Bowel Obstruction

  1. Airway Support: O2 / BVM / Intubate for profound shock
  2. Gastric decompression with Salem sump tube and place to low continuous suction, including patients with a G-tube.
  3. Establish venous access, start desired intravenous fluids (IVF)
  4. Bolus with 0.9% NS 20 mL/kg for compromised perfusion. Reassess and repeat bolus for indications of cardiovascular compromise.
  5. Obtain blood cultures and start the following antibiotics
    1. Vancomycin 15 mg/kg IVPB
    1. Gentamicin age based (See Pediatric Medication Formulary)
    1. Metronidazole (Flagyl) 7.5 mg/Kg IVPB over 1 hour
  6. Maintain normal body temperature
  7. Obtain serum chemistry. Treat abnormal levels per medical control.
  8. Obtain abdominal films if possible.


  1. Hajivassiliou CA Intestinal obstruction in neonatal/pediatric surgery. Semin Pediatr Surg. 2003 Nov;12(4):241-53.