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33 Cards in this Set

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In the BioTel system, pediatric means anyone who has not reached their (blank) birthday. However, for legal considerations such as the right to give or refuse treatment, a"pediatric" patient is anyone who has not reached their (blank) birthday.
13th
18th
A "normal" average systolic BP can be estimated with what formula?

Lower limits of Systolic BP can be estimated by what formula?
average BP: 80 + (2 x age in years) = average mean systolic BP

70 + (2 x age in years) = Lower Limits of systolic BP
The ET tube size can be estimated by using the size of the childs nostrils, the little finger of the child or what forumul?
Age + 16 divided by 4 = ET Tube size.
Cardiac arrest in pediatric patients are most commonly caused by (blank).
respiratory failure
Hypotension and bradycardia in pediatrics are both signs of ....
impending cardiac arrest.
Your pediatric patient is unresponsive, has a pulse of < 60 and shows signs of hypoperfusion after 60 seconds of ventilation with supplemental oxygen. You're next step is to (blank).
Begin CPR
Rarely, TCP is necessary due to bradycardia. If this occasion does occur, you should (blank).
Place the pads anterior and posterior and contact BioTel for setting.
When necessary, normal saline for initial pre-hospital fluid resuscitation is given rapidly at (blank) and can be repeated once after contacting BioTel.
20mL/kg (do NOT run IV's wide open in children)
In patients less than (blank) pounds, use a microdrip set to administer fluid therapy.
20 pounds ("10 kg") (quoted from the biotel pediatric treatment guidelines handout)
The maximum dose for all drugs is always the adult dose except for (blank).
Epinephrine 1:1000 via ETT
Scenario: You run on a 3 year old patient with urticaria, facial swelling, wheezing and difficulty breathing. He is allergic to strawberries and peanuts and his mother said he opened a package of strawberry poptarts by himself when she wasn't looking. He is responsive to pain and respirations are labored when you arrive. Name the (BioTel) protocol and steps.
Allergic Reaction/anaphylactic shock:

0.01 mg/kg Epinephrine 1:1000 SQ (max dose 0.3mg)

O2, IV access, Monitor ECG
Fluid bolus (20mg/kg),

Diphenhydramine 1 mg/kg to 2 mg/kg IV/IO push.

If no improvement to SQ Epinephrine 1:1000, administer 0.01 mg/kg Epinephrine 1:10,000 IV/IO push.

Administer 2.5 mg nebulized Albuterol if bronchospasm are refractery to epinephrine after 5 minutes (may be repeated up to three times.
You arrive on a call for "hives" on a 50 lb, 5 year old girl. The mother tells you that she was playing outside about four hours ago and came in with a rash and itching. She has called you because the hives are not going away. Name the protocol and steps.
Allergic Reaction:

Administer 22.5 kg diphenhydramine (1mg/kg to 2mg/kg) IM.
After treating a pediatric patient for moderate to severe allergic reaction who is unresponsive to standard measures (Epi, benadryl, albuteral), BioTel may order (blank).
1 mg glucagon IM/SC/IV/IO
You arrive on scene to find a 6 year old boy who is confused, dizzy and disoriented. slurred speeach, appears very tired and often falls in and out of sleep (nodding off), he is having a hard time standing or sitting straight, and appears extremely unbalanced and uncoordinated. Pupils are pinpoint. His parents tell you that he is usually a normal 6 year old boy but when he came in from playing with his friends, he didnt' seem right. No signs of trauma and the patient denies hitting his head or falling but said he found candy pills at his friend's house. Name the protocol and steps in treatment.
Altered Level of Consciousness:
ABC's, O2, SPO2, D-stick, ECG, V/S, IV.
If blood glucose levels are WNL (<60 non-diabetic <90 diabetic) administer 0.1 mg/kg Naloxone slow IVP. If IV cannot be established administer naloxone via IM.
You arrive on scene to find a 10 year old autistic girl who is dizzy and disoriented with slurred speeach. Her mother tells you she has thrown up twice and is not acting like herself. The mother also states that two of her diltiazm's are missing from her daily pill organizer and she thinks the little girl may have ingested them. Name the protocol and steps.
Altered Mental Status:
If D-stick is normal, it would be reasonable to suspect calcium channel blocker toxicity. Monitor, D-stick, O2, contact BioTel for orders. BioTel will probably instruct you to give 10 - 15 mg/kg of calcium chloride and/or 1mg glucogon IM/SC or IV (glucogon has positive inotropic and chronotropic properties inspite of beta blocker and calcium channel blockers).
You're called to the home of a diabetic 9 year old boy who is unconscious. Name the protocol and the steps of care.
Altered Level of Consciousness: O2, Monitor, IV, D-stick "22", SPO2, ETCO2.

Administer 2ml/kg of D-25 IVP may be repeated in 10 minutes. If IV or IO cannot be established, administer 1mg IM of glucogon.
The 16 year old calls 911 upset and says he was experimenting with drugs and believes his little brother may have gotten into his ecstasy. The 3 year old appears agitated, restless, diaphoretic, tachycardic and dilated pupils. Name the protocol and steps.
Altered LOC:
Monitor, IV/IO, O2, D-stick, SPO2, ETCO2.

Ecstasy suspected: Contact BioTel to administer 0.5 mg/kg diazapam PR to max of 10 mg or tachycardia slows. Monitor temperature frequently and be prepared to cool patient but don't allow patient to shiver.
You arrive on scene of a 5 year old in asystole. What are the steps per protocol?
ABC's begin CPR. Apply monitor with ECG, ETCO2, establish vascular access. Confirm asystole in two leads and return monitor to paddles mode.

Administer Epinephrine 1:10,000 via IV/IO 0.01 mg/kg every three to five minutes.

Search for causes and follow appropriate protocol as indicated.
For Opioid OD: 0.1 mg/kg naloxone
Hypoglycemia: 2mL/kg D-25
Hypovolemia: 20mL/kg NS bolus
Tricyclic OD, or suspected hyperkalemia (renal failure). 1 mEq/kg sodium bicarbonate.
S/S tricyclic antidepressant overdose.
A partial list of potential signs and symptoms suggestive of TCA overdose include: • Known or suspected ingestion • Coma • Seizure • Acidosis • Hypotension (SBP < 90) • Tachycardia • EKG Changes o Prolonged PR interval o Prolonged QRS greater than 0.1 seconds o Prolonged QT interval o Rightward shift of the terminal 40 milliseconds of the frontal plane QRS vector (Deep S wave in Lead 1 along with large R wave - greater than 3 mm height - in a VR) (senitivity 0.83; specificity 0.63) o Ventricular arhythmias • Anticholinergic signs/symptoms o Dry mouth o Mydriasis o Urinary retention o Ileus o Confusion
Pediatric bradycardia protocol is....
ABC's, O2, SPO2, ETCO2, D-stick, V/S, 12 lead.

If HR is <60 bpm ventilate with 100 % O2 for one full minute.

If after one minute, HR is still < 60, begin chest compressions (100/minute)

Administer 0.01 mg/kg of Epinephrine 1:10,000 IV/IO.

0.02 mg/kg (minimum dose of .1mg) Atropine which may be repeated once to a maximum dose of 1mg.
What is the rule of nines for pediatric burns?
Head 18
Leg 14
Arm 9
Anterior trunk 18
Posterior trunk 18
genitalia 1
You arrive on scene to a pediatric patient who was pulled from a fire. He has 2nd and 3rd degree burns to his right leg, right arm and face. Breathing is labored with signs of burns to upper upper airway. What is the BSA and what protocol will you follow?
BSA is 32% (face-9, leg-14, arm-9).

Protocol: "Burn" IV/IO access and administer 0.1 mg/kg morphineSlow IV/IO Push up to max of 10 kg.

Fluid bolus of 20mL/kg up to 1L. NOTE: Parkland Burn Formula for fluid bolus is 4cc x patient's weight in kg x percent of BSA = amount of fluid needed in the first 24 hours. Half of which is to be given in the fire 8 hours.
You arrive on scene for a 10 year old boy in sickle cell crisis. What do you do?
Fluid bolus 10cc/kg and maintain TKO. Contact BioTel to administer 0.1mg/kg morphine.
Pediatric patient has ingested calcium channel blockers. What medications are indicated.
Calcium Chloride 10-15 mg/kg in 10 percent solution of NS SLOW IVP.

1mg Glucogon IM/IV/SQ
Pediatric patient has ingested tricyclic antidepressants and has wide complex tachycardia. What medications are indicated.
1mEq/kg sodium bicarbonate.
Pediatric patient has ingested stimulant drug such as cocaine, LSD, anphetamine, PCP, ecstasy. What medications are indicated.
0.5 mg/kg of diazapam (valium).
Pediatric patient has PEA with electrical activity indicating 45 bpm. What drugs might be indicated by protocol?
Epinephrine is indicated.

Sodium Bicarbonate if caused by acidosis (ASA overdose, renal failure, methanol ingestion), tricyclic depressant OD

0.1 mg/kg Naloxone if Opiode ingestion suspected.

20mL/kg fluid bolus for hypovolemia.
List drugs for pediatric respiratory distress.
2.5 mg albuterol up to three doses.
If there is no sign of improvement, 0.5mg mg of atropine may be given with the next two doses of albuterol (for pedi's under 12 months old, give 0.25 mg).

If refractory to the above, contact BioTel for orders to give 0.01 mg/kg Epinephrine 1:1000 SQ (max 0.3mg).
Pediatric shock protocols.
ABC's, Supine with legs elevated, keep warm, O2 via NBR, ECG, SPO2, ETCO2, IV access with 20 mL/kg NS bolus repeat once if BP < 70.
70 + (2 x age in years) = normal systolic low bp.
Cardiogenic run fluid TKO rate. Contact BioTel for vasopressor.

Additional BioTel options: Additional bolus of 20 mL/kg to maintain BP of 70 systolic.

BioTel may authorize needle thoracostomy for tehsion pneumothorax.

If rate and rhythm have been treated and BP is below 70, begin dopamine drip at 2-10 mcg/kg/minute.
Pediatric PSVT:
ABC's, O2, SPO2, Monitor, ETCO2, 12 lead transmitted to BioTel. Rule out Sinus Tach, IV TKO rate.

Contact BioTel.
With HR greater than 220 bpm, immediate synchronized cardioversion @ 0.5 j/kg, 1.0 j/kg and 2.0 j/kg.
Pediatric WIDE complex Tachycardia and/or PVC's.
ABC's, O2, SPO2, monitor, ETCO2, 12 lead and transmit to BioTel (must not delay treatment to the unstable patient).
STABLE PT. w/ unsustained PVC's transport and monitor closely.

STABLE with SUSTAINED or UNSTABLE CONSCIOUS OR UNCONSCIOUS with Wide-complex tachycardia: contact BioTel for orders.

BioTel TREATMENT OPTIONS for stable patients and sustained W/Complex Tachycardia may include 5mg/kg slow IV/IO amiodarone in 100 mL NS over 30 minutes or Lidocaine 1mg/kg IV/IO.

W/complex Tach unstable Immediate sync cardioversion @ 0.5 j/kg, 1.0 j/kg, 2.0j/kg.
Pediatric Ventricular fibrillation and pulseless ventricular tachycardia:
ABC's, CPR until defibrillator is ready. If collapse was witnessed by paramedic, defibrillate immediately at 2 J/kg (subsiquent shocks @4j/kg).

If collapse was not witnessed, CPR for two minutes, deliver shock and return to two minutes of CPR. Check pulse and rhythm, if a perfusing rhythm begins, administer 1mg/kg lidocaine. Contact BioTel for drip information.

If patient remains in Vfib, obtain IV access and administer Epinephrine 1:10,000 IV/IO 0.01 mg/kg q 3 to 5 minutes. Shock again at 4j/kg and return to CPR for two minutes (check pulse and rhythm) and shock again if necessary. Contact biotel for orders to give Amiodarone 5mg/kg in 100 mL NS IV over 30 minutes.

If other rhythm develops at any time in the CPR, follow those protocols (dah).
Pediatric Patient "Vomiting" protocol.
20 mL/kg bolus (promethazine should NOT be given to the pediatric patient).