ValleyProtocolBook

The Valley Hospital Emergency Services

16

Standing Orders / Communications Failure Orders

i. For patient < 1 month of age administer 0.5 g/kg of a 10% dextrose solution via vascular access

ii. For patients > 1 month of age administer 0.5 g/kg of a 25% dextrose solution via vascular access

iii. If unable to establish vascular access, administer Glucagon 0.1 mg/kg (0.1 mL/kg) to a maximum of 1 mg IM (1 mg = 1 mL = 1 unit);

f. If there is no change in the patient’s mental status and there are signs of possible opioid toxicity (eg., decreased respirations), administer Naloxone 0.2 mg and if no response, then administer Naloxone 0.1 mg/kg, with a maximum dose of 2 mg via vascular access, endotracheal tube or intranasal route;

g. If there is a history of dehydration and vascular access has been established, administer a fluid bolus of normal saline at 20 mL/kg via vascular access

h. Contact medical command.

Communications Failure Orders for pediatric altered mental status

(a) If the patient has a blood glucose level > 300mg/dL and is presenting with signs and symptoms of Diabetic Ketoacidosis, administer Normal Saline 20 ml/kg IV/IO drip.

(b) If the patient is combative and requires sedation, administer Lorazepam 0.05 mg/kg up to 2 mg IV/IM.

(c) If the provider suspects an overdose, treat according to suspected agents:

a. Opiate toxicity: Naloxone 0.1 mg/kg to a maximum of 2 mg IV/IO push.

b. Benzodizepine toxicity: Romazicon 0.01 mg/kg IV/IO push to a maximum of 0.2mg

i. Hold Romazicon for any patient who may be chronically taking benzodiazepines

c. Tricyclic Antidepressant toxicity: Sodium Bicarbonate 8.4% 1 mEq/kg to a maximum of 50 mEq IV/IO push.

d. Beta Blocker: Glucagon 0.1 mg/kg to a maximum of 3mg IV/IO push.

e. Calcium Channel Blocker: Calcium Chloride 20 mg/kg to a maximum of 1 gram IV/IO push.