General Approach to All Pediatric Patients

Measures to Manage All Pediatric Patients

The following measures will apply to the management of all pediatric patients:

  • A Child shall be defined as:
    • Age ≤ 12 years or weight ≤ 40 kilograms (if age unknown)
    • For PALS resuscitation: infant up to puberty
    • For Trauma alert: ≤ 15 years

Basic Life Support

  • Establish patient responsiveness
  • Immobilize spine if cervical or other spine injury suspected
  • Assess airway and breathing
    • Supplemental 100% oxygen if any respiratory signs or symptoms
  • Assess circulation and perfusion by measuring heart rate, and observing skin color, temperature, capillary refill, and the quality of central/peripheral pulses
    • For children with absent pulses initiate cardiopulmonary resuscitation
  • Control hemorrhage using direct pressure or a pressure dressing
  • Measure BP only in children older than 3 years of age
  • Evaluate mental status, including pupil reaction, motor function and sensation
    • For mental status, use the AVPU scale:
      • A- The is patient alert and oriented (age appropriate)
      • V- The patient is responsive to verbal stimulus
      • P- The patient is responsive to painful stimulus
      • U- The patient is unresponsive to any stimulus
  • Expose the child only as necessary to perform further assessments
  • Maintain the child’s body temperature throughout the examination

Advanced Life Support

  • When condition warrants (specified as “Full Pediatric ALS Assessment and Treatment” in individual protocols):
    • Advanced airway/ventilatory management as needed
    • Perform cardiac monitoring
    • Continuously monitor oxygen saturation and capnography
    • If symptoms severe or for medication access IV 0.9% NaCl KVO or IV lock
    • If signs of shock administer boluses of 0.9% NaCl at 20ml/kg until signs of shock resolve or 60ml/kg total
    • If signs of severe cardiopulmonary compromise and IV attempts unsuccessful in a child < 5 years old, establish intraosseous access
  • If child’s condition is critical or unstable, initiate transport without delay
  • For patients with severe nausea or vomiting:
    • Ondansetron (Zofran), 2 mg (8-15 kg) or 4 mg (>15 kg) oral disintegrating tablet (ODT) by mouth (break 4 mg tablet in half for 2 mg dose)
  • Reassess the patient frequently