Burns-adult #14070 - Answer - Estimate % TBSA burned and depth using rule of nines. tltl tltl tltl tl tl tltl tltl tl tl tltl tltl tltl tltl tltl tltl tltl
- Thermal burns: Stop burning process. DO not break blisters. Cover affected body surface with
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dry, sterile dressing or sheet.
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- Chemical burns: Brush off dry powder, if present. Remove any contaminated or wet clothing.
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Irrigate with copious amounts of saline or water.
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- Tar burns: Cool with water, do not remove tar
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- Electrical burns: Remove from electrical source (without endangering self) with nonconductive
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material. Cover affected body surface with dry, sterile dressing or sheet
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- Eye involvement: Continuous flushing with NS during transport. Allow patient to remove
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contact lenses if possible
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- Advanced airway as clinically indicated. King airway is contraindicated
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- Iv access: Unstable- BP less than 90 and/or signs and symptoms of inadequate tissue
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perfusion, start 2nd IV line. Give 250mL boluses and repeat to max of 1L
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Stable- BP more than 90 and signs of adequate tissue perfusion, administer 500ml/ hr.
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- Respiratory distress: Use BVM as needed. Contact receiving hospital ASAP. Administer
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albuterol with Atrovent. High flow oxygen Is essential with known or potential respiratory
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injury. Beware of smoke inhalation. Do not apply ice water directly to skin surfaces, as
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additional injury will result. Intubate patient if facial/ oral swelling is present or if respiratory
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depression or distress develops due to inhalation injury. CPAP may be considered if indicated
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after consultation with BH
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- Treat pain with analgesics as indicated
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Pain management #14100 - Answer Patients with a GCS of 15 or at baseline mentation and have
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a pain score of 5 or higher and have: acute traumatic injuries, acute abdominal/ flank pain,
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burn injuries, cancer pain, or sickle cell crisis
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• What drugs/dosages are used?
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,- Must always monitor and assess vital signs prior to administration of any analgesic. After
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administration must continually monitor EKG and place on capno. Reassess vital signs, capno,
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and pain scores every 5 minutes.
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- Once a pain medication has been administered via route of choice, changing route (i.e. IM to
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IV) requires BHO.
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- Shifting from one analgesic while treating a patient requires BHO
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- For pain and a SBP below 100, administer 0.3mg/kg Ketamine IVPB to a max single dose of 30
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mg. May repeat once in 15 minutes.
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- For pain and an SBP above 100, administer 50 mcq Fetanyl slow IV/IO push over 1 minute. May
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repeat every 5 minutes titrated to pain but not to exceed 200 mcq OR 100 mcq IM/IN. May
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repeat 50 mcq every 10 minutes titrated to pain, not to exceed 200 mcq. Peds dose is
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0.5mcq/kg slow IV/IO over 1 minute. May repeat in 5 min titrated to pain, not to exceed 100
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mcq OR 1 mcq/kg IM/IN, may repeat every 10 minutes titrated to pain but not to exceed 200
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mcq. Can also use 0.3mg/kg of Ketamine IVPB to a max of 30mg as a single dose in 50-100mL of
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NS over 5 minutes. May repeat one time in 15 minutes, if pain is still a 5 or higher. DO not
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administer IVP, IO, IM, IN
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Respiratory emergencies-Peds #14120 - Answer - Maintain airway with appropriate adjuncts, tltl tltl tltl tltl tltl tltl tltl tltl tltl tltl
obtain O2 sat room air if possible.
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- Administer 2.5mg Albuterol with 0.5mg of Atrovent nebulized as indicated. May repeat
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Albuterol 2 times and Atrovent 1x.
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- If no response to Albuterol or Atrovent, consider 0.01mg/kg Epi 1:1000 via IM no to exceed
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adult dosage of 0.3mg. Obtain vascular access at TKO rate
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- If allergic reaction suspected, administer 1mg/kg diphenhydramine IV/IO, not to exceed adult
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dose of 25mg IV or 2mg/kg IM not to exceed adult dose of 50mg IM. Need orders for patients 2
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years of age or older
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- If apneic and unable to ventilate, consider oral tracheal intubation for patients who are taller
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than the maximum length of a pediatric emergency measuring tape or equivalent measuring
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from the top of the head to the heel of the foot. BHO may order additional medications or
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interventions
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- Base hospital: for severe asthma / respiratory distress that has failed to the other previous
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treatments, administer 50 mg/kg of Magnesium Sulfate slow IV drip over 20 minutes. DO not
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exceed adult dosage of 2gm total. Do not repeat.
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, Allergic reactions-Peds #14140 - Answer - Maintain airway with appropriate adjuncts, obtain
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room air saturation if possible. Administer 2.5mg Albuterol nebulized, may repeat 2x. Combine
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with 0.5mg of Atrovent. Only give 1x.
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- If no response to Albuterol, consider 0.01mg/kg of Epi 1:1000 IM, not to exceed adult dose of
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0.3mg IM
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- Administer 1mg/kg Benadryl IV/IO not to exceed 25mg IV or 2mg/kg IM, not to exceed 50mg
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IM
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- For symptomatic hypotension with poor perfusion, consider fluid bolus of 20ml/kg of NS, not
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to exceed 300 mL NS and repeat as indicated.
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- Est IV/IO access if indicated
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- For anaphylactic shock (no palpable radial pulse and a depressed LOC) administer 0.01mg/kg
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of Epi 1:10000 IV/IO, no more than 0.1mg per dose. May repeat to maximum of 0.5mg.
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- If apneic and unable to ventilate, consider oral tracheal intubation for patients who are taller
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than the maximum length of a pediatric measuring tape or equivalent measuring from the top
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of the head to the heel of the foot.
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Cardiac arrest-Peds #14150 - Answer - High quality CPR ventilate 12-20 per minute. Ventilation
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rate decreases as patient age increases. Obtain IV/IO access (IO preferred if under 9)
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- For continued signs of inadequate tissue perfusion, administer fluid bolus of NS. Reassess after
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each bolus. May repeat 2x for continued signs of inadequate tissue perfusion. 1-8 years:
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20mL/kg NS and 9-14 years: 300mL NS
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- Determine cardiac rhythm and defibrillate at 2J/kg (or manufacturer recommended
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equivalent) if indicated. After defibrillation, immediately resume CPR, beginning a 2-minute
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cycle.
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- Utilize waveform capno for monitoring airway and effectiveness of chest compressions and for
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early identification of ROSC. Document waveform and capno number in ePCR
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- ET intubation is advanced airway of choice for patients taller than the maximum length of
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pediatric measuring tape. Insert NG/OG tube
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- V-fib/V-tach: Initial D-fib at 2J/kg. Second D-fib at 4J/kg. Third and subsequent defibrillation
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attempts should be administered at 10J/kg, not to exceed adult dose. Administer 0.01mg/kg
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