Pediatric emergency medicine trisk 0272 0272

Organ system

Definition of dysfunction

Cardiovascular Despite administration of isotonic IV fluid bolus of at least 40
mL/kg in 1 hr, presence of ANY of the following:
• Hypotension <5th percentile for age
• Need for vasoactive medication to maintain normal blood
pressure
• Two of the following:
• Unexplained metabolic acidosis (base deficit >5 mEq/L)
• Increased arterial lactate >2ì upper limit of normal
ã Oliguria: Urine output <0.5 mg/kg/hr
• Prolonged capillary refill >5 sec
• Core to peripheral temperature gap >3°C
Respiratory
Presence of ANY of the following:
• PaO2 /FiO2 <300 in absence of cyanotic heart disease or preexisting lung disease
• PaCO2 >65 Torr or 20 mm Hg over baseline PaCO2
• Proven need for >50% FiO2 to maintain saturation >92%
• Need for nonelective invasive or noninvasive mechanical
ventilation
Neurologic
Presence of EITHER:
• Glasgow coma score ≤11
• Acute change in mental status with a decrease in Glasgow
coma score ≥3 points from abnormal baseline
Hematologic
Presence of EITHER:
• Platelet count <80,000/mm3
• Decline of 50% platelet count from highest value recorded

over past 3 days (for chronic hematology/oncology
patients)
• International normalized ratio >2
Renal
Presence of EITHER:
ã Serum creatinine 2ì upper limit of normal for age
• Twofold increase in baseline creatinine
Hepatic
Presence of EITHER:
• Total bilirubin ≥4 mg/dL (not applicable for newborn)