PEARS (Pediatric Emergency Assessment, Recognition, and Stabilization) is a training program designed to help healthcare providers respond effectively to pediatric emergencies, particularly when a child experiences acute deterioration or a life-threatening event. It provides guidelines for assessing and stabilizing pediatric patients in urgent situations, focusing on early recognition and intervention.

The following are key immediate interventions and stabilization techniques used in the PEARS framework:

1. Initial Assessment (A-B-C-D-E)

The PEARS approach starts with a structured assessment to quickly identify life-threatening conditions.

• A: Airway

  • Immediate Intervention: Ensure the airway is patent. If the child has visible airway obstruction (e.g., foreign body), clear the airway using the appropriate technique (back blows, chest thrusts for infants, or Heimlich maneuver for older children).

  • Intervention for Breathing Issues: If the child is unable to breathe or showing signs of respiratory distress, provide oxygen support using a bag-valve mask (BVM) or oxygen via a non-rebreather mask (depending on severity).

  • Advanced Interventions: In severe cases, intubation may be required to secure the airway.

• B: Breathing

  • Immediate Intervention: Assess respiratory effort, rate, and oxygenation. If the child has inadequate or absent breathing:

    • Provide rescue breaths (mouth-to-mask ventilation for infants/children).

    • Oxygen via face mask or nasal cannula if oxygen saturation is below target (typically < 94%).

    • Use positive pressure ventilation (via BVM) if the child is not breathing adequately or has poor oxygen saturation.

• C: Circulation

  • Immediate Intervention: Assess for signs of poor circulation, such as weak pulse, delayed capillary refill, or hypotension.

  • If there are signs of shock (e.g., cool extremities, rapid heart rate, or hypotension), start fluid resuscitation with isotonic fluids (e.g., normal saline or lactated Ringer’s). In most cases, administer 20 mL/kg of fluid over 5-10 minutes, repeating as necessary.

  • For severe bradycardia (<60 bpm) or shock unresponsive to fluids, consider epinephrine administration (0.01 mg/kg IV/IO for bradycardia or shock).

• D: Disability (Neurological Status)

  • Immediate Intervention: Assess the child’s level of consciousness using the AVPU scale (Alert, responds to Verbal stimuli, responds to Painful stimuli, Unresponsive).

  • If the child is unresponsive or has signs of altered mental status (e.g., confusion, inability to follow commands), assess blood glucose levels (especially for hypoglycemia) and treat accordingly.

  • Consider administering dextrose (e.g., D10 or D25) if hypoglycemia is suspected (especially if the child is under 1 year old).

• E: Exposure (Environment)

  • Immediate Intervention: Expose the child to assess for injuries or underlying causes of deterioration, but ensure the child is kept warm to prevent hypothermia.

  • Maintain body temperature with blankets or warming devices if necessary.

2. Airway Management and Respiratory Support

• Positioning: Ensure the head and neck are properly positioned to keep the airway open (e.g., head tilt-chin lift, or jaw thrust).

• Oxygenation: Administer oxygen to maintain an oxygen saturation of at least 94%. For respiratory failure, start with bag-valve-mask (BVM) ventilation.

• Advanced Airway Support: If necessary, proceed with endotracheal intubation or other advanced airway techniques, particularly if the child is not responding to initial efforts.

3. Fluid Resuscitation and Shock Management

Fluid Bolus: For signs of hypovolemic shock (e.g., tachycardia, hypotension, cool extremities), initiate a fluid bolus of 20 mL/kg of isotonic fluid (normal saline or lactated Ringer's).

• Administer quickly (over 5–10 minutes) and reassess the child’s response.

• Repeat fluid boluses if the child remains hypotensive or in shock after the initial bolus.

Vasopressors: If there is persistent shock after adequate fluid resuscitation, consider starting epinephrine or dopamine depending on the clinical situation and underlying cause of shock.

4. Cardiac Arrest Management

• Immediate Recognition: If a child goes into cardiac arrest, follow pediatric resuscitation guidelines with high-quality chest compressions and appropriate ventilation.

  • Compression-to-Ventilation Ratio: If alone, provide 30 compressions to 2 breaths; if two rescuers are present, provide 15 compressions to 2 breaths.

• Defibrillation: If the child’s rhythm is shockable (e.g., ventricular fibrillation or pulseless ventricular tachycardia), administer defibrillation using a pediatric defibrillator (or an adult defibrillator with appropriate pads).

  • The initial dose is typically 2 J/kg, and subsequent shocks can be administered with higher doses as per the guidelines.

• Epinephrine: Administer epinephrine (0.01 mg/kg IV/IO) every 3-5 minutes during the resuscitation attempt.

• Advanced Airway: Intubate if necessary to secure the airway and manage ventilation effectively.

5. Medications for Stabilization

• Epinephrine: For bradycardia or shock that does not respond to fluids, administer epinephrine (0.01 mg/kg IV/IO) for children in severe distress.

• Atropine: If bradycardia is due to vagal stimulation or an AV block, atropine (0.02 mg/kg IV) can be administered.

• Dextrose: If the child is hypoglycemic (e.g., if the blood glucose is <60 mg/dL), administer dextrose as appropriate (D10 or D25 solution for infants, D50 for older children).

• Naloxone: If the child’s deterioration is suspected to be from opioid overdose, consider administering naloxone (0.1 mg/kg).

6. Monitoring and Reassessing

• Continuous Monitoring: After initial stabilization, continuously monitor vital signs (heart rate, blood pressure, respiratory rate, oxygen saturation, temperature) and reassess the child frequently.

• Focused Assessments: Monitor for signs of improvement or deterioration. Look for changes in mental status, circulation, and airway patency.

7. Transport to Higher-Level Care

• If the child remains unstable or if the situation is not resolving with initial interventions, prepare for transport to a higher-level facility with pediatric intensive care or specialized care.

• Keep the child stable during transport by ensuring oxygenation, monitoring vitals, and maintaining appropriate airway and circulation support.

Key PEARS Principles:

• Early Recognition: The faster a problem is identified; the quicker effective interventions can be implemented. The PEARS approach emphasizes recognizing early signs of deterioration.

• Rapid Intervention: Time-sensitive actions, such as providing airway management and fluid resuscitation, should be implemented as soon as possible.

• Reassessment: After initial stabilization, continue monitoring the patient closely and reassess for any signs of worsening or improvement.

By following these guidelines, healthcare providers can quickly stabilize pediatric patients in emergency situations, improving outcomes and preventing further deterioration. PEARS emphasizes systematic, evidence-based interventions that can save lives.