Ottawa Ems Pediatric Acp Directives

Front 1

Defib Joules for Medical Cardiac Arrest

Back 1

30 days to 8 years old
First shock is 2j/kg
Every shock after is 4j/kg

Front 2

Epi for Medical Cardiac Arrest
I.V

Back 2

30 days to 12 years old
1:10 000
0.01mg/kg
Min single dose is 0.1mg
Q 4 minutes

Front 3

Epi for Medical Cardiac Arrest
ETT

Back 3

30 days to 12 years old
1:1000
0.1mg/kg
Min single dose is 0.1mg Max single dose is 2mg
Q 4 minutes

Front 4

Lido for Medical Cardiac arrest

Back 4

30 days to 12 years old AND under 40kg
1mg/kg
Q 4 min
Max 2 doses

Front 5

N/S for Medical Cardia Arrest

Back 5

30 days to 12 years old
20ml/kg
Reassess every 100ml's
Max dose is 20ml's/kg up to 2000ml's

Front 6

Considerations for Medical Cardiac arrest

Back 6

Consider transport after first no shock
ETT only if IV/IO is delayed by more than 5 minutes
If anaphylaxis is suspected, a single dose of 0.01 mg/kg 1:1000 solution, to a maximum of 0.5 mg IM, may be given prior to obtaining the IV/IO

Front 7

Mandatory patch points for Medical Cardiac arrest

Back 7

After 3 rounds of epinephrine OR after 3rd analyses if no IV/IO/ETT access
If the BH patch fails, transport to the closest appropriate receiving hospital following the 4th epinephrine administration OR 4th analysis if no IV/IO/ETT access

Front 8

N/S for Cardiogenic shock

Back 8

Under 18 years old
10ml/kg
Reassess every 100ml's
Max dose of 10ml/kg

Front 9

N/S Maintenance infusion

Back 9

Under 12 years old
15 ml's and hour

Front 10

Mandatory patch point for N/S bolus

Back 10

Patch to BHP for authorization to administer IV NaCl bolus to patients <12 years with suspected Diabetic
Ketoacidosis (DKA)

Front 11

N/S bolus

Back 11

Less than 12 years old
20ml/kg
Reassess every 100ml's
Max dose is 20ml's/kg up to 2000ml's

Front 12

Indications for I/O

Back 12

Actual or potential need for intravenous medication or
fluid therapy AND
Intravenous access is unobtainable
AND
Cardiac arrest or near‐arrest state

Front 13

Conditions for I/O

Back 13

Less than 12

Front 14

Contraindications for I/O

Back 14

Fracture or crush injuries or suspected or known replacement / prosthesis proximal to the access site

Front 15

Indications for Dextrose

Back 15

Agitation
OR
altered LOA
OR
seizure OR symptoms of stroke

Front 16

Dextrose dose for under 30 days

Back 16

D10W
0.2 g/kg OR 2 ml/kg
Max single dose of 5g (50 ml)
Q 10 min's, max 2 doses

Front 17

Dextrose dose for 30 days to under 2 years

Back 17

D25W
0.5g/kg OR 2ml/kg
Max single dose of 10g (40 ml)
Q 10 min's max 2 doses

Front 18

Dextrose dose for over 2 years

Back 18

D50W
0.5g/kg OR 1ml/kg
Max single dose of 25g (50ml)
Q 10 min's max 2 doses

Front 19

Glucagon dose

Back 19

Under 25 kg
0.5mg
Q 20 minutes
Max 2 doses

Front 20

Midazolam dose for seizure for IV

Back 20

0.1mg/kg
Max single dose of 5mg
Q 5 minutes
Max 2 doses

Front 21

Midazolam dose for seizure for IM/IN/Buccal

Back 21

0.2mg/kg
Max single dose of 10mg
Q 5 minutes
Max 2 doses

Front 22

Bronchoconstriction indications

Back 22

Respiratory distress
AND
Suspected bronchoconstriction

Front 23

Salbutomol for Bronchoconstriction MDI dose

Back 23

Under 25kg
Up to 600 mcg (6 puffs)
Max single dose of 600 mcg
Q 5-15 PRN and Max 3 doses
100 mcg approximately every 4 breaths

Front 24

Salbutomol for Bronchoconstriction NEB dose

Back 24

Under 25kg
2.5mg
Max single dose of 2.5mg
Q 5-15 PRN and Max 3 doses

Front 25

Bronchoconstriction special considerations

Back 25

Epinephrine should be the first drug administered if the patient is apneic.
Salbutamol MDI may be administered subsequently using a BVM MDI adapter

Front 26

Epi for Bronchoconstriction dose

Back 26

0.01 mg/kg rounded to nearest 0.05mg
Max single dose of 0.5 mg
Max 1 dose

Front 27

Mod-Severe allergic reaction directive indications

Back 27

Exposure to a probable allergen
AND
Signs and/or symptoms of a moderate to severe allergic reaction (including anaphylaxis)

Front 28

Epi for Mod-Severe allergic reaction dose

Back 28

0.01 mg/kg rounded to nearest 0.05mg
Max single dose of 0.5 mg
Max 1 dose

Front 29

Diphenhydramine for Mod-Severe allergic reaction dose

Back 29

Over 25kg to under 50kg
25mg
Max 1 dose
IV/IM

Front 30

Mod-Severe allergic reaction considerations

Back 30

Epinephrine should be the first drug administered in anaphylaxis

Front 31

Croup medical directive indications

Back 31

Severe respiratory distres AND Stridor at rest
AND
Current history of URTI
AND
Barking cough OR recent history of a barking cough

Front 32

Epi for Croup medical directive conditions

Back 32

Less than 8 years old
Heart rate under 200 bpm

Front 33

Epi for Croup medical directive dose for under 1 year and under 5 kg

Back 33

Epi 1:1000 NEB
0.5mg
Max 1 dose
Add 2ml n/s to meet the minimum initial volume for nebulization of 2.5 ml

Front 34

Epi for Croup medical directive dose for under 1 year and over 5 kg

Back 34

Epi 1:1000 NEB
2.5mg
Max 1 dose

Front 35

Epi for Croup medical directive dose for over 1 year

Back 35

Epi 1:1000 NEB
5mg
Max 1 dose