NJ MICU Pediatric Standing Orders

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Author:
medicstudent1125
ID:
295662
Filename:
NJ MICU Pediatric Standing Orders
Updated:
2015-02-13 14:59:57
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MICU StandingOrders
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Description:
NJ state MICU pediatric standing orders (MONOC)
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  1. Bradycardia
    • 1) Secure Airway
    • 2) Oxygen
    • 3) Maintain Body Temp.
    • 4) HR </=60 w/ Cardiopulmonary     Compromise after o2 & vents
    • 5) IV access w/ NSS 20mL/kg
    • 6) start CPR 3:1
    •     Epi 1:10,000 0.01mg/kg IV
    •     No IV Epi 1:1000 0.1mg/kg ETT
    • 7) Medical Control
  2. Narrow Complex Tachycardia
    • 1) Airway
    • 2) O2
    • 3) Temp
    • 4) IV 20ml/kg NSS bolus
    • 5) vagal if stable
    • 6) adenosine 0.1mg/kg rapid IVP, 10ml flush
    • 7) no a-fib, a-flutter or WPW
    • 8) adenosine 0.2mg/kg
    • 9) Medical Control
  3. V-Fib / Pulseless V-Tach
    • Determine pulselessness
    • Start CPR
    • Vent w 100%
    • O2
    • Advanced airway
    • IV NSS @ KVO
    • Temp
    • Defib @ 2j/kg, cont CPR 2 min cycle
    • No change, Defib @4j/kg, cont CPR
    • EPI 0.01mg/kg 1:10,000
    • Or 0.1mg/kg 1:1,000/ETT
    • No change, Defib @ 4j/kg
    • Continue CPR
    • Amiodarone 5mg/kg
    • Medical Control
  4. Wide Complex Tachycardia
    • Airway
    • O2
    • Temp
    • IV 20ml/kg NSS
    • Medical Control
  5. PEA
    • Determine pulselessness
    • Start CPR
    • Vent @ 100% O2
    • Secure airway
    • IV NSS @ KVO
    • Temp
    • Asystole – confirm in more than one lead
    • BGL? <1month 0.5g/kg D10%
    •         >1month 0.5g/kg D25%
    • No IV Glucogon 0.1mg/kg max of 1mg
    • OD? Narcan 1st dose 0.2mg
    • 2nd dose 0.1mg/kg MAX 2mg
    • EPI 3-5 min 0.01mg/kg 1:10,000
    •  (or 0.1mg/kg/ETT 1:1,000 in 5 ml NSS)
    • Medical Control
  6. Allergic Reaction / Anaphylaxis
    • Airway
    • O2
    • Temp
    • EPI 0.01mg/kg 1:1,000 IM 
    • MAX 0.3mg
    • Wheeze – albuterol 2.5mg neb
    • IV NSS @ KVO
    • low BP - 20mg/kg NSS rapid bolus
    • no improvement – diphenhydramine 1mg/kg
    • Medical Control
  7. Asthma
    • Airway
    • O2
    • Temp
    • Duoneb – 2.5mg albuterol / 0.5mg atrovent
    • Subsequent tx 2 more ALBUTEROL ONLY
    • No improvement EPI 0.01mg/kg 1:1,000 MAX 0.5mg
    • IVNSS@KVO
    • Medical Control
  8. Seizures
    • Airway
    • O2
    • Temp
    • BGL <60<1 month 0.5mg/kg 10%DEXTROSE
    • >1month 0.5mg/kg 25%DEXTROSE
    • no IV, glucagon 0.1mg/kg MAX 1mg
    • ALS witnessed seizure
    • Ativan 0.05mg/kg, MAX2mg
    • Vailum 0.1mg/kg MAX 5mg
    • NO IV, Ativan 0.05mg/kg MAX 2MG IM/IN     
    • Versed 0.15mg/kg MAX 5mg IM/IN
    • Medical Control
  9. Trauma
    • Spine
    • Airway
    • O2
    • Control bleeding
    • Temp
    • Transport decision
    • IV Ringers @KVO
    • Trauma w/ burns, use NSS20ml/kg rapid fluid bolus
    • Sys>90
    • Morphine 0.1mg/kg MAX 10mg
    • Fentanyl 1mcg/kg MAX  100mcg
  10. Croup
    • Airway
    • O2
    • Temp
    • Position of comfort
    • Mild – 3cc NSS via neb
    • SEVERE – epi 3mg 1:1,000 neb
    • No change, IV NSS @KVO
  11. Burn Management
    • Stop burning
    • Hazmat
    • Spine
    • Airway
    • Consider ETT100% O2
    • dry dressing
    • temp maintainance
    • transport decision
    • trauma center considered
    • IV KVO
    • Sys>90
    • morphine 0.1mg/kg 10mg MAX, slow IVP               
    • Fentanyl 1mcg/kg MAX100mcg slow IVP
  12. Non Traumatic Shock
    • Airway
    • O2
    • Temp
    • IV NSS@KVO 20ml/kg NSS,
    • rapid BGL <1 month 0.5g/kg D10%
    •                >1 month 0.5g/kg D25%
    • No IV 0.1mg/kg Glucogon max 1mg IM
    • No change, give 2nd 20ml/kg NSS, rapid
  13. Altered Mental Status
    • Airway
    • O2
    • Temp
    • (trauma considered)
    • IV, NSS @ KVO
    • BGL <1mth 0.5g/kg D10% >1mth D25%
    • RESP DRIVE,
    • narcan 0.2mg, 0.1mg/kg MAX 2mg
    • HX of dehydration, 20ml/kg NSS bolus
  14. General Sedation
    • All situation permitting
    • Baseline vitals, bp, hr, rr, patency, spo2, bgl
    • High flow O2 via NRB
    • IV NSS@KVO
    • Ativan 0.1mg/kg 2mg MAX
    • May repeat 1 time
    • No IV, versed 2mg approved route.
    • Continuously monitor airway, vitals, LOC
  15. Sedation Painful Procedure
    • O2 via NRB
    • IV in AC
    • NSS @ KVO
    • Versed 0.1mg/kg slow IVP MAX 5mg
    • Sys > 70 + (agex2)
    • No IV, versed 5mg approved route
  16. Sedation Adv. Airway
    • High flow O2 via NRB
    • IV in AC
    • NSS@KVO
    • Etomidate 0.15mg/kgMAX 30mg sys>80
    • Sys<80, etomidate 0.15mg/kg MAX15mg
    • Post intubation
    • Versed 0.1mg/kg, MAX 5mg
    • Record vitals, etco2, spo2

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