Presentation of the pediatric patient with associated signs and symptoms of dehydration, including nausea, vomiting, fever, with signs of redistributive shock. Pediatric heart rates are intrinsically higher than adults while pediatric blood pressures are intrinsically lower than adults. A complete assessment and history are necessary to accurately determine hydration status. Remember, the pale, quiet, lethargic child is in serious trouble and should be treated aggressively.

1. Perform patient assessment and ABC's.
2. Administer oxygen by the most appropriate device to insure adequate patient oxygenation.
3. Monitor vital signs in accordance with S.O.P. protocol.
4. Consider trendelenburg positioning.
5. Request ALS Interface early in a critical child.

INTERMEDIATE LIFE SUPPORT

1. Establish IV access using an isotonic fluid.
2. Administer 20cc/kg bolus as quickly as possible if clinical impression or vitals suggest severe dehydration. This bolus may be repeated as needed up to a total of 60cc/kg. Reasses regularly between boluses since the response is often dramatic.
3. Neonates should receive 10 cc/kg bolus's. (Maximum 30cc's/kg)

ADVANCED LIFE SUPPORT

1. Attach and monitor ECG.
2. Other therapies appropriate for this protocol:
   1. Intraosseous line (IO) in medial tibial plateau if patient is unstable and IV access is not readily available. Refer to INTRAOSSEOUS INFUSION protocol.
   2. Measure blood glucose and correct if below 80mg/dl (Dilute D50 1:1 to achieve D25). Refer to DIABETIC EMERGENCIES protocol.