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Prehospital protocol pediatric shock
From WikEM
Contents
Perform general assessment
- 100% O2 NRB and Obtain Vital Signs
- If hypotensive, elevate lower extremities IV NS TKO
- Cardiac Monitor / 12 lead ECG / Pulse Oximetry
Is patient symptomatic with?
- Chest Pain
- Difficulty Breathing
- Seizure
- Altered Mental Status
- Bradycardia
Follow individual associated protocols
Assess for signs of hypotension and poor perfusion
- Weak Pulses
- Capillary refill 3 seconds
- Mottled or cool skin
- Altered mental status
- Hypoxia
Other signs of shock
Tachycardia, fever AND one of the following
- Cancer
- Sickle Cell
- Transplant
- Indwelling catheter
- Immune deficiency
- Severe developmental delay
Pulmonary edema?
Yes
- Give (weight *10)mL NS bolus.
- Reassess for pulmonary edema after each bolus
- Repeat up to 3 boluses
No
- Give (weight *20)mL NS bolus.
- Reassess for pulmonary edema after each bolus
- Repeat up to 3 boluses
Advanced Notification
If treating for shock then ensure advanced notification to receiving hospital.
Continued hypotension or signs of shock?
Yes
- Begin dopamine drip with titration to age appropriate SBP
- Further orders per on-line physician
No
- Reassess en-route
