This document provides pediatric protocols for childbirth, neonatal resuscitation, and pediatric dysrhythmias for Sacramento County EMS. For childbirth, it outlines steps for transporting mothers in various positions, managing abnormal presentations, delivering the newborn, assessing the newborn with APGAR scores, and treating the mother post-delivery. For neonatal resuscitation, it details assessing and clearing the airway, warming and stimulating the newborn, and steps for providing positive pressure ventilation and medications if the heart rate is below thresholds. For pediatric dysrhythmias like bradycardia, tachycardia, and cardiac arrest, it lists the order of performing CPR, airway management, IV/IO access,
This document outlines updates made to pre-hospital protocols in Southwest Ohio. Key changes include:
- Creation of new protocols for advanced EMT scope of practice and use of EMS units as transport vehicles.
- Revisions to trauma, medical, pediatric and toxicological protocols based on new evidence and guidelines.
- Addition of protocols for push dose epinephrine, over-the-counter medications, submersion injuries, tranexamic acid and spinal immobilization.
- Revisions to airway management procedures emphasizing supraglottic airways and positioning for airway compromise.
This study compared pediatric drug dosages in 38 EMS protocols to those listed on the Broselow Length-Based Tape. The researchers found significant discrepancies, with 49% of medications listed at incongruent doses on the tape and 38% of medications missing from the tape altogether. The most commonly missing medications were ondansetron, diphenhydramine, morphine, and albuterol. The medications most often listed at incorrect doses were epinephrine IM, midazolam, fentanyl, and diazepam. The study concluded that a significant discrepancy exists between pediatric drug dosages in EMS protocols and those on the Broselow tape.
- The document summarizes changes to prehospital treatment protocols as presented by REMO Medical Advisory Committee, including:
- Epinephrine administration moved to AEMT level for cardiac arrest. Sodium bicarbonate recommended if acidosis suspected as primary cause.
- Norepinephrine replaces dopamine as pressor for shock. It requires saline bolus before administration.
- Ketamine and haloperidol added as options for excited delirium and procedural sedation by paramedics with online medical control approval.
- Hypoglycemia defined as blood glucose below 60mg/dL. Clinical judgement still important.
- Other clarifications and emphasis on interventions for conditions like asthma, anaphylaxis,
Office Preparedness For Pediatric EmergenciesDang Thanh Tuan
This document provides guidance for medical office preparedness for pediatric emergencies. It outlines objectives like recognizing emergencies, ensuring staff preparation, choosing appropriate equipment, updating provider skills, and maintaining readiness. It describes a scenario of an infant experiencing difficulty breathing in a medical office. It asks questions about staff preparedness and recommends training receptionists to identify issues, having emergency equipment and medications available, and calling 911 to access local emergency response. The document provides lists of signs of emergencies, recommended emergency equipment, and ways to practice and maintain skills like through mock codes and documentation.
This document provides a summary of changes made to the Massachusetts Statewide EMS Protocols. Key changes include:
1. Allowing paramedics to access PICC lines for medication administration in critical patients with no other vascular access.
2. Requiring infusion pumps to meet minimum standards and capabilities when being used to administer medications like norepinephrine.
3. Expanding the scope of practice for some providers to administer epinephrine intramuscularly for conditions like anaphylaxis and bronchospasm.
4. Adding ketamine to the options for treating severely agitated patients for paramedics.
5. Updating glucose and vasopressor dosing amounts in some protocols
This document summarizes changes to the Rhode Island Emergency Medical Services Statewide EMS Protocols from October 2016. It includes:
- This is a new section with 24 protocols, separate pediatric protocols, and new PEARLS educational guidelines.
- Protocols are reorganized with new and renamed sections. Protocol numbers and titles are listed with their corresponding previous protocol section when applicable.
- Summaries of selected protocol changes are provided showing adjustments to medications, dosages, and treatment guidelines. The Altered Mental Status and Respiratory Distress protocols provide examples of pediatric and adult divisions.
This document provides an overview of the Ministry of Health (MOH) Formulary system in Saudi Arabia. It discusses the role of the Pharmacy and Therapeutics Committee in evaluating drugs for inclusion in the formulary and establishing policies. The formulary is divided into therapeutic categories with information on each drug. It outlines policies on formulary additions and deletions, restricted drugs, non-formulary drugs, and investigational drugs. It also discusses guidelines for penicillin administration and reporting adverse drug reactions.
This document summarizes changes made to the Rhode Island Emergency Medical Services Statewide EMS Protocols for October 2016. Key points include:
- The Cardiac Protocols section was expanded from 8 to 10 protocols, with 2 new Post Cardiac Arrest Care protocols added for adults and pediatrics.
- Many of the previous protocols were reorganized and renamed for clarity.
- The protocols provide standing orders and guidelines for emergency responders at different certification levels to manage cardiac emergencies, cardiac arrest, dysrhythmias, and post-resuscitation care for both adults and pediatrics.
- The protocols detail treatments and interventions that can be performed at each response level, from basic
This document outlines updates made to pre-hospital protocols in Southwest Ohio. Key changes include:
- Creation of new protocols for advanced EMT scope of practice and use of EMS units as transport vehicles.
- Revisions to trauma, medical, pediatric and toxicological protocols based on new evidence and guidelines.
- Addition of protocols for push dose epinephrine, over-the-counter medications, submersion injuries, tranexamic acid and spinal immobilization.
- Revisions to airway management procedures emphasizing supraglottic airways and positioning for airway compromise.
This study compared pediatric drug dosages in 38 EMS protocols to those listed on the Broselow Length-Based Tape. The researchers found significant discrepancies, with 49% of medications listed at incongruent doses on the tape and 38% of medications missing from the tape altogether. The most commonly missing medications were ondansetron, diphenhydramine, morphine, and albuterol. The medications most often listed at incorrect doses were epinephrine IM, midazolam, fentanyl, and diazepam. The study concluded that a significant discrepancy exists between pediatric drug dosages in EMS protocols and those on the Broselow tape.
- The document summarizes changes to prehospital treatment protocols as presented by REMO Medical Advisory Committee, including:
- Epinephrine administration moved to AEMT level for cardiac arrest. Sodium bicarbonate recommended if acidosis suspected as primary cause.
- Norepinephrine replaces dopamine as pressor for shock. It requires saline bolus before administration.
- Ketamine and haloperidol added as options for excited delirium and procedural sedation by paramedics with online medical control approval.
- Hypoglycemia defined as blood glucose below 60mg/dL. Clinical judgement still important.
- Other clarifications and emphasis on interventions for conditions like asthma, anaphylaxis,
Office Preparedness For Pediatric EmergenciesDang Thanh Tuan
This document provides guidance for medical office preparedness for pediatric emergencies. It outlines objectives like recognizing emergencies, ensuring staff preparation, choosing appropriate equipment, updating provider skills, and maintaining readiness. It describes a scenario of an infant experiencing difficulty breathing in a medical office. It asks questions about staff preparedness and recommends training receptionists to identify issues, having emergency equipment and medications available, and calling 911 to access local emergency response. The document provides lists of signs of emergencies, recommended emergency equipment, and ways to practice and maintain skills like through mock codes and documentation.
This document provides a summary of changes made to the Massachusetts Statewide EMS Protocols. Key changes include:
1. Allowing paramedics to access PICC lines for medication administration in critical patients with no other vascular access.
2. Requiring infusion pumps to meet minimum standards and capabilities when being used to administer medications like norepinephrine.
3. Expanding the scope of practice for some providers to administer epinephrine intramuscularly for conditions like anaphylaxis and bronchospasm.
4. Adding ketamine to the options for treating severely agitated patients for paramedics.
5. Updating glucose and vasopressor dosing amounts in some protocols
This document summarizes changes to the Rhode Island Emergency Medical Services Statewide EMS Protocols from October 2016. It includes:
- This is a new section with 24 protocols, separate pediatric protocols, and new PEARLS educational guidelines.
- Protocols are reorganized with new and renamed sections. Protocol numbers and titles are listed with their corresponding previous protocol section when applicable.
- Summaries of selected protocol changes are provided showing adjustments to medications, dosages, and treatment guidelines. The Altered Mental Status and Respiratory Distress protocols provide examples of pediatric and adult divisions.
This document provides an overview of the Ministry of Health (MOH) Formulary system in Saudi Arabia. It discusses the role of the Pharmacy and Therapeutics Committee in evaluating drugs for inclusion in the formulary and establishing policies. The formulary is divided into therapeutic categories with information on each drug. It outlines policies on formulary additions and deletions, restricted drugs, non-formulary drugs, and investigational drugs. It also discusses guidelines for penicillin administration and reporting adverse drug reactions.
This document summarizes changes made to the Rhode Island Emergency Medical Services Statewide EMS Protocols for October 2016. Key points include:
- The Cardiac Protocols section was expanded from 8 to 10 protocols, with 2 new Post Cardiac Arrest Care protocols added for adults and pediatrics.
- Many of the previous protocols were reorganized and renamed for clarity.
- The protocols provide standing orders and guidelines for emergency responders at different certification levels to manage cardiac emergencies, cardiac arrest, dysrhythmias, and post-resuscitation care for both adults and pediatrics.
- The protocols detail treatments and interventions that can be performed at each response level, from basic
This document summarizes the treatment protocols and transition experience for patients with juvenile idiopathic arthritis (JIA) in Slovenia. It discusses the treat-to-target approach for JIA, which aims for clinical remission. Treatment involves pharmacological interventions, physical therapy, and psychosocial support from a multidisciplinary team with a focus on patient-centered care. The document outlines treatment indications, protocols, and efficacy for medications like methotrexate and biologics. It also describes Slovenia's transition program which aims to transfer pediatric JIA patients to adult care starting in early adolescence through a structured multi-year process.
Stridor is a noisy, high-pitched breathing sound caused by upper airway obstruction. It is common in infants due to their small larynx size and loose tissues. The relationship of stridor to inspiration and expiration can provide clues to its cause. Acute stridor is usually due to inflammation and edema causing supraglottic or subglottic obstruction. Common causes include croup, epiglottitis, and infections. Chronic stridor may be due to congenital abnormalities, neurogenic issues, or tumors. Evaluation involves history, examination, and endoscopy. Management depends on the specific cause but may include antibiotics, steroids, intubation, or surgery.
This document provides information and examples for calculating drug dosages. It discusses reconstituting powdered medications and calculating the amount to administer based on the resulting concentration. It also covers calculating dosages for pediatric patients based on weight, reconstituting multiple strength solutions, and calculating dosages using body surface area (BSA). Safety is emphasized, including an example where a misread decimal point in an order led to a baby receiving an overdose and dying. Formulas are provided for calculating both metric and non-metric BSA for adults and pediatric patients.
This document provides information about the Utah Emergency Medical Services for Children (EMSC) program and its efforts to develop pediatric protocol guidelines for EMS providers in Utah. It discusses the development of 41 pediatric protocols across various categories (medical, trauma, respiratory, etc.) by a team over 10 months. The protocols are meant to serve as guidelines for pre-hospital care of pediatric patients when online medical direction is unavailable. The document outlines a 4 stage plan to rollout and educate providers on the new offline protocols.
This document discusses classical dosage forms, which are conventional dosage forms prepared without advanced techniques. It describes lozenges as medicated candies dissolved in the mouth to soothe throat irritation. Pills are small, round solids containing medication. Cachets enclose medication within a wafer shell. Draughts are single-dose liquid preparations packaged in larger volumes. Suppositories and pessaries are solid medications inserted into orifices to exert local or systemic effects as they dissolve.
This document provides guidance on pediatric dosage calculation, which differs from adult dosage calculation in that doses are based on body weight in kilograms and recommended ranges rather than standard doses. It covers converting weight from pounds to kilograms, writing medication orders, calculating liquid medication doses, reading medication labels, rounding rules, and intravenous drip rates. Practice problems are provided to help learn these concepts.
Here are some potential chains using preferred foods as a starting point to introduce new flavors and textures:
- Yogurt -> Fruit yogurt -> Pudding -> Custard
- Applesauce -> Peaches -> Bananas -> Melon
- Mac and cheese -> Pasta with butter -> Pasta primavera -> Spaghetti
The key is going gradually, one small change at a time, based on the child's acceptance and preferences.
This document outlines the dimensional analysis method for calculating medication dosages and the policies for dosage calculation exams at GCC Nursing Program. It provides examples of identifying the beginning label, ending label, and conversion factors in dosage problems. It also explains setting up the basic dimensional analysis equation. The document emphasizes accurately calculating dosages is essential for patient safety and outlines the requirements and policies for passing dosage calculation exams throughout the nursing courses.
Author: Danielle Cassidy, Pharm.D., BCPS
Audience: Third year pharmacy students at University of Colorado School of Pharmacy
Background: describes common causes of seizures, differentiates dosing of antiepileptic drugs in pediatrics vs. adults, common risk factors associated with febrile seizures, treatment of febrile seizures, treatment of status epilepticus (inpatient & outpatient), & how to dispense/counsel parents on the administration of Diastat.
This document discusses several key points regarding pediatric pharmacy practice:
- Children represent a significant portion of the global population but have poorly developed organ functions and are at higher risk for toxicity and adverse drug reactions. Historical events like the sulfanilamide elixir death and thalidomide tragedy demonstrate this risk.
- Pediatric patients require specialized pharmacist care due to age-related variability in drug absorption, distribution, metabolism, and excretion, as well as higher risk of dosing errors due to non-standard doses, need for compounding and dilutions, and less tolerance for mistakes.
- The roles of pediatric pharmacists include dosing calculations and consultations, medication history reviews, discharge counseling, drug
This document discusses the pediatric airway, including normal anatomy, physiology, airway evaluation, and management of normal versus abnormal airways. It notes that the pediatric airway differs from adults in having a more rostral larynx, relatively larger tongue, angled vocal cords, differently shaped epiglottis, and a funneled larynx with the narrowest part being the cricoid cartilage. Proper evaluation of the pediatric airway involves obtaining a thorough medical history and performing a physical exam to identify any signs of impending respiratory failure. Life-threatening causes of acute upper airway obstruction include epiglottitis, retropharyngeal abscess, and foreign body aspiration.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
This document summarizes the treatment protocols and transition experience for patients with juvenile idiopathic arthritis (JIA) in Slovenia. It discusses the treat-to-target approach for JIA, which aims for clinical remission. Treatment involves pharmacological interventions, physical therapy, and psychosocial support from a multidisciplinary team with a focus on patient-centered care. The document outlines treatment indications, protocols, and efficacy for medications like methotrexate and biologics. It also describes Slovenia's transition program which aims to transfer pediatric JIA patients to adult care starting in early adolescence through a structured multi-year process.
Stridor is a noisy, high-pitched breathing sound caused by upper airway obstruction. It is common in infants due to their small larynx size and loose tissues. The relationship of stridor to inspiration and expiration can provide clues to its cause. Acute stridor is usually due to inflammation and edema causing supraglottic or subglottic obstruction. Common causes include croup, epiglottitis, and infections. Chronic stridor may be due to congenital abnormalities, neurogenic issues, or tumors. Evaluation involves history, examination, and endoscopy. Management depends on the specific cause but may include antibiotics, steroids, intubation, or surgery.
This document provides information and examples for calculating drug dosages. It discusses reconstituting powdered medications and calculating the amount to administer based on the resulting concentration. It also covers calculating dosages for pediatric patients based on weight, reconstituting multiple strength solutions, and calculating dosages using body surface area (BSA). Safety is emphasized, including an example where a misread decimal point in an order led to a baby receiving an overdose and dying. Formulas are provided for calculating both metric and non-metric BSA for adults and pediatric patients.
This document provides information about the Utah Emergency Medical Services for Children (EMSC) program and its efforts to develop pediatric protocol guidelines for EMS providers in Utah. It discusses the development of 41 pediatric protocols across various categories (medical, trauma, respiratory, etc.) by a team over 10 months. The protocols are meant to serve as guidelines for pre-hospital care of pediatric patients when online medical direction is unavailable. The document outlines a 4 stage plan to rollout and educate providers on the new offline protocols.
This document discusses classical dosage forms, which are conventional dosage forms prepared without advanced techniques. It describes lozenges as medicated candies dissolved in the mouth to soothe throat irritation. Pills are small, round solids containing medication. Cachets enclose medication within a wafer shell. Draughts are single-dose liquid preparations packaged in larger volumes. Suppositories and pessaries are solid medications inserted into orifices to exert local or systemic effects as they dissolve.
This document provides guidance on pediatric dosage calculation, which differs from adult dosage calculation in that doses are based on body weight in kilograms and recommended ranges rather than standard doses. It covers converting weight from pounds to kilograms, writing medication orders, calculating liquid medication doses, reading medication labels, rounding rules, and intravenous drip rates. Practice problems are provided to help learn these concepts.
Here are some potential chains using preferred foods as a starting point to introduce new flavors and textures:
- Yogurt -> Fruit yogurt -> Pudding -> Custard
- Applesauce -> Peaches -> Bananas -> Melon
- Mac and cheese -> Pasta with butter -> Pasta primavera -> Spaghetti
The key is going gradually, one small change at a time, based on the child's acceptance and preferences.
This document outlines the dimensional analysis method for calculating medication dosages and the policies for dosage calculation exams at GCC Nursing Program. It provides examples of identifying the beginning label, ending label, and conversion factors in dosage problems. It also explains setting up the basic dimensional analysis equation. The document emphasizes accurately calculating dosages is essential for patient safety and outlines the requirements and policies for passing dosage calculation exams throughout the nursing courses.
Author: Danielle Cassidy, Pharm.D., BCPS
Audience: Third year pharmacy students at University of Colorado School of Pharmacy
Background: describes common causes of seizures, differentiates dosing of antiepileptic drugs in pediatrics vs. adults, common risk factors associated with febrile seizures, treatment of febrile seizures, treatment of status epilepticus (inpatient & outpatient), & how to dispense/counsel parents on the administration of Diastat.
This document discusses several key points regarding pediatric pharmacy practice:
- Children represent a significant portion of the global population but have poorly developed organ functions and are at higher risk for toxicity and adverse drug reactions. Historical events like the sulfanilamide elixir death and thalidomide tragedy demonstrate this risk.
- Pediatric patients require specialized pharmacist care due to age-related variability in drug absorption, distribution, metabolism, and excretion, as well as higher risk of dosing errors due to non-standard doses, need for compounding and dilutions, and less tolerance for mistakes.
- The roles of pediatric pharmacists include dosing calculations and consultations, medication history reviews, discharge counseling, drug
This document discusses the pediatric airway, including normal anatomy, physiology, airway evaluation, and management of normal versus abnormal airways. It notes that the pediatric airway differs from adults in having a more rostral larynx, relatively larger tongue, angled vocal cords, differently shaped epiglottis, and a funneled larynx with the narrowest part being the cricoid cartilage. Proper evaluation of the pediatric airway involves obtaining a thorough medical history and performing a physical exam to identify any signs of impending respiratory failure. Life-threatening causes of acute upper airway obstruction include epiglottitis, retropharyngeal abscess, and foreign body aspiration.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
Kosmoderma Academy, a leading institution in the field of dermatology and aesthetics, offers comprehensive courses in cosmetology and trichology. Our specialized courses on PRP (Hair), DR+Growth Factor, GFC, and Qr678 are designed to equip practitioners with advanced skills and knowledge to excel in hair restoration and growth treatments.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
2. PT NOT YET DELIVERED
CHILDBIRTH
-Transport mother in Left Lateral Recumbent position to appropriate facility.
**ALS-If Pt (mother) hemodynamically unstable-Obtain IV access with NS; titrate to a systolic blood pressure between 90 - 100 mm Hg.
O2- Airway- Transport in proper position
ABNORMAL PRESENTATION
-(i.e. foot, buttocks, hand or face), place patient in the knee-chest or left lateral position. IMMEDIATE TRANSPORT.
DELIVERY IN PROGRESS
-Control descent of fully crowned head with your hand over the cranium.
-Suction mouth and nose with bulb syringe before newborn takes 1st breath. Ensure - cord around neck
*If the cord is around the neck, gently slip it over the head or shoulder if possible.
-If the cord cannot be removed, gently clamp the cord in two locations approximately 1cm apart and cut the cord between the clamps
-Support the head; keep pressure off the cord ***Prepare to transport immediately.
When the head is delivered, it will rotate naturally to face laterally. Gently lower the head to deliver the anterior (upper) shoulder.
-When the upper shoulder is delivered, raise the head to deliver the lower shoulder. The remainder of the baby’s body should then deliver smoothly.
-Suction the mouth first, then the nose. Hold baby in slightly head down position.
-Clamp and cut the cord with scissors/scalpel. Leave a minimum of six (6) inches of cord for the umbilicus.
*Do not delay drying and warming the newborn
DELIVERY PTA OF EMS, OR ALS
-If resuscitation not necessary, suction mouth then nose w/ bulb syringe then dry and place newborn skin to skin with mother, apply cap to baby's head.
-Clamp and cut cord, leaving 6” from umbilicus, warm baby first.
*Begin cardiopulmonary resuscitation as needed. See NEONATAL RESUSCITATION
** ALS-If mother’s B/P < 90, heavy bleeding or signs of shock, refer to SHOCK protocol.
-Massage abdomen over the uterus (fundus) to aid in contraction. Putting the infant to the mother's breast (if infant's condition allows) will also stimulate contraction.
-DO NOT attempt to deliver placenta, if delivered, bag and transport in with mother.
PROLAPSED CORD VISIBLE AT PERINEUM
-High flow O2, place in Knee-Chest position, insert a gloved hand into the vagina and gently push the presenting part off of the cord.
If head is crowning with the prolapsed cord, immediate delivery is the most rapid means of restoring oxygen to the infant. If an abnormal presentation is noted- TRANSPORT.
Trigger Points:
-Of all 11 hospitals, only KHN and SGH are NON-L&D hospitals. (so do not transport there)
- The vast majority of deliveries are completely uncomplicated and require minimal, if any, assistance-The major life threats are prenatal/neonatal asphyxia and maternal
hemorrhage.
- Neonatal hypothermia is an easily preventable threat.
APGAR-Assess at birth and at five (5) minutes after birth.
If APGAR of 7 or greater - dry, place skin to skin with mother or if mother refuses, wrap and keep warm. Admin. blow-by oxygen w/ trans. NEONATAL protocol as needed
SIGN 0 1 2
APPEARANCE COLOR CENTRAL CYANOSIS PERIPHERAL NORMAL
PULSE HEART RATE ABSENT CYANOSIS
<100 (SLOW) > 100
GRIMACE REFLEX - RESPONSE + GRIMACE COUGH/SNEEZE
ACTIVITY MUSCLE TONE LIMP SOME MOVEMENT ACTIVE MOTION
RESPIRATIONS RESPIRATIONS ABSENT IRREGULAR/SLOW +CRYING
3. PEDIATRIC PARAMETERS
RESPIRATORY ET TUBE
AGE WEIGHT (KG) HEART RATE SYSTOLIC B/P ET TUBE SIZE BLADE #
RATE DEPTH
DIFFICULT TO
PREMIE <3 100-190 40-60 2.5 7 0-STRAIGHT
OBTAIN
NEONATE 3-4 90-190 30-60 50-70 3.5 9 1-STRAIGHT
6 MONTHS 5-7 80-180 25-40 60-110 3.5 11 1-STRAIGHT
1 YEAR 10 80-150 20-40 70-110 4.0 12 1-STRAIGHT
3-4 YEARS 15 80-140 20-30 80-115 5.0 16 2-STRAIGHT
5-6 YEARS 20 70-120 20-25 80-115 5.5-6.0 16 2-STRAIGHT
7-8 YEARS 25 70-110 20-25 85-120 5.5-6.0 18 2-3
11-12 YEARS 35 60-110 15-20 95-135 5.5-7.0 20 2-3
CAVEATS:
A) Unless otherwise stated, pediatric protocols apply to patients 14 AND under. If no known age, work based off pt’s physical signs (puberty, adolescence) boys-armpit
hair girls-breast development
B) V/S vary with age, with children BP increases with age, HR decreases with age. Around 12 years old V/S more comparable with Adults
C) Hypotension, late sign of shock, indicates imminent Cardiorespiratory arrest. Children may lose up to 25% of blood volume before becoming hypotensive
D) For ages not listed above use judgement
E) Broselow Tape is very helpful in Pt weight determination and proper drug dose administration
5. NEONATAL RESUSCITATION
-Assess for meconium staining: if newborn not vigorous (HR >100bpm, + respiratory effort and
good muscle tone- Tracheal Suction w/ ET tube and Meconium Aspirator.
*Meconium-Important to clear airway w/ suction before stimulating newborn to breath
-Suction the airway (Mouth then Nose)
-Dry Newborn
-Stimulate newborn and Warm w/ blanket.
Assessment
- If breathing inadequate -OR- Cyanotic then PPV w/ O2 @ 40-60 ensuring + chest rise
HEART RATE > 100 BPM
-Monitor breathing, O2 w/ flow as needed, Transport
HEART RATE < 100 BPM
-PPV w/ O2 @40-60/min ensuring + chest rise. *30 seconds then reassess, (use proper size BVM)
-Airway adjuncts as needed. * most bradycardias corrected w/ good ventilation 100% O2.
-ECG monitor and Transport
HEART RATE < 60 BPM
-PPV w/ O2 @40-60/m ensuring + chest rise. *30 seconds then reassess, (use proper size BVM)
-Intubate and ventilate 100% O2. *PPV acceptable alternative to ETI if good seal present
-ECG monitoring, ***If HR remains below 60bpm after 30seconds of BVM
-Chest compressions 3:1 (90c/30v) for ~120 events/min
After 30 sec PPV/Comp and still <60HR: Epinephrine 1:10,000- .01mg/kg IV/IO q 3-5 until >80bpm
TRANSPORT
6. PEDIATRIC DYSRHYTHMIAS
BRADYCARDIA
ABC’s, Oxygen, Attach ECG Monitor
Begin Chest Compressions if HR <60 BPM post O2/Ventilation
ALS Airway as needed
Establish IV/IO Access
EPINEPHRINE 0.01mg/kg IV/IO 1:10,000 q 3-5 min
ATROPINE 0.02 mg/kg IV/IO q 3-5
(minimum dose 0.1mg, max single dose of 1.0mg)
TRANSCUTANEOUS PACING @80-100 BPM adjust mA to capture
TRANSPORT
VENTRICULAR TACHYCARDIA >150 BPM
Assess ABC’s, Oxygen, ECG monitor
ALS Airway as needed
If normal perfusion- Valsalva Maneuver, Transport
If not, Consider IV w/ fluid challenge 20ml/kg if possibly hyppovolemic
If perfusion diminished or Pt poorly responsive, See BASE ORDER BELOW
NARROW TACHYCARDIA >220BPM
Assess ABC’s, Oxygen, ECG monitor
ALS Airway as needed
If normal perfusion-Transport
If not, Establish IV/IO Access
If perfusion diminished or Pt poorly responsive, See BASE ORDER BELOW
BASE HOSPITAL ORDER: PERFUSION DIMINISHED OR POORLY RESPONSIVE PT
-VERSED 0.1mg/kg, not to exceed 1mg, SLOW IVP/IM
SYNCHRONIZED CARDIOVERSION-
1 Joules/kg, check rhythm, if no response then,
SYNCHRONIZED CARDIOVERSION-
2 Joules/kg, check rhythm, if no response then,
SYNCHRONIZED CARDIOVERSION-
4 Joules/kg, check rhythm, if no response then...
--TRANSPORT--
7. PEDIATRIC CARDIAC ARREST Assess responsiveness, spontaneous respirations and pulses
Initiate CPR
BVM 100% O2 @15 lpm w/ BLS airway
Attach Monitor and prepare for immediate transport
VF/VT PEA/ ASYSTOLE
DEFIBRILLATE @ 2J/KG Intubate w/ 100% O2
Check rhythm-Shockable? Establish IV/IO access- give 20 ml/kg of NS bolus (may rpt
If so; DEFIBRILLATE @ 4J/KG x2)*TKO post bolus
Intubate w/ 100% O2 EPINEPHRINE 1;10,000 - 0.01mg/kg IV/IO q 3-5
Establish IV/IO access- give 20 ml/kg of NS bolus TRANSPORT
EPINEPHRINE 1;10,000 - 0.01mg/kg IV/IO q 3-5
DEFIBRILLATE @4J/KG
SEARCH FOR & TREAT H’S/T’S
LIDOCAINE 1.0 mg/kg IV/IO (max 100mg)
-HYPOVOLEMIA
DEFIBRILLATE @4J/KG
-HYPOXIA
TRANSPORT
-HYDROGEN ION (ACIDOSIS)
***DO 5 Cycles (~2 mins) CPR post Shock THEN reassess for return spontaneous circulation -HYPO-HYPERKALEMIA
-HYPOGLYCEMIA
-HYPOTHERMIA
-TOXINS
-TAMPONADE-CARDIAC
-TENSION PNEUMOTHORAX
POST RESUSCITATION CONSIDERATIONS -THROMBOSIS
1.IV fluids should be placed TKO unless Hypotension exists -TRAUMA
-Bradycardia- tx per protocol
-Hypotension/Shock
-20 ml/kg NS, may repeat once, reassess v/s post each bolus
-assess Cap Refill 2 secs, brachial/femoral pulses (absent/weak/present)
-Systolic BP for >1 year
a. 90mmHg + (2x age in years)
b. 70mmHg + (2x age in years) LOWER END
BASE HOSPITAL ORDER ONLY:
DOPAMINE @ 10mcg/kg/min, if Hypotensive
8. PEDIATRIC AIRWAY OBSTRUCTION/RESPIRATORY ARREST
PARTIAL AIRWAY OBSTRUCTION BY F.B.O.-Conscious
Able to speak, cry or cough
-REASSURE PT- Encourage coughing
-OXYGEN- Administered as indicated
-SUCTION- Per need to control secretions
-Transport in position of comfort
COMPLETE AIRWAY OBSTRUCTION BY F.B.O.-Conscious
Unable to speak, cry or cough
-AGE 1 and UNDER- Back blows/Chest Thrusts, 5 each alternating
-AGE 1 and OVER- Heimlich, abdominal thrusts, reassess.
If not clear repeat until pt unconscious, OXYGEN + TRANSPORT IF Airway cleared
AIRWAY OBSTRUCTION BY F.B.O.-Unconscious
-Begin chest compressions
-Attempt to visualize airway prior to ventilation attempt to remove any potential FBO. -
blind finger sweeps
ALS-Use proper laryngoscope blade and Magill forceps
-Begin ventilations
-Transport pt along with FBO removed from airway
RESPIRATORY ARREST
ABC’S w/ O2, if airway obstructs, go to that protocol
TRANSPORT
Intubate w/ 100% O2
Attempt IV/IO access TKO
Blood Sugar determination
DEXTROSE-0.5gm/kg of 25% IV to max of 25g if <60 mg/dl
9. PEDIATRIC RESPIRATORY DISTRESS
ASTHMA/BRONCHOSPASM
MILD/MODERATE- PT’S w/ intercostal retractions, nasal flaring and >2 sec cap refill
O2 flow as needed, Transport
ALBUTEROL 2.5mg HHN; reassess after first tx, rpt as needed based on reassessment
SpO2-titrate >92%
ECG Monitoring
SEVERE- Pt may be unable to speak, have decreased/elevated v/s (SBP/Pulse) or AMS
BLS/ALS Airway as needed, high flow O2, Transport
SpO2-titrate >92%
ALBUTEROL 2.5mg HHN continuously
EPINEPHRINE 0.01mg/kg 1;10,000 SC, to max .3ml (1mg/ml solution)
Establish IV access w/ NS @ TKO. Not to take precedence over Alb/Epi admin
ECG Monitoring
CROUP/STRIDOR
MILD/MODERATE-Slow onset, barking cough, fever and respiratory stridor. *Unilateral stridor may be due to bronchial FBO
BLS Airway as needed, Oxygen, Transport in position of comfort
NS: 3ml HHN, Reassess after 1st Treatment
SEVERE- Pt unable to speak, pt may have decreased/elevated v/s (SBP/Pulse); Mental status is altered. *Unilateral stridor may be due to bronchial FBO
BLS/ALS Airway as needed
SpO2-titrate >92%
EPINEPHRINE 0.01mg/kg 1;10,000 SC, to max .3ml (1mg/ml solution)
Establish IV access w/ NS @ TKO. Not to take precedence over Epi admin
ECG Monitoring
10. ALLERGIC REACTION/ANAPHYLAXIS
ALLERGIC REACTION
Local response to an antigen, involves skin (rash, hives, edema) w/ normal v/s. ANY airway involvement (wheezing, stridor, oral/facial
edema) will be treated as Anaphylaxis. Reassess often and prepare to tx for Anaphylaxis.
Oxygen, Airway adjuncts as needed, Remove sting/injection, Transport w/ Tx simultanously
Consider BENADRYL- 1mg/kg PO, IV, IM to a max of 50mg.
ANAPHYLAXIS
Systemic response to an antigen involving 2 or more organ systems OR any upper/lower airway involvement OR
any derangement in V/S
Oxygen, Airway adjuncts as needed, Remove sting/injection, Transport w/ Tx simultaneously
EPINEPHRINE 0.01mg/kg of 1:1,000 SC to max of 0.3mg, rpt q 15 to max of 3 doses, until
minimal SBP for pt’s age is achieved or + improvement w/ symptoms
Establish IV w/ NS (if hypotensive) 20 ml/kg bolus, reassess after each.
ECG Monitoring
BENADRYL- 1mg/kg IV or IM to a max of 50mg.
ALBUTEROL 2.5mg HHN for wheezing, reassess after 1st tx, rpt as needed
BASE HOSPITAL ORDER ONLY
EPINEPHRINE 0.01 mg increments of 1:10,000, slow IV/IO for stridor AND hypotension, until
minimal SBP reached OR total of 0.01mg/kg given.
11. DECREASED SENSORIUM
SUSPECTED HYPOGLYCEMIA
Suspected hypoglycemia w/ 1) decreased responsiveness (Pedi GCS < 14) OR 2) w/ a Hx of Diabetes
Oxygen, Airway, C-Spine (as needed)
Perform BG determination
Initiate IV w/ NS TKO-titrate SBP
DEXTROSE 0.5g/kg IV push, max of 25g if BS <60
GLUCAGON 0.5 mg IM if BS <60
Oral Glucose if pt able to swallow and +gag reflex, test w/ water first.
TRANSPORT
SUSPECTED NARCOTIC OVERDOSE
Clinical findings may include pin-point pupils, dec sensorium, respiratory depression/insufficiency, bradycardia or hypotension
Oxygen, Airway, C-Spine (as needed), Protect pt if seizing.
Initiate IV w/ NS TKO-titrate SBP
Perform BG determination
NARCAN 0.1mg/kg IV/IM (IM if - IV possibility) titrated to respiratory status or max of 2mg
If - improvement, consider 2 more doses for total of 3. Continuous reassessment
BASE HOSPITAL ORDER ONLY:
NARCAN 0.1mg/kg IN - titrate to respiratory status
ECG Monitoring
TRANSPORT
SEIZURES
Active generalized seizing, focal seizing w/ respiratory compromise or recurrent seizure w/o lucid interval
Oxygen, Airway, C-Spine, Protect PT, Consider cooling if appears febrile in nature
Perform BG determination- if <60, go to hypoglycemia protocol
if - seizure activity, +improvement, continue transport
If seizure activity continues: Initiate IV w/ NS TKO-titrate SBP
Continuous Seizures:
VERSED- 0.1 mg/kg slow IVP/IM (Max of 4.0mg) in 1-2mg increments, titrated to seizure control
IN- 0.2mg/kg (Max of 6.0mg)
TRANSPORT
12. PEDIATRIC OVERDOSE/POISONING
OVERDOSE
Oxygen, Airway adjuncts, Transport
ECG Monitoring
Follow appropriate protocol if PT seizing or is hypotensive
If non-responsive, - gag, - ability to swallow, unstable or unprotected airway, go to Dec. Sensorium
CALCIUM CHANNEL BLOCKER OVERDOSE
Initiate IV/IO w/ NS- TKO rate
FLUID CHALLENGE- 20ml/kg NS if SBP < age appropriate
ATROPINE 0.02mg/kg IV/IO;minimum 0.1mg q 5 for age specific Bradycardia AND Hypotension
EPINEPHRINE-up to 1.0mg in 0.1mg increments:10,000 slow IVP/IO, over 60 seconds if SBP remains low.
Repeat until SBP increases for minimum age.
BETA BLOCKER OVERDOSE
Initiate IV w/ NS- TKO rate
FLUID CHALLENGE- 20ml/kg NS if SBP < age appropriate
ATROPINE 0.02mg/kg IV/IO;minimum 0.1mg q 5 for age specific Bradycardia AND Hypotension
GLUCAGON 0.05 mg/kg IV/IO if HR/SBP below normal for age.
EPINEPHRINE-up to 1.0mg in 0.1mg increments:10,000 slow IVP/IO, over 60 seconds if SBP remains low.
Repeat until SBP increases for minimum age.
TRICYCLIC AND RELATED COMPOUNDS
Initiate IV/IO w/ NS- TKO rate
FLUID CHALLENGE- 20ml/kg NS if SBP < age appropriate
SODIUM BICARBONATE- 1 mEq/kg IV/IO if ANY of following signs of cardiac toxicity:
1) HR 20 bpm >than max for age
2) SBP < Minimum for age
3) QRS > .12 msec
4) Seizures
5) PVC’s > 6/min
13. PEDIATRIC BURNS
TREATMENT
-Remove PT from burn source, also remove burning/smoldering clothing
Oxygen, Airway Adjuncts as needed
ESTABLISH LARGE BORE IV ACCESS
>9% TBSA - 20 ml/kg NS fluid bolus if Hypotensive for age (major burns) IV ACCESS as follows:
1) unburned upper extremity or Jugular
2) unburned lower extremity
3) burned upper extremity
4) burned lower extremity
5) IO infusion if Hypotensive
ECG Monitoring-Follow appropriate Protocol
Assess for inhalation injuries, singed nasal hair, facial/neck/chest burns, soot around mouth, Chemicals suspected
DRY STERILE DRESSINGS TO BE PLACED ON BURNED AREAS
CAUSTIC CHEMICAL BURNS
Remove source, remove all clothing, flush w/ copious amounts of water, DO NOT SCRUB. Wear proper PPE, Sterile water or NS
PAIN MANAGEMENT
If partial OR full thickness w/o evidence or mechanism of internal HEAD, CHEST or ABDOMINAL injury then administer:
MORPHINE 0.1 mg/kg IV/IM for max loading of 10mg, titrate to effect, q 15 on standing orders, MAX 20mg.
***Must contact base hospital for further MS doses.
TRANSPORT GUIDELINES
UCDMC-Partial thickness >9%, ANY electrical/chemical burn, Evidence of poss. Inhalation injury, ANY burn to Face, hands, feet,
genitalia, perineum or major joints
-Look for assossiated injuries, Treat SHOCK if present. DO NOT USE creams/ointments/ice
Child Body Part/% TBS
Palms or hands = 1%
Arm (shoulder to fingertips) = 9%
Head and neck = 18%
Anterior trunk = 18%
Posterior trunk = 18%
Leg (groin to toe) = 14%
14. PEDIATRIC SHOCK
DEFINITION
Where inadequate tissue perfusion is occurring w/ inability to meet the bodies metabolic demands.
S/S: Tachycardia, ALOC, Weak Central Pulses, Weak or Absent peripheral pulses, >4 sec cap refill,
Bradycardia, Hypotension and Irregular respirations
TREATMENT
Oxygen, Airway, Assess/Tx for Trauma (C-Spine?), Maintain Body Temp
ECG Monitoring
ESTABLISH IV/IO ACCESS w/ NS 20 ml/kg fluid bolus, repeat bolus.
Then titrate to a minimal SBP for Pt’s age.
15. PEDIATRIC TRAUMA
GUIDELINES/ T.P.’s
Time on scene not to exceed 10 minutes under normal circumstances
Document occurrences where >10 minute on scene time exists
Tx for Trauma varies from Adults w/ Orthopedic trauma, IV Fluids and Transport Destination
TREATMENT
Oxygen, Airway, ALS Airway as needed, C-Spine, Transport
Establish IV access w/ NS if Hypotensive for age, 20 ml/kg reassess after each bolus. If in extremis then
establish IO. Same fluid bolus. Titrate SBP to minimal SBP for Pt’s age.
1) Amputations- dress stump w/ dry sterile dressing, place part in dry, sterile bag/container and seal closed. Place in melting ice, not
directly on.
2) Evisceration- Cover w/ large saline-soaked dressing-DO NOT replace abdominal contents
3) Flail Chest- Hand or pillow to make Pt more comfortable, remove if respirations deteriorate. Assist ventilations as needed.
4) Hemorrhage Control- Direct Pressure, Immediate transport essential
5) Impaled Object- Only remove if affecting CPR or Respirations, otherwise, secure in place
6) Open chest wounds- Occlusive dressing, if (JVD/-bs on one side/falling SBP/Cyanosis/Tracheal shift/Dyspnea) “Burp” dressing
TENSION PNEUMOTHORAX
1) Decreased LOC
2) Severe Respiratory Distress
3) S/S of Shock
4) Unilateral decreased BS on w/ hx chest trauma
DECOMPRESS SUSPECTED TENSION PNEUMOTHORAX on affected side, 2nd or 3rd intercostal space, mid-clavicular line,
w/ 14g catheter, if other side meets same criteria, Decompress it.
CAVEAT: If you are unable to access 2nd-3rd intercostal, you may go for 4th-5th intercostal Mid-Axillary line
7) Eye Injuries
- Chemical- flush w/ NS profusely until at hospital, remove contacts,
-Trauma- Cover both eyes loosely, avoid pressure to globes, C-Spine?, Position of comfort, Stabilize impaled objects, cover both eyes
8) Head Trauma
- Oxygen, Airway, C-Spine, Transport, Tx SHOCK if present
-Pressure dressing for scalp bleeds
Further Assess: AVPU
16. ORTHOPEDIC TRAUMA
***IF AGE <5 YEARS OLD, CONTACT BASE FOR MORPHINE ADMINISTRATION.
FOR PT’S 5 Years old and above w/ severe pain due to amputation, suspected extremety fx (including hip fx) or dislocations where
ALL of following exist:
1) Severe pain present
2) No Hx of syncope
3) No evidence of head injury and GCS=15
4) No evidence of torso injury upon complete physical exam
5) SBP > age appropriate
MORPHINE 2mg increments @ 1 minute intervals per increment, to a max of 0.1mg/kg OR 10mg
Must meet criteria prior to each incremental dose.
SPLINTING
-If angulated w/ NO pulse- attempt to straighten unless pain/resistance, splint.
-If angulated, STABLE w/ GOOD pulses, Splint in position found unless hinders transport.
-If SEVERELY angulated, gently straighten, check pulse before/after positioning.
Open Fractures- moist, sterile dressings, not to be reduced unless open femur fx. Document presence of open Fx’s.
All Critical Trauma Patients less than 15 years of age :will be transported to UCDMC with exceptions below:
1. Pediatric patients without an effective airway-Transport to nearest available facility for airway establishment.
2. Pediatric trauma patients under CPR will be transported to the time closest trauma facility (MSJ/KHS/SRMC)
**do not use SRMC for “Trauma Base”