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IF suspected anaphylaxis, proceed directly to epinephrine administration |
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(Estimated by Broselow tape) |
Adults |
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Infusion Rate |
mcg/min |
mcg/min |
mcg/min |
mcg/min |
mcg/min |
mcg/min |
mcg/min |
gtt set |
drops/min |
drops/min |
drops/min |
drops/min |
drops/min |
drops/min |
drops/min |
gtt set |
drops/min |
drops/min |
drops/min |
drops/min |
drops/min |
drops/min |
drops/min |
gtt set |
drops/min |
drops/min |
drops/min |
drops/min |
drops/min |
drops/min |
drops/min |
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BRADYCARDIA CRITERIA: Heart rate < 60/minute for children (1-15) and adults; < 80/minute in infants. Bradycardia with hemodynamic compromise is an ominous sign of impending cardiac arrest in infants and children.
SYMPTOMATIC CRITERIA: Bradycardia with signs of poor perfusion and altered mentation, chest pain or dyspnea with associated hypotension.
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Oxygenation and ventilation are of utmost importance in pediatric cardiac arrest care! Most pediatric cardiac arrests are secondary to a primary respiratory arrest.
Use the Broselow® tape (or appropriate equivalent) to obtain approximate weight and determine correct dosing regimen.
For EMS witnessed cardiac arrest, quick defibrillation is key – do not delay defibrillation!
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Eye Opening | Spontaneous | |
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To Sounds | ||
To Painful Stimuli | ||
None | ||
Verbal Response | Appropriate Words or Social Smile | |
Cries but Consolable | ||
Persistently Irritable | ||
Restless, Agitated | ||
None | ||
Verbal Response | Spontaneous Movement | |
Localizes to Pain | ||
Withdraw to Pain | ||
Flexion to Pain | ||
Extension to Pain | ||
None | ||
Total |
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Jump-START is a modification of the START triage guidelines for pediatric patients and takes into account the normal variation in respiratory rate on the basis of age, and the fact that primary respiratory failure can be corrected easily.
An apneic child is more likely to have a primary respiratory problem than an adult. Perfusion may be maintained for a short time and the child may be salvageable.
A respiratory rate of 30 may either over-triage or under-triage a child, depending on age.
Capillary refill may not adequately reflect peripheral hemodynamic status in a cool environment.
Obeying commands may not be an appropriate gauge of mental status for younger children.
Move the walking wounded | |
Apneic or irregular respirations: Open airway | |
Resume breathing? | |
Still apneic and no peripheral pulse? | |
Still apneic but has a peripheral pulse | |
Mouth-toMask for 15 seconds (4-5 breaths) | |
Resume breathing? | |
Still apneic? | |
Respirations <15 or >45 | |
Pulse: No peripheral pulse (least injured extremity) | |
Mental status: Unresponsive or responsive to pain only | |
Otherwise | |
Age <1: | |
If all Jump-START “delayed” criteria are satisfied and there are no significant external injuries, the child may be classified as “ambulatory” and tagged. | |
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Infants - rate usually > 220/min Children - rate usually > 180/min |
Hypotension, acutely altered mentation, signs of shock |
Reassess after each step before proceeding to the next. |
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If difficulty breathing is suspected from reactive airway disease or obstructive airway disease and there is no improvement from prescribed inhaler or if no inhaler was administered:
For Pediatric patients over 2 years old, administer 0.01 mg/kg Epinephrine 1:1,000 IM. (Max 0.3 mg) |
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3 |
0.3 ml |
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20 |
2 ml |
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4 |
0.4 ml |
22 |
2 ml |
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5 |
0.5 ml |
24 |
2 ml |
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6 |
0.6 ml |
26 |
2 ml |
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7 |
0.7 ml |
28 |
2 ml |
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8 |
0.8 ml |
30 |
2 ml |
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9 |
0.9 ml |
32 |
2 ml |
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10 |
1 ml |
34 |
2 ml |
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11 |
1.1 ml |
36 |
2 ml |
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12 |
1.2 ml |
38 |
2 ml |
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13 |
1.3 ml |
40 |
2 ml |
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14 |
1.4 ml |
44 |
2 ml |
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15 |
1.5 ml |
48 |
2 ml |
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16 |
1.6 ml |
52 |
2 ml |
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17 |
1.7 ml |
56 |
2 ml |
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18 |
1.8 ml |
60 |
2 ml |
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19 |
1.9 ml |
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Indianapolis EMS |
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Movement/Touch |
No hurt |
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Hurts little bit |
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Hurts little more |
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Hurts even more |
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Hurts whole lot |
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Hurts worst |
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NOTE: The positions for Pediatric Pit Crew CPR are slightly different to emphasize the importance of Oxygenation and Ventilation
Unlike other situations, choice of safety restraints are directly related to the child’s size. Therefore, for the purposes of this protocol, child specific safety seats or restraints are required until the child has reached adult size by provider judgment (As a general guide, greater than 5 feet tall and 100 lbs. ) .
*Ideal transport method is in bold & highlighted, with acceptable alternatives listed.
Reference: Working Group Best-Practice Recommendations for the Safe Transportation of Children in Emergency Ground Ambulances. National Highway Traffic Safety Administration (NHTSA), September 2012, available at www.ems.gov
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Criteria: Continuous seizure activity for longer than 3 minutes or two or more consecutive seizures without regaining consciousness.
Focal seizure activity meeting the above criteria should also be considered status epilepticus
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BLS providers should immediately direct trained caregivers to replace trach tube. ALS providers should locate emergency replacement trach tubes that are usually kept near the patient and attempt tube replacement. |
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Suctioning
Ventilation
Displaced Tracheostomy Tube
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Ventilator Patients
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Chest pain or dyspnea |
Hypotension, acutely altered mentation, signs of shock |
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