Pediatric Protocols Flashcards
AIRWAY OBSTRUCTION PEDIATRIC
BLS
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:
5 Back Blows and Chest thrusts for infants <1 year. 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 epiglottitis:
• Place patient in sitting position
• Do not visualize the oropharynx
STAT transport
Treat as per Respiratory Distress Protocol S-167.
AIRWAY OBSTRUCTION PEDIATRIC
ALS
If patient becomes unconscious or has a decreasing LOC:
Direct laryngoscopy and Magill forceps SO. MR prn
Once obstruction is removed:
- Monitor EKG
- IV/IO SO adjust prn
ALTERED NEUROLOGIC FUNCTION (NON-TRAUMATIC) PEDIATRIC
BLS
Ensure patent airway, O2 and/or ventilate prn
O2 Saturation
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 mg/dL (Neonate <45 mg/dL):
If patient is awake and has gag reflex, give oral glucose paste or 3 tablets (15 g). Patient may eat or drink if able.
If patient is unconscious, NPO.
Seizures:
Protect airway, and protect from injury.
Treat associated injuries. oIf febrile, remove excess clothing/covering.
Behavioral Emergencies:
Restrain only if necessary to prevent injury.
Avoid unnecessary sirens. oConsider law enforcement
support.
ALTERED NEUROLOGIC FUNCTION (NON-TRAUMATIC) PEDIATRIC
ALS
- IV SO adjust prn
- Monitor EKG /blood glucose prn
• Capnography SO prn
Symptomatic ?opioid OD (excluding opioid dependent pain management patients):
Naloxone per drug chart IN/IV/IM SO. MR SO
Symptomatic ?opioids OD in 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
Hypoglycemia:
Symptomatic patient unresponsive to oral glucose agents:
D10 per drug chart IV SO if BS <60 mg/dL (Neonate<45mg/dL)
If patient remains symptomatic and BS remains <60 mg/dL(Neonate <45 mg/dL) MR SO
If no IV:
Glucagon per drug chart IM SO if BS <60 mg/dL(Neonate <45 mg/dL)
Seizures:
For:
A. Ongoing generalized seizure lasting >5 minutes (includes seizure time prior to arrival of prehospital provider) SO
B. Partial seizure with respiratory compromise SO
C. Recurrent tonic-clonic seizures without lucid interval SO
GIVE:
Versed per drug chart slow IV, (d/c if seizure stops) SO. MRx1 in 10 minutes SO
If no IV:
Versed per drug chart IN/IM SO. MR x1 in 10 minutes SO
ALLERGIC REACTION/ANAPHYLAXIS PEDIATRIC
BLS
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
ALLERGIC REACTION/ANAPHYLAXIS PEDIATRIC
ALS
- Monitor EKG
- IV/IO SO adjust prn
Hives (Urticaria):
o Diphenhydramine per drug chart IV/IM SO
Anaphylaxis:
o Epinephrine 1:1000 per drug chart IM SO MR x2 q5 minutes SO
then
o Fluid bolus IV/IO per drug chart SO to maintain adequate perfusion MR SO
o Diphenhydramine per drug chart IV/IM SO
o Albuterol per drug chart via nebulizer SO for respiratory involvement MR SO
o Atrovent per drug chart via nebulizer added to first dose of Albuterol SO for respiratory involvement
o Epinephrine 1:10,000 per drug chart IV/IO . MR x2 q3-5 minutes BHO
- *Anaphylaxis criteria (may include any):**
1. Unknown exposure: Skin and respiratory and/or cardiovascular
2. Likely allergen exposure (e.g. bee sting, peanut): - *2/4 systems involved** (skin,GI,respiratory,cardiovascular)
3. Known allergen exposure
Angioedema: lip/tongue/face swelling/difficulty swallowing, throat tightness, hoarse voice
ENVENOMATION INJURIES PEDIATRIC
BLS
• O2 and/or ventilate prn
Jellyfish Sting:
oLiberally rinse with salt water for at least 30 seconds.
oScrape to remove stinger(s).
oHeat as tolerated (not to exceed 110
degrees).
Stingray or Sculpin Injury:
oHeat as tolerated (not to exceed 110 degrees).
Snakebites:
oMark proximal extent of swelling and/or tenderness
oKeep involved extremity at heart level and immobile
oRemove pre-existing constrictive device
ENVENOMATION INJURIES PEDIATRIC
ALS
- IV SO adjust prn
- Treat pain as per Pain Management Protocol (S- 173)
POISONING/OVERDOSE PEDIATRIC
BLS
- Ensure patent airway
- O2 Saturation prn
- O2 and/or ventilate prn
- Carboxyhemoglobin monitor prn, if available
Ingestions:
o Identify substance
Skin:
o Remove clothes
o Brush off dry chemicals o Flush with copious water
Inhalation of Smoke/Gas/Toxic Substance:
o Move patient to safe environment
o 100% O2 via mask
o Consider transport to facility with hyperbaric chamber for suspected carbon monoxide poisoning in the unconscious or pregnant patient.
Symptomatic suspected opioid OD:
o May assist family or friend to medicate with patients own Naloxone
POISONING/OVERDOSE PEDIATRIC
ALS
- Monitor EKG
- IV/IO SO adjust prn
Ingestions:
o Charcoal per drug chart PO if ingestion within 60 minutes and recommended by Poison Center SO.
o Assure child has gag reflex and is cooperative.
o 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): o Narcan per drug chart IN/IV/IM SO. MR SO
Symptomatic suspected opioid OD in opioid dependent pain management patients:
o Narcan titrate per drug chart IV (dilute per drug chart) or IN/IM SO. MR BHO
Symptomatic organophosphate poisoning:
o Atropine per drug chart IV/IM/IO SO. MR x2 q3-5” SO. MR q3-5” prn BHO
Extrapyramidal reactions:
o Benadryl per drug chart slow IV/IM SO
Suspected Tricyclic OD with cardiac effects (hypotension, heart block, widened QRS):
o NaHCO3 per drug chart IV x1 BHO
NEWBORN DELIVERIES PEDIATRIC
BLS
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 remains <60 bpm after 90 seconds 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
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.
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.
NEWBORN DELIVERIES PEDIATRIC
ALS
- Monitor
- 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 minutes SO.
- MR q3-5 minutes BHO
RESPIRATORY DISTRESS PEDIATRIC
BLS
Ensure patent airway
Dislodge any airway obstruction
O2 Saturation
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:
o Coaching/reassurance.
o Remove patient from causative environment. o Consider underlying medical problem.
Toxic Inhalants (CO exposure, smoke, gas, etc.):
o Consider transport to facility with Hyperbaric chamber for suspected carbon monoxide poisoning for unconscious or pregnant patient
Respiratory Distress with croup-like cough:
o Aerosolized saline or water 5 ml via oxygen powered nebulizer/mask. MR prn
RESPIRATORY DISTRESS PEDIATRIC
ALS
- Monitor EKG
- IV SO adjust prn
- BVM prn
- Capnography monitoring SO prn
Respiratory Distress with bronchospasm:
o Albuterol per drug chart via nebulizer SO. MR SO
o 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:
o Epinephrine 1:1,000 per drug chart IM SO. MR x2 q5 minutes SO
Respiratory Distress with stridor at rest:
o Epinephrine 1:1,000 per drug chart via nebulizer SO. MR x1 SO
o Epinephrine 1:1000 per drug chart IM SO. MR x 2q 5 minutes SO
SHOCK PEDIATRIC
ALS
Monitor EKG
IV/IO SO
Capnography SO prn
Shock (Non cardiogenic):
o IV/IO fluid bolus per drug chart SO. MR SO if without rales.
Shock (Cardiac etiology):
o IV/IO fluid bolus per drug chart SO. MR BHPO
- to maintain adequate perfusion if without rales.
