Fluids

In the face of hypotension due to volume depletion, isotonic fluid boluses of 20 mL/kg should be given as rapidly as possible and repeated, depending on response. 4 A syringe attached to a three-way stopcock and extension tubing can be used to deliver aliquots of fluid rapidly, until the entire bolus is administered. Do not depend on gravity or pressure bags. The bolus should be delivered in a maximum of 20 min, and then the child's condition should be reassessed. If volume depletion has been corrected (at most, three to four boluses) and hypotension persists, a pressor agent should be strongly considered, preferably with the aid of a central venous pressure catheter. In normotensive patients or when the IV line is being used for drug administration only, it should be maintained at the minimum rate that will keep the vein open (KVO). Fine fluid and electrolyte calculations and adjustments can be made after the emergency treatment has been completed. Overhydration, even when IV lines are set at KVO, is common when adult equipment is used in pediatric resuscitations. To enable easy monitoring of the total volume given, preventing accidental overhydration, a pediatric microdrip should always be used when resuscitating children.

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