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The Valley Hospital Emergency Services
Standing Orders / Communications Failure Orders
7
8.41-8.5 Standing orders for pediatric advanced airway
(a) The following standing orders for placement of an advanced airway are authorized in the event
that an pediatric patient presents:
1. In respiratory arrest;
2. In respiratory failure with associated inadequate spontaneous ventilatory volume;
and/or
3. Unconscious with absent protective gag reflex.
(b) Advanced interventions shall only be attempted after all BLS interventions have been instituted.
(c) It is imperative that the ALS crewmembers initiate contact with medical command as soon as
possible after the above treatment has been rendered. These procedures shall not delay the
transportation of a patient in the event of a difficult intubation, nor shall contact with medical
command be delayed by a difficult airway.
(d) This standing order may be utilized in conjunction with any other standing order where the
patient’s airway needs to be secured.
Communications Failure Orders for pediatric advanced airway:
(a) Do not delay transport in the event of a patient with a difficult airway.
(b) ALS crewmembers shall consider the underlying disease process or injury prior to performing
intubation and shall treat underlying, reversible causes prior to intubation (eg. hypoglycemia,
reversible overdose).
(c) Provide high flow oxygen (12-15 lpm via non-rebreather mask) prior to intubation. Positive
pressure ventilation shall be instituted prior to intubation as needed to maintain a pulse oximetry
reading >90% or as dictated by patient’s spontaneous respiratory effort.
(d) If the patient requires sedation in order to achieve intubation, administer Midazolam 0.1 mg/kg
IV/IO push (maximum dose 10 mg) in order to facilitate the intubation process as long as the
systolic blood pressure is at least 90 mmHg.
(e) Orotracheal and nasotracheal intubation are both considered appropriate management options.
(f) ALS personnel will be permitted only two intubation attempts per person. If the intubation attempts
are unsuccessful, a supraglottic airway should be utilized.
(g) If insertion of a supraglottic airway does not result in adequate ventilation, ALS crewmembers
shall ventilate the patient with a bag valve mask and basic airway adjuncts.