M1 Pediatric

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Author:
stan5155
ID:
98071
Filename:
M1 Pediatric
Updated:
2011-08-23 17:22:39
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Pediatric
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Description:
Pediatric Protocols
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  1. Acetaminophen Ingestion
    Activated Charcoal if ingested < 2 hrs, 1 g/kg

    draw Tylenol level, calculate dose ingested, (mg ingested/ weight in kg)

    consider mucomyst infused over 1 hr (see chart in protocol)
  2. Acute Allergic Reaction
    Non-life threatening, Epi 1:1,000 0.01 mg/kg SC to max of 0.3 mg.

    Life Threatening, Epi 1:1,000 0.01 ml/kg IM to max of 0.3 ml. Repeat in 15 min.

    • Albuterol
    • <5 y/o and <30 kg 2.5 mg q 20 x 3
    • >5 y/o and >30 kg 5.0 mg q 20 min x3

    Benadryl 2 mg/kg IV max of 50 mg

    Decadron 0.3 mg/kg, max of 10 mg

    BP < 90, fluid bolus 10-20 ml/kg

    dopamine 2-20 mcg/kg/min
  3. Asthma/Status Asthmaticus
    • MILD:
    • single dose albuterol
    • <20 kg 2.5 mg q 20 min
    • >20 kg 5.0 mg q 20 min

    • MODERATE:
    • Albuterol/Atrovent < 20 kg or < 6y 0.25 mg, > 20 kg or 6y 0.5 mg q 20 x 3

    Solu-Medrol 2 mg/kg IV max of 60

    • SEVERE:
    • RSI only if AMS or resp arrest, use Ketamine
    • Epi 0.01 mg/kg SQ, max 0.5 mg
    • Albuterol/Atrovent followed by continuous Albuterol
    • Mag Sulfate 50 mg/kg IV over 20 min, max of 2 grams
    • Solu-Medrol
  4. Analgesia/Anxiolysis-Intubated
    NORMOTENSIVE:

    • Morphine 0.1-0.2 IV q hr, max single dose 4 mg.
    • Fentanyl 1-2 mcg/kg q hr, max single dose 100 mcg.
    • Versed 0.1 mg/kg IV q 30 min, max single dose 2 mg
    • Zemuron 0.6-1 mg/kg q hr
    • Vecuronium 0.1 mg/kg q hr

    HYPOTENSIVE:

    • Fentanyl
    • Ketamine 0.5-1 mg/kg q 30 min
    • Zemuron
  5. Analgesia/Anxiolysis- Non-Intubated
    • Pain score 1-4 Tylenol 20-30 mg/kg PR x 1
    • 15 mg/kg PO every 14 hrs.

    • Pain score 5-10
    • Morphine 0.05 mg IV q 30 min
    • Fentanyl 1 mcg/kg q hr.

    • Anxiolysis
    • Versed 0.05 mg/kg IV q 30 min, max dose 2 mg
  6. Bradycardia
    Consider Hypoxia as cause

    Compressions with HR < 60 and poor perfusion

    Epi IV/IO 0.01 mg/kg 1:10,000 q 3-5 minutes

    Atropine 0.02 mg/kg, max 0.5 mg child and 1 mg adolescent q 5 minutes to max of 1 mg child or 2 mg adolescent

    TCP
  7. Bronchiolitis
    • Racemic Epi if not given in the past 2 hrs
    • 2.25% in 3 mL

    Albuterol < 20 kg 2.5 q 20 min, > 20 kg 5 mg q 20 min
  8. Combative
    Ativan 0.05-0.1 mg IV/IM q 30 prn to max of 2 mg
  9. Diabetic Ketoacidosis
    • Regular Insulin infusion 100u/100mL NS
    • 0.1 u/kg/hr

    NS fluid rate during transport:

    100 mL/kg x 24 - total fluid received/24
  10. Hypoglycemia
    glucagon if no IV access, <20 kg 0.5 mg IM/SQ, >20 kg 1 mg IV/SQ.

    Dextrose:

    • Infant < 6 mo 3 mL/kg D10
    • Infant > 6 mo to child 2mL/kg D25
    • Adolescent: 1 mL/kg D50 or 2 mL/kg D25

    IVF with dextrose. D10 at 1.5 x maintenance rate
  11. Increased Intracranial Pressure (known or at risk for)
    • maintain PaCO2 35-35 mmHg
    • hyperventilation <30 mmHg only if herniation
    • Avoid hypotension, see MAP reference
    • elevate HOB

    Treat fever with PR tylenol 20-30 mg/kg

    Ativan for seizures 0.1 mg/kg IV/IM, max 2 mg

    Treat analgesia per MAP

    Mannitol if normotensive 0.5-1 gram.kg

    3% NACL 4 ml/kg over 30 min if hypotensive
  12. Opiod/Benzodiazepine Overdose
    Narcan < 20 kg 0.1 mg/kg IV, SQ, IM q 2-3 min. > 20 kg 2 mg q 2-3 min

    Romazicon 0.01 mg/kg IV, max 0.2 mg
  13. RSI
    • Atropine 0.01 mg/kg IV, max 0.4 mg
    • < 2 y/o
    • bradycardic
    • using Ketamine

    Fentanyl 2-3 mcg/kg

    Versed 0.1 mg/kg

    Ketamine 1-2 mg/kg

    Etomidate 0.3 mg/kg

    Sux 1.5 mg/kg

    Rocuronium 0.6 mg/kg
  14. Seizures/Status Epilepticus
    call Med control for hypo/hypernatrremia, hypomagneseamia, hypocalcemia

    Ativan 0.1 mg/kg IV repeat 5-10 min x 1, max dose 4 mg.

    Cerebyx 20 PE/kg

    Phenobarbital 20 mg/kg, max 1 gram

    Versed drip 1 mg/1mL NS 1 mcg/kg/min
  15. Sepsis
    • Fever >100.5
    • HR > 100
    • RR > 20 or PaCO2 <32
    • WBC <4000 or >12000

    IVF 10-20 ml/kg within first two hours

    Dopamine

    Levophed 0.05 mcg/kg/min to max dose of 2 mcg/kg/min
  16. Supraventricular Tachycardia
    • Adenosine 0.1 mg/kg IV or max of 6 mg
    • Second and third dose doubled

    Amioderone 5 mg/kg over 20-60 minutes if wide complex

    • Cardioversion 0.5-1 J
    • Cardioversion 2 J
  17. Tricyclic Antidepressant Overdose
    Charcoal if ingested within 2 hrs 1g/kg, max of 50 g

    QRS > 100 msec, sodium bicarbonate bolus < 1 y/o 4.2% 1 mEq/kg IV. > 1 y/o use 8.4% 1-2 mEq/kg IV

    Bicarb infusion mix 100 mEq in 100 mL D5W and infuse at 2x maintenance

    IVF 20 mL/kg, repeat with persistant hypotension

    Levophed 0.1-2 mcg/kg/min
  18. V-Tach, perfusing
    Cardioversion 0.5 J/kg, 1 J/kg

    Amiodarone 5 mg/kg IV over 20-60 minutes

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