Standing Orders
1. Assure patent airway. Begin oxygen therapy.
2. Obtain history: Time of onset, history of previous seizures, other risk factors such as previous trauma, illness, or drugs.
3. Determine blood glucoseand treat hypoglycemiaper protocol.
4. If seizure ongoing >5 minutes and IV access already established give,
a. Midazolam HCL (Versed0.1 mg/kg IV over two minutes. (maximum dose = 5 mg).
OR
b. Consider Ativan0.05 mg/kg IV, titrated to stop seizure, up to a maximum dose of 4 mg.
5. If seizure ongoing >5 minutes and no IV access, give midazolam HCL (Versed 0.2 mg/kg IM prior to starting IV (maximum dose = 7 mg).
6. Contact a medical control physician for further orders if necessary.
After Obtaining Verbal Orders
7.
If seizure not terminated within 10 minutes after Versedgive additional 0.05 mg/kg
Versed over two minutes (maximum dose = 2.5 mg).
Be prepared to support respirations.
1. Anaphylaxis
Standing Orders
a. For signs and symptoms of anaphylaxis, Begin oxygen therapy; assist respirations with PPV as needed; ET intubate, if authorized, for severe respiratory distress and/or ineffective ventilation.
b. Consider placing venous tourniquet proximal to sting or injection site and/or ice pack at sting or injection site.
c. May administer epinephrine1:1000, 0.01 mg/kg (0.01 cc/kg) SC or IM up to 0.3 cc (or EpiPen Jr.) if patient was exposed to commonly recognized allergen and has respiratory distress OR hypotension.
d. May administer Albuterol2.5 mg mixed with Atrovent0.5 mg via nebulizer. If no improvement, may nebulize continuously with Albuterol. 2.5 mg.
e. Start Normal Saline IV.
f. If patient meets criteria in c. above, may also administer diphenhydramineHCL (Benadryl) mg/kg IV/IM while contacting a medical control physician (maximum dose = 50 mg).
g. Transport early.
After Obtaining Verbal Orders
h. If patient ET intubated and becomes agitated from increased level of consciousness, may give Versed0.1 mg/kg titrated up to 1mg IV, IM, or SC. May repeat
i. Consider fluid bolus - 20 cc/kg.
2. Allergic Reaction
Standing Orders
a. For signs and symptoms consistent with an allergic reactionwhere the patient:
- Is NOT hypotensive AND
- Has NO evidence of respiratory distress
b. Consider diphenhydramine (Benadryl ) 1 mg/kg IV, IO or IM up to a total of 50 mg.
Standing Orders
1. Begin oxygen therapy if child obtunded.
2. Tricyclic ODs requiring ventilatory support should be hyperventilated.
3. For all significant overdoses, obtain IV access and contact a medical control physician for orders.
4. For all suspected tricyclic overdoses, also monitor ECG.
After Obtaining Verbal Orders
5. Consider Narcan0.1 mg/kg IM or IV up to 2 mg.
6. Consider Sodium Bicarbonate1 mEq/kg IV for tricyclic ingestions.
7. If child unconscious and blood glucose<60 mg/dl, consider D50W 1 cc/kg IV up to 50 cc for patients four years or older. For patients three years or younger, use D25W, 2 cc/kg.
Standing Orders
1. Begin oxygen therapy.
2. Obtain available history.
3. Immobilize spine if trauma is possible.
4. Obtain IV access - Transport early if no IV site available.
5. Determine blood glucose.
6. Contact a medical control physician.
After Obtaining Verbal Orders
7. If blood glucose<60 mg/dl, may give D50W, 1 cc/kg IV up to 50 cc to patients four years or older. For patients three years or younger, use D25W, 2 cc/kg.
8. Consider Narcan0.1 mg/kg IM or IV up to 2 mg.
Standing Orders
1. Determine blood glucose.
2. If patient is conscious, cooperative, and able to swallow effectively, give oral glucosetherapy.
3. If patient unable to take oral fluids due to altered level of consciousness:
a. Obtain IV access.
b. Determine blood glucose.
c. Give D50W, 1 cc/kg up to 50 cc to patients four years or older. For patients three years or younger, use D25W, 2 cc/kg IV.
d. May give glucagon1 mg IM if IV access difficult or impossible.
4. A medical control physician must be contacted in any case where the patient experienced a hypoglycemic event and the parent or guardian refuses medical transportation.