Pediatric Protocols Flashcards Preview

Paramedic San Diego Protocols > Pediatric Protocols > Flashcards

Flashcards in Pediatric Protocols Deck (26)
Loading flashcards...
1

AIRWAY OBSTRUCTION PEDIATRIC

BLS

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.

2

AIRWAY OBSTRUCTION PEDIATRIC

ALS

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

3

ALTERED NEUROLOGIC FUNCTION (NON-TRAUMATIC) PEDIATRIC

BLS

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.

4

ALTERED NEUROLOGIC FUNCTION (NON-TRAUMATIC) PEDIATRIC

ALS

• 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

5

ALLERGIC REACTION/ANAPHYLAXIS PEDIATRIC 

BLS

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

6

ALLERGIC REACTION/ANAPHYLAXIS PEDIATRIC 

ALS

• 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

7

ENVENOMATION INJURIES PEDIATRIC 

BLS

• 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

8

ENVENOMATION INJURIES PEDIATRIC 

ALS

• IV SO adjust prn

• Treat pain as per Pain Management Protocol (S- 173)

9

POISONING/OVERDOSE PEDIATRIC

BLS

• 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

10

POISONING/OVERDOSE PEDIATRIC

ALS

• 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

11

NEWBORN DELIVERIES PEDIATRIC 

BLS

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.

12

NEWBORN DELIVERIES PEDIATRIC 

ALS

• 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

13

RESPIRATORY DISTRESS PEDIATRIC 

BLS

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

14

RESPIRATORY DISTRESS PEDIATRIC 

ALS

• 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

15

SHOCK PEDIATRIC 

ALS 

 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.

16

SHOCK PEDIATRIC 

BLS 

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

TRAUMA PEDIATRIC 

BLS

  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

TRAUMA PEDIATRIC 

ALS

  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

BURNS PEDIATRIC 

BLS

• 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

BURNS PEDIATRIC 

ALS

• 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

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

 

BLS 

 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

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

 

ALS 

 Monitor EKG
 Obtain blood glucose prn 

 IV SO prn

23

PAIN MANAGEMENT PEDIATRIC 

BLS

Assess level of pain

Ice, immobilize and splint

when indicated Elevation of extremity trauma when indicated

24

PAIN MANAGEMENT PEDIATRIC 

ALS

• 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

GI/GU (NON-TRAUMATIC) PEDIATRIC

ALS

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

GI/GU (NON-TRAUMATIC) PEDIATRIC

BLS

• Ensure patent airway 

• O2 Saturation SO prn

 • NPO