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San Diego EMS Protocols 2019 > 2019 Protocols (Pediatric) > Flashcards

2019 Protocols (Pediatric) Flashcards

1
Q

S-160 Pediatric Airway Obstruction BLS

A

For a CONSCIOUS patient:

  • Reassure, encourage coughing
  • O2 prn
For inadequate air exchange:
(airway maneuvers AHA)
-Abdominal thrusts
-Use chest thrusts in the obese or pregnant patient
Note: for infants <1 year
-5 back blows and chest thrusts
-MR prn

If patient becomes UNCONSCIOUS or is found UNCONSCIOUS:
-Begin CPR

Once obstruction is removed:
-O2 saturation prn
-High flow O2 ventilate prn
Note: if suspected epiglottits:
-Place patient in sitting position
-Do not visualize the oropharynx
-STAT transport
-Treat as per Respirator Distress Protocol S-167
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2
Q

S-160 Pediatric Airway Obstruction ALS+Note

A

If patient becomes unconscious or has a decreasing LOC:
-Direct laryngoscopy and Magill forceps SO
MR prn SO
-
Once obstruction is removed:
-Monitor EKG
-IV/IO SO adjust prn

Note:
If unable to secure airway, transport STAT while continuing CPR (unconscious patient).

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3
Q

S-161 Pediatric Altered Neurologic Function (Nontraumatic) BLS

A
  • Ensure patent airway, O2 and/or ventilate prn
  • O2 saturation prn
  • Spinal stabilization when indicated
  • Secretion problems; position on affected side
  • Do not allow patient to walk
  • Restrain prn
  • Monitor blood glucose prn

Hypoglycemia (suspected) or patient’s glucometer results, if available, read <60 (Neonate <45):

  • If patient is awake and has gag reflex, give oral glucose paste or 3 tablet (15g). Patient may eat or drink if able.
  • If patient is unconscious, NPO

Seizures:

  • Protect airway, and protect from injury
  • Treat associate injuries
  • If febrile, remove excess clothing/covering

Behavioral Emergencies:

  • Restrain only if necessary to prevent injury
  • Avoid unnecessary sirens
  • Consider law enforcement support
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4
Q

S-161 Pediatric Altered Neurologic Function (Nontraumatic) ALS

A
  • IV/IO SO adjust prn
  • Monitor EKG/blood glucose prn
  • Capnography SO prn

Symptomatic ?opioid (excluding opioid dependent pain management patients):
-Naloxone per drug chart IN/IV/IM SO. MR SO

Symptomatic ?opioids OD is opioid dependent pain management patients:
-Naloxone titrate per drug chart IV (dilute IV dose per drug chart) or IN/IM per drug chart SO. MR BHO

Hypoglycemia: Symptomatic patient unresponsive to oral glucose agents:

  • D10 per drug chart IV SO if BS <60 (Neonate <45)
  • If patient remains symptomatic and BS remains <60 (Neonate <45) MR SO
  • If no IV: Glucagon per drug chart IM SO if BS <60 (Neonate <45)

Seizures:
FOR:
-Ongoing generalized seizure lasting >5 minutes (including seizure time prior to arrival of prehospital provider) SO
-Partial seizure with respiratory compromise SO
-Recurrent tonic-clonic seizures without lucid interval SO
GIVE:
-Versed per drug chart slow IV, (d/c if seizure stops) SO
MR x1 in 10” SO
-If no IV: Versed per drug chart IN/IM SO
MR x1 in 10” SO

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5
Q

S-162 Pediatric Allergic Reaction/Anaphylaxis BLS

A
  • Ensure patent airway
  • O2 saturation prn
  • O2 and/or ventilate prn
  • Remove sting/injection mechanism
  • May assist patient to self-medicate own prescribed epinephrine auto injector or MDI ONE TIME ONLY. Base hospital contact required prior to any repeat dose
  • Epinephrine auto-injector 0.15mg IM x1
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6
Q

S-162 Pediatric Allergic Reaction/Anaphylaxis ALS

A
  • Monitor EKG
  • IV/IO SO adjust prn

Hives (Urticaria):
-Diphenhydramine per drug chart IV/IM SO

Anaphylaxis:
-Epinephrine 1:1,000 per drug chart IM SO
MR x2 q5” SO
THEN
-Fluid bolus IV/IO per drug chart SO
to maintain adequate perfusion MR SO
-Diphenhydramine per drug chart IV/IM SO
-Albuterol per drug chart via nebulizer SO for respiratory involvement MR SO
-Atrovent per drug chart via nebulizer added to first dose of Albuterol SO for respiratory involvement
-Epinephrine 1:10,000 per drug chart IV/IO BHO
MR x2 q3-5” BHO

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7
Q

S-162 Pediatric Allergic Reaction/Anaphylaxis (Anaphylaxis Critera+Angioedema+Note)

A

Anaphylaxis critera (may include any):

  • Unknown exposure: Skin AND respiratory AND/OR cardiovascular
  • Likely allergen exposure (e.g. bee sting, peanut): 2/4 systems involved (skin, GI, respiratory, cardiovascular)
  • Known allergen exposure

Angioedema: lip/tongue/face swelling/difficulty swallowing, throat tightness, hoarse voice

Note: In pediatric anaphylaxis, the maximum Epinephrine dose is 0.1mg IV/IO (should not exceed adult dose).

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8
Q

S-163 Pediatric Dysrythmias BLS+Unstable Dysrhythmia

A
  • Assess level of consciousness
  • O2 saturation prn
  • Determine peripheral pulses
  • Ensure patent airway, O2 and/or ventilate prn

Unstable Dysrhythmia:
Includes heart rates listed and any of the following:
-Poor perfusion (cyanosis, delayed capillary refill, mottling)
OR
-Altered LOC, Dyspnea
OR
-BP 200/min.

-Pulseless and unconscious, use AED if available. If pediatric pads not available may use adult pads but ensure they do not touch each other when applied.
-When heart rate indicates patient is unstable ventilate per BVM for 30 seconds, reassess HR and begin compression if indicated:
Heart rate:
<9 yrs HR <60
9-14 yrs HR <40

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9
Q

S-163 Pediatric Dysrythmias ALS (Unstable Bradycardia/ Unstable/Stable Supraventricular Tachycardia)

A

-Monitor EKG
-IV/IO SO
-Fluid bolus IV/IO per drug chart with clear lungs SO
MR to maintain systolic adequate perfusion SO

Unstable Bradycardia:
Heart rate:
Infant/Child (<9 yrs) <60
Child (9-14 yrs) <40
-Ventilate per BVM for 30 seconds, then reassess HR prior to compressions and drug therapy
-Epinephrine 1:10,000 per drug chart IV/IO SO
MR x2 q3-5” SO. MR q3-5” BHO
After 3rd dose of Epinephrine:
-Atropine per drug chart IV/IO SO. MR x1 in 5” SO

Unstable Supraventricular Tachycardia:
Heart rate:
<4 yrs >220
>4 yrs >180
-VSM per SO. MR SO
-Adenosine per drug chart rapid IV BHPO
follow with NS 20ml rapid IV
-Adenosine per drug chart rapid IV BHPO
follow with NS 20ml rapid IV
-If no sustained rhythm change, MR x1 BHPO

prn precardioversion
-Versed per drug chart IV BHPO
-Synchronized cardioversion per drug chart* BHPO
MR per drug chart BHPO
*or according to defibrillators manufacturer’s recommendations

Stable Supraventricular Tachycardia:
-Continue to monitor

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10
Q

S-163 Pediatric Dysrythmias BLS (Ventricular Tachycardia/VF/Pulseless VT)

A
  • O2 and/or ventilate prn
  • CPR: Being compressions. After first 30 compressions give first ventilation
  • Use AED if, pulseless and unconscious, and AED available. If pediatric pads not available may use adult pads but ensure they do not touch each other when applied.
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11
Q

S-163 Pediatric Dysrhythmias ALS (Ventricular Tachycardia/VF/Pulseless VT)

A

Ventricular Tachycardia:

  • 12-lead to confirm
  • Contact BHPO for direction
VF/Pulseless VT:
-Begin CPR
If arrest witnessed by medical personnel
-Perform CPR until ready to defibrillate
If unwitnessed arrest
-Perform CPR x2 min.
  • Defibrillate per drug chart** SO
  • Resume CPR for 2 min immediately after shock
  • Perform no more than 5 second rhythm/pulse check if rhythm is organized
  • Defibrillate per drug chart** for persistent VF/Pulseless VT prn SO
  • Continue CPR for persistent VF/Pulseless VT. Repeat 2 min cycle followed by rhythm/pulse check, followed by defibrillation/medication, if indicated
  • IV/IO SO Do not interrupt CPR to establish IV/IO

Once IV/IO is established, if no pulse after pulse/rhythm check:
-Epinephrine 1:10,000 per drug chart SO
MR x2 q3-5” SO. MR q3-5” BHO

After first shock if still refractory:

  • Amiodorone per drug chart IV/IO MR x1 in 3-5” SO
  • *OR**
  • Lidocaine per drug chart IV/IO MR x1 in 3-5” SO
  • BVM
  • Avoid interruption of CPR
  • Capnography monitoring SO
  • NG/OG prn SO

** = see notes

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12
Q

S-163 Pediatric Dysrhythmias Notes (Ventricular Tachycardia/VF/Pulseless VT)

A
  • For patients with a Capnography reading of less than 10mmHg or patients in nonperfusing rhythms after resuscitative effort, consider early Base Hospital contact for disposition/pronouncement at scene
  • Medication should be administered as soon as possible after rhythm checks. The timing of drug delivery is less important than is the need to minimize interruptions in chest compressions
  • Flush IV line with Normal Saline after medication administration
  • CPR should be performed during charging of defibrillator

**or according to defibrillator manufacturer’s recommendations

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13
Q

S-163 Pediatric Dysrhythmias BLS (Pulseless Electrical Activity[PEA]/Asystole)

A
  • O2 and/or ventilate prn

- CPR: begin compressions. After first 30 compressions give first ventilations

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14
Q

S-163 Pediatric Dysrhythmias ALS (Pulseless Electrical Activity[PEA]/Asystole)

A
  • Perform CPR x2 min
  • Perform no more than 5 second rhythm/pulse check if rhythm is organized
  • CPR for 2 min
  • IV/IO SO Do not interrupt CPR to establish IV/IO

Once IV/IO established, if no pulse after rhythm/pulse check:
-Epinephrine 1:10,000 per drug chart IV/IO SO
MR x2 in q3-5” SO. MR q3-5” BHO
-Fluid per drug chart IV/IO. may repeat x1

  • BVM
  • Capnography monitoring SO
  • NG/OG prn SO
  • Pronouncement at scene BHPO
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15
Q

S-164 Pediatric Envenemation Injuries BLS

A

-O2 and/or ventilate prn

Jellyfish sting:

  • Liberally rinse with salt water for at least 30 sec
  • Scrape to remove stinger(s)
  • Heat as tolerated (not to exceed 110 deg)

Stingray or Sculpin injury:
-Heat as tolerated (not to exceed 110 deg)

Snakebites:

  • Mark proximal extent of swelling and/or tenderness
  • Keep involved extremity at heart level & immobile
  • Remove pre-existing constrictive device
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16
Q

S-164 Pediatric Envenemation Injuries ALS

A
  • IV/IO SO adjust prn

- Treat pain as per Pain Management Protocol (S-173)

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17
Q

S-165 Pediatric Poisoning/Overdose BLS

A
  • Ensure patent airway
  • O2 saturation prn
  • O2 and/or ventilate prn
  • Carboxyhemoglobin monitor prn, if available

Ingestions:
-Identify substance

Skin:

  • Remove clothes
  • Brush off dry chemicals
  • Flush with copious water

Inhalation of Smoke/Gas/Toxic substance:

  • Move patient to safe environment
  • 100% O2 via mask
  • Consider transport to facility with hyperbaric chamber for suspected carbon monoxide poisoning in the unconscious or pregnant patient

Symptomatic suspected opioid OD:
-May assist family or friend to medicate with patients own prescribed Naloxone

18
Q

S-165 Pediatric Poisoning/Overdose ALS

A
  • Monitor EKG
  • IV/IO SO adjust prn

Ingestions:

  • Charcoal per drug chart PO if ingestion within 60 minutes and recommended by Poison Center SO
  • Assure child has gag reflex and is cooperative
  • In oral hypoglycemic agent ingestion, any change in mentation requires blood glucose check or recheck SO

Symptomatic suspected opioid OD (excluding opioid dependent pain management patients):
-Naloxone per drug chart IN/IV/IM SO. MR SO

Symptomatic suspected opioid OD in opioid dependent pain management patients:
-Naloxone titrate per drug chart IV (dilute per drug chart) or IN/IM SO. MR BHO

Symptomatic organophosphate poisoning:
-Atropine per drug chart IV/IM/IO SO. MR x2 q3-5” SO. MR q3-5” prn BHO

Extrapyramidal reactions:
-Benadryl per drug chart slow IV/IM SO

Suspected Tricyclic OD with cardiac effects (hypotension, heart block, widened QRS):
-NaHCO3 per drug chart IV x1 BHO

19
Q

S-165 Pediatric Poisoning/Overdose Notes

A
  • For scene safety, consider HAZMAT activation as needed.
  • In symptomatic suspected opioid OD (excluding opioid dependent pain management patients) administer Narcan IN/IM prior to IV.
20
Q

S-166 Newborn Deliveries BLS+Low Heart Rate Births

A
  • Ensure patent airway
  • Suction baby’s airway if excessive secretions causing increased work of breathing, first mouth, then nose, suction after fully delivered
  • O2 saturation prn

Low Heart Rate Births:

  • Ventilate via BVM room air if HR <100 bpm
  • If HR <60 after 90 sec of ventilation, increase to BVM 100% O2:
  • CPR
  • Clamp and cut cord between clamps following delivery (wait 60 seconds after delivery prior to clamping and cutting cord)
  • Keep warm & dry (wrap in warm, dry blanket). Keep head warm
  • APGAR at 1 minute and 5 minutes
  • Document name of person cutting cord, time cut & address of delivery
  • Place identification bands on mother and infant
  • Bring mother and infant to same hospital
  • Complete “Out of Hospital Birth Form” (S-166A) and provide to parent
21
Q

S-166 Newborn Deliveries BLS (Premature and/or Low Birth Weight Infants+Cord Wrapped Around Neck)

A

Premature and/or Low Birth Weight Infants:

  • If amniotic sac intact, remove infant from sac after delivery
  • STAT transport
  • When HR <100bpm, ventilate room air
  • If HR <60bpm after 90 seconds of ventilation, increase to BVM 100% O2 and start CPR
  • CPR need NOT be initiated if there are no signs of life AND gestational age is <24 weeks

Cord Wrapped Around Neck:
-Slip the cord over the head and off the neck. Clamp and cut the cord if wrapped too tightly

22
Q

S-166 Newborn Deliveries BLS (Prolapsed Cord+Breech Birth)

A

Prolapsed Cord:
-Place the mother with her hips elevated on pillows
Insert a gloved hand into the vagina and gently push the presenting part off the cord
-Transport STAT while retaining this position. Do not remove hand until relieved by hospital personnel

Breech Birth:

  • Allow infant to deliver to the waist without active assistance (support only)
  • When legs and buttocks are delivered, the head can be assisted out. If head does not deliver within 1-2 min, insert a gloved hand into the vagina and create an airway for the infant
  • Transport STAT if head undelivered
23
Q

S-166 Newborn Deliveries ALS

A
  • Monitor EKG
  • NG prn SO

If HR remains <60bpm after 30 seconds of CPR:

  • Epinephrine 1:10,000 per drug chart IV/IO SO
  • MR x2 q3-5” SO
  • MR q3-5” BHO
24
Q

S-167 Pediatric Respiratory Distress BLS

A
  • Ensure patent airway
  • Dislodge any airway obstruction
  • O2 saturation prn
  • Transport in position of comfort
  • Reassurance
  • Carboxyhemoglobin monitor prn, if available
  • O2 and/or ventilate prn
  • May assist patient to self-medicate own prescribed MDI ONE TIME ONLY. Base Hospital contact required to any repeat dose

Hyperventilation:

  • Coaching/reassurance
  • Remove patient from causative environment
  • Consider underlying medical problem
Toxic Inhalants (CO exposure, smoke, gas, etc.):
-Consider transport to facility with hyperbaric chamber for suspected carbon monoxide poisoning for unconscious or pregnant patient

Respiratory Distress with croup-like cough:
-Aerosolized saline or water 5ml via oxygen powered nebulizer/mask. MR prn

25
Q

S-167 Pediatric Respiratory Distress ALS

A
  • Monitor EKG
  • IV SO adjust prn
  • BVM prn
  • Capnography monitoring SO prn

Respiratory Distress with bronchospasm:

  • Albuterol per drug chart via nebulizer SO. MR SO
  • Atrovent per drug chart via nebulizer added to first dose of Albuterol SO

If severe respiratory distress with bronchospasm or inadequate response to Albuterol/Atrovent, consider:
-Epinephrine 1:1,000 per drug chart IM SO.
MR x2 q5” SO

Respiratory Distress with stridor at rest:
-Epinephrine 1:1,000 per drug chart via nebulizer SO. MR x1 SO
-Epinephrine 1:1,000 per drug chart IM SO.
MR x2 q5” SO

26
Q

S-167 Pediatric Respiratory Distress Notes

A
  • If history suggests epiglottitis, do NOT visualize airway. Utilize calming measure.
  • Avoid Albuterol in Croup.
  • Consider anaphylaxis if wheezing in the patient with prediatric distress, especially if no history of asthma. Refer to Allergic Reaction/Anaphylaxis Protocol (S-162).

<2 years old with no prior Albuterol use (broncholitics) consider:

  • Suctioning of nose with bulb suction prn
  • Capnography, assessing respirations with a one minute count
  • Provide position of comfort
  • O2 saturation prn pulse <90% and/or respiratory distress (tachypnea, retractions, grunting)
  • BVM to assist ventilation prn for significant respiratory distress, grunting, ALOC
27
Q

S-168 Pediatric Shock BLS

A
  • O2 saturation prn
  • O2 and/or ventilate prn
  • Control obvious external bleeding
  • Determine peripheral pulses and capillary refill
  • Assess level of consciousness
  • Obtain baseline temperature
  • Keep warm
  • Treat associated injuries
  • NPO, anticipate vomiting
28
Q

S-168 Pediatric Shock ALS

A
  • Monitor EKG
  • IV/IO SO
  • Capnography SO prn

Shock (non cardiogenic):
-IV/IO fluid bolus per drug chart SO.
MR SO if without rales

Shock (cardiac etiology):
-IV/IO fluid bolus per drug chart SO
MR BHPO- to maintain adequate perfusion if without rales

29
Q

S-168 Pediatric Shock Notes

A

“Shock” is defined by the following criteria:
Patients age: <15 years
Exhibiting any of the following signs of inadequate perfusion:
A. Altered mental status (decreased LOC, confusion, agitation)
B. Tachycardia (<5yrs >180, >5yrs >160)
C. Pallor, mottling, or cyanosis
D. Diaphoresis
E. Comparison (difference) of peripheral vs. central pulses
F. Delayed capillary refill
G. Systolic BP < [70+(2x age)]

30
Q

S-169 Pediatric Trauma BLS

A
  • Ensure patent airway, protecting C-spine
  • Control obvious bleeding
  • Spinal motion restriction prn (except in penetrating trauma without neurological deficits)
  • O2 saturation prn
  • O2 and/or ventilate prn
  • Keep warm
  • Hemostatic gauze

Abdominal trauma:
-Cover eviscerated bowel with saline pads

Chest Trauma:

  • Cover open chest wound with three-sided occlusive dressing; release dressing if suspected tension pneumothorax develops
  • Chest seal

Extremity Trauma:

  • Splint neurologically stable fractures as they lie.
  • Use traction splint as indicated
  • Grossly angulated long bone fractures with neurovascular compromise may be reduced with GENTLE unidirectional traction for splinting BHO
  • Apply tourniquet in severely injured extremity when direct pressure or pressure dressing fails to control life-threatening hemorrhage SO
  • In mass casualty, direct pressure not required prior to tourniquet application

Impaled Objects:
-Immobilize and leave impaled objects in place
-Remove BHPO
EXCEPTION: may remove impaled object in face/cheek, or from neck if there is total airway obstruction

Neurological Trauma (Head &amp; Spine injuries):
-Assure adequate airway and ventilate without hyperventilation

Traumatic Arrest:

  • CPR
  • Consider pronouncement at scene BHPO
31
Q

S-169 Pediatric Trauma ALS

A
  • Monitor EKG
  • IV/IO SO adjust prn
  • If MTV IV/IO en route SO
  • IV/IO fluid bolus per drug chart for hypovolemic shock SO. MR to maintain adequate perfusion SO
  • Treat pain per Pain Management Protocol (S-173)
Crush Injury (with extended compression >2 hours of extremity or torso:
Just prior to extremity being released:
-IV/IO fluid bolus per drug chart BHO
-NaHCO3 drug chart IV/IO BHO

Grossly Angulated Long Bone Fractures:
-Reduce with GENTLE unidirectional traction for splinting per SO

Severe Respiratory Distress (with unilateral diminished breath sounds AND signs of inadequate perfusion):
-Needle Thoracostomy BHO

Traumatic Arrest:
-Consider pronouncement at scene BHPO

32
Q

S-170 Pediatric Burns BLS

A

Tar Burns:

  • Cool with water
  • Transport
  • Do not remove tar

Inhalation of smoke/gas/toxic substance:

  • Move patient to safe environment
  • 100% O2 via mask
  • Consider transport to facility with hyperbaric chamber for suspected carbon monoxide poisoning for unconscious or pregnant patient
33
Q

S-170 Pediatric Burns ALS

A
  • Monitor EKG for significant electrical injury and prn
  • IV/IO SO adjust prn
  • Treat pain as per Pain Management Protocol (S-173)
For patients with >10% partial thickness or >5% full thickness burns:
5-14 yo:
-250ml fluid bolus IV/IO then TKO SO
<5 yo:
-150ml fluid bolus IV/IO then TKO SO

In the presence of respiratory distress with bronchospasm:
-Albuterol per drug chart via nebulizer SO. MR SO

Respiratory distress with stridor:
-Epinephrine 1:1,000 per drug chart via nebulizer SO.
MR x1 SO
-Epinephrine 1:1,000 per drug chart IM SO.
MR x2 q5” SO

34
Q

S-170 Pediatric Burns Notes/Burn Center Criteria

A

Base Hospital contact and transport (per S-415):
Will be made to UCSD Base Hospital for patients meeting burn center criteria

Burn Center Criteria:
Patients with burns involving:
->10% BSA partial thickness or
->5% BSA full thickness
-Suspected respiratory involvement or significant smoke inhalation in a confined space
-Injury to the face, hands, feet, perineum, or circumferential
-Electrical injury due to high voltage (>120 volts)

Disposition:
-Consider hyperbaric chamber for suspected CO poisoning in unconscious or pregnant patient

35
Q

S-172 Pediatric ALTE (Apparent Life-Threatening Event)/ BRUE (Brief Resolved unexplained Event) BLS

A

-Ensure patent airway
-O2 saturation prn
-O2 and/or ventilate prn
If trained and available:
-Monitor blood glucose prn

Hypoglycemia (suspected) or patient’s glucometer results, if available, read <60 (Neonate <45):

  • If patient is awake and has gag reflex, give oral glucose paste or 2 tablets (15g) Patient may eat or drink if able
  • If patient is unconscious, NPO
36
Q

S-172 Pediatric ALTE (Apparent Life-Threatening Event)/ BRUE (Brief Resolved unexplained Event) ALS

A
  • Monitor EKG
  • Obtain blood glucose prn
  • IV SO prn
37
Q

S-172 Pediatric ALTE (Apparent Life-Threatening Event)/ BRUE (Brief Resolved unexplained Event) Notes

A

-If the parent/caretaker refuses medical care and/or transport, contact base hospital prior to completing a refusal of care form

Definition:
An ALTE (Apparent Life-Threatening Event)/ BRUE (Brief Resolved Unexplained Event) is defined as an episode involving an infant less than 12 months of age that is frightening to the observer and is characterized by one or more of the following:
-Apnea (central or obstructive)
-Color change (cyanosis, pallor, erythema)
-Marked change in muscle tone
-Unexplained choking or gagging

Transport:

  • Transport to nearest appropriate facility:
  • ALS transport, if child is symptomatic
  • BLS transport, if child is asymptomatic
  • Private transport acceptable for asymptomatic patient IF:
  • Transportation is available now
  • The parents/caretaker are reliable
  • The parents/caretaker understand the importance of evaluation
38
Q

S-173 Pediatric Pain Management BLS

A
  • Assess level of pain
  • Ice, immobilize, and splint when indicated
  • Elevation of extremity trauma when indicated
39
Q

S-173 Pediatric Pain Management ALS

A

-Continue to monitor and reassess pain as appropriate

For treatment of pain as needed with signs of adequate perfusion:
-Morphine IV per drug chart SO. 
MR per drug chart BHO
**OR**
-Morphine IM per drug chart SO.
MR per drug chart BHO

OR

<10kg:
-Fentanyl IV/IN per drug chart BHO. 
MR per drug chart BHO
>10kg:
-Fentanyl IV/IN per drug chart SO.
MR per drug chart BHO, max 75mcg

OR

<2 years of age:
-IV Acetaminophen contraindicated
>2 years of age:
-IV Acetaminophen per drug chart SO x1 infuse over 15”

Special Considerations:

  1. When changing route of administration requires BHO (e.g. IV to IM or IN to IV)
  2. A change in analgesic while treating a patient requires BHO (e.g. changing from Morphine to Fentanyl)

BHPO for:

  • Chronic pain states
  • Isolated head injury
  • Acute onset severe headache
  • Drug/ETOH intoxication
  • Multiple trauma with GCS <15
  • Suspected active labor

Note: IV Acetaminophen should be drawn from the vial using syringe and diluted in a 50ml or 100ml normal saline bag and administered over 15 minutes using the pediatric drug chart indicated doses.

40
Q

S-174 Pediatric GI/GU (Non Traumatic) BLS

A
  • Ensure patent airway
  • O2 saturation SO prn
  • NPO
41
Q

S-174 Pediatric GI/GU (Non Traumatic) ALS

A
  • Monitor EKG
  • IV/IO SO prn
  • Fluid bolus IV for suspected volume depletion per pediatric drug chart SO
  • Treat pain as per Pain Management Protocol (S-173)
  • Refer to Shock Protocol (S-186) if needed

For nausea or vomiting:

  • 6mo-3yrs of age: Zofran 2mg ODT/IV SO
  • Greater than 3yrs : Zofran 4mg ODT/IV SO
  • If suspected head injury, Zofran BHPO

San Diego EMS Protocols 2019 (7 decks)

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