Crashing / Shocky Neonate

Crashing / Shocky Neonate
SICCCFITS
Sepsis
Inborn Errors of Metab
CNS bleed
Congenital HD
CAH
Formula mixup
Intestinal catastrophe
Toxin
Seizures

or THE MISFITS
Trauma
CNS bleed; look for retinal hemorrhage, get head CT
Heart & Lung
Bronchiolitis, PNA, cyanotic heart dz, CHF …
cyanotic heart disease: ductal dependent for pulmonary blood flow. Blue baby, central cyanosis, hypoxia despite O2, clear CXR, give PGE1, usual pressors
outflow obstruction issue: i.e., critical coarct. Check 4-extremity BPs, give PGE1, avoid pressors that clamp down systemically, use milrinone, dobutamine
pulmonary edema: CHF, with typical CXR. Presents later typically, from L->R shunt. Consider thyrotoxicosis. Pink & sweaty.

Endocrine
CAH: Circ collapse in first 2 weeks. Tachy, shocky. Clitoromegaly. Acidotic, hypoglycemia, hyperkalemia
Hypothyroid
Hyperthyroid: CHF, tachy, shocky, in first 2 weeks

Metabolic
HypoNa+
HypoGlc
HypoCa++

Inborn Errors
Check VBG, lactate, ammonia
D5NS

Sepsis
Full labs, urine, LP
Acyclovir, abx, +/- Vanc
Formula Mixup
Intestinal catastrophe
Toxins
Seizures

[ ] Airway
[ ] Access
[ ] < 60 always a low SBP, > 60 always a fast RR
[ ] Succ 2 mg/kg, Etomidate 0.3 mg/kg (“double the wt / 1/3rd the wt”)*

Pedi Age / Wt guesstimation
new / 3
1 / 10
3 / 15
5 / 20
7 / 25

[ ] ETT = 16+age ÷ 4
[ ] D5 NS 20 cc/kg bolus (D5 for inborn errors)
[ ] abx + Acyclovir
[ ] Alprostadil (PGE1) 0.1 mcg/kg/min IV
[ ] Hydrocortisone 1 mg/kg IV
[ ] Send red top prior to steroids
[ ] Ativan 0.1 mg/kg for seizing
[ ] If hypoNa+ and seizing: 3% NS 1-3 mL/kg
[ ] if hypoGlc: D10 x 10 cc/kg (or for older kid, D25 at 2 cc/kg)
[ ] Cardioversion at 2 J/kg, Defib at 4 J/kg
[ ] pRBCs at 10 cc/kg
[ ] chest tube = 4xETT tube size (in Fr)

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