Pediatrics

Hypotension

Diagnosis

Sustained low blood pressure with patient at risk for end-organ hypoperfusion, typically > 20% below baseline

Age · BP (mmHg)*

  • Infant · MAP 30 or post-conceptual age in weeks
  • 3 mo - 1 yr · 65 - 68 · < 5th% Systolic BP
  • 1 - 3 yr · 68 - 74
  • 4 - 12 yr · 70 - 85
  • > 12 yr · 85 - 92

* Numbers are only a guide and vary for individual patients and situations

Diagnosis

Sustained low blood pressure with patient at risk for end-organ hypoperfusion, typically > 20% below baseline

Age · BP (mmHg)*

  • Infant · MAP 30 or post-conceptual age in weeks
  • 3 mo - 1 yr · 65 - 68 · < 5th% Systolic BP
  • 1 - 3 yr · 68 - 74
  • 4 - 12 yr · 70 - 85
  • > 12 yr · 85 - 92

* Numbers are only a guide and vary for individual patients and situations

  1. In pediatrics, hypotension is almost always treated by correcting hypovolemia or decreasing the anesthetic agent

  2. Ensure oxygenation/ ventilation

  3. Turn anesthetic agents down or off

  4. Check cuff size and transducer position

  5. If severe and/or persistent, consider placing arterial line if not already present

  6. Etiology (Pick One):

    Decreased preload

    Expand circulating blood volume (administer fluids rapidly, consider PRBCs and albumin)

  7. Trendelenberg position

  8. Place or replace IV; consider intraosseous line

  9. Causes: hypovolemia/HEMORRHAGE, vasodilation, impaired venous return, TAMPONADE, pulmonary embolism, hypocalcemia/blood product administration, IVC compression (prone, obese, surgical), pneumothorax/pneumoperitoneum, and increased PIP or PEEP

  10. Decreased contractility

    Start inotrope infusion, as needed

    • Dopamine 2-20 MICROgrams/kg/min infusion IV
    • Bolus epinephrine 1-10 MICROgrams/kg IV/IO, consider infusion 0.05-1 MICROgrams/kg/min IV
    • Infusion 2-20 MICROgrams/kg/min IV
    • Bolus 1-10 MICROgrams/kg IV/IO
    • Consider infusion 0.05-1 MICROgrams/kg/min IV

  11. Consider Calcium chloride 10-30 mg/kg IV or Calcium gluconate 50 mg/kg IV

    • 10-30 mg/kg IV
    • 50 mg/kg IV

  12. Review ECG for rhythm disturbances or ischemia

  13. Send ABG, Hgb, electrolytes

  14. Causes: negative inotropic drugs (anesthetic agents), arrhythmias, HYPOXIA, and heart failure (ISCHEMIA)

  15. Decreased afterload

    Start vasopressor infusion

    • Consider infusion of norepinephrine 0.05-2 MICROgrams/kg/min IV
    • Bolus phenylephrine 1-20 MICROgrams/kg IV/IO, consider infusion 0.1-2 MICROgrams/kg/min IV
    • Consider infusion 0.05-2 MICROgrams/kg/min IV
    • Bolus 1-20 MICROgrams/kg
    • Consider infusion 0.1-2 MICROgrams/kg/min IV

  16. Administer steroids for adrenal crisis

  17. Causes: drug-induced vasodilation, sepsis, ANAPHYLAXIS, adrenal crisis, adrenal insufficiency, hypocalcemia, thyroid crisis

  18. Crisis Management (If Severe)

    Notify surgeon, call for help and code cart

  19. Call for Transesophageal Echocardiography

  20. Start chest compressions

  21. Give epinephrine 10 MICROgrams/kg IV/IO

    • Bolus 1-10 MICROgrams/kg IV/IO
    • Consider infusion 0.05-1 MICROgrams/kg/min IV

  22. If cardiac arrest, go to CARDIAC ARREST

  23. Consider ECMO

Patient weight

Between 0.5 kg and 120 kg

Reset the checklist?

Checked steps, the timer and this crisis log are cleared. The patient’s weight is kept.

Finish the crisis?

The timer pauses, and you can review the case and the event log.