P618

Pediatric restraints are to used only when necessary in situations where the patient is violent or potentially violent and may be a danger to themselves or others.

• Administer midazolam (Versed) 0.1 mg/kg (max 5 mg) IV/IO or 0.2 mg/kg (max 10 mg) IN/IM
• When able and safe to do so, place patient on cardiac monitor, continuous pulse oximetry, check blood glucose level, and end-tidal capnography.
• Administer oxygen

P616

• Remove victim from water and keep patient warm
• If suspected diving accident or axial load to head, apply C-spine stabilization
• Ensure adequate airway, breathing, and oxygenation
• For cardiac arrest, follow appropriate protocol
• Transport to appropriate trauma center
• For ice water drowning, transport to pediatric ECMO-capable facility (Cincinnati Children’s Hospital)

S500

• Trauma WITH head injury
  • Fluid resuscitation to maintain SBP ≥90 and
  • O2 saturation >90%
• Trauma
  • 2 large bore IVs of 0.9% NaCl
  • Fluid bolus of 500 ml
  • Reassess mental status
  • Repeat fluid bolus

T710

• Tourniquets
  • 1-2″ proximal to hemorrhage
  • Tightened until controlled
  • Record application time
• Wound packing
  • Wound to groin, axilla, or neck
  • Place gauze as deeply as possible
  • apply pressure dressing
  • Apply manual direct pressure for at least 3 minutes
• Tranexamic Acid (TXA)
  • Refer to TXA protocol

SB211

• Pulse >120 or <50 or SBP <90
• RR <10 or >29
• Intubated
• Evidence of head injury
  • GCS ≤13
  • Alteration in LOC or LOC > 5 min
  • Failure to localize pain
• Suspected spinal cord injury
• Penetrating trauma to head, chest, abdomen, neck, extremities proximal to knee or elbow
• Amputation proximal to wrist or ankle
• Fractures of 2 or more proximal long bones
• Evidence of neurovascular compromise
• tension pneumothorax that is relieved
• Head, neck, or torso visible crush injury
• Abdominal tenderness, distention or seat belt sign
• Pelvic fracture
• Flail chest
• Burn injury >10% TBSA and other traumatic injuries
• Significant mechanism of injury = high index of suspicion
• Ground <30 min transport time to Level 1 trauma center

S506

• Evidence of significant blunt or penetrating trauma AND
• Age ≥16 y.o. AND
• Presence of hemodynamic instability AND
• Sustained SBP <90 or <100 if age >55 AND
• Sustained heart rate >110 AND
• Time since injury is KNOWN to be <3 hours

•  Mix 1 g TXA in 100 ml of 0.9% NaCl or LR and infuse over approximately 10 minutes IV or IO
• Use a dedicated line
• Notify receiving trauma center

• Be sure the scene is safe
• Absorbed poison: Remove clothing and fully decontaminate. If eye(s) involved, irrigate ≥20 minutes
• Inhaled/ingested poison: Administer high-flow O2. Pulse oximetry may be inaccurate
• Ingested poison:
  Contact Poison Control
  Review circumstances with Medical Control and Poison Control
• Envenomations: Immobilize extremity in dependent position; consider ice pack for bee stings

M410

• Assess for spinal injuries and treat/immobilize appropriately
• If actively seizing give Versed 10mg IM
• Versed 2-4mg/min IV/IM/IO, until seizure resolves or a total of 10mg is given
• Dextrose 50% 12.5 – 25g IV/IO or Glucagon 1 mg IM if Glucose < 70
• Narcan 0.4 to 2mg IV if suspect narcotic OD
• If in the 3rd trimester of pregnancy- or up to 6 wks postpartum -actively seizing with no seizure history consider magnesium sulfate 4g IVP slowly over 15 mins
• Transport to hospital with OB services

SB213

• GCS ≤ 14
• Pulse > 90, SBP < 110
• Fall from any height with evidence of traumatic brain injury, even from standing
• Pedestrian struck by motor vehicle
• Suspected long bone fx from motor vehicle crash
• Injuries sustained in two or more body regions
• Anticoagulation and head injury

S504

• Stabilize impaled objects in place and cover other eye
• Cover penetrating eye injuries with metal eye patch—do not press on globe
• Irrigate chemicals or non-penetrating foreign matter from eye with copious amounts of water or normal saline
• Instill 2 drops of 0.5% proparacaine (Alcaine) or tetracaine into affected eye for pain (note it may sting initially, < 20 sec)
• Can repeat Alcaine in 20 min if necessary