Most acutely ill and injured children are managed within emergency departments that are not part of a children’s hospital. Difficulties in getting the right resources and training have been cited as barriers to providing the best possible care in these settings. This has resulted in variable levels of emergency care for children. TREKK is a knowledge mobilization network established to address these critical knowledge gaps and improve emergency care for children.
The optimal sequence of PALS interventions, including administration of antiarrhythmic drugs during resuscitation, and the preferred manner and timing of drug administration in relation to shock delivery are still not known. One
| System | Action |
| Airway | Intubate → Ventilation tidal volume @ 6-8 mL/kg |
| Place OG or NG tube | |
| Confirm endotracheal and OG/NG tube placement with chest x-ray | |
| Breathing | SpO2 goal >94% → adjust PEEP & FiO2 to achieve goal |
| EtCO2 goal 30-40 mmHg → adjust respiratory rate to achieve | |
| Circulation | 12-lead ECG → Activate cardiac catheterization lab for STEMI; consult cardiology for all other patients |
| SBP goal >90 mmHg (MAP > 65 mmHg) → Use fluids, norepinephrine infusion, then epinephrine infusion to achieve goal | |
| Place central line | |
| Place arterial line | |
| Perform point of care ultrasound with the cardiac, lung, and IVC views | |
| Send labs, which includes an arterial blood gas and serum lactate | |
| Place Foley catheter → Goal urine output 0.5-1 mL/kg/hr | |
| Consider CT chest angiography to rule-out a pulmonary embolism | |
| Disability | Begin cooling → Goal temperature 32–36°C |
| Consider head CT |
The pediatric assessment triangle, provides a valuable checklist that we should go through for every child we see in the ED to help us assess their risk of crashing. The pediatric assessment triangle is based solely on observing the child from the foot of the bed.
ILCOR 2015 – paediatric summary
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