2 Critically Ill Pediatric Patients

13 CRITICALLY ILL PEDIATRIC PATIENTS **Pediatric Patients Are Defined As ≤14 Years of Age** I. Assessment and documentation on all pediatric patients should include the following: A. Primary and secondary assessment including presence and quality of all extremity pulses. B. Cardiac ECG rhythm and SpO2 oxygen saturations. C. If coarctation (congenital heart anomaly) is suspected and extremity pulses are diminished, then obtain, and document, a B/P in each extremity. II. Treatment will follow the general guidelines established by the American Heart Association in the Pediatric Advanced Life Support course. All newborns or infants who present in shock or respiratory failure should be assumed to be septic until proven otherwise. Specific interventions for all critically ill children will include: A. Airway – Ensure airway is patent. Utilize appropriately sized ETT or LMA. (Broselow tape or pediatric standard calculations may be utilized to determine size.) B. Breathing 1. Injured children – Provide supplemental oxygen to maintain SpO2 > 92% unless patient suffers from Congenital Heart Defect (CHD) then use O2 as per guideline 2. Provide ETCO2 monitoring on all intubated patients. Adjust ventilation parameters to maintain ETCO2 between 35-45 mmHg. C. Circulation 1. Assess and monitor vital signs (including BP’s) and temperatures on all children. Monitor cardiac rhythm and provide thermal regulatory support as necessary. 2. Treat specific dysrhythmias per guidelines 3. Place combination defibrillation / pacer pads on children with evidence of or possibility of rhythm disturbances in flight.

4. Initiate venous access by peripheral, IO or femoral venous routes. Umbilical vein catheterization may be performed in newborns. a. Newborns – D10% ¼ NS if available. Otherwise, use Normal Saline. 14 b. Infants / Children > 3 mo. Age – D5% ½ NS if available. Otherwise, use Normal Saline. 5. Calculate maintenance fluids for patients < 8 y/o: a. Holiday – Segar Method: i. First 10 Kg = 4cc/kg/hr ii. Second 10 Kg = 2cc/kg/hr iii. Each additional Kg over 20 = 1cc/kg/hr b. EXAMPLE: 24kg child 1st 10 kg = 4 x 10 = 40cc 2nd 10 kg = 2 x 10 = 20cc 4 kg (> 20 kg) = 4 x 1 = 4cc TOTAL maintenance fluids = 64cc/hr 6. Monitor arterial line if placed by transferring facility. 7. If sepsis is suspected, request transferring physician to initiate antibiotic therapy prior to transfer. Document dose and time of medication(s) administered. D. Deficits 1. Assess for and document the following: a. GCS b. Pupil size and response to light accommodation c. Bulging or sunken fontanels E. Additional Interventions 1. Consider NG or OG tube placement and apply Low Intermittent Suction for unresponsive patients, those with absent bowel sounds, or those whom are intubated. 3. Pain control as per guideline 4. Other interventions per specific guideline

5. Monitor I & O’s. (Count diapers or consider Foley-catheter placement F. Documentation. The Patient Care Record (PCR) should contain the following: 1. Treatment prior to arrival (PTA) of AirLIFE 15 2. History of present illness. If patient is a newborn, document birth weight, complications at birth and gestational age. 3. Pertinent past medical history (PMH) – previous surgeries. 4. Initial assessment – to include perfusion and cardiac rhythm. 5. Treatment rendered while in care of AirLIFE personnel. 6. Reassessment and evaluation of treatment. 7. Any contact with Medical Control. Developed 6/2002 Reviewed / Revised: 01/04, 03/05, 03/07, 02/09