Weekly Pediatric Protocols

Front 1

Overdose & Poisonings Clinical Pearls

Back 1

Do not transport contaminated patient by air.
IV administration of atropine should wait until adequate ventilation is present.
CO level in fetus might be higher than mother.

Front 2

Overdose & Poisonings General Treatment

Back 2

Wear PPE
Remove pt from toxic environment
Take glucose level
History includes: type of agent, route of exposure and duration of exposure
Oxygen
12 leads
Contact Poison Control. However, must contact OLMD first for permission to follow Poison Control recommendation.

Front 3

Overdose & Poisonings Beta Blocker

Back 3

If bradycardic: Atropine 0.02 mg/kg (min is 0.1 mg and max is 0.5 mg)
If hypotensive: 20 ml/kg NS rapid bolus. If refractory then repeat once in 10 minutes.
If hypotension or bradycardia is refractory: TCP
Contact OLMD: for consideration of glucagon and calcium chloride.

Front 4

Overdose & Poisonings Carbon Monoxide Poisoning

Back 4

contact OLMD for transport decision

Front 5

Overdose & Poisonings Caustic Ingestion

Back 5

Administer nothing by mouth

Front 6

Overdose & Poisonings Cyanide Exposure

Back 6

Cyanokit administration requires both incident specific and patient specific conditions:
Incident specific: Known exposure or suspected exposure from significant smoke inhalation
Patient specific: Hypotension, seizure, severe respiratory distress, cardiac arrest and decreased loc.
Administration notes:
Establish separate IV site for Cyanokit
In CPR, administer Cyanokit only during ROSC
Gently rotate med and saline for 30 secs to mix
Draw blood: 1 blue tube first then 2 yellow tubes then 4 purple tube
Medication: Cyanokit 70 mg/kg in 100 ml NS IV drip set at 4 gtts/sec (20 gtts/ml). Repeat once.

Front 7

Overdose & Poisonings Evenomation

Back 7

Remove all jewelery
Splint involved extremity and placed in dependent position
Do not use cold pack on poisonous snakes bite

Front 8

Overdose & Poisonings Hydrocarbon/Petroleum Ingestion

Back 8

Administer nothing by mouth.

Front 9

Overdose & Poisonings Narcotic Overdose

Back 9

Narcan 0.1 mg/kg IV, IM, repeat until adequate respiratory or up to 2 mg. Can also give 2 mg IN.

Front 10

Overdose & Poisonings Phenothiazines (Dystonic) Reactions

Back 10

Benadryl 1 mg/kg IV or IM

Front 11

Overdose & Poisonings Tricyclic overdose (TCO)

Back 11

If widened QRS complex: Sodium Bicarb (8.4%) 1 mEq/kg IV over 5 mins. If refractory, repeat once.
For infant: use Sodium Bicarb (4.2%) 1 mEq/kg IV

Front 12

Overdose & Poisonings Organophosphate / Nerve Agent Poisoning

Back 12

Contact OLMD if small children are exposed
Signs and symptoms:
Mild Exposure: Pinpoint pupils, rhinorrhea, chest tightness, and secretions (salivation, tearing eyes).
Moderate Exposure: Mild symptoms and trouble breathing, wheezing, muscle weakness, gastrointestinal effects (vomiting and/or diarrhea)
Severe Exposure: Mild and Moderate symptoms and one of the following: unconsciousness, seizures, flaccidity, apnea, or copious secretions
Treatment: Atropine .05 mg/kg (mild) to .1 mg/kg (severe), minimum dose of .1 mg. Repeat every 10 minutes until drying of secretions.
Contact OLMD: Pralidoxime (2-PAM) autoinjector IM for pt over 15 kg.
Follow seizure protocol.

Front 13

Overdose & Poisonings Organophosphate / Nerve Agent Poisoning OLMD Alternate Nerve Agent Antidote Dosing Infant (0-3 years and <13 kg)

Back 13

Atropine .05-.1 mg IM/IV or 0.1-1 mg MDV. 2-PAM 25-50 mg/kg IM/IV or 150-600 mg MDV. Diazepam 0.2-0.5 mg/kg IM/IV or 1.25-5 mg Carpuject syringe.

Front 14

Overdose & Poisonings Organophosphate / Nerve Agent Poisoning OLMD Alternate Nerve Agent Antidote Dosing Small child to child (3-10 years and 13-35 kg)

Back 14

Atropine 1-4 mg IV/IM MDV or MARK I. 2-PAM 25-50 mg/kg IM/IV or 300-1200 mg MDV or MARK I. Diazepam 0.2-0.5 mg/kg IM/IV or 2.5 - 10 mg Carpuject/Autoinjector.

Front 15

Overdose & Poisonings Organophosphate / Nerve Agent Poisoning OLMD Alternate Nerve Agent Antidote Dosing Older child (>10 years and >35 kg)

Back 15

Atropine 2-6 mg IM/IV MDV or MARK I. 2-PAM 25 mg/kg IM/IV or 600-1800 mg IM/IV MDV or MARK I. Diazepam 5-10 mg IM/IV Carpuject/Autoinjector.