criteria & treatment guidance
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. Use IO dextrose only when the additional criteria are met.
- Provide ALS escort and report the suspected cause, weight, cumulative fluids, BP response, glucose, medication dose/concentration, and base orders.
VISUAL FIELD REFERENCE
Pediatric shock: fluids and pulmonary edema differ
Pediatric · ALS
Identify the cause and reassess after each intervention. Pediatric push-dose epinephrine requires a base order.
Initial fluid pathway
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.
Cardiogenic shock with pulmonary edema
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.
- Pediatric push-dose epinephrine still requires a base order; the adult PR-230 authorization change does not apply.
Selected checkpoints; read the complete guide for criteria, exclusions, doses, and ongoing care. SO-P-080 · PR-205
UNDERSTAND THE CARE
Why every pediatric fluid repeat is a new decision
The clinical assessment joins pulse, pressure, skin signs, mental status and breathing with the likely cause of poor perfusion. Hemorrhage, dehydration, infection and cardiac disease do not all imply the same next intervention. Obtain and communicate weight before calculating treatment.
Applying the guidance
The fluid maximum and permitted repeats are limits within a pathway, not instructions to give the entire allowance regardless of response. Repeat the lung and perfusion assessment after each bolus. When the first bolus fails to improve pressure, follow the contact and escalation instructions. Cardiogenic pulmonary edema changes the initial approach and requires base direction without an automatic fluid bolus.
Reassess after each fluid bolus
Putting it together
Teaching example: a child has poor perfusion with pulmonary edema. State the suspected cardiogenic branch in the base report rather than beginning the clear-lung fluid sequence by default.
Diagram text & teaching checkpoints
- Cause
- Volume loss, infection or cardiac concern.
- Bolus decision
- Check the relevant branch and lung findings.
- Response
- Repeat pressure and clinical perfusion assessment.
- Escalation
- PR-205 requires pediatric base authorization.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.