PEDIATRICS

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The apnea is associated with color change (cyanosis, gray, or pallor), a loss of muscle tone, and choking or gagging. By definition, patient has recovered and appears well-If patient has not recovered fully, consider appropriate guideline based on patient's condition. All patients with ALTE need transport for evaluation to rule out serious cause. Many will be admitted. Refusals should generally involve online medical direction. ALTE is now referred to as a “BRUE” (Brief Resolved Unexplained Event).\u003cbr\u003e\n\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\n\u003cbr\u003e\nEMPHASIS ON PATIENT CARE \u003cbr\u003e\n\u003cbr\u003e\n1.\tPrimary Management - Assess ABC’S and manage as indicated.\u003cbr\u003e\n\u003cbr\u003e\n2.\tProvide humidified oxygen if SpO2 \u003c95%\u003cbr\u003e\n\u003cbr\u003e\n3.\tTransport to appropriate facility.\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nPARAMEDIC\u003cbr\u003e\n\u003cbr\u003e\n1.\tApply EKG and treat arrhythmias per appropriate protocol.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128876/10048251"},{"listId":12473129,"catId":2128876,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"Pediatric Cardiac Arrest (Medical)","summary":"","detail":"CARDIAC ARREST PEDIATRIC/ MEDICAL\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nSigns and symptoms include an unresponsive, apneic patient with absent brachial, femoral, or carotid pulses. If patient does not meet Termination of Resuscitation guidelines, continue with the following Treatment Guidelines.\u003cbr\u003e\n\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\n1.\tUninterrupted effective CPR using pit crew approach, if possible, defibrillation and ALS intervention as rapidly as possible\u003cbr\u003e\n\u003cbr\u003e\n2.\tPatients in cardiac arrest should be initially managed in the field. Establish ventilation and circulation (compressions) as quickly as possible. Establish airway and vascular access rapidly. Consider first defibrillations and EPINEPHRINE (if indicated) before considering transport. \u003cbr\u003e\n\u003cbr\u003e\n3.\tIf the patient has a return of spontaneous circulation (ROSC) (sustained palpable pulses and measurable blood pressure), the patient should be transported to the closest appropriate facility. At the present time (2022) MMC has NICU and PICU capabilities.\u003cbr\u003e\n\u003cbr\u003e\n4.\tAll patients in cardiac arrest require immediate CPR, airway management and ventilations with oxygen. CPR and initial defibrillation take precedence over advanced airway management unless the airway cannot be managed with BLS maneuvers.\u003cbr\u003e\n\u003cbr\u003e\n5.\tDefibrillation of the VF/ VT patient should occur as soon as possible\u003cbr\u003e\nAEMT/PARAMEDIC\u003cbr\u003e\n1.\tEstablish IV/IO access and flush to confirm patency.\u003cbr\u003e\n\u003cbr\u003e\n2.\tAdminister Epinephrine, IV/IO\u003cbr\u003e\na.\tEPINEPHRINE (1:10,000) 0.01 mg./kg. IV/IO (0.1 ml./kg.) every 3-5 minutes throughout Cardiac Arrest as indicated\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nCARDIAC ARREST PEDIATRIC\t/ MEDICAL\u003cbr\u003e\n3.\tBe certain that early ventilations and effective compressions are being done. Ventilate at ratio of 15:2 for multiple rescuers. If LMA inserted ventilate at rate of every 2-3 seconds. Compress bag to raise chest only. Intubation limited to age 13 and older regardless of size or maturity of patient.\u003cbr\u003e\n4.\tIf indicated defibrillate early (V-fib and pulseless V-tach) 2 J/kg. initial. Subsequent shocks at 4 J/kg. increasing to maximum of 10 J/kg. or adult dose.\u003cbr\u003e\n5.\tIf indicated establish IV/IO and administer EPINEPHRINE early (Asystole and PEA) (1:10,000) 0.01 mg./kg. or 0.1 ml/kg. IV/IO. Repeat EPINEPHRINE every 3-5 minutes throughout resuscitation in all rhythms. Humeral IO preferred but other sites may be used as necessary.\u003cbr\u003e\n6.\tConsider inserting LMA. Monitor ETCO2.\u003cbr\u003e\n7.\tConsider staying at scene for first ten minutes of call, time to complete above interventions. Decision to transport a difficult one. Many parents/family members/bystanders are not accustomed to full resuscitation on-scene. In small children CPR can be safely and effectively performed in route. If unable to accomplish above interventions early consider transport for further level of care. Use your best judgement in deciding when to transport.\u003cbr\u003e\n8.\tFollow the PALS pediatric cardiac arrest algorithm with rotation of compressor, adequate compressions, adequate ventilation, and medical and electrical interventions as indicated.\u003cbr\u003e\n9.\tFor refractory V-fib and V-tach consider AMIODARONE. 5 mg./kg. bolus. May repeat bolus two times every five minutes (three boluses total).\u003cbr\u003e\n10.\tConsider all treatable causes of arrest (H’s and T’s).\u003cbr\u003e\n\u003cbr\u003e\nTERMINATIION OF RESUSCITATION\u003cbr\u003e\n1.\tAny patient who presents in cardiac arrest assumed to be from a medical cause will have CPR performed on scene for a minimum of 30 minutes if not transported after initial interventions. If ROSC is achieved at any time during resuscitation efforts the patient will be transported to the closest most appropriate hospital.\u003cbr\u003e\n\u003cbr\u003e\n2.\tIf after 30 Minutes the patient remains in Cardiac arrest, Medical Control should be contacted.\u003cbr\u003e\n\u003cbr\u003e\n3.\tThe following information should be collected if available, and relayed to medical control for further instructions:\u003cbr\u003e\n \u003cbr\u003e\nThe Patient’s:\u003cbr\u003e\n•\tAge\u003cbr\u003e\n•\tPMH\u003cbr\u003e\n•\tGeneral health (skin turgor, muscle tone, mobility of patient prior to arrest)\u003cbr\u003e\n•\tLast time patient was seen alive\u003cbr\u003e\n•\tWitnessed arrest\u003cbr\u003e\n•\tBystander CPR\u003cbr\u003e\n•\tPupillary Response\u003cbr\u003e\n•\tTemperature\u003cbr\u003e\n•\tBlood sugar\u003cbr\u003e\n•\tInitial and current cardiac Rhythm\u003cbr\u003e\n•\tCurrent ETCO2 reading\u003cbr\u003e\n•\tFamily wishes of resuscitation effort. \u003cbr\u003e\nResuscitation efforts may be terminated in the field if the patient meets the requirements for TOR guidelines, or with medical direction approval and if ALL of the following criteria are met:\u003cbr\u003e\na.\tCPR and ALS interventions have been attempted for at least 30 minutes,\u003cbr\u003e\nb.\tNo ROSC at any time during resuscitation efforts\u003cbr\u003e\nc.\tThe arrest is not the result of hypothermia\u003cbr\u003e\nd.\tETCO2 \u003c15\u003cbr\u003e\ne.\tAbsence of Palpable Carotid/Femoral/Brachial pulses\u003cbr\u003e\nf.\tFamily is accepting of the decision to terminate efforts for resuscitation.\u003cbr\u003e\ng.\tThe patient does not have an LVAD in place\u003cbr\u003e\n\u003cbr\u003e\n5.\tAll patients with a LVAD (left ventricular assist device) in cardiac arrest should be transported unless there is an active DNR.\u003cbr\u003e\n6.\tThe patient may be transported prior to reaching the 30-minute benchmark if responders feel that staying on scene does not promote good patient care or exposes them to harm or there are other mitigating circumstances.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128876/12473129"},{"listId":10048252,"catId":2128876,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"REFUSAL TREATMENT/TRANSPORT","summary":"","detail":"REFUSAL OF TREATMENT / TRANSPORT (PED)\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nChildren are unable to refuse treatment and transport on their own behalf. A parent, or guardian, may refuse any part of or all treatment and/or transport on behalf of the patient. Remember this guideline is used only if no life threats exist. If a life threat is present, follow Involuntary Restraint and Transport Guideline.\u003cbr\u003e\n\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\nProvider safety, transport decisions\u003cbr\u003e\n\u003cbr\u003e\n1.\tAssess ABC’s and ensure no immediate life threats.\u003cbr\u003e\n2.\tSecondary Management - History, physical exam, vital signs (if patient allows):\u003cbr\u003e\na.\tInform parent or legal guardian of patient’s medical condition, potential injury or illness, potential ramifications if treatment and transport are refused.\u003cbr\u003e\nb.\tAssure the parent or legal guardian fully understands what you are saying.\u003cbr\u003e\nc.\tAttempts to inform must be done in the presence of a witness, i.e. family members, bystander, or police officer (preferably not a member of the EMS service).\u003cbr\u003e\nd.\tObtain the parent’s or legal guardian’s signature on refusal and information for report.\u003cbr\u003e\ne.\tHave a witness sign the refusal.\u003cbr\u003e\nf.\tDocument all attempts to gain consent for treatment, advisement of potential injury or illnesses, and potential ramifications if treatment is not rendered.\u003cbr\u003e\n\u003cbr\u003e\n3.\tIf parents are not available, make all reasonable efforts to locate parents or legal guardians and have them come to the scene, otherwise transport the patient to the nearest appropriate facility. \u003cbr\u003e\n4.\t EMS refusal of care represents one of the highest liability exposures that an EMS\u003cbr\u003e\n Provider will ever face. All refusals should be carefully documented. Consider\u003cbr\u003e\n having medical control speak directly with the patient by cell phone or radio.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128876/10048252"},{"listId":10048254,"catId":2128876,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"RESPIRATORY DISTRESS","summary":"","detail":"RESPIRATORY DISTRESS (PED)\u003cbr\u003e\n\u003cbr\u003e\nDESIGNATION OF CONDITIONPEDIATRIC RESPIRATORY DISTRESS:\u003cbr\u003e\n•\tAlert, irritable, anxious\u003cbr\u003e\n•\tStridor\u003cbr\u003e\n•\tAudible wheezing/grunting\u003cbr\u003e\n•\tRespiratory rate outside normal range for child's age\u003cbr\u003e\n•\tSniffing position\u003cbr\u003e\n•\tNasal flaring\u003cbr\u003e\n•\tHead bobbing\u003cbr\u003e\n•\tNeck muscle use\u003cbr\u003e\n•\tlntercostal retractions\u003cbr\u003e\n•\tCentral cyanosis that resolves with oxygen administration\u003cbr\u003e\nPEDIATRIC RESPIRATORY FAILURE:\u003cbr\u003e\n•\tSleepy, intermittently combative or agitated\u003cbr\u003e\n•\tRespiratory rate \u003c 10 breaths per minute\u003cbr\u003e\n•\tAbsent or shallow respirations with poor air movement\u003cbr\u003e\n•\tSevere intercostal retractions\u003cbr\u003e\n•\tParadoxical breathing\u003cbr\u003e\n•\tLimp muscle tone\u003cbr\u003e\n•\tInability to sit up\u003cbr\u003e\n•\tCyanosis and/or mottled skin\u003cbr\u003e\n•\tBradycardia\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nALL LEVELS \u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\nPrevent agitation to the patient, airway management, and adequate oxygenation. Patients with stridor from airway infection can decompensate and quickly develop an airway disaster. Calm patient as much as possible and avoid airway manipulation and painful procedures as much as possible unless necessary due to critical condition.\u003cbr\u003e\n\u003cbr\u003e\n1.\tPrimary Management - Assess ABC’S and manage as indicated.\u003cbr\u003e\n2.\tProvide humidified oxygen.\u003cbr\u003e\n3.\tConsider underlying cause of respiratory distress and treat appropriately.\u003cbr\u003e\na.\tAnaphylaxis, allergic reaction, asthma, foreign body obstruction, infection.\u003cbr\u003e\n\u003cbr\u003e\n4.\tInitiate transport to appropriate facility and consider AEMT/ALS intercept\u003cbr\u003e\n5.\tConsider Nebulized Albuterol\u003cbr\u003e\n6.\tSecondary Management - History, physical exam, vital signs\u003cbr\u003e\n7.\tContinuous EtCO2 SpO2 monitoring\u003cbr\u003e\n8.\tConsider CPAP (Basic level).\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nAEMT\u003cbr\u003e\n1.\tConsider IV/IO access\u003cbr\u003e\n\u003cbr\u003e\na.\tFluid bolus NS/LR at 20 ml /kg for hypotension or dehydration\u003cbr\u003e\n\u003cbr\u003e\n2.\tConsider ALBUTEROL 1.25-2.5 mg in 3 ml NS. Or ALBUTEROL/IPRATROPRIUM combination (Duo Neb and others). May repeat as needed.\u003cbr\u003e\n\u003cbr\u003e\n3.\tIf patient will tolerate may use CPAP up to 10 cm H2O PEEP\u003cbr\u003e\n\u003cbr\u003e\n4.\tIf respiratory failure develops consider placement of SGA/EGA. LMA preferred.\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nPARAMEDIC\u003cbr\u003e\n\u003cbr\u003e\n1.\tConsider MAGNESIUM SULFATE 50 mg/kg IV if bronchospasm suspected.\u003cbr\u003e\n\u003cbr\u003e\n2.\tConsider EPINEPHRINE 1:1,000 (1.0 mg./ml.)\u003cbr\u003e\n\u003cbr\u003e\na.\tPediatric (less than 25 kg.) 0.15 ml. IM or SQ in anterolateral thigh (preferred) if severe allergic reaction or anaphylaxis suspected.\u003cbr\u003e\n\u003cbr\u003e\n3.\tConsider oral DEXAMETHASONE for bronchospasm. Using a TB (1 ml.) syringe draw up 0.6 mg./kg. (0.06 ml./kg.) to a maximum of 10 mg. (1 ml.). Remove needle and administer orally. Check vial’s concentration before drawing it up; usual concentration is 10 mg./ml.\u003cbr\u003e\n\u003cbr\u003e\n4.\tSee RESPIRATORY DISTRESS/CROUP\u003cbr\u003e\n\u003cbr\u003e\n5.\tDo not attempt to intubate if there is adequate air exchange.\u003cbr\u003e\n\u003cbr\u003e\n6.\tIntubate the patient only if the patient is 13 years or older and meets other intubation criteria.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128876/10048254"},{"listId":10048256,"catId":2128876,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"RESPIRATORY DISTRESS/CROUP","summary":"","detail":"RESPIRATORY DISTRESS (PED-CROUP)\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nThe most common age group affected is 1 to 3 years but this process can develop in any age patient. The onset is slow. Signs and symptoms are: hoarse voice, harsh “seal bark” cough, stridor upon inhalation, and high-pitched squeaking sounds may be present. In addition, other signs of respiratory distress may be present. Always consider the possibility of foreign body aspiration.\u003cbr\u003e\n\u003cbr\u003e\nBASIC / AEMT\u003cbr\u003e\n\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\n1.\tAirway management, adequate oxygenation\u003cbr\u003e\n2.\tPrimary Management - Assess ABC’s and manage as indicated.\u003cbr\u003e\n3.\tInitiate transport to an appropriate medical facility. Consider ALS intercept.\u003cbr\u003e\n4.\tSecondary Management - History, physical exam, vital signs\u003cbr\u003e\n\u003cbr\u003e\nPARAMEDIC\u003cbr\u003e\n1.\tConsider Nebulized EPINEPHRINE 1:1000 (0.5 mg.) Repeat as needed.\u003cbr\u003e\n2.\tConsider oral DEXAMETHASONE. Using a TB (1 ml.) syringe draw up 0.6 mg./kg. (0.06 ml./kg.) to a maximum of 10 mg. (1 ml.). Remove needle and administer orally. Check vial’s concentration before drawing it up; usual concentration is 10 mg./ml.\u003cbr\u003e\n3.\tDo not attempt to intubate if there is adequate air exchange. Intubation rarely needed\u003cbr\u003e\nIntubate the patient only if the patient is 13 years or older and meets other intubation criteria.","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128876/10048256"},{"listId":10048257,"catId":2128876,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"RESPIRATORY DISTRESS/EPIGLOTITIS","summary":"","detail":"RESPIRATORY DISTRESS (PED EPIGLOTTITIS)\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nThe most common age group affected is 3 to 7 years, but this process can develop in any age patient. The onset is usually rapid. Signs and symptoms are: Pain on swallowing, high fever (102 to 104) degrees F, drooling, mouth breathing, stridor upon inhalation, changes in voice quality, tripod positioning, chin and neck thrust forward. In addition, other signs of respiratory distress may be present. Since the development of Hemophilus B immunization, the incidence of epiglottitis has been reduced significantly, however it should still be considered for patients presenting with the usual signs and symptoms.\u003cbr\u003e\n\u003cbr\u003e\nBASIC / AEMT \u003cbr\u003e\n\u003cbr\u003e\nEMPHASIS ON PATIENT CARE\u003cbr\u003e\nPrevent agitation to the patient, airway management, and adequate oxygenation\u003cbr\u003e\n\u003cbr\u003e\n1.\tPrimary Management - Assess ABC’S and manage as indicated.\u003cbr\u003e\n\u003cbr\u003e\n2.\tDo not attempt to place anything, including airway adjuncts or fingers, in the patient’s mouth. This may lead to complete airway block or bleeding into airway.\u003cbr\u003e\n\u003cbr\u003e\nPARAMEDIC\u003cbr\u003e\n1.\tDo not attempt to intubate if there is adequate air exchange.\u003cbr\u003e\n\u003cbr\u003e\n2.\tIntubation may be very difficult due to swelling of the epiglottis and surrounding structures. Well-performed BVM ventilation can provide adequate oxygenation until arrival at the hospital.\u003cbr\u003e\n\u003cbr\u003e\n3.\tNote: Assisted ventilation of any type can agitate the child causing complete airway obstruction. Judicious observation and intervention are best, reserving aggressive airway interventions for children who proceed to respiratory arrest.\u003cbr\u003e\n\u003cbr\u003e\n4.\tNote: For pediatric patients, refer to the pediatric-specific treatment guidelines","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128876/10048257"},{"listId":10048468,"catId":2128876,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"SEIZURE","summary":"","detail":"SEIZURE (PED)\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\nThis protocol is intended for patients who are experiencing status epilepticus or recurrent seizures. \u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nDESIGNATION OF CONDITION\u003cbr\u003e\nStatus epilepticus, the patient will be experiencing an active seizure when rescuers arrive, with a single episode of seizures lasting longer than 5 minutes, or 2 or more episodes of seizure activity between which the patient remains unconsciousness.\u003cbr\u003e\n\u003cbr\u003e\nALL LEVELS\u003cbr\u003e\n1.\tEstablish patient responsiveness/Assess mental status.\u003cbr\u003e\n2.\tProtect the patient from injury during involuntary muscular movements.\u003cbr\u003e\n3.\tAssess ABC’s\u003cbr\u003e\n4.\tConsider placing an OPA or NPA if the airway cannot be maintained with positioning IF the patient is unresponsive consider LMA.\u003cbr\u003e\n5.\tSuction as necessary\u003cbr\u003e\n6.\tObtain pulse oximeter reading.\u003cbr\u003e\n7.\tIf breathing is inadequate\u003cbr\u003e\na.\tAssist ventilation using a BVM device with high-flow, 100% concentration oxygen. \u003cbr\u003e\n8.\tIf abdominal distention arises, consider placing a nasogastric tube to decompress the stomach.\u003cbr\u003e\n9.\tIf breathing is adequate, place the child in a position of comfort and administer high-flow, 100% concentration oxygen as necessary. Use a non-rebreather mask or blow-by as tolerated.\u003cbr\u003e\n10.\tDetermine blood glucose level.\u003cbr\u003e\n11.\tAssess temperature. \u003cbr\u003e\nAEMT\u003cbr\u003e\n1.\tIf the patient is found to be febrile, cool the patient without overcooling. \u003cbr\u003e\n2.\tIf scene and transport time is greater than 20 minutes administer ACETOMINOPHEN 15 mg/kg orally\u003cbr\u003e\n3.\tIn-route, initiate an IV/IO of an isotonic solution at a TKO rate.\u003cbr\u003e\n4.\tInitiate cardiac monitoring.\u003cbr\u003e\n5.\tIf blood glucose level is lower than 60 mg/dl or cannot be determined, administer intravenous dextrose as follows:\u003cbr\u003e\na.\tD10W at 5.0 ml./kg. of 250 ml. bag IV/IO titrated to patient condition\u003cbr\u003e\nb.\tMay be repeated x1 if BGL remains \u003c 60 mg/dl or if the BGL cannot be determined and the patient is still in status epilepticus.\u003cbr\u003e\n\u003cbr\u003e\n6.\tRepeat blood glucose level 1 to 2 minutes after DEXTROSE is administered.\u003cbr\u003e\n\u003cbr\u003e\n\u003cbr\u003e\nPARAMEDIC\u003cbr\u003e\n\u003cbr\u003e\n1.\tAdminister MIDAZOLAM (0.2mg./kg.) IM to maximum of 10 mg. as a safe and effective route.\u003cbr\u003e\nAlternatively (0.1 mg./kg.) IV/IO/IN to maximum of 4 mg.\u003cbr\u003e\n\u003cbr\u003e\nAge Based Dose:\u003cbr\u003e\n\u003cbr\u003e\n6-16 months\t\t1.25 mg.\t\t\u003cbr\u003e\n17 mo. to 5 years\t2.5 mg.\t\u003cbr\u003e\n6 – 11 years\t\t5.0 mg.\t\t\u003cbr\u003e\n12 and up years\t10 mg.\u003cbr\u003e\n\u003cbr\u003e\n2.\tConsider ETT placement if \u003e12 y/o and meets other intubation criteria or SGA. LMA preferred.\u003cbr\u003e\na.\tConfirm placement with capnography\u003cbr\u003e\nb.\tMaintain SpO2 \u003e94%","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128876/10048468"},{"listId":10049260,"catId":2128876,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"TRAUMA ASSESSMENT","summary":"","detail":"TRAUMA ASSESSMENT (PED)\u003cbr\u003e\n\u003cbr\u003e\n \u003cbr\u003e\nOn-scene time for a traumatic injury should be no more than 10 minutes, unless there are extenuating circumstances such as extrication, hazardous conditions, or multiple victims. \u003cbr\u003e\nGOLDEN RULE: Life-threatening conditions should be corrected during the initial assessment. Transport should not be delayed; Focused history and detailed physical should be done enroute.\u003cbr\u003e\n\u003cbr\u003e\n Arrival On Scene\u003cbr\u003e\n1.\tEnsure scene safety\u003cbr\u003e\n\u003cbr\u003e\n2.\tGeneral Impression (“Across the Room” Assessment)\u003cbr\u003e\n\u003cbr\u003e\n3.\tDetermine Life Threatening Condition\u003cbr\u003e\na.\tAirway – complete or severe airway obstruction\u003cbr\u003e\nb.\tBreathing – apnea, significant work of breathing, bradypnea\u003cbr\u003e\nc.\tCirculation – absence of detectable pulses, poor perfusion, hypotension, bradycardia\u003cbr\u003e\nd.\tDisability – Unresponsiveness, decreased LOC\u003cbr\u003e\ne.\tExposure – significant hypothermia, significant bleeding\u003cbr\u003e\n4.\tAIRWAY\u003cbr\u003e\na.\tOpen airway using modified jaw thrust\u003cbr\u003e\nb.\tSuction as necessary\u003cbr\u003e\nc.\tConsider OPA, NPA if airway cannot be maintained with \u003cbr\u003e\n•\tNPA is contraindicated in the presence of facial trauma\u003cbr\u003e\n5.\tBREATHING\u003cbr\u003e\na.\tAssess for symmetry of chest expansion, breath sounds, chest rise and trauma\u003cbr\u003e\nb.\tObtain SpO2 and EtCO2 reading.\u003cbr\u003e\nc.\tIf breathing is INADEQUATE\u003cbr\u003e\n•\tAssist ventilation with BVM with high flow oxygen\u003cbr\u003e\n•\tIf airway cannot be maintained place SGA/EGA. LMA preferred.\u003cbr\u003e\nd.\tIf breathing is ADEQUATE\u003cbr\u003e\n•\tPlace the child in a position of comfort (consider spine stabilization) and administer high flow oxygen as necessary. Use a non-rebreather mask or blow-by oxygen as tolerated.\u003cbr\u003e\ne.\tABSENT/DIMINISHED BREATH SOUNDS/Severe Respiratory Distress\u003cbr\u003e\n•\tSuspect hemothorax or pneumothorax\u003cbr\u003e\n•\tPerform needle decompression using an 18 gauge catheter. \u003cbr\u003e\n•\tInsert the needle in the mid-clavicular line at the 2nd intercostal space, or 5th intercostal space anterior axillary line\u003cbr\u003e\n\u003cbr\u003e\n6.\tCIRCULATION\u003cbr\u003e\na.\tControl obvious bleeding using direct pressure, pressure dressing or wound packing\u003cbr\u003e\nb.\tConsider tourniquet use\u003cbr\u003e\nc.\tCheck capillary refill\u003cbr\u003e\nd.\tPlace on cardiac monitor\u003cbr\u003e\ne.\tIncreased or decreased heart rate may be an indication of shock, head, or spinal trauma\u003cbr\u003e\nf.\tObtain vascular access and administer NS TKO. \u003cbr\u003e\n•\tDo not delay transport to obtain vascular access.\u003cbr\u003e\ng.\tIf there is evidence of shock, initiate vascular access in two sites. If IV access cannot be obtained in a child proceed with IO access. \u003cbr\u003e\n•\tAdminister a fluid bolus of normal saline at 20 ml/kg\u003cbr\u003e\n\u003cbr\u003e\n7.\tNEUROLOGICAL STATUS\u003cbr\u003e\nA.\tAssess Level of Consciousness\u003cbr\u003e\nB.\tPediatric Glasgow Coma Scale (GCS) and AVPU\u003cbr\u003e\nC.\tRestlessness, agitation, and lethargy may be due to hypoxia and decreased cerebral perfusion.\u003cbr\u003e\nD.\tUnresponsiveness and coma may be due to prolonged hypoxia, shock, head injury, metabolic disorders, or other causes.\u003cbr\u003e\nE.\tConsider the H’s and T’s for reversible cause\u003cbr\u003e\nF.\tImmobilize the patient as appropriate.\u003cbr\u003e\n\u003cbr\u003e\n8.\tExpose the child only as necessary to perform assessments. Maintain the child’s body temperature throughout the examination.\u003cbr\u003e\n\u003cbr\u003e\n9.\tSplint obvious fractures of long bones.\u003cbr\u003e\n\u003cbr\u003e\n10.\tPerform focused history and detailed physical examination IN-ROUTE elicit personal history\u003cbr\u003e\n\u003cbr\u003e\n11.\tVital Signs (See Addendum for Normal Ranges)\u003cbr\u003e\nA.\tRemember to use appropriate B/P cuff size for accuracy!\u003cbr\u003e\nB.\tCAUTION: Children tend to compensate very well for blood loss and may have perfect vital signs in late stages of shock. Watch for other indicators of decompensation – such as pallor, delayed capillary refill and decreasing LOC\u003cbr\u003e\n\u003cbr\u003e\n12.\tSECONDARY ASSESSMENT\u003cbr\u003e\n13.\tFocused History\u003cbr\u003e\nA.\tSAMPLE:\u003cbr\u003e\n•\tSigns and Symptoms\u003cbr\u003e\n•\tAllergies\u003cbr\u003e\n•\tMedications\u003cbr\u003e\n•\tPast Medical History\u003cbr\u003e\n•\tLast meal\u003cbr\u003e\n•\tEvent\u003cbr\u003e\n14.\tFocused Physical Exam\u003cbr\u003e\nA.\tMedical or minor trauma – perform body check pertinent to chief complaint Major trauma – perform total body check\u003cbr\u003e\nB.\tComplete Head-to-Toe Examination Note paralysis and paresthesia\u003cbr\u003e\nC.\tFull spinal immobilization with notation of circulation, motor, and sensory function before and after immobilization","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":null,"widget_label":"Widget Label","widget_code":null},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128876/10049260"},{"listId":10049261,"catId":2128876,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","header":"TRAUMA FIELD MANAGEMENT","summary":"","detail":"TRAUMA TREATMENT FIELD MANAGEMENT (PED)\u003cbr\u003e\n\u003cbr\u003e\n1.\tHead and Spinal Injuries\u003cbr\u003e\na.\tBasic Life Support (BLS)\u003cbr\u003e\ni.\tSpinal restriction/airway management\u003cbr\u003e\nii.\tOxygen to keep SpO2 100%\u003cbr\u003e\niii.\tHyperventilation should be avoided. Maintain End Tidal CO2 between 35 and 45.\u003cbr\u003e\niv.\tElevation of head if possible to decrease cerebral edema\u003cbr\u003e\nv.\tAssist with ALS management\u003cbr\u003e\nb.\tAdvanced Life Support (ALS)\u003cbr\u003e\ni.\tRapid transport to PEDIATRIC Critical Care Center if significant mechanism of injury or suspected head or spinal injury\u003cbr\u003e\nii.\tLarge bore venous access/Intraosseous access Cardiac Monitor\u003cbr\u003e\niii.\tFluid bolus NS/LR at 20 ml /kg for hypotension or dehydration\u003cbr\u003e\niv.\tIf hypotension and shock are present in a child with a head injury, consider another cause – suspect internal bleeding! Avoid hypotension.\u003cbr\u003e\n\u003cbr\u003e\n2.\tTorso Injuries\u003cbr\u003e\na.\tBasic Life Support (BLS)\u003cbr\u003e\ni.\tSpinal restriction/airway management\u003cbr\u003e\nii.\tOxygen to keep SpO2 \u003e94%\u003cbr\u003e\niii.\tAssist with ALS management\u003cbr\u003e\nb.\tAdvanced Life Support (ALS)\u003cbr\u003e\ni.\tRapid transport to PEDIATRIC Critical Care Center if significant mechanism of injury\u003cbr\u003e\nii.\tLarge bore venous access/Intraosseous access \u003cbr\u003e\niii.\tFluid bolus NS/LR at 20 ml /kg for hypotension or dehydration\u003cbr\u003e\niv.\tCardiac Monitor\u003cbr\u003e\nv.\tNeedle decompression if suspected pneumothorax or hemothorax\u003cbr\u003e\n\u003cbr\u003e\n3.\tExtremity Injuries\u003cbr\u003e\na.\tBasic Life Support (BLS)\u003cbr\u003e\ni.\tSpinal restriction/airway management if appropriate \u003cbr\u003e\nii.\tOxygen to keep SpO2 \u003e94%\u003cbr\u003e\niii.\tExtremity immobilization, elevation, and ice\u003cbr\u003e\niv.\tFrequent check of distal circulation, sensation and motor function \u003cbr\u003e\nv.\tAssist with ALS management\u003cbr\u003e\nb.\tAdvanced Life Support (ALS)\u003cbr\u003e\ni.\tLarge bore venous/Intraosseous access\u003cbr\u003e\nii.\tFluid bolus NS/LR at 20 ml /kg for hypotension or dehydration\u003cbr\u003e\niii.\tPain management per pain protocol\u003cbr\u003e\n\u003cbr\u003e\n \u003cbr\u003e\nVI TAL SIGNS AND REFERENCE (PED)","adBanner":{"ad_banner_enable":0,"banner":"","redirect_url":""},"mapThirdParty":"0","MapThirdParty":"0","reviewRating":1,"attributesForList":[],"directoryInfo":[],"formIdentifier":"default","formType":"custom","widgetInfo":{"widget_enable":0,"widget_label":"Widget Label","widget_code":""},"listOwner":"","claimStatus":null,"pwaUrl":"https://www.lcfdapp.com/services_1582148118880_5/2114007/2128876/10049261"}],"data":false,"categoryData":{"catName":"PEDIATRICS","catId":2128876,"catIcon":""},"parentCategoryData":{"catId":2114007,"catName":"GUIDELINES"}},"match":{"hostname":"www.lcfdapp.com","page":"services_1582148118880_5","category":"2128876"}}},"page":"/[...slug]","query":{"slug":["services_1582148118880_5/2128876"]},"buildId":"1234567890","isFallback":false,"dynamicIds":[1204],"customServer":true,"gip":true,"scriptLoader":[]}