Crashing Neonate Algorithm v1

Photo of PAT: General Impression
  • Assess ABCs / PAT
    • steps
      • Place on monitor, pulse oximeter
      • Place on oxygen, assist ventilation with bag-valve-mask as needed
      • Get vascular access: IV or IO or if < 1 week old may try umbilical venous catheter
      • Get bedside glucose, i-Stat lytes / lactate, POC hemoglobin, venous blood gas
    • Give 10-20 cc/kg NS bolus rapidly (hand push) & reassess. Unless worsens w/fluids, cont. boluses 10-20 cc/kg prn to 60 cc/kg
      • Perform focused rapid history and PE THE MISFITS DIFFERENTIAL DX
        • Trauma
        • Heart disease
        • Endocrine (CAH, thyrotoxicosis)
        • Metabolic disorders
        • Inborn errors of metabolism
        • Sepsis
        • Formula mishap
        • Intestinal catastrophe (volvulus, NEC)
        • Toxins
        • Seizures
      • Cardiac
        • Get EKG, CXR
          • HR>220: r/o SVT:
            • Adrenosine 0.1 mg/kg
        • 1-2 wks of life, poor perfusion + O2 sat low and not increased with oxygen: r/o ductal-dep lesion:
          • Prostaglandin E1 0.1 mcg/kg/min
        • Gallop, hepatomeg, worse w/fluids:
          • r/o CHF Furosemide 1 mg/kg
      • Surgical
        • Abd distension, tenderness, bilious vomiting, volvulus, NEC
          • Get KUB, consult surgeon
        • Bruises, abd distension, bulging fontanel, dropping Hct: Trauma
          • FAST, serial Hct, CT, surgeon
        • CAH: ambig genitalia, hypoNa, hyperK, hypoglycemia, low BP -> Hydrocort 25mg IV
      • Seizure: lip-smacking, blinking
        • Lorazepam 0.1 mg/kg IV or 0.2 mg/kg IN, Phenobarb 20 mg/kg, empiric Pyridoxine 100mg IV x 1
      • Inborn errors: send
        • NH3, lactate; NPO, D10 1/2 NS maint fluids
    • Correct abnormal POC labs:
      • labs
        • Hypoglycemia D10W 2-3 cc/kg
        • Hyponatremia NS bolus or 3% saline 5 cc/kg
        • Hypocalcemia calcium gluconate 100 mg/kg
        • Hyperkalemia calcium as above, insulin 0.1 u/kg
          • dextrose D10W as above, albuterol neb
        • Severe anemia PRBCs 10 cc/kg
      • Resp failure / arrest:
        • RSI
        • Fentanyl 1 mcg/kg
        • Rocuronium 1 mg/kg
        • 3.5 ETT, 1 blade Miller
        • (No etomidate in pediatric sepsis, no ketamine in < 3mo)
      • R/o sepsis & labs:
        • labs
          • CBC, blood cx, chem panel, UA, Utox
          • Ampicillin 50 mg/kg IV/IM
          • Cefotaxime 50 mg/kg IV or Gentamicin 4 mg/kg IM
          • Consider
            • vanco 15 mg/kg IV
            • Acyclovir 20 mg/kg IV
        • Fluid-refractory shock

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