Pediatric

Question 1

Newborn Resuscitation

Answer 1

-Provide ventilations 40 breaths/min
-If inadequate and HR< 100 and 30 seconds add 100% O2
-HR< 60; chest compressions at 120/min 3:1
-HR still below 60
-IV/IO
-Epi .01 mg/kg (1:10,000); repeat as needed q 3-5 min
-Consider ETT
MED CONTROL
- NS Bolus
- BGL
- Dextrose 10%
- Needle D
- Epi 1:1,000
- Atropine
- Sodium Bicarb (4.2%)
- Monitor

Question 2

Newborn Resus w/ Meconium

Answer 2

• ETT w/ suctioning; MAX 3 times
• Stimulation if ventilations inadequate
• HR<60; Chest compression at 120/min; 3:1
• IV/IO
• Epi .01 mg/kg (1:10,000); repeat as needed q 3-5 min

Question 3

Organophosphate/ Nerve agent

Answer 3

• Decon
• Airway
• Broselow tape for dosages
  MED CONTROL
• IV/IO NS
• Atropine
• 2-PAM
• repeat atropine
• Diazepam
• Midazolam

Question 4

Advanced Airway

Answer 4

• BLS airway
• BLS Foreign body
• Pulse Ox, Monitor
• Magill forceps to remove object if needed
• ETT
• Needle cric

Question 5

Anaphylaxis/ Allergic RXN

Answer 5

• If severe respiratory distress, shock, SBP <=70
• Epi Jr. or .15 mg (1:1,000) IM
• Diphenhydramine 1 mg/kg IM
• Wheezing present; Combi-vent; total 2 TX
• > 30 kg Epi .3 mg (1:1,000) IM
• IV NS 20 ml/kg
• Methylprednisolone 2 mg/kg IV
  ALLERGIC RXN
• Monitor
• Diphenhydramine 1 mg/kg IM
  MED CONTROL
• Epi infusion

Question 6

Bradycardia

Answer 6

• BLS
• Airway
• Monitor
• HR<60; assist ventilations w/ BVM
• HR<60 and Poor Perfusion; begin CPR
• IV/IO
• Epi 1:10,000 .01 mg/kg IV/IO
• Consider ETT
• repeat Epi 1:10,000 .01 mg/kg q 3-5 min
• Atropine .02 mg/kg IV/IO, may be repeated once
  MED CONTROL
• Glucagon
• Transcutaneous pacing
• Epi Drip

Question 7

Bronchospasm

Answer 7

• Secure Airway
• SpO2, ETCO2
• Combivent 2 x TX
• Monitor
• IV NS KVO
• Epi (1:1,000) .01 mg/kg
• Methylprednisolone 2 mg/kg IV
  MED CONTROL
• IV/IO
• Albuterol
• Mag Sulfate

Question 8

Asystole/ PEA

Answer 8

• BLS
• Secure Airway
• Monitor
• IV/IO 20 ml/kg
• Epi 1:10,000 IV/IO .01 mg/kg q 3-5 min
• If tension pneumo; Needle D
• If hypovolemia; 20ml/kg fluid bolus; MAX 60 ml/kg
• Hyperkalemia/ TCA OD; Sodium bicarb 1 mEq/kg IV/IO
  MED CONTROL
• Sodium Bicarb
• Needle D
• Epi 1:1,000
• Glucagon
• Calcium Chloride
• Dextrose
• Discontinuation of resuscitation

Question 9

V-FIb/ Pulseless V-Tach

Answer 9

• BLS
• Monitor
• D-Fib 2 J/kg
• Secure Airway
• IV/IO
• Epi 1:10,000 .01 mg/kg q 3-5 min
• D-Fib 4 J/kg
• Amiodarone 5 mg/kg IV/IO bolus; repeat one time
• D-Fib 4 J/kg
  MED CONTROL
• D-Fib 4 J/kg- 10 J/kg
• Mag Sulfate
• Sodium Bicarb
• Epi 1:1,000

Question 10

Hypoglycemia

Answer 10

• If AMS
• IV NS KVO
• D25% .5 g/kg
• IV access not available; Glucagon per Broselow tape (x2)
• Monitor

Question 11

Hyperkalemia

Answer 11

• BLS
• Secure Airway
• IV/IO 20 ml/kg

Question 12

Hypoperfusion

Answer 12

• BLS
• Airway
• Monitor
• IV 20 ml/kg
• Cardiogenic shock; MED CONTROL
• Adrenal Insufficiency;
• Hydrocortisone Sodium Succinate 2 mg/kg bolus IV/IM, MAX 100 mg
  OR
• Methylprednisolone .4 mg/kg IV/IM, MAX 125 mg
• repeat 20 ml/kg fluid bolus
• repeat 20 ml/kg IVP
  MED CONTROL
• Epi drip
• Norepi infusion

Question 13

Major Trauma

Answer 13

• BLS
• Transport Determination
• Airway management
• IV/IO NS 20 ml/kg wide open
• Monitor
• Repeat NS fluid bolus 20 ml/kg; may repeat 1 additional time at MAX of 60 ml/kg
• If Tension Pneumo; Needle D
• Additional IV/IO

Question 14

Opiate OD

Answer 14

• Secure Airway
• SpO2, ETCO2
• Monitor
• BGL
• If Hypoventilation and Respiratory Distress;
• Naloxone .1 mg/kg IM/IN; may repeat 2 mg total dose
• IV/IO NS

Question 15

Pain Management

Answer 15

• BLS
• Airway Management
• Document pain
• Monitor
• IV NS
• Morphine .1 mg/kg IV; repeated once to MAX dose of 10 mg
  OR
• Fentanyl 1 mcg/kg slow IV/IM/IN
• Ondansetron 4 mg IV/IM (if >4yo), between 2-4yo, 2 mg IV/IM
  MED CONTROL
• Diphenhydramine

Question 16

Respiratory Arrest

Answer 16

• BVM 100% O2
• Consider Foreign body obstruction
• Monitor
• Needle Cric for unrelieved (>6yo)
• ETT if unable to ventilate
• Needle D if Tension Pneumo suspected
• IV/IO

Question 17

Respiratory Distress/ Stridor

Answer 17

• BLS
• Consider Foreign Body Obstruction
• If pt. goes into cardiac arrest refer to that protocol
• Monitor
  MED CONTROL
• IV NS
• Methylprednisolone
• Epi 1:1,000 via NEB

Question 18

Seizure

Answer 18

• BLS
• Secure Airway
• BGL
• Monitor
• Midazolam .1 mg/kg IM/IN
  OR
• Diazepam .5 mg/kg PR
• IV NS KVO
  MED CONTROL
• IO

Question 19

Tachycardia

Answer 19

- IV NS 20 ml/kg; may repeat once
V-TACH
- IV NS KVO
SVT
- Vagal
- IV NS KVO
- .1 mg/kg Adenosine IVP
UNSTABLE V-TACH/ UNCONSCIOUS
- Synchronized Cardioversion .5 J/kg
UNSTABLE SVT/UNCONSCIOUS
- Synchronized Cardioversion .5 J/kg
MED CONTROL
- Morphine
- Fentanyl
- Midazolam
- Amiodarone
- Mag Sulfate
- Sync 1-2 J/kg

Question 20

Cyanide/ Smoke Inhalation

Answer 20

• remove pt. from source
• IV/IO NS KVO
• Monitor
• SpCO reading if available
  If cardiac arrest or profoundly hypotensive
• 2nd IV/IO NS
• Hydroxocobalamin 70 mg/kg over 15 min
  MED CONTROL
• repeat Hydroxocobalamin 70 mg/kg over 15 minutes