New Pediatric Protocols - 1-1-17

Question 1

Any patient under what age is considered a “pediatric patient?”

Answer 1

15 years

Question 2

Explain the three parts of the Pediatric Assessment Triangle (PAT).

Answer 2

Appearance:
- TICLES mnemonic
Work of breathing -
Circulation -

Question 3

Explain the “TICLES” mnemonic

Answer 3

This is the appearance portion of the PAT. They might be “alert,” by AVPU, but still ill.

T - Muscle tone
I - Interactiveness with others
C - Consolability - Can they be consoled by caregiver?
L - Look/gaze - “glazed over?”
E - “empty”
S - Speech/cry - Is it a strong cry? Confused/garbled?

Question 4

Explain the “Work of breathing” portion of the PAT

Answer 4

Abnormal airway sounds?
Abnormal position?
Retractions?
Flaring of nostrils?

Question 5

Explain the “Circulation” portion of the PAT

Answer 5

Pallor - white/pale skin
Mottling - Patchy skin 2/2 to vasoconstriction OR vasodilation
Cyanosis - bluish discoloration of skin/mucous membranes

Question 6

Why is monitoring for shock important in children?

Answer 6

Children have excellent compensatory mechanisms. They will maintain normal vital signs for quite some time, until they are unable to maintain perfusion.

Question 7

The “first line” drug for control of pediatric pain is ____.

a. Aspirin
b. Ketoralac
c. Morphine
d. Fentanyl

Answer 7

c. morphine

Question 8

Current AHA guidelines for pediatric arrest includes what ventilation:compression ratio in two rescuer CPR?

Answer 8

15:2 w/o advanced airway.

Question 9

Under what heart rate do you begin pediatric CPR?

A. 30 BPM
B. 40 BPM
C. 50 BPM
D. 60 BPM

Answer 9

D. 60 BPM

Question 10

If pediatric defibrillation pads are unavailable, how should adult pads be placed on the pediatric patient?

Answer 10

Anterior-posterior placement

• Anterior: center of chest
• Posterior: back between shoulder pads

Question 11

Initial dose of V-fib/Pulseless V-tach for pediatric patients.

Answer 11

2 J/kg

Question 12

What is the MINIMUM dose of pediatric 1:10,000 IV/IO epinephrine in cardiac arrest?

Answer 12

0.1 mg (0.1 mg/mL)

Formulation:
1 mg/10mL = 0.1mg/mL

Question 13

For refractory V-fib/V-tach, what drug is administered in pediatric patients?

Answer 13

5 mg/kg IV/IO amiodarone

Question 14

In the pediatric patient, what is the second dose of defibrillation?

Answer 14

4 J/kg

Question 15

In the pediatric patient, what are the treatments of hypoglycemia?

Answer 15

0-1 month: dilute D25 1:1 with sterile water, 2 mL/kg IV/IO
1 month - 2 years: D25 2mL/kg IV/IO
Over 2 years: D50 2 ml/kg IV/IO

Question 16

Which of the following accounts for the largest amount of pediatric seizures?

A. Fever
B. Hypoglycemia
C. Trauma
D. Overdose

Answer 16

A. Fever

Question 17

What is the IN/IM dose of Midazolam for pediatric patients?

Answer 17

0.2 mg/kg IN/IM over 1 minute

Question 18

What is the IO/IV dose of pediatric Midazolam for seizures?

Answer 18

0.1 mg/kg IO/IV

Question 19

Epinephrine SQ for pediatric patients.

a. 0.01 mg/kg SQ 1:1000
b. 0.1 mg/kg SQ 1:1000
c. 0.001 mg/kg SQ 1:000
d. 1 mg/kg SQ 1:000

Answer 19

a. 0.01 mg/kg SQ 1:1000

Question 20

Epinephrine IV for pediatric patients with allergic reaction/anaphylaxis

a. 0.01 mg/kg IV 1:10,000
b. 0.1 mg/kg IV 1:10,000
c. 0.001 mg/kg IV 1:100,00
d. 1 mg/kg IV 1:100,000

Answer 20

a. 0.01 mg/kg IV 1:10,000

Question 21

IV fluid therapy for pediatric patients in anaphylaxis/allergic reaction with hypotension.

Answer 21

20 mL/kg

Question 22

In the event of a pediatric patient is found to be contaminated, what must be done to remove up to 90% of the contaminant?

a. Remove the pt’s clothing
b. Irrigate the entire body with 1L NS
c. Irrigate the entire body with 1L sterile water
d. Brush off all visible contaminants from the pt’s clothing

Answer 22

a. Remove the pt’s clothing

Question 23

With a medical control order, a pediatric patient may be given ____ in the event of a KNOWN ASA/TCA overdose.

a. 1 gm CaCl2 IV
b. 1 mEq/kg sodium bicarb IV
c. 2mL/kg D50 IV

Answer 23

b. 1 mEq/kg sodium bicarb IV

NaHCO3 acts to neutralize (HCO3-) the excess H+ produced through TCA/ASA ingestion.

Question 24

In the event of nerve agent/organophosphate exposure in the pediatric patient, what should be given after establishing contact with medical control?

a. 1 gm CaCl2 IV
b. 1 mEq/kg sodium bicarb IV
c. 2mL/kg D50 IV
d. 0.02 mg/kg atropine IV

Answer 24

d. 0.02 mg/kg atropine IV

Question 25

Overall care for the injured pediatric patient involves:

a. oxygenation
b. rapid transport
c. blood glucose monitoring
d. cardiac monitoring

Answer 25

b. rapid transport