ICEMA PROTOCOL EXAM STUDY GUIDE
Burns-adult #14070 - Answer -- Estimate % TBSA burned and depth using rule of
nines.
- Thermal burns: Stop burning process. DO not break blisters. Cover affected body
surface with dry, sterile dressing or sheet.
- Chemical burns: Brush off dry powder, if present. Remove any contaminated or wet
clothing. Irrigate with copious amounts of saline or water.
- Tar burns: Cool with water, do not remove tar
- Electrical burns: Remove from electrical source (without endangering self) with
nonconductive material. Cover affected body surface with dry, sterile dressing or sheet
- Eye involvement: Continuous flushing with NS during transport. Allow patient to
remove contact lenses if possible
- Advanced airway as clinically indicated. King airway is contraindicated
- Iv access: Unstable- BP less than 90 and/or signs and symptoms of inadequate tissue
perfusion, start 2nd IV line. Give 250mL boluses and repeat to max of 1L
Stable- BP more than 90 and signs of adequate tissue perfusion, administer 500ml/ hr.
- Respiratory distress: Use BVM as needed. Contact receiving hospital ASAP.
Administer albuterol with Atrovent. High flow oxygen Is essential with known or potential
respiratory injury. Beware of smoke inhalation. Do not apply ice water directly to skin
surfaces, as additional injury will result. Intubate patient if facial/ oral swelling is present
or if respiratory depression or distress develops due to inhalation injury. CPAP may be
considered if indicated after consultation with BH
- Treat pain with analgesics as indicated
Allergic reactions-Peds #14140 - Answer -- Maintain airway with appropriate adjuncts,
obtain room air saturation if possible. Administer 2.5mg Albuterol nebulized, may repeat
2x. Combine with 0.5mg of Atrovent. Only give 1x.
- If no response to Albuterol, consider 0.01mg/kg of Epi 1:1000 IM, not to exceed adult
dose of 0.3mg IM
- Administer 1mg/kg Benadryl IV/IO not to exceed 25mg IV or 2mg/kg IM, not to exceed
50mg IM
- For symptomatic hypotension with poor perfusion, consider fluid bolus of 20ml/kg of
NS, not to exceed 300 mL NS and repeat as indicated.
- Est IV/IO access if indicated
- For anaphylactic shock (no palpable radial pulse and a depressed LOC) administer
0.01mg/kg of Epi 1:10000 IV/IO, no more than 0.1mg per dose. May repeat to maximum
of 0.5mg.
- If apneic and unable to ventilate, consider oral tracheal intubation for patients who are
taller than the maximum length of a pediatric measuring tape or equivalent measuring
from the top of the head to the heel of the foot.
, Cardiac arrest-Peds #14150 - Answer -- High quality CPR ventilate 12-20 per minute.
Ventilation rate decreases as patient age increases. Obtain IV/IO access (IO preferred if
under 9)
- For continued signs of inadequate tissue perfusion, administer fluid bolus of NS.
Reassess after each bolus. May repeat 2x for continued signs of inadequate tissue
perfusion. 1-8 years: 20mL/kg NS and 9-14 years: 300mL NS
- Determine cardiac rhythm and defibrillate at 2J/kg (or manufacturer recommended
equivalent) if indicated. After defibrillation, immediately resume CPR, beginning a 2-
minute cycle.
- Utilize waveform capno for monitoring airway and effectiveness of chest compressions
and for early identification of ROSC. Document waveform and capno number in ePCR
- ET intubation is advanced airway of choice for patients taller than the maximum length
of pediatric measuring tape. Insert NG/OG tube
- V-fib/V-tach: Initial D-fib at 2J/kg. Second D-fib at 4J/kg. Third and subsequent
defibrillation attempts should be administered at 10J/kg, not to exceed adult dose.
Administer 0.01mg/kg EPI 1:10000 every 5 minutes, unless capnography indicates
ROSC. After 2 cycles of CPR, consider administering 1mg/kg Lidocaine if ages 1-14,
may repeat after 5 minutes at 0.5mg/kg, to a max of 3 mg/kg. If patient remains in VF/V-
tach after 20 minutes, consult base hospital
- PEA/ asystole: CPR, fluid bolus of 20mL/kg if ages 1-8 or 300mL fluid bolus if 9-14.
Administer 0.01mg/kg of Epi 1:10000 IV/IO every 5 minutes
- ROSC: obtain 12-lead, transport to closest receiving hospital. Utilize waveform capno
to identify loss of circulation. Check blood glucose level and if indicated administer
Dextrose. Repeat checking blood glucose and repeat Dextrose if indicated. For
suspected narcotic overdose, administer 0.1mg/kg Naloxone, not to exceed adult dose
of 0.5mg per dose to a max of 10mg. For continued
Pain management #14100 - Answer -Patients with a GCS of 15 or at baseline
mentation and have a pain score of 5 or higher and have: acute traumatic injuries, acute
abdominal/ flank pain, burn injuries, cancer pain, or sickle cell crisis
• What drugs/dosages are used?
- Must always monitor and assess vital signs prior to administration of any analgesic.
After administration must continually monitor EKG and place on capno. Reassess vital
signs, capno, and pain scores every 5 minutes.
- Once a pain medication has been administered via route of choice, changing route
(i.e. IM to IV) requires BHO.
- Shifting from one analgesic while treating a patient requires BHO
- For pain and a SBP below 100, administer 0.3mg/kg Ketamine IVPB to a max single
dose of 30 mg. May repeat once in 15 minutes.
- For pain and an SBP above 100, administer 50 mcq Fetanyl slow IV/IO push over 1
minute. May repeat every 5 minutes titrated to pain but not to exceed 200 mcq OR 100
mcq IM/IN. May repeat 50 mcq every 10 minutes titrated to pain, not to exceed 200
mcq. Peds dose is 0.5mcq/kg slow IV/IO over 1 minute. May repeat in 5 min titrated to
pain, not to exceed 100 mcq OR 1 mcq/kg IM/IN, may repeat every 10 minutes titrated
to pain but not to exceed 200 mcq. Can also use 0.3mg/kg of Ketamine IVPB to a max
Burns-adult #14070 - Answer -- Estimate % TBSA burned and depth using rule of
nines.
- Thermal burns: Stop burning process. DO not break blisters. Cover affected body
surface with dry, sterile dressing or sheet.
- Chemical burns: Brush off dry powder, if present. Remove any contaminated or wet
clothing. Irrigate with copious amounts of saline or water.
- Tar burns: Cool with water, do not remove tar
- Electrical burns: Remove from electrical source (without endangering self) with
nonconductive material. Cover affected body surface with dry, sterile dressing or sheet
- Eye involvement: Continuous flushing with NS during transport. Allow patient to
remove contact lenses if possible
- Advanced airway as clinically indicated. King airway is contraindicated
- Iv access: Unstable- BP less than 90 and/or signs and symptoms of inadequate tissue
perfusion, start 2nd IV line. Give 250mL boluses and repeat to max of 1L
Stable- BP more than 90 and signs of adequate tissue perfusion, administer 500ml/ hr.
- Respiratory distress: Use BVM as needed. Contact receiving hospital ASAP.
Administer albuterol with Atrovent. High flow oxygen Is essential with known or potential
respiratory injury. Beware of smoke inhalation. Do not apply ice water directly to skin
surfaces, as additional injury will result. Intubate patient if facial/ oral swelling is present
or if respiratory depression or distress develops due to inhalation injury. CPAP may be
considered if indicated after consultation with BH
- Treat pain with analgesics as indicated
Allergic reactions-Peds #14140 - Answer -- Maintain airway with appropriate adjuncts,
obtain room air saturation if possible. Administer 2.5mg Albuterol nebulized, may repeat
2x. Combine with 0.5mg of Atrovent. Only give 1x.
- If no response to Albuterol, consider 0.01mg/kg of Epi 1:1000 IM, not to exceed adult
dose of 0.3mg IM
- Administer 1mg/kg Benadryl IV/IO not to exceed 25mg IV or 2mg/kg IM, not to exceed
50mg IM
- For symptomatic hypotension with poor perfusion, consider fluid bolus of 20ml/kg of
NS, not to exceed 300 mL NS and repeat as indicated.
- Est IV/IO access if indicated
- For anaphylactic shock (no palpable radial pulse and a depressed LOC) administer
0.01mg/kg of Epi 1:10000 IV/IO, no more than 0.1mg per dose. May repeat to maximum
of 0.5mg.
- If apneic and unable to ventilate, consider oral tracheal intubation for patients who are
taller than the maximum length of a pediatric measuring tape or equivalent measuring
from the top of the head to the heel of the foot.
, Cardiac arrest-Peds #14150 - Answer -- High quality CPR ventilate 12-20 per minute.
Ventilation rate decreases as patient age increases. Obtain IV/IO access (IO preferred if
under 9)
- For continued signs of inadequate tissue perfusion, administer fluid bolus of NS.
Reassess after each bolus. May repeat 2x for continued signs of inadequate tissue
perfusion. 1-8 years: 20mL/kg NS and 9-14 years: 300mL NS
- Determine cardiac rhythm and defibrillate at 2J/kg (or manufacturer recommended
equivalent) if indicated. After defibrillation, immediately resume CPR, beginning a 2-
minute cycle.
- Utilize waveform capno for monitoring airway and effectiveness of chest compressions
and for early identification of ROSC. Document waveform and capno number in ePCR
- ET intubation is advanced airway of choice for patients taller than the maximum length
of pediatric measuring tape. Insert NG/OG tube
- V-fib/V-tach: Initial D-fib at 2J/kg. Second D-fib at 4J/kg. Third and subsequent
defibrillation attempts should be administered at 10J/kg, not to exceed adult dose.
Administer 0.01mg/kg EPI 1:10000 every 5 minutes, unless capnography indicates
ROSC. After 2 cycles of CPR, consider administering 1mg/kg Lidocaine if ages 1-14,
may repeat after 5 minutes at 0.5mg/kg, to a max of 3 mg/kg. If patient remains in VF/V-
tach after 20 minutes, consult base hospital
- PEA/ asystole: CPR, fluid bolus of 20mL/kg if ages 1-8 or 300mL fluid bolus if 9-14.
Administer 0.01mg/kg of Epi 1:10000 IV/IO every 5 minutes
- ROSC: obtain 12-lead, transport to closest receiving hospital. Utilize waveform capno
to identify loss of circulation. Check blood glucose level and if indicated administer
Dextrose. Repeat checking blood glucose and repeat Dextrose if indicated. For
suspected narcotic overdose, administer 0.1mg/kg Naloxone, not to exceed adult dose
of 0.5mg per dose to a max of 10mg. For continued
Pain management #14100 - Answer -Patients with a GCS of 15 or at baseline
mentation and have a pain score of 5 or higher and have: acute traumatic injuries, acute
abdominal/ flank pain, burn injuries, cancer pain, or sickle cell crisis
• What drugs/dosages are used?
- Must always monitor and assess vital signs prior to administration of any analgesic.
After administration must continually monitor EKG and place on capno. Reassess vital
signs, capno, and pain scores every 5 minutes.
- Once a pain medication has been administered via route of choice, changing route
(i.e. IM to IV) requires BHO.
- Shifting from one analgesic while treating a patient requires BHO
- For pain and a SBP below 100, administer 0.3mg/kg Ketamine IVPB to a max single
dose of 30 mg. May repeat once in 15 minutes.
- For pain and an SBP above 100, administer 50 mcq Fetanyl slow IV/IO push over 1
minute. May repeat every 5 minutes titrated to pain but not to exceed 200 mcq OR 100
mcq IM/IN. May repeat 50 mcq every 10 minutes titrated to pain, not to exceed 200
mcq. Peds dose is 0.5mcq/kg slow IV/IO over 1 minute. May repeat in 5 min titrated to
pain, not to exceed 100 mcq OR 1 mcq/kg IM/IN, may repeat every 10 minutes titrated
to pain but not to exceed 200 mcq. Can also use 0.3mg/kg of Ketamine IVPB to a max
