PPHNis a condition in which pulmonary vascular resistance remains abnormally high after birth. In this fragile state,handling or stresscan worsen pulmonary vasospasm.Minimal stimulation—such as reducing noise, light, and touch—is critical to preventing exacerbation.

“Infants with PPHN are highly sensitive to stress. Minimal stimulation reduces sympathetic discharge and prevents exacerbation of pulmonary vasoconstriction.”

(Referenced from CCRN Pediatric – Direct Care: Pulmonary, Neonatal Pulmonary Hypertension Management)

Alprostadilis used in ductal-dependent congenital heart lesions, not in primary management of PPHN.

Free air on abdominal x-rayindicatesbowel perforation, andloculated fluidsuggests hemoperitoneum or intra-abdominal bleeding. This is asurgical emergency, and the child requiresimmediate operative interventionto prevent further deterioration.

“Free intraperitoneal air and fluid suggest perforation and hemorrhage, which require emergent surgical exploration and correction to prevent peritonitis and shock.”

(Referenced from CCRN Pediatric – Direct Care: Gastrointestinal, Surgical Emergencies and Acute Abdomen)

Neutropenic fever or hypothermiais a medical emergency in oncology patients.Blood cultures should always be obtained before starting antibioticsto guide therapy.Hypothermiacan be a sign of sepsis in immunocompromised children.

“First steps in febrile neutropenia evaluation include obtaining blood cultures before initiating antibiotics to allow pathogen identification and targeted treatment.”

(Referenced from CCRN Pediatric – Direct Care: Hematology, Oncology Emergencies and Infection Management)

In a trauma situation, theprimary and secondary surveys take precedenceto assess life-threatening injuries and prioritize interventions. While a certified interpreter should be used for communicationas soon as possible, thenurse should not delay the physical assessmentduring a critical time.

“The priority in trauma is completion of the primary and secondary assessments. While interpreter use is standard, care must not be delayed in critical evaluations.”

(Referenced from CCRN Pediatric – Professional Caring and Ethical Practice: Cultural Competence and Emergency Protocols)

Positive End-Expiratory Pressure (PEEP)helpskeep alveoli open at end-expiration, therebyincreasing functional residual capacityand improvinggas exchange. In aspiration-related lung injury, alveolar collapse and inflammation impair oxygenation, soPEEP is used to recruit alveoli and improve oxygenation.

“PEEP increases oxygenation by preventing alveolar collapse, especially important in aspiration pneumonitis and ARDS. It improves oxygen delivery while minimizing barotrauma.”

(Referenced from CCRN Pediatric – Direct Care: Pulmonary, Mechanical Ventilation Strategies)

This clinical picture is classic forcompartment syndrome: a surgical emergency. Symptoms includecool extremity, prolonged capillary refill, pain, paresthesia, and loss of motor function.Fasciotomyis the definitive treatment torelieve pressure and prevent permanent damage.

“Compartment syndrome requires immediate fasciotomy. Delay in intervention may lead to muscle necrosis and permanent disability.”

(Referenced from CCRN Pediatric – Direct Care: Musculoskeletal, Orthopedic Trauma and Emergencies)

Peritonitis is acommon and serious complicationof peritoneal dialysis. It presents withfever, abdominal pain, and cloudy effluent. A WBC >100/mcL in the dialysate confirmsinfection. Empiricbroad-spectrum IV or intraperitoneal antibioticsshould be started immediately to prevent progression to sepsis.

“A peritoneal fluid WBC >100 with symptoms mandates initiation of antibiotics due to high suspicion for peritonitis in pediatric dialysis patients.”

(Referenced from CCRN Pediatric – Direct Care: Renal, Dialysis and Peritonitis Management)