M1 Pediatric

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)

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

• 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

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

• 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

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

• 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

Ativan 0.05-0.1 mg IV/IM q 30 prn to max of 2 mg

• 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

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

• 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

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

• 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

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

• 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

• 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

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

Cardioversion 0.5 J/kg, 1 J/kg

Amiodarone 5 mg/kg IV over 20-60 minutes