Lexington County South Carolina

Pediatric Protocol II

PEDIATRIC ALTERED MENTAL STATUS / SEIZURES / GENERAL MEDICAL PROTOCOL

GENERAL: This protocol addresses the treatment of pediatric patients who present with an altered level of consciousness

Altered mental status (AMS) in a pediatric patient may result from a wide variety of conditions; seizures, infection, trauma, poisoning, hypoglycemia etc. Initial management should focus on aggressive stabilization of vital signs (with emphasis on the respiratory status) followed by an assessment of the causes of the mental status change.

ACTIONS:

1. Assess the patient and manage ABC’s.

If signs of trauma are present stabilize c-spine at the beginning of the assessment.

2. Administer supplemental O2 to keep sats > 96%.

3. Intubate if necessary.

4. Place INT.

5. Check BGL.

6. Contact Medical Control.

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Pediatric Protocol

PEDIATRIC DEHYDRATION / HYPOVOLEMIC SHOCK PROTOCOL

GENERAL: This protocol addresses the treatment of pediatric patients who present with signs and symptoms of dehydration and/or shock.

A systematic approach in patient assessment is essential in order to appreciate the often subtle signs of impending shock. Hypotension is a late sign of shock. If you rely on the blood pressure to diagnose shock you will miss the early signs.

ACTIONS:

1. Assess the patient and manage ABC’s.

2. Supply O2 to keep sats >96%.

3. Intubate as necessary.

4. Start IV of Normal Saline [0.9%] and administer a bolus 20cc/kg over 20 minutes.

5. Check BGL.

6. Contact Medical Control.

CONSIDERATIONS:

Reassess patient after each fluid bolus to determine need for futher fluid administration. If any signs rales or hepatomegaly (Liver enlargement), do not give further boluses.

Minimum Acceptable BP By Age
Newborn	60 systolic
Six (6) Month	70 systolic
> One (1) Year	70 + (2 x age in years)

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Pediatric Protocol IV

PEDIATRIC MAJOR TRAUMA PROTOCOL

GENERAL: This protocol addresses the treatment of pediatric patients who present with traumatic injuries.

Trauma management in a pediatric patient is much the same as in adults. A systematic non-threatening approach to assessment is essential.

* On all suspected trauma full spinal precautions must be maintained *

ACTIONS:

1. Assess the patient and manage ABC’s.

2. Administer O2 via non-rebreather at 15 LPM. If not tolerated use “blow by”.

3. Intubate as necessary.

4. As soon as practical notify Medical Control as to the age, gender, site of trauma and trauma score of the patient.

5. Start IV of Normal Saline [0.9%].

6. Reassess patient and assess for causes of hypotension.

7. If unable to initiate an IV be prepared to initiate an IO.

8. Contact Medical Control.

CONSIDERATIONS:

Hyperventilation with 100% O2 via BVM is the primary treatment for elevated ICP in a patient with head trauma.

In the prehospital environment increased ICP is a greater concern than intracranial bleeding. Intermediates should monitor closely for signs of increased ICP, which may include; severe headaches, uncontrolled vomiting, AMS.

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