EMT Peds SOP Flashcards
when treating a pediatric patient in Vfib/ pulseless V tach, what should be the first part of your pediatric assessment
use Broslow tape
When working with a pediatric patient in a shockable rhythm, defibrilate at __ joules per kg and continue CPR for __ minutes, then reassess for pulses and reassess and repeat defibrilation every 2 minutes with __ joules per kg
2
2
2
4
While resuscitating a pediatric patient administer __ mg/kg of a __:__ solution (__ cc/kg) every __-__ minutes via IV.
0.01
1:10,000
0.1 cc/kg
3 - 5 minutes
If you have no IV/IO access, how should you give epinephrine during resuscitation for a pediatric patient?
What is the dilution?
How many times can you repeat?
0.1 mg/kg of a 1:10,000 solution via ETT tube duluted with 5cc NSS
Repeat every 3-5 minutes throughout resuscitation
What are the two antiarrhythmics used while resuscitating a pediatric patient?
Amiodarone and Lidocaine
What is the dose for Lidocaine IV/IO for pediatric resuscitation and how often can you repeat?
1 mg/kg
repeat once after 5-10 minutes
What is the dose for Amiodarone IO/IV and how often can you repeat?
5 mg/kg
repeat 2 times up to total dose of 15 mg/kg
In pediatric bradycardia, if a patient has a HR
60
100
What is the range for pediatric tachycardia?
rate >= __ for infant
rate >= __ for children
220 infant
180 child
For stable pediatric narrow complex tachycardia, what would you first consider?
What is meant by “stable”
Vagal maneuver
blow into syringe
no evidence of poor perfusion
For stable pediatric narrow complex tachycardia refractory to vagal maneuvers, what should you give?
start IV/IO access and give NSS bolus 20ml/kg
Administer Adenosine 0.1 mg/kg rapid push followed by 10cc bolus. If no change in 2 minutes repeat with 0.2 mg/kg for a maximum of 12mg followed by a 10cc bolus of NSS.
The dosage for Adenosine for stable narrow complex tachycardia is __ mg/kg rapid push followed by __cc bolus. If no change in __ minutes repeat with __ mg/kg for a maximum of __mg followed by a __cc bolus of NSS.
0.1 mg/kg
10cc bolus
2 minutes repeat with 0.2 mg/kg (double dose)
12mg followed by a 10cc bolus of NSS.
If pediatric patient with narrow complex tachycardia is refractory to max dose of Adenosine, what do you do?
Call medical control for possible dose of amiodarone or cardioversion
In the ped patient with narrow complex tachycardia who is refractory to adenosine max dose and order for amiodarone has been given, what is the expected dose?
5 mg / kg over 20 - 60 minutes
In the ped patient with narrow complex tachycardia who is refractory to adenosine max dose and order for cardioversion has been given what is the expected dose?
0.5-1 joules/kg. If the patients rhythm does not change, may obtain order to repeat cardioversion at 2 joules per kg
Prior to administering cardioversion to a peds patient, sedation should be given. What are the two medications you can give?
What are the doses?
What are the max doses?
Ativan 0.1 mg/kg IV/IO, max dose 2 mg per dose
Versed 0.05 mg / kg IV/IO titrated to sedation
What are the determining features of an unstable patient in pediatric narrow complex tachycardia?
(5 including SBP parameters)
-Poor perfusion suggested by central cyanosis
- tachypnea
-altered level of consciousness
-weak or absent peripheral pulses
SBP<70 + 2 x age
When treating pediatric narrow complex tachycardia, if patient is unstable, what are the rules for adenosine and cardioversion?
Do not delay cardioversion for administration of sedtion or adenosine.
If borderline unstable, Adenosine may be tried and conscious patients should be given sedation prior to cardioversion
For unstable pediatric narrow complex tachycardia, if no IV access is readily available and HR > 180, what should you do?
go directly to cardioversion 0.5 - 1 joules per kg. If no change repeat at 2 joules per kg. Sedate if possible but don’t delay cardioversion.
For a pediatric patient with WIDE complex tachycardia, you should consider and treat the possible causes.
Name 8 causes.
Fever Pneumothorax Shock Hypovolemia Drug ingestions Hypoxia Cardia Tamponade Abnormal electrolytes
When treating a pediatric patient with wide complex tachycardia who is stable, what should you give?
What is the dose?
Amiodarone
5mg/kg IV over 20 - 60 minutes
When treating a pediatric patient with wide complex tachycardia who is stable, and refractory to amiodarone, what should you do?
Contact medical control for cardioversion at 0.5-1 joules per kg. If the patients rhythm does not change, may obtain order to repeat cardioversion at 2 joules per kg
if pt is unstable with wide complex tachycardia, what should you do?
Go directly to cardioversion at 0.5-1 joule per kg. Increase to 2 joules if no change. Sedate if possible but do not delay crdioversion.
contct medical control for further orders
For pediatric change is mental status, what should you do?
- Secure airway with high flow O2
- assess for truama
- Establish IV/IO and infuse NSS KVO
- Check blood sugar
For pediatric change in mental status with a blood sugar <60 and child is less than 1 month old, what should you do?
administer 0.5g/kg of a 10% dextrose solution via IV/IO
For pediatric change in mental status with a blood sugar <60 and child is greater than 1 month old, what should you do?
Give D25% at 0.5g/kg (2cc per kg) IV/IO.
Max dose of 50cc
For pediatric change in mental status with a blood sugar <60 and child is more than 1 month old, what should you do?
Give ___% at __g/kg (__cc per kg) IV/IO.
Max dose of __cc
Give D25% at 0.5g/kg (2cc per kg) IV/IO.
Max dose of 50cc
For pediatric change in mental status with a blood sugar <60 and child is more than 1 month old, what should you do if no IV/IO access?
give glucagon 0.1 mg per kg (0.1 cc/kg) IM or SC up to max of 1 mg
For pediatric change in mental status with a blood sugar <60 and child is more than 1 month old and you have no IV/IO access, give glucagon __ mg per kg (__ cc/kg) IM or SC up to max of __ mg
give glucagon 0.1 mg per kg (0.1 cc/kg) IM or SC up to max of 1 mg
If a pediatric change in mental status has signs of opioid toxicity (decreased respirations) and/or has no improvement after treating blood sugar, what should you give?
Naloxone 0.2 mg/kg
if no response give naloxone 0.1/kg to a maximum dose of 2 mg IV/IO/ET/IM
For pediatric change in mental status and there is a history of dehydration, what should you give?
fluid bolus of NSS 20 ml/kg via IV/IO
For pediatric allergic reaction, what are the 7 steps you can take?
- secure airway
- high flow O2
- maintain body temperature
- if wheezing, albuterol
- IV NSS KVO
- no improvement Benadryl
- Solu medrol
For pediatric allergic reaction, what is the dose for albuterol?
2.5mg/3ccNS via nebulizer
For pediatric allergic reaction, after trying ___, what is the dose for benadryl IV?
Can you give IM?
1 mg / kg to a max dose of 50 mg slowly via IV/IO
Benadryl can be given IM but you don’t have a standing order for it.
For pediatric allergic reaction, after trying ___ and ___, you may give what?
Solu-Medrol 2 mg /kg for a max dose of 125 mg
For pediatric allergic reaction, the SOP for Solu-Medrol is __ mg /kg for a max dose of __ mg
2
125
For a pediatric pt in Anaphylaxis, what is the dose for Epinephrine?
0.01cc/kg of a 1:1000 solution via SC route with a max dose of 0.3mg
For a pediatric pt in Anaphylaxis, if wheezing is present, what should you give?
Can you repeat?
Albuterol 2.5 mg/3ccNS via neb.
May repeat once if needed
For a pediatric pt in Anaphylaxis that has become unstable, what should you give?
rapid fluid bolus of NSS at a dose of 20cc/kg
For a pediatric pt in Anaphylaxis that has not improved from albuterol and fluid bolus, what should you give?
Benadryl 1 mg / kg to a max dose of 50 mg slowly via IV
Same dose as allergic reaction
For a pediatric pt in Anaphylaxis, after giving albuterol, fluid bolus, and benadryl, what else can you give?
Solu-Medrol 2 mg/kg for a max dose of 125 mg
For a pediatric pt with asthma, what are the 7 steps to take for a stable pt?
- complete primary assessment
- Administer 100% O2 and assist with ventalations
- maintain body temperature
- albuterol and atrovent (duoneb)
- IV/IO access w/NSS KVO
- repeat albuterol
- Solu-Medrol
For a pediatric pt in Asthma, what is the first thing you should give?
O2 100%
For a pediatric pt with Asthma, what is the first line of treatment? Give two names
albuterol with atrovent
Duoneb
For a pediatric pt with Asthma that has not improved with albuterol and atrovent, what are the SOP for repeat?
you can give a max dose of 2 additional treatments of albuterol 2.5 mg / 3cc NSS
For a pediatric pt with Asthma that is unstable, what can you do?
Administer Epinephrine 0.01 mg/ kg (0.01 cc/kg) of 1:1,000 solution subcutaneous to a max dose of 0.5 mg
For a pediatric pt with Asthma that is unstable, Administer Epinephrine __ mg/ kg (__ cc/kg) of 1:1,000 solution subcutaneous to a max dose of __ mg
- 01
- 01
- 5 mg
For a pediatric patient with croup, what should you do?
100% O2 and 3 ml NSS via nebulizer with mask
What do croup and epiglottitis have in common?
they are both upper airway obstructions
What are the S/S of Epiglottitis?
7
high fever drooling stridor at rest retractions tripod position accecory muscle use cyanosis
For a pediatric patient who appears to be in severe croup/ epiglottitis, what are the 4 steps you should take?
- Administer racemic epinephrine 2.25% solution, 0.5 ml duluted in 3 ml of NSS via neb
- Establish IV/IO access with NSS at KVO rate
- Administer Solu-Medrol 2mg/kg IV/IO to a max dose of 125mg
- contact medical control if no improvement
For a pediatric patient with seizure activity, what shoud you assess for?
- Hx
- Possible underlying causes
- Imaging/ labs/ glucose
- current medications
For a pediatric patient with seizure activity, what are the 13 steps you should take?
As stated in SOP (there are repeats)
- determine LOC
- maintain airway, GCS<8, intubate
- protect from injury
- Establish IV/IO
- observe subjectively seizure activity
- maintain body temp
- IV (again)
- check blood sugar, treat if necessary
- Ativan
- more Ativan
- Versed
- continue to monitor for respiratory depression, intubate if necessary
- call medical control
For a pediatric patient with seizure activity and found to have a blood sugar less than 60 and is less than a year old, what do you do?
administer 0.5g/kg of a 10% dextrose solution via IV/IO
For a pediatric patient with seizure activity and found to have a blood sugar of less than 60 that is greater than 1 month of age, what do you do?
What is the max dose?
administer 0.5 g/kg of Dextrose 25% solution via IV/IO, max dose 50cc
For a pediatric patient with seizure activity and found to have a blood sugar of less than 60 and has no IV/IO access, what do you do?
administer glucagon 0.1 mg / kg (0.1 cc / kg) IM or SC to a max of 2 mg IV
For a pediatric patient with seizure activity and found to have a blood sugar of less than 60 and has no IV/IO access, you should administer ___ __ mg / kg (__ cc / kg) IM or SC to a max of __ mg IV
Glucagon
0.1
0.1
2
If pediatric seizure persists greater than __ minutes or is having repetitive seizures, administer ___ __ mg/kg IV over __-__ minutes up to a max dose of __ mg IV.
2 Ativan 0.05 mg/kg 2-5 minutes 2 mg
If seizure activity is not controlled with the first round of ativan having reached the max dose of 2 mg IV, can you repeat? And if so, what is the further max dose and time frame?
Yes
if seizure activity is not controlled with the first line treatment dose, you may administer ativan 0.1 mg/kg up to 2 mg at a time with a max dose of 4 mg. Repeat may be done in 10-15 minutes for reoccurring seizure activity.
If a pediatric patient is having seizure activity and doses of ativan have been exhausted, what should you do?
Versed 0.1 mg /kg up to 5 mg IN (intranasal)
What is the first step you should take for a pediatric non-traumatic shock patient?
(4)
ok, the first 4 steps
- complete primary assessment
- high flow O2 NRB
- maintain body temperature
- start IV and give NSS 20cc an over 5-10 minutes. If no change may repeat fluid bolus same dose and timeframe.
After establishing IV access on a non traumatic pediatric patient, what should you do?
What do you do after treating that?
check blood sugar
frequent assessment and call medical control
How would you treat a blood sugar of less that 60 on a pediatric non traumatic shock patient?
(3)
- If a child is less than 1 month old give 0.5 g/kg of a 10% dextrose solution via IV/IO
- If a child is more than 1 month old give D25% at 0.5 g/kg IV/IO with a max dose of 50cc
- If no IV access give glucagon 0.1 mg/kg (0.1 cc/kg) IM or SC to a max of 1 mg
For pediatric burns, after the obligatory stop burning process and assesment of mechanism of injury, what do you do regarding airway?
(11)
High flow O2 and consider advanced airway for conditions like
- burn in a closed space (ie room entrapment)
- Extensive 2nd or 3rd degree burns
- singed nasal or facial hair
- charring of the mouth
- blackened sputum
- Erythematous oral mucosa
- Carboxyhemoglobin level elevation causing decreased congnitive function
- total body surface area burn >25%
- circumferential neck burns
- wheezing, stridor, rhonchi present
For a pediatric burn patient, where should you start your IV?
unburnt skin
Once you have IV access with a pediatric burn pt, what should you do?
infant (newborn to 1 month)
child (greater than 1 month but less than 13 years)
and if still hemodynamically unstable?
infant - 10 ml/kg of NSS and may repeat as needed for a total of 30 ml/kg
child - 20 ml/kg NSS and may repeat for a total of 60 ml/kg
- if child remains hemodynamically unstable call medical control for more orders
What type of dressing should you use for a pediatric burn patient?
dry sterile dressing
What pain medication orders do you have to treat pediatric burn patients
None.
You have to contact medical control
For a pediatric trauma patient, what are the rules for using a backboard and collar?
a pediatric trauma patients will be transported with c spine immobilization unless a physician specifically requests full immobilization
What are the fluid orders regarding the pediatric trauma pt?
What is the trauma is associate with burns?
administer NSS or LR and administer fluid bolus of 20 ml/kg.
If trauma is associated with burns substitute NSS for LR
If a pediatric trauma patient is hemodynamically unstable
- How could you tell?
- What would you do in regard to fluids?
- What should you always remember?
- signs of poor perfusion; ie capillary refill, increased HR, increased HR, increased respiratory rate, decrease in BP
- repeat 20 cc/kg bolus rapidly over 5-10 minutes
- remember that a decrease in BP is a late sign in a child
When would you NOT give a fluid bolus to a pediatric trauma patient?
patients with isolated head trauma, or penetrating thoracic/ abdominal trauma
If pediatric trauma patient has no response to fluid administration, what do you do?
contact medical control
What is the preferred site for IO placement?
The flat anteriomedial surface of the tibia one to two-finger breadths below the level of the tibial tuberosity is the preferred site.
True or false
After placing an IO, blood should be freely aspirated.
False
Marrow cannot always be aspirated.
If a large amount of blood is freely aspirated, you are not in the bone marrow but have probably lacerated a vessel. Remove the needle and contact medical control for further orders.
You can give any medication through an IO that can be infused through the IV except what?
What should you do about it?
D50
you have to first dilute it down to 25% dextrose
