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The Valley Hospital Emergency Services
Standing Orders / Communications Failure Orders
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b. If at any point the patient develops signs or symptoms of acute significant respiratory
distress and /or profound hypotension (systolic blood pressure less than or equal to
90mmHg) with clinical evidence of shock, (altered mental status; cool clammy or
mottled skin; and /or delayed capillary refill), refer to 8.41-8.10 Standing orders for
allergic reaction/anaphylactic shock and part (b) below.
(b) The following Communications Failure Orders are authorized in the event that a pediatric patient
presents with signs of generalized allergic findings such as urticaria with signs of acute significant
respiratory distress and /or profound hypotension (systolic blood pressure less than or equal to
(70+[2*Age]) mmHg) with clinical evidence of shock, (altered mental status; cool clammy or
mottled skin; and /or delayed capillary refill).
a. If patient is receiving Albuterol via nebulizer, administer Ipratropium Bromide 0.5 mg /
2.5 mL normal saline via nebulizer.
b. If the patient continues to have serious signs and symptoms that are not resolving,
repeat administration of Epinephrine 0.01 mg/kg (0.01 ml/kg) of a 1:1,000 solution to a
maximum of 0.3 mg IM in lateral thigh or deltoid.
c. Consider intubation for patients who fail to respond to initial therapy. Refer to the
Standing Orders and Communications Failure Orders for pediatric advanced airway.
d. Administer additional Normal Saline 20 mL/kg IV/IO and repeat as necessary up to 60
mL/kg.
e. If patient is severely hypotensive (systolic blood pressure less than or equal to 70
mmHg), administer Epinephrine 1:10,000, 0.01 mg/kg, up to 0.25 mg IV/IO slow push.
8.41-8.11 Standing orders for pediatric altered mental status
(a) The following standing orders are authorized in the event that a pediatric patient presents with
altered mental status:
a. Assess and secure the airway;
b. Administer oxygen therapy as patient condition indicates; Maintain normal body
temperature;
c. If evidence of trauma, refer to the “Standing Orders for Pediatric Trauma” found at
N.J.A.C. 8:41-8.8;
d. Establish vascular access with normal saline solution at a KVO rate;
e. Obtain a rapid glucose test. If blood glucose is < 60 mg/dl;