Peds Protocols and Drugs

Question 1

Ondansetron (Zofran)

Answer 1

Indication: Nausea/Vomiting

Less than 50 kg: 0.1 mg/kg IV push or appropriate portion of an ODT

Question 2

Croup Treatment

Answer 2

If over 6 months age, stridor at rest with retractions or accessory muscle use:

Administer one of the following:

1. 0.5 mL of 2.25% racemic epinephrine (Vaponephine) diluted with 4.5 mL of 0.9% NS (total volume of 5 mL) via nebulizer with 5-6 LPM O2 – Preferred
2. 5 mL of 1:1000 epinephrine by nebulizer with 5-6 LPM O2

Question 3

Obstructive/Reactive Airway Pediatric Management

Answer 3

Administer 2.5 mg Albuterol and 0.5 mg Ipatropium (max of three doses of ipatropium). Increase albuterol dose to 5 mg if patient regularly uses nebulized albuterol.

IF patient is OVER age of 2 with a known history of asthma and is receiving 2nd neb treatment: give either (a) 50-60 mg oral prednisone if patient able to swallow AND over 30 kg (b) Methylprednisolone 2 mg/kg IV (max of 125 mg)

If patient is over 2 Y with known has respiratory failure, respiratory arrest, status asthmaticus, or continues to decline –> administer 0.01 mg/kg epi 1:1,000 IM (max of 0.3 mg)

Question 4

Smoke inhalation with suspected cyanide poisoning (responsive patient with soot in airway with altered level of consciousness or hypotension) as well as pediatric unresponsive smoke inhalation

Answer 4

administer cyanockit (70 mg/kg over 15 minutes)

Question 5

Pediatric Bradycardia

Answer 5

Perform CPR if clinically indicated.
Intubate only if BVM ventilations/oxygenation is inadequate
Administer epinpehrine 0.01 mg/kg (1:10,000) IV or IO every 3-5 minutes
For increased vagal tone or primary AV block: administer 0.02 mg/kg (minimum dose of 0.1 mg, max single of 0.5 mg) atropine IV or IO. Repeat one time 305 minutes after if necessary.

Consider reversible causes, often hypoxia

Question 6

Narrow Tachycardias - Pediatric (SVT)

Answer 6

Infant rate usually over 220; child rate usually over 180

If “urgent”:
Have patient perform Valsalva maneuver using the REVERT method.
Administer adenosine 0.1 mg/kg (max 6 mg) w/ rapid flush
Second dose of adenosine: 0.2 mg/kg (max 12 mg) IVP w/rapid flush

in pediatric patients, our protocols consider tachycardias to be “emergent” when they exhibit hypotension, acutely altered mentation, and signs of shock. This is different than our protocol for adults, which requires them to be unconscious or with no obtainable BP

Question 7

Wide Tachycardias (VT) - Pediatrics

Answer 7

Asymptomatic: establish IV and contact medical control

Chest pain or dyspnea: contact medical control

Hypotension, acutely altered mentation, signs of shock: perform sync cardioversion beginning with 0.5-1 J/Kg. If not effective, increase to 2 J/kg. Contact medical control for further directions.

Question 8

Pediatric VFib/VTach Cardiac Arrest

Answer 8

Initial Defibrillation at 2 J/Kg. Subsequent defibrillation at 4 J/kg.

Establish IV/IO.

Administer epinephrine 0.01 mg/Kg 1:10,000 IVP/IOP (max of 1 mg per dose) every 3-5 minutes.

Check for an organized rhythm at 2 minute intervals. Shock if indicated. Immediately resume CPR.

Administer amiodarone 5 mg/kg IV/IO (max dose of 300 mg).

Question 9

Pediatric Hypoglycemia

Answer 9

1. Perform blood glucose analysis. (Neonates <40, Other pediatrics <60 –> indicates hypoglycemia). Administer 4 mL/kg D25 IVP OR 4 mL/kg D10 (not to exceed 200 mL). If unable to establish IV after 2 attempts, administer 0.5 mg glucagon IM or IN for children <20 kg. Administer 1.0 mg glucagon IM or IN for children >/= 20kg

Question 10

Pediatric Opioid Overdose

Answer 10

If pediatric patient has respiratory depression and a history suggestive of possible opiate overdose, initiate ventilation using BVM and administer 0.1 mg/kg naloxone up to 2 mg IVP or IN.

If respiratory depression persists after 2 minutes, contact medical control for recommendations for any further dosing.

Question 11

Pediatric Status Seizure

Answer 11

1. High flow O2. Protect patient from injury.
2. Perform blood glucose analysis. If hypoglycemia (<40 neonates, <60 other pediatrics): administer 4 mL/kg D25 to infants OR 2 mL/kg of D50 for older children (not to exceed 50 mL).
3. If patient is hypoglycemic and unable to establish IV after 2 attempts, administer glucagon 0.5 mg IM or IN for children <20 kg and 1 mg for children >20 kg.
4. Apply cardiac monitor and pulse oximetry.
5. Administer midazolam IV, IM, IN: 0.1 mg/kg (max of 5 mg). If intra-nasal, divide the dose so that each nares receives