ICEMA PROTOCOL STUDY GUIDE
RECENTLY REFRESHED AND
UPDATED
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
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 of 30mg as a single dose in 50-
100mL of NS over 5 minutes. May repeat one time in 15 minutes, if pain is still
a 5 or higher. DO not administer IVP, IO, IM, IN
Respiratory emergencies-Peds #14120 - ANSWER - Maintain airway with
appropriate adjuncts, obtain O2 sat room air if possible.
- Administer 2.5mg Albuterol with 0.5mg of Atrovent nebulized as indicated.
May repeat Albuterol 2 times and Atrovent 1x.
,- If no response to Albuterol or Atrovent, consider 0.01mg/kg Epi 1:1000 via
IM no to exceed adult dosage of 0.3mg. Obtain vascular access at TKO rate
- If allergic reaction suspected, administer 1mg/kg diphenhydramine IV/IO, not
to exceed adult dose of 25mg IV or 2mg/kg IM not to exceed adult dose of
50mg IM. Need orders for patients 2 years of age or older
- If apneic and unable to ventilate, consider oral tracheal intubation for patients
who are taller than the maximum length of a pediatric emergency measuring
tape or equivalent measuring from the top of the head to the heel of the foot.
BHO may order additional medications or interventions
- Base hospital: for severe asthma / respiratory distress that has failed to the
other previous treatments, administer 50 mg/kg of Magnesium Sulfate slow IV
drip over 20 minutes. DO not exceed adult dosage of 2gm total. Do not repeat.
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
ALOC-Peds #14160 OR GCS #12020 - ANSWER - Obtain blood glucose. If
indicated administer 1 tube of oral glucose or 0.5g/kg (5mL/kg) Dextrose. May
RECENTLY REFRESHED AND
UPDATED
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
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 of 30mg as a single dose in 50-
100mL of NS over 5 minutes. May repeat one time in 15 minutes, if pain is still
a 5 or higher. DO not administer IVP, IO, IM, IN
Respiratory emergencies-Peds #14120 - ANSWER - Maintain airway with
appropriate adjuncts, obtain O2 sat room air if possible.
- Administer 2.5mg Albuterol with 0.5mg of Atrovent nebulized as indicated.
May repeat Albuterol 2 times and Atrovent 1x.
,- If no response to Albuterol or Atrovent, consider 0.01mg/kg Epi 1:1000 via
IM no to exceed adult dosage of 0.3mg. Obtain vascular access at TKO rate
- If allergic reaction suspected, administer 1mg/kg diphenhydramine IV/IO, not
to exceed adult dose of 25mg IV or 2mg/kg IM not to exceed adult dose of
50mg IM. Need orders for patients 2 years of age or older
- If apneic and unable to ventilate, consider oral tracheal intubation for patients
who are taller than the maximum length of a pediatric emergency measuring
tape or equivalent measuring from the top of the head to the heel of the foot.
BHO may order additional medications or interventions
- Base hospital: for severe asthma / respiratory distress that has failed to the
other previous treatments, administer 50 mg/kg of Magnesium Sulfate slow IV
drip over 20 minutes. DO not exceed adult dosage of 2gm total. Do not repeat.
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
ALOC-Peds #14160 OR GCS #12020 - ANSWER - Obtain blood glucose. If
indicated administer 1 tube of oral glucose or 0.5g/kg (5mL/kg) Dextrose. May
