**Kids... look great until they plummet. Appear well until very close to decompensation. INTUBATION - DO IT BEFORE IT IS TOO LATE **Intubate early for children who are doing poorly, do not wait until they are becoming increasingly hypoxic and bradycardic! **40% of infant cardiac output goes to work of breathing - tremendous metabolic requirement. May need to intubate for non-respiratory reasons - use blood gases **Consider ketamine for sick neonate needing intubation/sedation INTUBATE THE STOMACH TOO!! **Decompress belly if needed: Infant diaphragm more horizontal, does not help with breathing as much. Distended gassy abdomen will severely inhibit breathing. Use NG TUBE RESUSCITATE!! GIVE FLUIDS FAST!! **FLUIDS: use up to 60cc/kg, one little bolus of 20cc/kg often gross under resuscitation. 60cc/kg is not the maximum... its the start DON'T FORGET THE SUGAR!! **Blood sugar: In infant it can drop from normal to low quickly. Can have wide range of symptoms or be asymptomatic. **sugar problems: infant brain uses 90% of glucose, head to body ratio MUCH higher in infant. Healthy infant uses 6-8 mg/kg/min sugar as opposed to 2mg/kg/min in adult **Sugar: High, keep checking. Normal, start basal rate. Low, give bolus! GET ACCESS NOW!! **IO: Difficult in infant, but it is DIFFICULT in the very young. We often wait too long to go to IO. Don't!
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