≥12 yr. Motion sickness. Apply 4h before exposure.
+
+
+
+
+
+ Pearls: Ondansetron is first-line in ED for acute gastroenteritis vomiting — single PO/ODT dose increases oral rehydration success. Avoid anticholinergics + opioid combinations. Check QTc if stacking ondansetron + other QT drugs.
+
+ Two large-bore IVs / IO. Control hemorrhage (direct pressure, tourniquet, pelvic binder).{' '}
+ {valid ? <>NS or LR 20 mL/kg = {bolus} mL bolus. : <>NS/LR 20 mL/kg bolus.}{' '}
+ Consider blood after 40-60 mL/kg crystalloid or in Class III shock.
+
Activate early if ≥40 mL/kg transfused or ongoing hemorrhage. Avoid excessive crystalloid.
+
Tranexamic acid (TXA)
15 mg/kg IV (max 1 g) over 10 min → 2 mg/kg/hr × 8h
IV
Within 3 hr of injury. CRASH-2 / MATIC.
+
Calcium
20 mg/kg CaCl or 60 mg/kg Ca-gluconate IV per unit citrated blood
IV
Citrated blood chelates calcium.
+
+
+
+
+
C-spine clearance (NEXUS / CCR)
+
+ Pediatric c-spine decision tools are imperfect. Imaging if any: focal neurologic deficit, altered mental status, neck pain / tenderness, torticollis, substantial torso injury, high-risk mechanism (diving, MVC >55 mph, fall >10 ft). Plain films + CT if positive or equivocal.
+
+
+
Pediatric shock — signs
+
+ Children compensate well — hypotension is a late finding. Early signs: tachycardia, cool extremities, weak peripheral pulses, prolonged cap refill (>3 sec), narrowed pulse pressure, altered mentation. Minimum SBP = 70 + (2 × age in years) for ages 1-10.
+
+
+
Secondary survey — AMPLE + head-to-toe
+
+ AMPLE: Allergies, Medications, Past history, Last meal, Events of injury. Head-to-toe exam; log-roll for back; digital rectal; neurovascular checks of all extremities.
+