|Intraosseous access can be used to infuse medications, electrolyte solutions, and blood|
|products. The absorption and duration of action are described as similar to those in |
peripheral and central venous routes. Second choice after failure to obtain peripheral access
in the injured child.
|(Epinephrine, atropine, naloxone, lidocaine, and vasopressin) may be used by endotracheal|
|Norepinephrine is the preferred vasoactive drug in a child with fluid-refractory septic shock|
|and warm extremities.|
|Epinephrine is the vasoactive agent of choice for treating patients in septic shock with cold|
|In children with norepinephrine-refractory shock, use of vasopressin may be considered, but|
|it should not be the first vasopressor administered.|
|Milrinone may be useful in the patient with adequate blood pressure but persistent signs of|
|Fluid-refractory septic shock
|Oral airways should not be used in patients with intact airway protective reflexes or gag reflex.|
|Nasal airways (NA) can be used in semiconscious patients with intact gag or airway reflexes.|
|They should not be used in children with suspected basal skull fracture, or those with nasal |
fracture or recent surgery.
|The NA tip is beveled and should be inserted with bevel facing the nasal septum. The NA is|
|curved in such a way that the right nostril should be used, if possible.|
|On occasion, if there is antidromic (retrograde conduction of the impulse through the|
|atrioventricular [AV] node) AV re-entry, the EKG tracing will demonstrate wide complexes and |
will look like ventricular tachycardia.
|After conversion to a sinus rhythm, the EKG in those patients with WPW will reveal the|
|classic delta wave with a short PR interval and upsloped initial portion of the QRS complex.|
|Unstable SVT, characterized by signs of cardiogenic shock and congestive heart failure,|
|requires immediate synchronized cardioversion. Initial attempts at 0.5 to 1 J/kg. If repeated |
attempts are needed, the energy should be doubled, up to 2 J/kg.