Pediatric SO

Question 1

Pedi Allergic Reaction w/out Shock

Answer 1

• O2 via NRM
• Epi 1:1k IM 0.01 mg/kg (max 0.3 mg/30 kg)
• Wheezing, go to Pedi Bronchospasm, and then Albuterol 2.5 mg neb
• IV @ TKO
• Benadryl 1 mg/kg IV (max 25 mg/25 kg), give IM if no IV
• S/S persist, give Solu-Medrol 2 mg/kg (125 mg max/62.5 kg)

Question 2

Pedi Allergic Reaction w/ Shock

Answer 2

• O2 via NRM
• Epi 1:1k IM 0.01 mg/kg (max 0.3 mg/30 kg)
• IV w/ 20 cc/kg bolus
• start IO if critical pt w/ out IV
• Epi 1:10k IV 0.01 mg/kg over 1-2 mins
• Benadryl 1 mg/kg IV (max 25 mg/25 kg), give IM if no IV
• Solu-Medrol 2 mg/kg (125 mg max/62.5 kg)
• Wheezing, go to Pedi Bronchospasm, and then Albuterol 2.5 mg neb
• if S/S continue: repeat 1:1k Epi IM (0.01 mg/kg) and NS bolus (20 cc/kg)

Question 3

Pedi Bradycardia (indications)

Answer 3

60> BPM w/ poor perfusion

Question 4

Pedi Bradycardia

Answer 4

• Assist respirations w/ BPM
• Intubate
• if Poor perfusion, start CPR
• IV/IO (one leg only)
• Epi 1:10k 0.01 mg/kg (or 1:1k Epi 0.01 mg/kg via ET) every 3-5 mins
• NS bolus 20 cc/kg
• if increased vagal tone is possible or AV block is present, IV Atropine 0.02 mg/kg, may repeat (min dose: 0.1 mg/5kg | Max dose: 1mg/50 kg)
• Apply pacemaker pads and ONLY turn on w/ BSP commo

Question 5

Pedi Bronchospasm (indications)

Answer 5

Respiratory distress w/ wheezing not involving foreign body airway obstruction

Question 6

Pedi Bronchospasm

Answer 6

• O2 via NRM
• Severe respiratory distress: EPI 1:1k 0.01 mg/kg (0.3 mg/30 kg max)
• 2.5 mg Albuterol neb, if severe, front load 5 mg Albuterol and 0.5 mg Atrovent
• if S/S persist, 2nd 2.5 mg Albuterol with 0.5 mg Atrovent (if not given already)
• Intubated pt w/ poor compliance due to bronchospasm: 1:10k EPI 0.01 mg/kg via ET

Question 7

Pedi Hypoglycemia

Answer 7

Check BGL and IF 70> mg/dl:
- pt alert and able to swallow/maintain airway, give 1g/kg oral glucose PO (50g/50kg max)
or
- pt unable to swallow/unconscious give appropriate IV dextrose (D10/D25/D50) to Newborn/Infant 30> kg/Pedi >30 kg
- If no IV unavailable, give 1 mg glucagon IM or if 1 y/o > 0.5 mg IM

Recheck BGL

Question 8

Pedi Hypoglycemia D10/Newborn Dose

Answer 8

0.2 g/kg
4 parts NS 1 part D50 = D10
2 cc/kg of D10

Question 9

Pedi Hypoglycemia D25/Infant 30> kg Dose

Answer 9

0.5 g/kg
1 part NS 1 part D50 = D25
2 cc/kg of D25

Question 10

Pedi Hypoglycemia D50/Pedi >30 kg Dose

Answer 10

0.5 g/kg (25g/50 kg max)

2 cc/kg of D50

Question 11

Pediatric (definition)

Answer 11

• 13> y/o

- IF >8 y/o size/age or size of small adult, use adult SO not covered in pedi SO

Question 12

Pedi Hypovolemia

Answer 12

S/S secondary to hypovolemia

• O2 via NRM or intubate
• IV or IO if pt critical and give 20 cc/kg bolus
• repeat 20 cc/kg bolus as needed while enroute
• Hemorrhagic shock due to trauma, 10 cc/kg bolus and reassess. NO 2nd bolus w/out commo to BSP
• keep pt warm and cover wounds

Question 13

Pedi Cardiac Arrest

Answer 13

• if no pulse or BP
• CPR/BVM 15:2
• EKG
• CPR for 2 mins prior to defib if in vtac/vfib unless good CPR done

Question 14

Pedi Cardiac Arrest - Asystole

Answer 14

• CPR
• ET
• IV/IO
• Epi 1:10k 0.01 mg/kg IV/IO or (0.1 mg/kg 1:1k via ET) every 3-5 mins

Question 15

Pedi Cardiac Arrest - PEA

Answer 15

• CPR
• ET
• IV/IO (leg only)
• Epi 1:10k 0.01 mg/kg IV or (0.1 mg/kg Epi 1:1k ET) every 3-5 mins
• NS bolus 20 cc/kg IV
• assess for reasons of PEA (H&T’s)

Question 16

Pedi Cardiac Arrest - Vfib/Vtac

Answer 16

• Defib 2J/kg (CPR prior to shock) (#1)
• CPR 2 mins with IV/IO
• Pulse/EKG check after 2 mins
• if VF/pulseless VT, epi 1:10k 0.01 mg/kg via IV/IO (or Epi 1:1k 0.1 mg/kg ET)
• if Torsades, give 25 mg/kg (max 2g/80kg)
• Defib 4J/kg (#2)
• CPR 2 mins then pulse/rhythm check
• VF/VT still, Amiodarone 5 mg/kg or Lido 1 mg/kg (if no Amio)
• Defib 4 J/kg (#3)
• CPR 2 mins then pulse/rhythm check

Question 17

Pedi Respiratory Arrest

Answer 17

with pulse:

• O2 via BVM
• ET, but if no ET, BVM
• IV @TKO

Question 18

Pedi Near Drowning

Answer 18

If pulse absent, begin CPR and go to Arrest SO
If pulse present:
- O2 via NRM
- if still in distress, CPAP
- Contraindications (BP 90>, Awake/follows, Mask fits, maintain airway)
- IV @ TKO
- keep warm
- Como of CPAP use and revert to BVM if deteriorates

Question 19

Pedi Drug OD

Answer 19

• Check airway O2 as needed
• EKG
• IV @ TKO
• if no gag, L lateral recumbent position and suction/manage airway PRN
• bring in bottles/containers

Question 20

Pedi Newborn Resus (indications)

Answer 20

• HR 100>/min
• poor respirations
• cyanotic and limp

Question 21

Pedi Newborn Resus

Answer 21

• Warm, dry, suction (only if meconium in mouth), stimulate and evaluate APGAR
• BVM 2:3 secs, use room air then 100% as needed
• if HR 60 >, BVM or ET 3.5 full (3.0 premature 2-3 kg, 2.5 if 2> kg)
• if HR still 60 >, CPR 120/mins, 3:1
• Epi 1:10k 0.03 mg/kg IV or 1:10k 0.1 mg/kg w/ 2 cc NS every 3-5 mins

Question 22

Pedi Sz (indications)

Answer 22

• continuous generalized sz or repeated sz w/out return to consciousness

Question 23

Pedi Sz

Answer 23

• O2 via NRM/BVM
• BGL check, and follow SO if indicated
• if Sz >5 mins
• Versed 0.2 mg/kg IN/IM
• IV @ TKO
• if no versed: 0.1 mg valium IV (5 mg/50 kg max) or 0.5 mg/kg rectally (10 mg/50 kg max)
• Valium unavailable, sub w/ lorazepam 0.1 mg/kg (2 mg/20 kg max)
• EKG/monitor as needed, refrain from ET

Question 24

Pedi Tachycardia

Answer 24

If pulses and poor/inadequate perfusion

• O2
• 12 lead
• como