**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!