Your SlideShare is downloading. ×
PEDIATRIC PROTOCOLS.doc
PEDIATRIC PROTOCOLS.doc
PEDIATRIC PROTOCOLS.doc
PEDIATRIC PROTOCOLS.doc
PEDIATRIC PROTOCOLS.doc
PEDIATRIC PROTOCOLS.doc
PEDIATRIC PROTOCOLS.doc
PEDIATRIC PROTOCOLS.doc
PEDIATRIC PROTOCOLS.doc
PEDIATRIC PROTOCOLS.doc
PEDIATRIC PROTOCOLS.doc
PEDIATRIC PROTOCOLS.doc
PEDIATRIC PROTOCOLS.doc
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

PEDIATRIC PROTOCOLS.doc

1,555

Published on

0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
1,555
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
60
Comments
0
Likes
1
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. GENERAL GUIDELINE FOR PEDIATRICSThe Pediatric Protocol section refers to infants and small children. All others shall be managed asper Adult Protocol. When in doubt, CONTACT MEDICAL CONTROL.Emphasis in treating the pediatric patient should be placed on the differences with adults. Thefollowing should assist in identifying points of emphasis with Pediatric Patients.Infants are primarily nose breathers – maintain open nasal passages.Respiratory compromise or deficiency is the primary cause of cardiac arrest and arrhythmias inpediatric patients. It is more common to see bradyarrhythmias and Asystole than ventricularirritability. Management emphasis should be placed on airway management and ventilatorysupport.Trauma is the leading cause of death in the pediatric patient. Pediatric patients allow for mobilityand fewer scene delays. Immediate life threatening problems shall be managed briefly on scenewith remaining treatment-performed enroute to the hospital.The Broselow tape or Pedi Wheel should be used to determine medication dosages, if the devicesare not available, use the appropriate protocol for doses.DO NOT use oxygen powered mechanical devices (demand valve) with pediatric patients – use theBVM with supplemental oxygen. P-1
  • 2. ASTHMA / BRONCHIOLITIS (RESPIRATORY DISTRESS)ABC’sAdminister high flow oxygen (humidified if available)Vital signsCardiac monitorEstablish IV NS TKOAdminister Albuterol 2.5 mg via HHNContact Medical Control Consider Epinephrine 1:1,000 at 0.01 mg / kg SQ P-2
  • 3. CROUP / EPIGLOTTITISABC’sAdminister high flow oxygen (humidified if available)Vital signsAvoid attempts at visualizing the vocal cordsCardiac monitorEstablish IV NS TKO (if able to)If croup you may try to remove the patient to cool airContact Medical Control Consider Albuterol 2.5 mg via HHN P-3
  • 4. NEONATAL RESUSCITATIONPosition, suction and stimulate the newborn to initiate respirations.Infant should be placed slightly head down and to the left side to allow drainage.Dry the infant and wrap in clean, dry materials (Silver Swaddler)Keep the infant warmSuction the mouth then the nose thoroughlyFlick the soles of the infant’s feet with the fingers or stroke the baby’s back.If the infant is not crying normally and / or pulse is <100 bpm, use blow by oxygen forapproximately 30 seconds and reevaluate.If infant is not crying normally and pulse is still <100 bpm, ventilate with BVM and supplementoxygen for approximately 30 seconds and reevaluate.If heart rate remains <80 bpm, initiate chest compressions at 120 / minIf heart rate still does not increase after 30 seconds of chest compressions, intubate and ventilatewith supplemental oxygen.If heart rate still does not increase >80 bpm, administer Epinephrine 1:10,000 0.01 to 0.03 mg / kg,IV, IO, ETT or UVC. Additional doses shall be 1:1,000 0.1mg / kg IV, IO, ETT or UVC.Initiate IV or IO NS TKO (Consider umbilical vein catheter with 5 FR cath for premature or 8 FR forterm infant)Consider Narcan 0.1 mg / kgPlace OG tubeCONSIDERATIONS: APGAR should be obtained on the 1st and 5th minute after birth. Hyperextension of the neck could cause obstruction of the infant’s airway. Failure to vent the stomach during BVM ventilations may produce gastric rupture, especially in the premature infants. An OG tube should be attempted, if available, after the first couple of chest compressions. Mechanical suction devices can cause injury to the delicate mucous membranes of the infant. A bulb syringe should be used for the mouth and nose. Neonates have a high glucose demand, if documented hypoglycemia, admin 2 ml / kg of D25. Umbilical vein catheterization should only be done by those trained in this procedure. P-4
  • 5. SEIZURESABC’sAdminister high flow oxygen (humidified if available) Evaluate the respiratory exchange & ventilate w/ BVM and O2 if indicatedProtect patient from injuryEstablish IV NS TKOIf possible febrile seizure cool patient using passive coolingIf patient is not febrile, establish IV or IO NS TKO and obtain Dextrose stick Administer D25 IVP / IO if hypoglycemic <3 year old, 2 cc / kg up to 25 g Age 3 – 14, 1 mg / kg D50 up to 25 g Neonate – Contact Medical Control – possibly D-10If actively seizing administer Diazepam 0.1 mg / kg IV, IO or RectalVital signsContact Medical ControlCardiac monitorCONSIDERATIONS: Febrile seizures are common among pediatric patients between the ages of 6 months and 6 years. Diazepam is given only if the patient is actively seizing. It may be givenrectally with a needleless syringe. Look for other possible causes of seizures, such as, Hypoglycemia, Head Injury, Hypoxia and Overdose. P-5
  • 6. OVERDOSE OR UNCONSCIOUSABC’sAdminister high flow oxygen (humidified if available) Evaluate the respiratory exchange & ventilate w/ BVM and O2 if indicated Maintain open airwayVital signsCardiac monitorEstablish IV NS TKODextrose stick Administer D25 IVP / IO if hypoglycemic <3 year old, 2 cc / kg up to 25 g Age 3 – 14, 1 mg / kg D50 up to 25 gContact Medical Control Administer Narcan 0.1 mg / kg (max dose 2.0 mg)CONSIDERATIONS: Look for possible causes of unconsciousness, such as Hypoglycemia, Head Injury, Hypoxia and Overdose. CONSIDER AIR TRANSPORT OF SERIOUSLY INJURED PEDIATRIC PATIENTS DUE TO LACK OF PEDIATRIC SPECIALIST AT MCKENNA. P-6
  • 7. VENTRICULAR FIBRILLATIONABC’sCPR (until monitor / defibrillator is available)Defibrillate x 3 (2 joules / kg, 2 - 4 joules / kg, and 4 joules / kg) – Confirm V-fibSecure airway – intubateEstablish IV or IOAdminister Epinephrine 1:10,000 0.01 mg / kg IVP / IO / 1:1,000 ETT Repeat dose should be Epinephrine 1:1,000Continue Defibrillation in correspondence to drug administration using either the Drug – Shock –Drug – Shock method or the Drug- Shock, Shock, Shock – Drug methodAdminister Epinephrine 1:1,000 0.1 mg / kg IVP / IO / ETTAdminister Amiodarone 5 mg / kg diluted in 20cc D5W IVP or IOIf patient has known allergy to Amiodarone or ETT is only route available:Administer Lidocaine 1.5 mg / kg IVP, IO or ETTAdminister Sodium Bicarbonate 1 mEq / kg IVPCONSIDERATIONS: After peripheral lines are attempted – initiate Intraosseous Consider doubling the dose of Lidocaine if using the ET tube for administration P-7
  • 8. ASYSTOLEABC’sConfirm in 2 leadsCPRSecure the airway – intubateCardiac monitorEstablish IV or IO NS TKOAdminister Epinephrine 1:10,000 0.01 mg / kg IVP / IO / ETTAdminister Epinephrine 1:1,000 0.1 mg / kg IVP / IO / ETTContact Medical ControlCONSIDERATIONS: After peripheral attempts on IV – initiate Intraosseous Rule out possible causes, such as Hypoxia, Hyperkalemia, Hypokalemia, Acidosis, Drug overdose and Hypothermia P-8
  • 9. PULSELESS ELECTRICAL ACTIVITYABC’sAssess heart tonesCPRSecure the airway – intubateCardiac monitorEstablish IV or IO NS TKOAdminister Epinephrine 1:10,000 0.01 mg / kg IVP / IO / 1:1,000 ETTAdminister Epinephrine 1:1,000 0.1 mg / kg IVP / IO / ETTContact Medical Control Consider Sodium Bicarbonate 1 mEq / kg May repeat Sodium Bicarbonate 1 mEq / kg every 10 minCONSIDERATIONS: After peripheral attempts on IV – initiate Intraosseous Rule out possible causes, such as Hypoxia, Acidosis, Drug overdose, Hypothermia, Hypovolemia, Tension Pneumothorax and Tamponade P-9
  • 10. BRADYARRYTHMIASABC’sAdminister high flow oxygen Assist ventilations as needed with BVM and supplemental oxygenVital signsCardiac monitorEstablish IV or IO NS TKOAdminister Epinephrine 1:10,000 0.01 mg / kg IVP / IO / ETTContact Medical Control Administer Epinephrine 1:1,000 0.1 mg / kg IVP / IO / ETTCONSIDERATIONS: Bradycardia in Pediatrics is often due to under-ventilation consider hyperventilation After 2 peripheral attempts on IV – initiate Intraosseous P - 10
  • 11. VENTRICULAR TACHYCARDIAABC’sIf pulseless, treat as V-fibAdminister high flow oxygen Assist ventilation with BVM and supplemental oxygen if indicatedVital signsCardiac monitorEstablish IV or IO NS TKOAdminister Amiodarone 5 mg / kg diluted in 20 cc D5W, IV or IO over 20 MinutesIf patient has known allergy to Amiodarone or IV / IO is unobtainable and ETT is only admin route:Administer Lidocaine 1.0 mg / kg IVP / IO / ETT Repeat Lidocaine 0.5 mg / kg every 3 – 5 min (maximum dose 3 mg / kg)Contact Medical Control Synchronized cardioversion 0.5 – 1.0 joules / kg Consider sedation prior to cardioversionCONSIDERATIONS: After 2 failed peripheral attempts on IV – initiate Intraosseous Consider doubling the dose of Lidocaine if giving ETT P - 11
  • 12. TRAUMA MANAGEMENT (MULTIPLE TRAUMA)Secure sceneABC’s (C-spine precautions)Administer high flow oxygen Assess respiratory exchange and assist ventilation if needed Intubate earlyVital signsCardiac monitorTransportEstablish IV or IO NS Administer 20 cc / kg fluid bolus Repeat fluid bolus as necessary to maintain BP >80 mmHG systolicContact Medical ControlCONSIDERATIONS: After 2 peripheral IV attempts – initiate interosseous access P - 12

×