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Paramedic > SMOs- Pediatric Protocols > Flashcards

SMOs- Pediatric Protocols Flashcards

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1
Q

Pediatric Pain Control (61)

A 
*Assess pain severity
Mild Pain: 0-6
1. Consider IV
2. Monitor and reassess
3. Transport

Moderate to Severe Pain: >6

  1. IV
  2. Cardiac monitor
  3. Consider pain med
    - Fentanyl 1mcg/kg IV/IO/IM/IN
    - -may repeat q5, max single dose 50mcg, max total dose 150mcg
    - Morphine .1mg/kg IV/IO/IM
    - -may repeat q5, max total 10mg
  4. Transport
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2
Q

Pediatric Cardiac Arrest (62)

-VF/Pulseless VTach

A
  • Confirm no pulse
    1. CPR
  • 100% O2 -Ventilate
    2. Pads/confirm VF/Pulseless VTach
    3. Shock #1 @ 2J/kg
    4. 2 min CPR (15:2)
  • Establish IV/IO TKO
  • consider advanced airway
    5. No pulse and shockable= #2 shock @ 4J/kg
    6. 2 min CPR
  • EPI .01mg/kg 1:10,000 IV/IO q3-5min
    7. No pulse and shockable= #3 @ 4J/kg
    8. 2 min CPR
  • Amiodarone 5mg/kg IV/IO
  • -may repeat 2x
  • -max single dose 300mg
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3
Q

Pediatric Cardiac Arrest (62)

-PEA/Asystole

A
  • Confirm no pulse
    1. CPR
  • 100% O2 -Ventilate
    2. Pads/confirm PEA/Asystole
    3. EPI .01mg/kg 1:10,000 IV/IO q 3-5min
  • Advanced airway
    4. No pulse= continue CPR
  • Tx reversible causes
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4
Q

Pediatric Bradycardia (63)

A

CORC

  1. Assess CABs
  2. 100% O2
  3. Initial assessment:
    - Respiratory difficulty
    - Cyanosis despite O2
    - Cool skin
    - Hypotension
    - No palpable BP
    - Weak thready pulse, no peripheral pulse
    - Decrease consciousness
  4. Cardiac monitor

No cardiorespiratory compromise:
5. Support, observe, keep warm, transport

Severe cardiorespiratory compromise: 
A Chest IEA
5. Secure airway/support vent with BVM
-Have pulse ox
6. Chest compressions if HR <60 despite O2 and ventilations
7. IV TKO
8. EPI .01mg/kg IV/IO 1:10,000 q 3-5
9. Atropine .02mg/kg IV/IO
-max single of 1 mg
-may be repeated 1x in 5 min
Improved= transport
Not Improved= external pacing per med control
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5
Q

Pediatric Tachycardia with Poor Perfusion (64) Narrow

A
  1. Assess CABs
  2. 100% O2
  3. Initial assessment:
    - Respiratory difficulty
    - Cyanosis despite O2
    - Cool skin
    - Hypotension
    - No palpable BP
    - Weak thready pulse, no peripheral pulse
    - Decrease consciousness
  4. Cardiac monitor

NO pulse= Cardiac arrest protocol

Pulse:
Narrow (< or equal to .08sec)
Sinus Tach (P waves, infant rate <220; child rate <180bpm)= tx reversible causes

Narrow SVT (infant >220; child >180bpm)
5. Attempt vagal
6. IV established or rapidly available?
No= sync cardioversion @ .5J/kg
-repeat @ 1J/kg and then 2J/kg and transport
Yes= Adenosine .1mg/kg IV/IO with 10ml flush
-persists= double the dose

Perfusion normal= support and transport
Rhythm converted but hypoperfusion= pediatric shock protocol (68)
Rhythm not converted= sync cardioversion and transport

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6
Q

Pediatric Tachycardia with Poor Perfusion (64) Wide

A
  1. Assess CABs
  2. 100% O2
  3. Initial assessment:
    - Respiratory difficulty
    - Cyanosis despite O2
    - Cool skin
    - Hypotension
    - No palpable BP
    - Weak thready pulse, no peripheral pulse
    - Decrease consciousness
  4. Cardiac monitor
Wide( > .08sec) (Tx as presumptive VTach)
5. IV established or rapidly available?
NO= sync cardiovert 
Yes= consider versed (.05mg/kg)
then sync cardiovert
6. Transport
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7
Q

Pediatric Tachycardia with Adequate Perfusion (65) Narrow

A

CORC

  1. Assess CABs
  2. 100% O2
  3. Initial assessment:
    - Respiratory difficulty
    - Cyanosis despite O2
    - Cool skin
    - Hypotension
    - No palpable BP
    - Weak thready pulse, no peripheral pulse
    - Decrease consciousness
  4. Cardiac monitor
Narrow (QRS <.08sec):
Sinus Tach= tx reversible causes
SVT:
5. Attempt vagal
6. IV
7. Adenosine .1mg/kg with 10ml flush
-persists= double dose
8. Support and transport
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8
Q

Pediatric Tachycardia with Adequate Perfusion (65) Wide

A
  1. Assess CABs
  2. 100% O2
  3. Initial assessment:
    - Respiratory difficulty
    - Cyanosis despite O2
    - Cool skin
    - Hypotension
    - No palpable BP
    - Weak thready pulse, no peripheral pulse
    - Decrease consciousness
  4. Cardiac monitor

Wide (QRS> .08sec)
5. Treat as presumptive VTach and transport

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9
Q

Pediatric Respiratory Distress (66) Reactive (lower) Airway Disease

A 
CORP
1. Assess CABs
2. Administer 100% O2
3. Assess for reactive airway disease
•wheezing
•grunting
•retractions
•tachypnea
•diminished respirations
•decreased breath sounds
•tachycardia/bradycardia
•decreasing consciousness
4. Position of comfort
DC
5. Duoneb
6. Cardiac monitor
7. Transport
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10
Q

Pediatric Respiratory Distress (66) Partial (upper) Airway Obstruction

A

CORP
1. Assess CABs
2. Administer 100% O2
3. Assess for partial airway obstruction:
•suspected foreign body, obstruction or epiglottitis
•stridor
•choking
•drooling
•hoarseness
•retractions
•tripod position
4. Position of comfort
5. Assess tolerance for O2 administration
6. Per med control: Duoneb
*Do not attempt intubation, visualization, or IV access
Relieved= transport
Unrelieved= Pediatric respiratory arrest protocol (67)

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11
Q

Pediatric Respiratory Distress (66) Upper Airway Disease

A 
CORP
1. Assess CABs
2. Administer 100% O2
3. Assess for upper airway disease:
•suspected foreign body, obstruction or epiglottitis
•stridor
•choking
•drooling
•hoarseness
•retractions
•tripod position
DE
4. Per med control: Duoneb
5. Nebulized EPI 1mg 1:1,000 in 2ml NS
-can repeat per med control
6. Transport
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12
Q

Pediatric Respiratory Arrest (67) w/ Adequate respiratory effort

A
  1. Assess airway
    -airway maneuver, and if needed jaw thrust/chin lift head tilt, suction, oropharyngeal airway
    Adequate Respiratory Effort:
  2. 100% O2
    -monitor spo2 and capno
  3. Support ventilations with BVM if indicated
  4. Consider BGL check
    -administer oral glucose or Glucagon .03mg/kg IN or D25/D12.5
  5. IV TKO
    If Normal Perfusion:
  6. Support CABs
  7. Cardiac monitor
  8. Transport
    If Hypoperfusion:
  9. Refer to Pediatric Shock Protocol (68) or Pediatric Cardiac Arrest Protocol (62)
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13
Q

Pediatric Respiratory Arrest (67) w/ Inadequate respiratory effort

A

AOV
1. Assess airway
-airway maneuver, and if needed jaw thrust/chin lift head tilt, suction, oropharyngeal airway
2. 100% O2
-monitor spo2 and capno
3. Support ventilations with BVM if indicated (20-30 breaths per minute)
Chest rise adequate= GO to step 5 of adequate res effort
Chest Rise Inadequate=
4. Relieve upper airway obstruction
-reposition airway
-back slaps or abdominal thrusts
-forcep removal
5. If failure: consider intubation then needle cricothyrotomy

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14
Q

Pediatric Shock (68)

A
  1. Assess CABs
    -secure airway
  2. 100% O2
  3. Cardiac monitor
  4. IV TKO
  5. Determine etiology of shock
    Cardiogenic:
    -Fluids at 10ml/kg
    -Dysrhythmia protocol
    Hypovolemic:
    -Fluids at 20ml/kg
    –If no response, repeat, max of 60ml/kg
    Distributive:
    -Fluids at 20ml/kg
    –If no response, repeat, max of 60ml/kg
  6. Transport
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15
Q

Pediatric Allergic Reaction/Anaphylaxis (69)

A
  1. Assess CABs
    - secure airway
    - Support ventilations with BVM as indicated
  2. 100% O2

Local:

  1. Apply ice pack to site
  2. Transfer

Anaphylaxis:

  1. EPI .01mg/kg 1:1,000
    - IV or pen
    - do not exceed .3mg
  2. IV TKO
  3. Benadryl 1mg/kg
  4. Deoneb if wheezing
  5. Fluids if hypotensive at 20ml/kg
  6. Cardiac monitor
  7. Transfer
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16
Q

Pediatric ALOC (71)

A 
O BC Glucose? Narcan?
*Initial medical care
1. 100% O2
2. BGL check
3. Cardiac monitor
Glucose <60:
4. Oral glucose or D25/12.5 
Improved=transport
Still ALOC= go to 'Inadequate respiratory effort
Glucose>60
Inadequate Respiratory Effort:
4. Consider Narcan at .1mg/kg IN if RR<12
-single dose 2mg, max 6mg
-for suspected acute narcotic exposure
17
Q

Pediatric D25 and D12.5

A

D25: 2ml/kg
-to make: dilute D50 with NS 1:1
D12.5 (<2months): 4ml/kg
-to make: dilute D25 with NS 1:1

18
Q

Pediatric Toxic Exposure/Ingestion (72)

A
  • Initial medical care
    1. 100% O2
    2. Cardiac monitor
    3. IV
    4. Initial interventions per med control as indicated for identified exposure
    5. Think narcotics, BGL, and be prepared for seizure
19
Q

Pediatric Heat Emergencies (73)

A
  • Initial medical care
    1. 100% O2
    2. Cardiac monitor
Normal LOC and Diaphoresis:
-SBP>100= cool liquids PO
Hypoperfusion or N/V:
3. Fluids IV 20ml/kg
-repeat if no improvement, max of 60ml/kg
4. Initiate cooling
5. Transport

Decreased Consciousness, Dry skin:

  1. Fluids IV 20ml/kg
    - repeat if no improvement, max of 60ml/kg
  2. Initiate cooling
  3. Transport
    * Secure airway if indicated
20
Q

Pediatric Cold Emergencies (74)

A

Frostbite:

  1. Move to warm area
  2. Tx skin like burn (light sterile dressing)
  3. Transport

Systemic Hypothermia:

  1. 100% O2
  2. IV TKO
  3. Rewarm
    - Hot packs in towels and placed on axilla, groin, neck, thorax
  4. Transport

Severe Hypothermia:

  1. Handle with extreme care and transport
  2. 100% O2
  3. IV TKO
21
Q

Pediatric Drowning (75)

A
  1. Assess CABs
  2. Assess for hypothermia
    Adequate Respiratory Effort:
  3. 100% O2
  4. Spinal precautions
  5. Rewarm/remove clothes
  6. IV
  7. Cardiac monitor
  8. Transport

Inadequate Respiratory Effort:

  1. Ventilate with BVM and 100% O2 (20-30 breaths per minute) and transport
  2. Obstructed airway= Ped Respiratory Arrest Protocol (67) or Ped Cardiac Arrest Protocol (62)

Paramedic (34 decks)

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