Resources and References

  • 12-Lead EKG
  • Airport Staging
  • APGAR
  • Burn Severity
  • Burn - Rule of Nines Adult
  • Burn - Rule of Nines Peds
  • Cardioversion Energy
  • D10 Chart
  • GCS - Adult
  • GCS - Peds
  • Levophed Drip
  • Magnesium Drip
  • Medical Alert
  • Pain Scale - Infant
  • Pain Scale - Numeric
  • Pain Scale - Spanish
  • Pain Scale - Visual
  • Peds Vitals Limits
  • Pit Crew CPR - Adult
  • Pit Crew CPR - Peds
  • Preductal SpO2
  • Stroke Scale - Cincinnati
  • Stroke Scale - RACE
  • Triage - Jump START
  • Triage - START
  • TBI - BP Ranges
  • TBI - Ventilations
  • Trauma Alert
  • Trauma Alert - Major

12-Lead EKG Cheat Sheet

I (Lateral)

aVR

V1 (Septal)

V4 (Anterior)

II (Inferior)

aVL (Lateral)

V2 (Septal)

V5 (Lateral)

III (Inferior)

aVF (Inferior)

V3 (Anterior)

V6 (Lateral)

Airport Staging

APGAR Scoring Chart

Burn Severity

BSA
Superficial
Partial Thickness
Full Thickness
100%
Moderate
> 50%
Critical
> 30%
Critical
> 30%
90%
80%
70%
60%
50%
40%
Minor
< 50%
30%
20%
Moderate
< 30%
15%
10%
Minor
< 15%
2%
Moderate
< 10%
0%
Minor
< 2%
 
Critical
Any partial or full thickness burn involving hands, feet, face, genitalia, or joints.

Rule of Nines

Pediatric
Rule of Nines

Cardioversion Energy Recommendations

Atrial Fibrillation
120J → 150J → 200J
Narrow Complex Tachycardia
50J → 100J → 150J → 200J
Wide Complex Tachycardia
100J → 150J → 200J

D10 Chart

Glucose
50% Dextrose
10% Dextrose
60-69
16 mL
80 mL
50-59
20 mL
100 mL
40-49
24 mL
120 mL
30-39
28 mL
140 mL
20-29
32 mL
160 mL
10-19
36 mL
180 mL

Glasgow Coma Scale

Eye Opening Spontaneous
4
To Voice
3
To Pain
2
None
1
Verbal Response Oriented
5
Confused
4
Inappropriate Words
3
Incomprehensible Sounds
2
None
1
Verbal Response Obeys Commands
6
Purposeful Movement to Pain
5
Withdraw to Pain
4
Flexion to Pain
3
Extension to Pain
2
None
1
Total  
3 - 15

Pediatric
Glasgow Coma Scale

(for use with children less than school age)
Eye Opening Spontaneous
4
To Sounds
3
To Painful Stimuli
2
None
1
Verbal Response Appropriate Words or Social Smile
5
Cries but Consolable
4
Persistently Irritable
3
Restless, Agitated
2
None
1
Verbal Response Spontaneous Movement
6
Localizes to Pain
5
Withdraw to Pain
4
Flexion to Pain
3
Extension to Pain
2
None
1
Total  
3 - 15

Levophed Drip

    Mix 4ml in 500 ml bag of D5W or NS (8 mcg/ml concentration)
    Start at 2-4 mcg/min and titrate to SBP > 90mm Hg. Max infusion 12 mcg/min.
    Rates (using 60 drops/ml set):

 

mcg/ml
2
3
4
5
6
7
8
9
10
11
12
ggt/min
15
22
30
37
45
52
60
67
75
82
90

Magnesium Drip

    ADULT - OBSTRUCTIVE or REACTIVE AIRWAY DISEASE
    Table is for 2g in 50mL
    Administer 2g over 20 minutes

 

Drop Set
10
15
20
ggt/min
25
38
50

Medical Alert Criteria

    Suspected acute MI
    Suspected Sepsis
    Acute neurological deficits of < 6 hours duration
    Inspiratory stridor

 

Physiological

 

    Systolic BP (SBP) < 90 mmHg or vital signs outside of physiologic ranges for pediatrics
    GCS < 13
    Respiratory rate < 10 or > 30 (adults), < 15 or > 45 (peds)
    Heart rate < 40 or > 120
    Temp < 92°F or > 105°F
         - Usually determined in the transferring ED
    Oxygen saturation < 88%
Healthcare provider discretion

Pediatric
Infant Pain Scale Assessment Tool

Behavior
Scoring
0
1
2
3
Facial
Neutral/smiling
Frowning/grimacing
Clenched teeth
Full cry expression
Body Movement
Calm, relaxed
Restless/fidgeting
Moderate agitation or moderate mobility
Thrashing, flailing, incessant agitation or strong voluntary immobility
Sleep
Sleeping quietly with easy respirations
Restless while asleep
Sleeps intermittently (sleep/awake)
Sleeping for prolonged periods of time interrupted by jerky movements or unable to sleep
Verbal/Vocal
No cry
Whimpering, complaining
Pain crying
Screaming, high pitched cry
Consolability
Neutral
Easy to console
Not easy to console
Inconsolable
Response to
Movement/Touch
Moves easily
Winces when touched/moved
Cries out when moved/touched
High-pitched cry or scream when touched or moved

Numeric Pain Scale

 

0
 No Pain
1
 No Pain -> Little
2
 Little
3
 Little -> Moderate
4
 Moderate
5
 Moderate -> Quite Bad
6
 Quite Bad
7
 Quite Bad -> Severe
8
 Severe
9
 Severe -> Unbearable
10
 Unbearable

Wong Baker Pain Scale - Spanish

0
Muy contento;
sin dolor
2
Siente sólo un poquite de dolor
4
Siente un poco más de dolor
6
Siente aún más dolor
8
Siente mucho dolor
10
El dolor es el peor que puede imaginarse
(no tiene que estar llorandor para sentir este dolor tan fuerte)

Wong Baker Pain Scale

0
No hurt
2
Hurts little bit
4
Hurts little more
6
Hurts even more
8
Hurts whole lot
10
Hurts worst

Pediatric
Vital Signs

Age Group

Respiratory Rate

Heart Rate

Systolic Blood Pressure

Newborn

30 - 60

120 -180

> 60

Infant
(1 - 12 months)

20 - 40

100 - 140

> 70

Toddler
(1 - 3 yrs)

20 - 34

90 - 130

> 75

Preschooler
(3 - 5 yrs)

20 - 30

80 - 120

> 80

School Age
(6 - 12 yrs)

18 - 30

70 - 110

> 80

Adolescent
(13+ yrs)

12-20

60 - 100

> 90

Pit Crew CPR

Pediatric
Pit Crew CPR

Pediatric
Targeted Preductal SpO2 After Birth

Time

Target SpO2

1 min

60%-65%

2 min

65%-70%

3 min

70%-75%

4 min

75%-80%

5 min

80%-85%

10 min

85%-90%

Cincinnati Stroke Scale

    Facial Droop (have patient show teeth or smile):

      Normal – both sides of face move equally well
      Abnormal – one side of face does not move as well as the other side

     

    Arm Drift (have patient close eyes and hold both arms out, palms up):

      Normal – both arms move the same or both arms do not move at all
      Abnormal – one arm does not move or one arm drifts down compared with the other

     

    Speech (have the patient say “you can’t teach old dog new tricks”):

      Normal – patient uses correct words with no slurring
      Abnormal – patient slurs words, uses inappropriate words, or is unable to speak

RACE Stroke Scale

Facial Palsy Absent
0
Mild
+1
Moderate/Severe
+2
Arm Motor Impairment Normal/Minimal
0
Moderate
+1
Severe
+2
Leg Motor Impairment Normal/Minimal
0
Moderate
+1
Severe
+2
Head and Gaze Deviation Absent
0
Present
+1
Left Hemiparesis

Ask the patient:
(1) While showing patient the paretic arm, “Whose arm is this?”
(2) “Can you lift both arms and clap?”
Patient recognizes his/her arm and the impairment
0
Does not recognize his/her arm or the impairment
+1
Does not recognize his/her arm AND the impairment
+2
Right Hemiparesis

Instruct the patient:
(1) Close your eyes”
(2) “Make a fist.”
Performs both tasks correctly
0
Performs one task correctly
+1
Performs neither task correctly
+2

Jump START Triage

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.

 

Criteria (Ages 1 - 8)
Tag
Move the walking wounded
Minor
Apneic or irregular respirations: Open airway
Resume breathing?
Immediate
Still apneic and no peripheral pulse?
Dead / Dying
Still apneic but has a peripheral pulse
Mouth-toMask for 15 seconds (4-5 breaths)
Resume breathing?
Immediate
Still apneic?
Dead / Dying
Respirations <15 or >45
Immediate
Pulse: No peripheral pulse (least injured extremity)
Immediate
Mental status: Unresponsive or responsive to pain only
Immediate
Otherwise
Delayed
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.
Minor
Developed by Lou Romig MD, FAAP, FACEP at Miami Children’s Hospital

START Triage

Marion County EMS providers have adopted a simple system for triaging patients in a multiple-patient scenario or a mass casualty incident. It is acknowledged that, under these circumstances, some patients that EMS could potentially save if encountered individually will not be given the benefit of all necessary resources.

Criteria
Tag
Move the walking wounded
Minor
No resp after head tilt - jaw thrust
Dead / Dying
Respirations > 30
Immediate
Pulse: No radial puls (least injured arm)
Immediate
Mental status: Unable to follow simple commands
Immediate
Otherwise
Delayed
Developed by the Newport Beach, CA Fire & Marine Dept., and the current DOT Standard for EMS providers.

TBI BP Monitoring

Age

SBP

0 - 24 months

>70 mmHG

2 - 7

> 80 mmHG

> 7

>90 mmHg

 

Prevent even a single isolated episode of hypotension by IV fluid resuscitation with initial bolus of 1 L NS, followed by repeat boluses of 500 ml NS to keep SBP>90 mmHg in adults.

 

20 ml/kg for pediatric patients, followed by repeat boluses of 10 ml/kg NS or at sufficient rate to keep SBP as above.

 

Do not treat hypertension, but restrict IVF TKO in adults with SBP >140 mmHg, infants with SBP >100 mmHg and older children/adolescents with SBP >130 mmHg.

TBI Ventilation

Age

Ventilation Rate

0 - 24 months

25 breaths/min

2 - 14

20 breaths/min

> 14

10 breaths/min

 

In intubated patients, use BVM to maintain ETCO2 between 35 and 45 mmHg.

Trauma Alert Criteria

Mechanism of Injury
    Ejection from vehicle
    Vehicle roll-over
    Prolonged extrication from vehicle
    Pedestrian struck by vehicle at speed > 20 MPH
    Falls > 20 feet (adults) or > 3x the child’s height

 

Healthcare provider discretion

Major Trauma Criteria

Physiologic

 

    Systolic BP < 90 mm Hg or vital signs outside of physiologic ranges for pediatrics
    Glasgow Coma Scale (GCS) ≤ 13
    Respiratory rate < 10 or > 29
    Patient receiving blood to maintain vital signs
    Airway or respiratory compromise as defined by:

      BVM, Intubation, adjunct airway, or cricothyroidotomy in the field
      Needle chest decompression

 

Anatomic

 

    Penetrating trauma to the head, neck, chest, abdomen, or extremities proximal to the knees and elbows
    Traumatic amputation proximal to the wrist or ankle
    Burns > 15% or high voltage (>1000 volts) electrical injury
    Any crushed, degloved, pulseless, or mangled extremity
    Pelvic fracture
    Two or more long bone fractures
    Flail chest
    Extremity paralysis suggestive of spinal cord injury
    Open or depressed skull fracture
    Victim of hanging who meet above criteria

 

Healthcare provider discretion