Set 2

Question 1

9008 Pediatric Seizures

Answer 1

Continuous Seizure: Midazolam (IN/IM preferred route):
- IM - 0.1 mg/kg (max dose 4 mg) OR
- IN 0.2 mg/kg (max dose 6 mg)
- IV 0.1 mg/Kg (max dose 4 mg) slow IV push in 1 - 2 mg increments, titrate to seizure control.
Cardiac Monitoring.
If seizures are continuing, initiate vascular access with NS, and titrate to a minimal SBP
for the patient’s age.
NOTES:
**May substitute Diazepam when there is a recognized pervasive shortage of
Midazolam.
- Diazepam 0.1mg/kg IV/IO to control seizures.
If no IV access is available:
- Diazepam 0.1mg/kg IM. May repeat once. Max dose 5 mg

Question 2

9009 Neonatal Resuscitation

Answer 2

Vascular access (may bolus 20mL/kg) for hypovolemia

For persistent HR < 60
Epinephrine 1:10,000 0.01mg/kg (0.1mL/kg) IV/IO

Question 3

9011 Pediatric Overdose

Answer 3

OPIOID

Naloxone:
- Preferred routes are IV or Intranasal (IN). Can also be given IM when IV or IN is difficult or impossible. 0.1 mg/kg IV/IN/IM push titrate to adequate respiratory status or a maximum of 2 mg.
If no improvement, consider repeating doses two (2) times (a total of three (3) doses).
Reassess after each dose.

Beta Blocker or Calcium Channel Blocker Overdose:

Atropine:
- 0.02 mg/kg IV/IO; minimum dose 0.1 mg with repeated dose after five (5)
minutes for age-specific bradycardia with hypotension.

Push Dose Epinephrine:
0.01 mg/ml (10mcg/ml) 0.5-2 ml (5-20mcg) IV/IO every 2-5 minutes. Titrate to SBP for the patient’s age, improvement of symptoms, or a total of 0.3mg is given

Tricyclic and Related Compounds Overdose:

SODIUM BICARBONATE:
- 1 mEq/Kg IV/IO push if any of the following signs of cardiac toxicity are
present:
- Heart rate greater than 20 beats per minute above max for age.
- Systolic blood pressure less than minimum for age.
- QRS complex greater than .12 msec.
- Seizures.
- Premature Ventricular Contractions (PVCs) greater than 6 a minute.

Question 4

9013 Pediatric Shock

Answer 4

For any signs of shock, attach Normal Saline (NS) and administer fluid challenge of 20 ml/kg if systolic blood pressure less than minimum for age.
If signs of shock continue, repeat 20 ml/kg fluid bolus x 1.

Question 5

9014 Cardiac Dysrhythmias

Answer 5

Epinephrine 1:10,000
0.01mg/kg IV/IO
Repeat every 3-5 minutes

ATROPINE:
For increased vagal tone or primary atrioventricular (AV) block 0.02 mg/kg IV/IO
Minimum dose: 0.1 mg
Maximum single dose: 0.5 mg
May repeat once in 3-5 minutes

If TCP
Consider sedation:
Midazolam 0.1 mg/kg SIVP/IO/ IN
Max Dose 4mg

Adenosine:
- 0.1 mg/kg rapid IV/IO (max dose 6 mg) followed by 20 ml NS rapid flush
- If no response, administer second dose
- 0.2 mg/kg rapid IV/IO (max dose 12 mg)
followed by 20 ml NS rapid flush
If IO/IV access not available, or if adenosine ineffective:
- SYNCHRONIZED CARDIOVERSION

Question 6

9021 Pediatric Behavioral Crisis Restraint

Answer 6

Midazolam:
- Patient must be ≥ twelve (12) years of age
9021.01-Page 3 of 3
- Intravenous (IV) - 0.1 mg/Kg (max dose 3 mg) slow IV push in 1 mg increments-titrate to reduction in agitation.
- Intranasal (IN) – 0.1 mg/Kg (max dose 3 mg) one-half dose in each nares. May
repeat x 2, q 5 minutes for a total max dose of 3 mg.
- Intramuscular (IM) - 0.1 mg/Kg (max dose 3 mg) in single IM injection (may be split into two sites if sufficient muscle mass is not present for a single injection).
May repeat x1, q 30 minutes for a total max dose of 3 mg.

Question 7

9020 Pediatric Nausea and/or Vomiting

Answer 7

If vital signs or exam suggests volume depletion, consider:
a) IV/IO access.
b) Normal Saline 20 ml/kg x 1.
c) Recheck vitals every 5 minutes.

Consider Ondansetron if age > one (1) month and weight ≥ eight (8) kg.
[8-15 kg]:
- Dose: 2 mg PO/IM x 1; Alt: 0.15 mg/kg/dose IV/IO x 1.
[16-30 kg]:
- Dose: 4 mg PO/IM x 1;
Max: 4 mg/dose; Alt: 0.15 mg/kg/dose IV/IO x 1.
[> 31 kg]:
- Dose 4 mg PO/IM x 1
Max: 8 mg/dose PO/IM; Alt: 0.15 mg/kg/dose IV/IO x 1.