San Diego County 2007/2008 Paramedic Pediatric Protocol Differences

Front 1

Pediatric Standing Order Skills

Back 1

-Defibrillation
-Glucose Monitoring
-Indwelling Devices
-Intraosseous Infusion
-Intubate (ET/Stomal/ETAD)
-Magill Forceps w/ Direct Laryngoscopy
-Nasogastric/Orogastric Tube Insertion
-Re-alignment of Fracture
-Removal of Impaled Object
-Valsalva Maneuver

The differnce compared to adult standing order skills is you lose Cardioversion however you gain Intraosseous Infusion.

Front 2

Airway Obstruction Pediatric Protocol Differences

Back 2

-5 Abdominal Thrusts only if complete airway obstruction, MR prn.
-Unconcious Patient < 1 year old perform 5 back blows and chest thrusts, MR prn
-If suspected epiglottitis: Place patient in sitting position, do not visualize the oropharynx, and STAT transport.

Front 3

Altered Neuro Function Pediatric Protocol Differences

Back 3

*BLS*
-Hypoglycemia only give 1 tablet instead of 3
-Seizures - If Febrile remove excess clothing/covering

*ALS*
-Opioid OD - There is no respiratory rate requirement for pediatric opioid OD.
-Seizures - There is no "Eclamptic seizure of any duration" cause.

Front 4

Allergic Reaction Pediatric Protocol Differences

Back 4

*BLS*
-No Changes

*ALS*
-Any respiratory distress with bronchospasm does not include "Cardiac History" requirement for Ped's.
-Anaphylaxis - No Dopamine is available since it is adult only drug.

Front 5

Dysrhythmias (Brady, SVT)Pediatric Protocol Differences

Back 5

*BLS*
-Start CPR when heart rate indicates and patient is unstable: <9yrs HR<60bpm, 9-14yrs HR<40bpm.
-Unstable dysrhythmias include heart rate as above and any of the following: Poor perfusion (cyanosis, delayed cap refill, mottling), or Altered LOC, Dyspnia or BP <70+[2xage], or diminished or absent peripheral pulses.
-Dehydration can cause tachycardias up to 200/min

*ALS*
-Unstable Brady heart rate: Infant/Child (<9yrs) <60bpm, Child (9-14yrs) <40bpm.
-Ventilate per BVM for 30 sec, then reassess HR prior to compressions and drug therapy.
-Epi PDC IVP/IO/ET/ETAD. After the standard 3 doses at SO, the repeat doses are BHO for peds.
-If age >30 days Atropine IV/IO/ET. MR x 1 in 5".

-SVT <4yrs >240bpm, >or= 4yrs >200bpm.
-All adenosine doses are BHPO.
-All versed and cardioversion procedures are BHPO.

Front 6

Dysrhythmias (VF/Pulseless VT) Pediatric Protocol Differences

Back 6

*BLS*
-Use AED if pt. >or= 1year, pulseless and unconscious.

*ALS*
-IO is an alternative option to IV Epi.
-After standard 3 Epi Doses at SO, repeat with BHO.
-Lidocaine can be repeated x 2 q3-5" instead of just repeating once for adults.

Front 7

Dysrhythmias (Post Conversion VT/VF w/ pulse >60) Pediatric Protocol Differences

Back 7

*ALS*

-Repeat lidocaine X 2 every 8-10" instead of repeating half doses to max dose for adults.

Front 8

Dysrhythmias (PEA/Asystole) Pediatric Protocol Differences

Back 8

*ALS*
-PEA and Asystole protocol are paired for pediatrics, where they are seperate for adults.
-IO is the alternative option to IV for Epi.
-After standard 3 doses of Epi with SO, repeat doses are BHO.

Front 9

Poisoning/Overdose Pediatric Protocol Differences

Back 9

*ALS*
-There is no respiratory rate requirement for opiod OD for peds.

Front 10

Respiratory Distress Pediatric Protocol Differences

Back 10

*BLS*
-Dislodge any airway obstruction

*ALS*
-There is no protocol for respiratory distress with rales for peds.
-Respiratory distress with stridor is added in, treating with epi 1:1,000 PDC via nebulizer, MR x 1 SO.

Front 11

Shock Pediatric Protocol Differences

Back 11

*BLS*
-Determine peripheral pulses/cap refill

*ALS*
-IO is an alternative to IV for fluids.
-Instead of grouping the 3 types of shock like adult protocols, peds shock has Noncardiogenic and Cardiogenic.
-For cardiogenic you can only repeat your PDC fluid bolus X 1 SO with clear lungs.

Front 12

Trauma Pediatric Protocol Differences

Back 12

*ALS*
-For crush injury: IV fluid bolus is BHO, and CaCl2 is not given for peds.

Front 13

Burns Pediatric Protocol Differences

Back 13

*ALS*
-Instead of >20% 2'nd degree for adults, it changes to >10% 2'nd degree burns for peds.
-Fluid boluses are age based: 5-14yrs 250ml bolus then tko, <5yrs 150ml bolus then tko.
-Burn center criteria also changes to >10% 2'nd degree burns for peds.

Front 14

Pain Management Protocol Differences

Back 14

*ALS*
-MS is PDC, instead of SO to 10mg, with a MR that's BHO.