›Antibiotics within 60 minutes for sepsis pathway local protocol dependent
›Ceftriaxone IV 50 mg/kg
›Add vancomycin IV 15 mg/kg if resistant pneumococcus risk
›Suspected encephalitis
›Acyclovir IV 10 mg/kg every 8 hours
›Renal dosing adjustment if kidney dysfunction
›Suspected opioid toxicity
›Naloxone IV 0.1 mg/kg
›Repeat every 2 to 3 minutes to effect
Diagnostic sequencing
›First line tests
›POC glucose
›VBG
›Electrolytes
›CBC
›Second line tests by suspicion
›Blood cultures if infection concern
›Toxicology labs if exposure concern
›Carboxyhemoglobin if CO concern
Monitoring and reassessment loop
›Monitoring
›Cardiorespiratory monitoring
›Frequent vitals every 15 minutes if unstable
›Reassessment timing
›Neuro checks every 30 to 60 minutes initially
›Repeat glucose after dextrose within 10 to 15 minutes
17Disposition/dispo25
ICU criteria
›ICU level care triggers
›Need for airway support
›Persistent GCS less than 13
›Refractory seizures
›Shock needing vasoactives
Inpatient admission criteria
›Admission indications
›Suspected CNS infection
›Ingestion requiring monitoring
›Persistent abnormal labs
›Observation pathway
›Improving mental status
›Normalizing vitals
›Clear diagnosis with low risk course
Transfer criteria
›Higher level pediatric center triggers
›Need for pediatric ICU
›Neurosurgical concern
›Continuous EEG need
Discharge criteria
›Discharge requirements
›Return to baseline mental status
›Normal vitals for age
›Tolerating oral intake
›Reliable caregiver supervision
›Follow up timing
›Primary care within 24 to 48 hours
›Specialty follow up if indicated
18Discharge Instructions/di25
Copy discharge instructions
›Summary
›Today you were seen for sleepiness and behavior change
›Testing did not show an emergency cause at this time
›Hydration and intake
›Encourage frequent small sips of fluids
›Monitor urine output
›Medications
›Use only medicines prescribed or recommended today
›Avoid cough and cold medicines unless specifically instructed
›Activity
›Quiet rest for 24 hours
›No risky activities if head injury concern
›Follow up
›Follow up with your primary care clinician in 1 to 2 days
›Return sooner if symptoms worsen
›Return to ED now for
›Trouble breathing
›Blue lips or face
›Seizure
›Not waking up normally
›New weakness
›Stiff neck
›Purple or spreading rash
›Persistent vomiting
›Signs of dehydration
19References/r18
Guidelines and key sources
›Pediatric Advanced Life Support guidelines, American Heart Association, 2020
›Pediatric resuscitation algorithms
›Pediatric shock management
›Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children, 2020
›Time sensitive antibiotics and fluids
›Vasoactive escalation framework
›PECARN Pediatric Head Trauma Prediction Rules, original validation studies, 2009
›Imaging reduction strategy
›Risk stratification for clinically important TBI
›American Academy of Pediatrics guidance on evaluation of febrile infants, 2021
›Age based SBI evaluation
›Disposition frameworks
›Infectious Diseases Society of America encephalitis guidelines, 2018
›Empiric acyclovir indications
›Diagnostic testing recommendations
›Poison control and toxicology management resources, local protocol dependent
›Regional toxidrome management pathways
›Decontamination criteria
Evidence & Review
Reviewed by SymptomDx Medical Team·Last reviewed
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