PEDIATRIC RESPIRATORY DISTRESS WITH BRONCHOSPASM

1. Manage airway and assist ventilations as necessary

2. Administer O2 as per Oxygen Therapy Protocol (Pg 44)

3. Continuous cardiac, SpO2, and BP monitoring

4. Measure temperature

5. Administer salbutamol based on dosing below:

Age

MDI + aerochamber 1

OR

Nebulized with O2

Less than 5 years

5 puffs (100 mcg/puff)

2.5 mg

Greater than or equal to 5 years

10 puffs (100 mcg/puff)

5 mg

Repeat every 5 minutes if indicated (Not to exceed a maximum total of 3 administrations)

1 Each puff must be followed by at least 4 breaths

6. Consider ipratropium bromide administration with 2nd and 3rd doses of salbutamol as per dosing guidelines below:

Age

MDI + aerochamber 1

OR

Nebulized with O2

All ages

3 puffs (20 mcg/puff) following dose of salbutamol

500 mcg (mix with salbutamol)

Repeat once in 5 minutes if indicated (Not to exceed a maximum total of 2 administrations)

1 Each puff must be followed by at least 4 breaths

7. Request ACP intercept if available



Contact OLMC for patients that are unrelieved by salbutamol and/or ipratropium bromide and condition is deteriorating for consideration of the following:

• Continued administration of salbutamol

• Epinephrine 1:1000 0.01 mg/kg (0.01 mL/kg) IM [Not to exceed a maximum single dose of 0.3 mg (0.3 mL)]

NOTES

• Patients should be treated with MDI with aerochamber unless it is deemed inappropriate, ineffective, or patient cannot tolerate

• Salbutamol or ipratropium bromide may be administered singularly if the patient has hypersensitivity to one of the other medications.

PEDIATRIC RESPIRATORY DISTRESS WITH INSPIRATORY STRIDOR

(Laryngotracheitis / Croup)

1. Manage airway and assist ventilations as necessary

2. Administer O2 as per Oxygen Therapy Protocol (Pg 44)

• Humidified O2 (Blow-by O2 acceptable if child refuses mask)

3. Continuous cardiac, SpO2, and BP monitoring

4. Keep child as comfortable as possible as agitation may worsen condition

5. Consider nebulized epinephrine 1:1000 in accordance with dosing guidelines below if Indications for Nebulized Epinephrine1 present:

Nebulized Epinephrine 1:1000

Age -Dose

Less than 1 year AND less than 5 kg

0.5 mg (0.5 mL) in 2 mL 0.9% NaCl

Less than 1 year AND greater than or equal to 5 kg

2.5 mg (2.5 mL)

Greater than or equal to 1 year

5 mg (5 mL)



Contact OLMC for refractory stridor and respiratory distress for consideration of:

• Repeat administration of nebulized epinephrine 1:1000

1) Current history of upper respiratory infection with a “barking cough”

AND

2) Severe respiratory distress

AND

3) Stridor at rest

PEDIATRIC ALLERGY AND ANAPHYLAXIS

1. Manage airway and assist ventilations as necessary

2. Administer O2 as per Oxygen Therapy Protocol (Pg 44)

3. Continuous cardiac, SpO2, and BP monitoring

4. IV access

5. If age-specific hypotension (Pg 99) present, administer a fluid bolus as per Pediatric Fluid Therapy Protocol (Pg 69)

6. If Findings of Anaphylaxis1 present administer:

• Epinephrine 1:1000 0.01 mg/kg (0.01 mL/kg) IM [Not to exceed a maximum single dose of 0.3 mg (0.3 mL)]

o Repeat once in 5 minutes if no improvement.

7. If respiratory distress present (including wheezing), administer salbutamol:

Less than 5 years

MDI + aerochamber

5 puffs (100 mcg/puff)

2.5 mg OR

Nebulized with O2

Greater than or equal to 5 years

MDI + aerochamber 2

10 puffs (100 mcg/puff)

OR

5 mg

Nebulized with O2

Repeat every 5 minutes if indicated (Not to exceed a maximum total of 3 administrations)

2Each puff must be followed by at least 4 breaths

8. Request ACP intercept if available



Contact OLMC if severe and refractory airway compromise, respiratory failure, or shock for consideration of:

• Additional IV fluid administration for refractory hypotension

NOTE

• Patients should be treated with MDI with aerochamber unless it is deemed ineffective or patient cannot tolerate

FINDINGS OF ANAPHYLAXIS

1) Acute onset (minutes to hours) of TWO OR MORE of the following after exposure to a LIKELY ALLERGEN:

• Skin symptoms (hives, itching, flushing)

• Oropharyngeal edema (lips, tongue, uvula)

• Respiratory compromise (dyspnea, wheeze, stridor, hypoxemia)

• Gastrointestinal symptoms (crampy abdominal pain, vomiting, diarrhea)

• Reduced blood pressure or associated symptoms (hypotonia, collapse, syncope)

OR

2) Age-Specific Hypotension (Pg 99) alone after exposure to a KNOWN ALLERGEN for patient

If patient meets criteria outlined in DNR Protocol (Pg 18) or Obvious Death Protocol (Pg 17) do not proceed with resuscitation

1. Confirm Vital Signs Absent (VSA) and initiate chest compressions

2. 100% O2 via BMV (15 L/min)

3. Request ACP intercept if available

4. Continuous cardiac and SpO2 monitoring

5. Consider and treat Reversible Causes1

6. IV access (DO NOT delay or interrupt CPR)

GENERAL GUIDELINES

• Confirm absence of pulse – pulse check NOT exceeding 10 seconds

• Initiate compressions immediately: C-A-B Sequence

• If arrest secondary to hypoxia suspected, proceed with A-B-C Sequence

• Begin CPR and immediately attach defibrillator – Analyze and defibrillate without delay if indicated

Compressions : Ventilation Ratio

One Rescuer

30:2

1/3 chest depth

• Infants: 4 cm

• Child: 5 cm

At least 100 per minute

Two Rescuers

15:2

• Ensure high quality CPR

o Minimize interruptions in CPR

o Allow full recoil of the chest between compressions

o Rotate rescuers every 2 minutes (if resources allow) concurrent with pulse checks

• After third rhythm analysis initiate transport

• Analyze patient every 10 minutes. Continue CPR.

• If return of spontaneous circulation (ROSC) proceed immediately with Pediatric Post Cardiac Arrest Care Protocol (Pg 56)

• If re-arrest occurs during transport, resume Cardiac Arrest Protocol

REVERSIBLE CAUSES OF CARDIAC ARREST

Hypovolemia

Hypoxia

Hypothermia

Hypoglycemia

Drug Overdose

HYPOTHERMIC CARDIAC ARREST 

(CORE TEMPERATURE LESS THAN 32ºC)

• Hypothermic patients are to be resuscitated as per Pediatric Cardiac Arrest Protocol.

• Resuscitation will be continued until active re-warming has returned core temperature to normal or there has been ROSC

1. Manage airway

2. O2 via NRB or BVM as appropriate (15 L/min)

• Assist ventilations with BVM if signs of inadequate ventilation are present:

o Abnormal sounds with breathing, such as snoring, gurgling, or stridor

o Fatigue with respiratory effort

o Gasping

o Irregular breathing pattern with periods of apnea

o Little or no chest rise

o Decreased or absent breath sounds (“Silent chest”)

o Rate and/or depth of breathing grossly insufficient for age

o Apnea

• If assisted ventilation is indicated, deliver ventilations by BVM in accordance with the following parameters:

Patient Age

Target Respiratory Rate

Infants (29 days to 12 months)

20 – 30 breaths per minute (1 breath every 2-3 seconds)

Children (1 year to puberty)

16 – 20 breaths per minute (1 breath every 3-4 seconds)

Adolescents (Pre-puberty to adult)

12 breaths per minute (1 breath every 5 seconds)

• Inspiratory time should not exceed 1 second

• Deliver only enough tidal volume to make the chest rise

• Avoid excessive ventilation

1. If defibrillator was used, leave pads in place

2. Request ACP intercept if available

3. Continuous cardiac, SpO2, and BP monitoring

4. Perform 12 Lead ECG

5. Two peripheral IVs (initiate second IV during transport)

6. Treat Reversible Causes1

7. Adjust ventilation, oxygenation, and fluid resuscitation to target values of:

• SBP – greater than age-specific hypotension (Pg 99)

• SpO2 – greater than or equal to 95%

8. If re-arrest occurs, resume Pediatric Cardiac Arrest Protocol (Pg 55) and appropriate algorithm

9. If persistent hypotension, proceed with Pediatric Shock Protocol (Pg 58)

NOTES

• A copy of the code summary and PCR must be left with the receiving facility

PEDIATRIC SHOCK

(Symptomatic Age-Specific Hypotension1)

1. Manage airway and assist ventilations as necessary

2. Administer O2 as per Oxygen Therapy Protocol (Pg 44)

3. Control bleeding (if applicable)

4. Assess for Signs and Symptoms of Shock1

5. Continuous cardiac, SpO2, and BP monitoring

6. Measure temperature AND blood glucose

7. Two IVs (Initiate second IV during transport)

8. Perform 12 lead ECG

9. Consider causes of shock and treat accordingly:

• If shock due to anaphylaxis, proceed with Pediatric Allergy and Anaphylaxis Protocol

(Pg 54)

• If shock due to sepsis, proceed with Pediatric Septic Shock Protocol (Pg 60)

10.For all other causes of shock, or when the cause of shock is unknown, administer a fluid bolus as per Pediatric Fluid Therapy Protocol (Pg 69)

11.Request ACP intercept if available



Contact OLMC if age-specific hypotension persists after initial fluid bolus for consideration of additional IV fluid administration.

CAUTION:

• Trendelenburg positioning is not indicated in the treatment of shock and is not to be utilized

• Position the patient supine unless they are in severe respiratory distress

• If the patient in shock is suffering from severe respiratory distress position them semi-sitting and assist ventilations as indicated

SIGNS AND SYMPTOMS OF SHOCK

Patients in shock will often present with the following clinical features:

1) Hypotension (Age dependent)

Age

Hypotension (Systolic Blood Pressure)

0 – 28 days

Less than 60 mmHg

1 month – 12 months

Less than 70 mmHg

1 year – 10 years

[70 + (2 x age in years)] mmHg

Greater than 10 years

Less than 90 mmHg

AND

2) Any ONE OR MORE of the following features:

• Rapid and / or shallow breathing

• Cool and / or clammy skin

• Rapid and / or weak pulse(s)

• Near fainting and / or fainting

• Weakness

NOTE

• Shock is a life-threatening, progressive medical condition that results from the inadequate flow of oxygenated blood to critical organs and tissues of the body

• When the blood pressure is inadequate to sustain a regular flow of oxygenated blood to the organs and tissues of the body, end-organ will ensure and shock will eventually result.

• Shock may result from a number of medical conditions including sepsis, trauma, blood loss, anaphylaxis, severe dehydration, and various medical conditions.

CAUTION:

• Trendelenburg positioning is not indicated in the treatment of shock and is not to be utilized

• Position the patient supine unless they are in severe respiratory distress

• If the patient in shock is suffering from severe respiratory distress position them semi-sitting and assist ventilations as indicated

1. Manage airway and assist ventilations as necessary

2. Administer O2 as per Oxygen Therapy Protocol (Pg 44)

3. Continuous cardiac, SpO2, and BP monitoring

4. Measure temperature AND blood glucose:

• Treat hypoglycemia in accordance with Pediatric Symptomatic Hypoglycemia Protocol

(Pg 61)

• Treat hyperglycemia in accordance with Pediatric Symptomatic Hyperglycemia Protocol (Pg 63)

5. Two IVs (Initiate second IV during transport)

6. If patient meets Pediatric Septic Shock Inclusion Criteria1 administer fluid bolus in accordance with Pediatric Fluid Therapy Protocol (Pg 69)

7. Request ACP intercept if available

PEDIATRIC SEPTIC SHOCK

INCLUSION CRITERIA

1) History suspicious for infection OR confirmed infection

AND

2) Age-specific hypotension (Pg 99)

AND

3) Any ONE OR MORE of the following clinical findings:

• Temperature less than 36ºC or greater than 38.5ºC

• Altered mental status

• Abnormal heart rate

o Infants – less than 90 or greater than 160 per minute

o Children – less than 70 or greater than 150 per minute

8. If hypotension persists after initial fluid bolus repeat IV fluid bolus to resolve age-specific hypotension (Pg 99)



Contact OLMC if age-specific hypotension persists after second fluid bolus for consideration of:

• Additional IV fluid administration

PEDIATRIC SYMPTOMATIC HYPOGLYCEMIA

CAUTION

• The protocol contained herein is NOT intended for routine management of hypoglycemia in patients that have just been born.

• For patients that have just been born refer to Neonatal Assessment and Resuscitation Protocol (Pg 78).

• In neonatal patients (other than those who have just been born), if BGL is less than 2.6 mmol/L proceed with IV dextrose or glucagon administration as outlined in this protocol.



For neonatal patients (other than those who have just been born) with BGL between 2.6 and 4 mmol/L, contact OLMC for direction.

1. Manage airway and assist ventilations as necessary

2. Administer O2 as per Oxygen Therapy Protocol (Pg 44)

3. Continuous cardiac, SpO2, and BP monitoring

4. Measure temperature AND blood glucose

5. IV access

6. If BGL is less than 4 mmol/L in the non-neonate, administer ONE of the following medications and recheck BGL in accordance with tables below:

Patient able to maintain own airway

(Awake and able to cough and swallow)

Oral glucose options:

5) Dex 4® tablets 20 g (5 tablets)

6) Insta-glucose® 1 tube (30 g)

7) 1 cup (250 mL) of juice or pop (Non-diet)

8) 4 teaspoons (20 mL) or 4 packets of table sugar dissolved in water

Recheck BGL in 15 minutes

IV established

IV dextrose as per dosing guidelines below

Recheck BGL in 10 minutes

Unable to establish IV

Glucagon1 as per dosing guidelines

(Pg 62)

Recheck BGL in 20 minutes

GLUCAGON DOSING GUIDELINES

Weight Less than 20 kg

0.5 mg IM

7. Repeat Step 6 ONCE if necessary



All pediatric hypoglycemic patients must be transported for assessment. If a parent, guardian, or mature minor is refusing transport, contact OLMC for direction.

1 NOTES

• Anticipate that it could take up to 20 minutes to observe an effect from glucagon.

• While waiting for glucagon to take effect, manage patient’s airway as indicated and initiate transport

CAUTION

• If head injury or stroke suspected administer half of the usual dose of dextrose, recheck BGL, and then administer the second half dose if necessary.

• The goal is to correct hypoglycemia while avoiding transient hyperglycemia that may lead to cerebral edema

DEXTROSE DOSING GUIDELINES

(See Pg 117 for instructions on preparing Dextrose 10% and 25%)

Weight Less than 10 kg

Volume-based Dosing mL/kg (0.5 g/kg SIVP)

Dextrose 10% - 5 mL/kg SIVP

DEXTROSE DOSING GUIDELINES

(See Pg 117 for instructions on preparing Dextrose 10% and 25%)

Weight 10 – 20 kg

Dextrose 25% - 2 mL/kg SIVP

DEXTROSE DOSING GUIDELINES

(See Pg 117 for instructions on preparing Dextrose 10% and 25%)

Weight 20 – 40 kg

Dextrose 50% - 1 mL/kg SIVP [to a maximum of 50 mL (25 g)]

DEXTROSE DOSING GUIDELINES

(See Pg 117 for instructions on preparing Dextrose 10% and 25%) Weight Greater than 40 kg

GLUCAGON DOSING GUIDELINES

Weight Greater than or equal to 20 kg

1 mg IM



All pediatric hypoglycemic patients must be transported for assessment. If a parent, guardian, or mature minor is refusing transport, contact OLMC for direction.

1 NOTES

• Anticipate that it could take up to 20 minutes to observe an effect from glucagon.

• While waiting for glucagon to take effect, manage patient’s airway as indicated and initiate transport

CAUTION

• If head injury or stroke suspected administer half of the usual dose of dextrose, recheck BGL, and then administer the second half dose if necessary.

• The goal is to correct hypoglycemia while avoiding transient hyperglycemia that may lead to cerebral edema

PEDIATRIC SYMPTOMATIC HYPERGLYCEMIA

This protocol is intended for patients who demonstrate findings of significant dehydration and presentations suggestive of diabetic ketoacidosis (DKA). Many diabetic patients may have blood glucose levels greater than 15 mmol/L during times of physiologic stress in the absence of dehydration and age-specific hypotension will NOT require fluid administration.

1. Manage airway and assist ventilations as necessary

2. Administer O2 as per Oxygen Therapy Protocol (Pg 44)

3. Continuous cardiac, SpO2, and BP monitoring

4. Measure temperature AND blood glucose

5. IV access

6. If Indications for IV Fluid Administration in Pediatric Hyperglycemia1 present administer

10 mL/kg 0.9% NaCl IV over 1 hour4



Contact OLMC if you are uncertain as to whether the patient meets criteria for fluid administration OR if age-specific hypotension persists despite administration of 10 mL/kg 0.9% NaCl IV for consideration of administration of additional IV fluids.

INDICATIONS FOR IV FLUID ADMINISTRATION IN PEDIATRIC HYPERGLYCEMIA

1) BGL greater than 15 mmol/L

AND

2) Signs and Symptoms of DKA2 OR Signs of Dehydration3

AND

3) Age-Specific Hypotension (Pg 99)

SIGNS AND SYMPTOMS OF DKA

SIGNS AND SYMPTOMS OF DKA

• Polyuria

• Polydipsia

• Polyphagia

• Tachypnea

• Tachycardia

• Nausea and vomiting

• Abdominal pain

• Signs of dehydration

SIGNS OF DEHYDRATION

• Dry mucous membranes

• Absence of tears

• Sunken fontanelle

• Delayed capillary refill

• Mottled skin

• Decreased urine output (oliguria)

• Tachycardia

• Age-specific or postural hypotension

• Weakness or lethargy

CAUTION

• Rapid bolus administration of 20 mL/kg IV fluid bolus is contraindicated in pediatric patients with DKA due to the risk of cerebral edema.

SIGNS AND SYMPTOMS OF CEREBRAL EDEMA

Early Warning Sign

• Headache

Additional Warning Signs

• Drowsiness

• Altered behavior

• Decreasing level of consciousness

1) Manage airway, assist ventilations as necessary

2) O2 via NRB (15 L/min)

3) Stop IV fluids

4) Measure blood glucose and treat hypoglycemia as per Pediatric Symptomatic Hypoglycemia Protocol (Pg 61)

5) Provide early notification to receiving facility of change in mental status

1. Manage airway and assist ventilations as necessary

2. Administer O2 as per Oxygen Therapy Protocol (Pg 44)

3. Spinal immobilization as indicated by mechanism of injury or evidence of injury above the clavicles

4. Position patient

• Actively seizing – place supine and protect from injury

• Postictal – place left lateral recumbent and maintain airway

5. Continuous cardiac, SpO2, and BP monitoring

6. Measure temperature AND blood glucose

• Treat hypoglycemia as per Pediatric Symptomatic Hypoglycemia Protocol (Pg 61)

7. IV access

8. Request ACP intercept for active seizures or recurrent seizures (Status Epilepticus)

1. Contact police and request that they attend the scene immediately

2. Manage airway and assist ventilations as necessary

3. Administer O2 as per Oxygen Therapy Protocol (Pg 44)

4. Continuous cardiac, SpO2, and BP monitoring

5. Measure temperature AND blood glucose

• Treat hypoglycemia as per Pediatric Symptomatic Hypoglycemia Protocol (Pg 61)

6. Consider and treat Reversible or Treatable Causes of Altered Mental Status1

7. IV access

8. Attempt verbal management techniques for crisis intervention to de-escalate the situation and calm the patient

9. If Indications for Physical Restraint2 present, apply the least amount of physical restraint necessary to protect the patient from harming themselves or bystanders until police arrive as per Agitated Combative / Physical Restraint Reference (Pg 96)

REVERSIBLE OR TREATABLE CAUSES OF ALTERED MENTAL STATUS

• Hypoxia

• Hypotension

• Hypoglycemia

• Medications or Toxins

• Sepsis

2 INDICATIONS FOR PHYSICAL RESTRAINT

1) Imminent danger3 to life OR threat of physical harm to patient and/or bystanders

AND

2) Attempts at verbal de-escalation have failed

AND

3) Attempts to restrain do NOT place the practitioner(s) at significant risk of harm to themselves

NOTES

3 Imminent Danger – an immediate threat of significant harm to one’s self or others, up to and including death

Examples of Imminent Danger:

• Actively attempting suicide

• Actively attempting to cause serious bodily injury to others

• Attempting to jump from a building or moving vehicle

CAUTION

• There is a high risk of positional asphyxia and/or aspiration in patients undergoing chemical or physical restraint. Close and continuous monitoring of these patients, including airway patency and adequacy of respirations is mandatory

• At NO TIME should the patient be restrained in the prone (face or chest-down) position

• Always maintain an ability to escape the scene. Position yourself between the patient and the exit at all times to maintain a safe exit should the situation escalate

• Be alert for potential weapons and hazards. If the patient has a weapon, do not attempt to disarm them. Instead, leave the scene and stage until the police declare the scene safe to re-enter

• Be aware of signs of increased agitation or aggression including, but not limited to:

o Tense posture

o Loud speech

o Pacing

o Threatening statements

o Clenched hands

o Hostile or aggressive body language

INDICATIONS FOR PHYSICAL RESTRAINT

1) Imminent danger3 to life OR threat of physical harm to patient and/or bystanders

AND

2) Attempts at verbal de-escalation have failed

AND

3) Attempts to restrain do NOT place the practitioner(s) at significant risk of harm to themselves

NOTES

3 Imminent Danger – an immediate threat of significant harm to one’s self or others, up to and including death

Examples of Imminent Danger:

• Actively attempting suicide

• Actively attempting to cause serious bodily injury to others

• Attempting to jump from a building or moving vehicle

CAUTION

• There is a high risk of positional asphyxia and/or aspiration in patients undergoing chemical or physical restraint. Close and continuous monitoring of these patients, including airway patency and adequacy of respirations is mandatory

• At NO TIME should the patient be restrained in the prone (face or chest-down) position

• Always maintain an ability to escape the scene. Position yourself between the patient and the exit at all times to maintain a safe exit should the situation escalate

• Be alert for potential weapons and hazards. If the patient has a weapon, do not attempt to disarm them. Instead, leave the scene and stage until the police declare the scene safe to re-enter

• Be aware of signs of increased agitation or aggression including, but not limited to:

o Tense posture

o Loud speech

o Pacing

o Threatening statements

o Clenched hands

o Hostile or aggressive body language

Imminent Danger – an immediate threat of significant harm to one’s self or others, up to and including death

Examples of Imminent Danger:

• Actively attempting suicide

• Actively attempting to cause serious bodily injury to others

• Attempting to jump from a building or moving vehicle

CAUTION

• There is a high risk of positional asphyxia and/or aspiration in patients undergoing chemical or physical restraint. Close and continuous monitoring of these patients, including airway patency and adequacy of respirations is mandatory

• At NO TIME should the patient be restrained in the prone (face or chest-down) position

• Always maintain an ability to escape the scene. Position yourself between the patient and the exit at all times to maintain a safe exit should the situation escalate

• Be alert for potential weapons and hazards. If the patient has a weapon, do not attempt to disarm them. Instead, leave the scene and stage until the police declare the scene safe to re-enter

• Be aware of signs of increased agitation or aggression including, but not limited to:

o Tense posture

o Loud speech

o Pacing

o Threatening statements

o Clenched hands

o Hostile or aggressive body language

1. Scene safety: protect rescuers and patients from immediate danger and contamination

• Toxic exposures might require special precautions, including CBRNE precautions or decontamination, before patient treatment begins

2. Manage airway and assist ventilations as necessary

3. Administer O2 as per Oxygen Therapy Protocol (Pg 44)

4. Continuous cardiac, SpO2, and BP monitoring

5. Measure temperature AND blood glucose

6. IV access

7. Perform 12 Lead ECG

8. If seizure occurs refer to Pediatric Convulsive Seizure Protocol (Pg 65)

9. Request ACP intercept if available

PEDIATRIC FLUID THERAPY

When IV medication or fluid therapy may be required, start a peripheral IV line or lock using 0.9% NaCl solution.

Unless otherwise directed by protocol or OLMC the drip rate will be set at TKVO rate as outlined below:

• If age less than 8 years:

 15 mL/hour

Fluid bolus should be initiated as follows unless otherwise specified by a specific treatment protocol.

FLUID ADMINISTRATION IN TRAUMA CASES

Bolus administration of IV fluid is to be reserved for cases of hypotension AND evidence of poor perfusion. When indicated, administer IV 0.9% NaCl as outlined below:

• 20 mL/kg bolus until SBP greater than or equal to age-specific hypotension guidelines (Pg 99)

• There is no limit to the amount of fluid that may administered to achieve the desired target SBP

Routine administration of bolus IV fluids in the absence of age-specific hypotension is CONTRAINDICATED in the trauma patient.

IV fluid boluses are only to be administered when above criteria is met to avoid inducing coagulopathy.

FLUID ADMINISTRATION IN MEDICAL CASES (NON-TRAUMA)

When indicated as per protocol administer IV 0.9% NaCl as outlined below:

• 20 mL/kg bolus until SBP greater than or equal to age-specific hypotension guidelines (Pg 99)

• May repeat bolus administration once while indications persist

• If indications for additional IV fluid persist despite administration of two IV fluid boluses, contact OLMC

NOTES

• Carefully observe for signs of pulmonary edema and auscultate chest for crackles after every 10 ml/kg. If crackles are detected stop IV fluid bolus

• Delivery of IV fluid bolus using a buretrol or syringe is mandatory in pediatric patients less than 8 years old and should be considered in all pediatric patients greater than or equal to 8 years old

CAUTION

• Neonates and pediatric patients with hyperglycemia (Greater than 15 mmol/L) must be restricted to 10 mL/kg bolus to maintain SBP greater than age-specific hypotension to avoid induction of cerebral edema

• Contact OLMC to administer additional IV fluid if age-specific hypotension persists after initial IV bolus of 10 mL/kg of 0.9% NaCl in the hyperglycemic patient

PEDIATRIC FLUID THERAPY

When IV medication or fluid therapy may be required, start a peripheral IV line or lock using 0.9% NaCl solution.

Unless otherwise directed by protocol or OLMC the drip rate will be set at TKVO rate as outlined below:

• If age greater than or equal to 8 years:

 30-60 mL/hour

Fluid bolus should be initiated as follows unless otherwise specified by a specific treatment protocol.

FLUID ADMINISTRATION IN TRAUMA CASES

Bolus administration of IV fluid is to be reserved for cases of hypotension AND evidence of poor perfusion. When indicated, administer IV 0.9% NaCl as outlined below:

• 20 mL/kg bolus until SBP greater than or equal to age-specific hypotension guidelines (Pg 99)

• There is no limit to the amount of fluid that may administered to achieve the desired target SBP

Routine administration of bolus IV fluids in the absence of age-specific hypotension is CONTRAINDICATED in the trauma patient.

IV fluid boluses are only to be administered when above criteria is met to avoid inducing coagulopathy.

FLUID ADMINISTRATION IN MEDICAL CASES (NON-TRAUMA)

When indicated as per protocol administer IV 0.9% NaCl as outlined below:

• 20 mL/kg bolus until SBP greater than or equal to age-specific hypotension guidelines (Pg 99)

• May repeat bolus administration once while indications persist

• If indications for additional IV fluid persist despite administration of two IV fluid boluses, contact OLMC

NOTES

• Carefully observe for signs of pulmonary edema and auscultate chest for crackles after every 10 ml/kg. If crackles are detected stop IV fluid bolus

• Delivery of IV fluid bolus using a buretrol or syringe is mandatory in pediatric patients less than 8 years old and should be considered in all pediatric patients greater than or equal to 8 years old

CAUTION

• Neonates and pediatric patients with hyperglycemia (Greater than 15 mmol/L) must be restricted to 10 mL/kg bolus to maintain SBP greater than age-specific hypotension to avoid induction of cerebral edema

• Contact OLMC to administer additional IV fluid if age-specific hypotension persists after initial IV bolus of 10 mL/kg of 0.9% NaCl in the hyperglycemic patient

PEDIATRIC FLUID THERAPY

When IV medication or fluid therapy may be required, start a peripheral IV line or lock using 0.9% NaCl solution.

FLUID ADMINISTRATION IN TRAUMA CASES

Bolus administration of IV fluid is to be reserved for cases of hypotension AND evidence of poor perfusion. When indicated, administer IV 0.9% NaCl as outlined below:

• 20 mL/kg bolus until SBP greater than or equal to age-specific hypotension guidelines (Pg 99)

• There is no limit to the amount of fluid that may administered to achieve the desired target SBP

Routine administration of bolus IV fluids in the absence of age-specific hypotension is CONTRAINDICATED in the trauma patient.

IV fluid boluses are only to be administered when above criteria is met to avoid inducing coagulopathy.

PEDIATRIC FLUID THERAPY

When IV medication or fluid therapy may be required, start a peripheral IV line or lock using 0.9% NaCl solution.

FLUID ADMINISTRATION IN MEDICAL CASES (NON-TRAUMA)

When indicated as per protocol administer IV 0.9% NaCl as outlined below:

• 20 mL/kg bolus until SBP greater than or equal to age-specific hypotension guidelines (Pg 99)

• May repeat bolus administration once while indications persist

• If indications for additional IV fluid persist despite administration of two IV fluid boluses, contact OLMC

Carefully observe for signs of pulmonary edema and auscultate chest for crackles after every_______

 If crackles are detected stop IV fluid bolus

• Delivery of IV fluid bolus using a buretrol or syringe is mandatory in pediatric patients less than ___ years old and should be considered in all pediatric patients greater than or equal to ____ years old

Neonates and pediatric patients with hyperglycemia (Greater than 15 mmol/L) must be restricted to _____ bolus to maintain SBP greater than age-specific hypotension to avoid induction of cerebral edema

• Contact OLMC to administer additional IV fluid if age-specific hypotension persists after initial IV bolus of ______ of 0.9% NaCl in the hyperglycemic patient