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":"","verified":0,"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":"","verified":0,"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":"","verified":0,"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.\t2.\tConsider ALBUTEROL 1.25-2.5 mg in 3 ml NS by nebulizer. Or ALBUTEROL/IPRATROPIUM (1.25-2.5 mg. Albuterol, 0.25-0.5 mg. Ipratropium) combination (Duo Neb and others). May repeat as needed.\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.\t4.\tConsider DEXAMETHASONE orally as alternative to Methylprednisolone. (Vial concentration 10 mg./1 ml.) Draw 0.6 mg./kg. (0.06 ml./kg.) from vial with TB (1 ml.) syringe. Remove needle and administer orally. (Vial concentration 20 mg./5 ml.) Dose is drawn in TB (1 ml) syringe without needle. 0.15 ml./kg. PO Maximum dose 10 mg. Concentration in vial should be confirmed;\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":"","verified":0,"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.\t4.\tConsider DEXAMETHASONE orally as alternative to Methylprednisolone. (Vial concentration 10 mg./1 ml.) Draw 0.6 mg./kg. (0.06 ml./kg.) from vial with TB (1 ml.) syringe. Remove needle and administer orally. (Vial concentration 20 mg./5 ml.) Dose is drawn in TB (1 ml) syringe without needle. 0.15 ml./kg. PO Maximum dose 10 mg. Concentration in vial should be confirmed;\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":"","verified":0,"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":"","verified":0,"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 orallyFollow bottle instructions. If using prefilled oral needless syringe (160 mg./5 m..) dose is 0.5 ml./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":13935638,"catId":2128876,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","verified":1,"header":"TRAUMA ASSESSMENT/TREATMENT PEDIATRIC","summary":"","detail":"TRAUMA ASSESSMENT/TREATMENT PEDIATRIC\u003cbr\u003e\nINTRODUCTION\u003cbr\u003e\nPediatric trauma patients are stressful. Trauma is a leading cause of death among certain age groups. Like most trauma patients the scene time should be limited to those procedures that are clearly beneficial to the patient.\u003cbr\u003e\nGENERAL GUIDELINES\u003cbr\u003e\n1.\tQuickly determine if a life threat exists following the XABC paradigm.\u003cbr\u003e\na.\tIdentify and manage any significant bleeding.\u003cbr\u003e\nb.\tAirways are readily compromised in younger children and need to be carefully assessed and managed.\u003cbr\u003e\nc.\tCirculation and perfusion should be assessed and managed where there are signs of inadequate perfusion like poor pulses, tachycardia, bradycardia, hypotension (see VITALS TABLES PEDIATRIC at end of PEDIATRIC\t section. Pediatric patients can maintain stable or normal vitals until late decompensation.\u003cbr\u003e\nd.\tEvaluate for altered mental status or depressed level of consciousness.\u003cbr\u003e\ne.\tExpose the patient to look for hidden injuries and to thoroughly evaluate.\u003cbr\u003e\nf.\tAssess the integrity of the cervical spine and stabilize as needed.\u003cbr\u003e\ng.\tAir transport to advanced trauma center should be considered for severe traumatic injuries. Local hospitals offer ER stabilization, blood products, and advanced airway management in smaller children. Limited in pediatric trauma care otherwise.\u003cbr\u003e\n2.\tInterventions to consider\u003cbr\u003e\na.\tAIRWAY\u003cbr\u003e\ni.\tPosition head to optimize airway.\u003cbr\u003e\nii.\tSuction may be necessary\u003cbr\u003e\niii.\tConsider airway adjuncts including NPA, OPA, and LMA.\u003cbr\u003e\niv.\tIntubation is limited to children older than 12.\u003cbr\u003e\n1.\tConsider post intubation pain management and sedation.\u003cbr\u003e\nb.\tBREATHING\u003cbr\u003e\ni.\tAssess the chest and obtain breath sounds\u003cbr\u003e\nii.\tIn cases of inadequate ventilation assist with BVM.\u003cbr\u003e\niii.\tOxygen should be considered by mask if tolerated to maintain pulse oximetry to approximately 94%.\u003cbr\u003e\n1.\tIf Traumatic Brain Injury (TBI) present push 100% oxygen to avoid any hypoxia.\u003cbr\u003e\n2.\tAvoid hyperventilation keeping end tidal in the 35-45 range.\u003cbr\u003e\niv.\tIn extreme cases where tension pneumothorax is suspected consider needle decompression of the chest in the 2nd anterior intercostal space or the 4th intercostal space in the anterior axillary line.\u003cbr\u003e\nv.\tObtain pulse oximetry and end tidal CO2 readings.\u003cbr\u003e\nc.\tCIRCULATION\u003cbr\u003e\ni.\tControl external bleeding with pressure, dressings, or hemostatic fabric.\u003cbr\u003e\nii.\tTourniquets are sometimes indicated.\u003cbr\u003e\niii.\tTXA approved over 15 years old. 2 grams IV/IO over ten minutes.\u003cbr\u003e\niv.\tIV/IO access should be considered. Below or equal to 7 years old proximal tibia or distal femur only. In cases of decreased perfusion bolus crystalloid fluids at rate of 20 ml./kg. If TBI present, use fluids to avoid hypotension. For smaller quantities utilize a Buretrol if accessible.\u003cbr\u003e\nv.\tTachycardia is usually present with hypovolemia or significant bleeding. Bradycardia is a worrisome late finding of hypovolemia and shock or indicates head or spinal trauma.\u003cbr\u003e\nd.\tMENTAL STATUS\u003cbr\u003e\ni.\tAssess mental status for lethargy, diminished level of consciousness, restlessness, agitation all of which could indicate hypoxia and poor cerebral perfusion\u003cbr\u003e\nii.\tUnresponsiveness and coma are troubling findings and late in hypoxia, hypotension, shock, and head trauma.\u003cbr\u003e\ne.\tBURNS\u003cbr\u003e\ni.\tUse crystalloid (LR) to maintain blood pressure.\u003cbr\u003e\nii.\tIf \u003e 20% BSA affected or patient is hypotensive administer fluids: 5 or younger: 125 ml./hr., 6-13: 250 ml./hr., and 14 or older: 500 ml./hr.\u003cbr\u003e\nf.\tSECONDARY SURVEY\u003cbr\u003e\ni.\tPerform a thorough head-to-toe assessment.\u003cbr\u003e\nii.\tObtain as much history as is possible \u003cbr\u003e\ng.\tPAIN MANAGEMENT\u003cbr\u003e\ni.\tIt is easy to underestimate the degree of pain a pediatric patient is experiencing. Pain scales are poor indicators. Tourniquets are painful within minutes of application, for example. Follow the PAIN MANAGEMENT GUIDELINES for interventions.\u003cbr\u003e\nh.\tTRAUMATIC ARREST\u003cbr\u003e\ni.\tFollow the TRAUMA ARREST guidelines.\u003cbr\u003e\nii.\tTransport patient","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_5/2114007/2128876/13935638"},{"listId":13933618,"catId":2128876,"dirPageId":"services_1582148118880_5","distance":"","chatUrl":"","chatType":"","verified":1,"header":"VITALS TABLES PEDIATRIC","summary":"","detail":"HEART RATE\t Awake\tAverage\tSleeping\u003cbr\u003e\nNewborn to 3 months\t85-205\t140\t 80-100\u003cbr\u003e\n3 months to 2 years\t100-190\t130\t 75-160\u003cbr\u003e\n2 years to 10 years\t 60-140\t 80\t 60-90\u003cbr\u003e\nOver 10 years\t 60-100\t 75\t 50-90\u003cbr\u003e\n\t\t\t\u003cbr\u003e\nBLOOD PRESSURE\tAge\t Systolic\tDiastolic\u003cbr\u003e\n\t Neonate\t60-75\t30-45\u003cbr\u003e\n\t I month\t73-94\t36-55\u003cbr\u003e\n\t 6 months\t82-105\t46-68\u003cbr\u003e\n\t 1 year\t67-104\t20-60\u003cbr\u003e\n\t 7 years\t79-115\t38-78\u003cbr\u003e\n\t 15 years\t93-131\t45-85","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_5/2114007/2128876/13933618"}],"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":[]}