Pediatric Toxicological Emergency

P611 If narcotic overdose, naloxone 0.1 mg/kg IV/IM/IN/IO (max 2 mg) If toxin remains on patient, wash or brush off as appropriate. Alert medical control if patient will require further decontamination; patient NOT to be brought through regular Triage. For eye exposure, flush the eyes with 0.9% NaCl for at least 15 min If patient […]

Pediatric Pain Management

P612 For children 5-15 y.o with extremity injury or burn Administer a single dose of either: Fentanyl 1 mcg/kg IV/IO (max 50 mcg for pain) – administer over 3-5 minutes slow IV push to prevent rigid chest Fentanyl 2 mcg/kg intranasal (max 100 mcg for pain) – use the undiluted injectable fentanyl product (100 mcg/2 […]

Pediatric Diabetic Reaction

P608 IF blood glucose is < 70 mg/dl: If dysrhythmia present, proceed to appropriate protocol For shock, push 20 ml/kg 0.9%NaCl IV/IO (max 1 L) If glucose ≤70, administer 1 ml/kg D50W IV/IO push; If child ≤3 y.o. or ≤ 15 kg, instead push 2 ml/kg of D25 IV/IO (D25 is made by mixing D50 […]

Pediatric Stridor

P605 Keep the patient calm Consider 0.9% NaCl mist via nebulizer Place patient on a cardiac monitor Contact medical control if considering nebulized epinephrine Epinephrine 0.5 ml of 1:1000 solution mixed in 2.5 ml of 0.9% NaCl, nebulized Continue nebulized 0.9% NaCl afterwards may be beneficial

Pediatric Respiratory Distress (Wheezing or Asthma)

P607 Assess need for assisted ventilation Allow patient to sit in a position of comfort If wheezing, albuterol 0.5 ml in 2.5 ml 0.9% NaCl nebulized Initiate transport May give 3 albuterol nebulized treatments. May considering adding 1 vial Ipratropium Bromide (0.5% of 0.02%) to the albuterol treatments, or substituting Duoneb.  Contact medical control if […]

Pediatric Respiratory Distress (Obstruction or FBO)

P606 Alert and not choking Begin transport with patient as comfortable as possible If wheezing, albuterol nebulized treatment Alert and choking <1 y.o., give 5 back slaps and 5 chest thrusts; repeat as necessary >1 y.o., give abdominal thrusts (Heimlich maneuver) Unconscious Begin CPR/BVM With laryngoscope, look for foreign body and remove with Magill forceps […]

Pediatric PVST

P604 Obtain 12 lead ECG If STABLE patient: Vagal maneuvers Contact medical control Adenosine 0.1 mg/kg IV rapid push (maximum first dose 6 mg); may repeat with dose doubled (maximum second dose 12 mg) Only on the conscious patient and the order of a medical control physician, administer midazolam 0.1 mg/kg (max 5 mg) IV/IO […]

Pediatric Bradycardia

P603 If symptomatic give oxygen, use BVM as needed, and recheck pulse rate If HR <60, BVM and chest compressions Epinephrine 1:10,000 IV/IO at 0.1 ml/kg or 1:1000 at 0.1 ml/kg via ETT (max dose 2 ml) Contact medical control Repeat epinephrine every 5 minutes After epinephrine, consider 1 dose of atropine, 0.02 mg/kg (min […]

Pediatric Pulseless VT/VF

P601 Defibrillate 2 J/kg (max 200 J) and resume CPR for two minutes; do not exceed adult dose Defibrillate 4 J/kg (max 360 J) and resume CPR; do not exceed adult dose Consider intubation Epinephrine 1:10,000 at 0.1 ml/kg IV/IO (preferred) or Epinephrine 1:1000 at 0.1 ml/kg ETT (max 2 ml); repeat Epinephrine every 3-5 […]

Pediatric Asystole / PEA

P602 After 2 minutes of CPR, check cardiac rhythm and pulse, then consider intubation Epinephrine 1:10,000 at 0.1 ml/kg IO/IV or Epinephrine 1:1000 at 0.1 ml/kg ETT (max dose 2 ml) Contact medical command 0.9% NaCl 20 ml/kg IV/IO Repeat epinephrine every 3-5 minutes