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Paramedic San Diego Protocols > Pediatric Protocols > Flashcards

Pediatric Protocols Flashcards

1
Q

AIRWAY OBSTRUCTION PEDIATRIC

BLS

A

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.

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2
Q

AIRWAY OBSTRUCTION PEDIATRIC

ALS

A

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
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3
Q

ALTERED NEUROLOGIC FUNCTION (NON-TRAUMATIC) PEDIATRIC

BLS

A

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.

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4
Q

ALTERED NEUROLOGIC FUNCTION (NON-TRAUMATIC) PEDIATRIC

ALS

A
  • 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

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5
Q

ALLERGIC REACTION/ANAPHYLAXIS PEDIATRIC

BLS

A

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

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6
Q

ALLERGIC REACTION/ANAPHYLAXIS PEDIATRIC

ALS

A
  • 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

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7
Q

ENVENOMATION INJURIES PEDIATRIC

BLS

A

• 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

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8
Q

ENVENOMATION INJURIES PEDIATRIC

ALS

A
  • IV SO adjust prn
  • Treat pain as per Pain Management Protocol (S- 173)
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9
Q

POISONING/OVERDOSE PEDIATRIC

BLS

A
  • 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

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10
Q

POISONING/OVERDOSE PEDIATRIC

ALS

A
  • 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

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11
Q

NEWBORN DELIVERIES PEDIATRIC

BLS

A

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.

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12
Q

NEWBORN DELIVERIES PEDIATRIC

ALS

A
  • 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
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13
Q

RESPIRATORY DISTRESS PEDIATRIC

BLS

A

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

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14
Q

RESPIRATORY DISTRESS PEDIATRIC

ALS

A
  • 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

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15
Q

SHOCK PEDIATRIC

ALS

A

 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.
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16
Q

SHOCK PEDIATRIC

BLS

A

Shock:

o O2 Saturation prn
o O2 and/or ventilate prn
o Control obvious external bleeding o Determine peripheral pulses and capillary refill
o Assess level of consciousness o Obtain baseline temperature
o Keep warm
o Treat associated injuries
o NPO, anticipate vomiting

17
Q

TRAUMA PEDIATRIC

BLS

A

 Ensure patent airway, protecting C-spine

 Control obvious bleeding

 Spinal motion restriction prn (except in penetrating trauma without neurological deficits)

 O2 saturation prn

 O2 and/or ventilate prn

 Keep warm

 Hemostatic gauze

Abdominal Trauma:

o Cover eviscerated bowel with saline pads

Chest Trauma:

o Cover open chest wound with three-sided occlusive dressing; release dressing if suspected tension pneumothorax develops

o Chest seal

Extremity Trauma:

o Splint neurologically stable fractures as they lie. o Use traction splint as indicated.
o Grossly angulated long bone fractures with neurovascular compromise may be reduced with gentle unidirectional traction for splinting .
o Apply tourniquet in severely injured extremity when direct pressure or pressure dressing fails to control life-threatening hemorrhage. SO
o In mass casualty, direct pressure not required prior to tourniquet application.

Impaled Objects:

o Immobilize and leave impaled objects in place
o Remove BHPO
Exception: may remove impaled object in face/cheek, or from neck if there is total airway obstruction

Neurological Trauma (Head & Spine Injuries):

o Assure adequate airway and ventilate without hyperventilation.

Traumatic Arrest:

o CPR
o Consider pronouncement at scene BHPO

18
Q

TRAUMA PEDIATRIC

ALS

A

 Monitor EKG

 IV/IO SO adjust prn

 If MTV IV/IO en route SO

 IV/IO fluid bolus per drug chart for

hypovolemic shock SO. MR to maintain

adequate perfusion SO

 Treat pain as per Pain Management Protocol S-173.

  • *Crush injury with extended compression >2 hours of extremity or torso:**
  • *Just prior to extremity being released:**

o IV/IO fluid bolus per drug chart BHO

o NaHCO3 drug chart IV/IO BHO

Grossly angulated long bone fractures:

o Reduce with gentle unidirectional traction for splinting per SO

Severe respiratory distress (with unilateral diminished breath sounds AND signs of inadequate perfusion:

o Needle thoracostomy BHO

Traumatic Arrest:

o Consider pronouncement at scene BHPO

19
Q

BURNS PEDIATRIC

BLS

A
  • Move to a safe environment
  • Break contact with causative agent
  • Ensure patent airway
  • O2 saturation prn
  • O2 and/or ventilate prn
  • Treat other life-threatening injuries

• Carboxyhemoglobin monitor prn

Thermal Burns:

o Burns of <10% BSA, stop burning with non-chilled saline or water.

o For burns of >10% BSA, cover with dry dressing and keep warm.

o Do not allow patient to become hypothermic.

Chemical Burns:

o Brush off dry chemicals o Flush with copious water

Tar Burns:

o Cool with water
o Transport
o Do not remove tar

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 for unconscious or pregnant patient

20
Q

BURNS PEDIATRIC

ALS

A

• Monitor EKG for significant electrical injury and prn

  • IV/IO SO adjust prn
  • Treat pain as per Pain Management Protocol S-173

For patients with >10% partial thickness or>5% full thickness burns:

5-14 yo:

o 250 ml fluid bolus IV/IO then TKO SO

<5 yo:
o 150 ml fluid bolus IV/IO then TKO SO

In the presence of respiratory distress with bronchospasm:

o Albuterol per drug chart via nebulizer SO. MR SO

Respiratory distress with stridor:

o Epinephrine 1:1,000 per drug chart via nebulizer SO. MR x1 SO

o Epinephrine 1:1,000 per drug chart IM SO MR x2 q5 minutes SO

21
Q

ALTE (APPARENT LIFE-THREATENING EVENT) / BRUE (BRIEF RESOLVED UNEXPLAINED EVENT)

BLS

A

 Ensure patent airway  O2 Saturation prn
 O2 and/or ventilate prn

If trained and available:
 Obtain 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.

22
Q

ALTE (APPARENT LIFE-THREATENING EVENT) / BRUE (BRIEF RESOLVED UNEXPLAINED EVENT)

ALS

A

 Monitor EKG
 Obtain blood glucose prn

 IV SO prn

23
Q

PAIN MANAGEMENT PEDIATRIC

BLS

A

Assess level of pain

Ice, immobilize and splint

when indicated Elevation of extremity trauma when indicated

24
Q

PAIN MANAGEMENT PEDIATRIC

ALS

A

• Continue to monitor and reassess pain as appropriate.
For treatment of pain as needed with signs of adequate perfusion:

• Morphine IV per drug chart SO MR per drug chart BHO

OR
• Morphine IM per drug chart SO MR per drug chart BHO

OR

<10 kg:
• Fentanyl IV/IN per drug chart BHO MR per drug chart BHO

>10 kg:
• Fentanyl IV/IN per drug chart SO 75mcg MR per drug chart BHO

OR
<2 years of age:

• IV Acetaminophen contraindicated

> or equal too 2 years of age:

• IV Acetaminophen per drug chart SO x1 infuse over 15 minutes

Special Considerations:

  1. When changing route of administration requires (e.g., IV to IM or IN to IV)
  2. A change in analgesic while treating a patient requires BHO

BHPO for:

Chronic pain states

Isolated head injury

Acute onset severe headache

Drug/ETOH intoxication

Multiple trauma with GCS <15

Suspected active labor

25
Q

GI/GU (NON-TRAUMATIC) PEDIATRIC

ALS

A

Monitor EKG

IV/IO SO prn

IV fluid bolus for suspected volume depletion per pediatric drug chart SO

Treat pain per Pain Management Protocol (S-173)

Refer to Shock Protocol (S-168) if needed

For nausea or vomiting:
o 6 months - 3 years of age: Zofran 2 mg ODT/IV SO

o Greater than 3 years: Zofran 4 mg ODT/IV SO

o If suspected head injury, Zofran BHPO

26
Q

GI/GU (NON-TRAUMATIC) PEDIATRIC

BLS

A
  • Ensure patent airway
  • O2 Saturation SO prn
  • NPO

Paramedic San Diego Protocols (9 decks)

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