2019 Protocols (Pediatric) Flashcards

Question

S-167 Pediatric Respiratory Distress ALS

Answer 1

- 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

Answer 2

- 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

Answer 3

- 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

Answer 4

- 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

Answer 5

"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)]

Answer 6

- 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 & Spine injuries): -Assure adequate airway and ventilate without hyperventilation ``` Traumatic Arrest: - CPR - Consider pronouncement at scene BHPO

Answer 7

- 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

Answer 8

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

Answer 9

- 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

Answer 10

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

Answer 11

-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

Answer 12

- Monitor EKG - Obtain blood glucose prn - IV SO prn

Answer 13

-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

Answer 14

- Assess level of pain - Ice, immobilize, and splint when indicated - Elevation of extremity trauma when indicated

Answer 15

-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.

Answer 16

- Ensure patent airway - O2 saturation SO prn - NPO

Answer 17

- 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