4-12 PEDIATRIC TOXIC EXPOSURE

Utilize appropriate personal protective equipment and consider the need to decontaminate the patient prior to continuing care if necessary for the safety of the patient and providers based on nature of the toxic exposure.

EMR - Emergency Medical Responder

1. Establish patient responsiveness.
2. Assess the patient’s airway of patency, protective reflexes and the possible need for advanced airway management. Look for signs of airway obstruction and if present proceed as per airway obstruction protocol.
3. Open the airway via chin lift or modified jaw thrust.
4. Suction as necessary
5. Consider placing an oropharyngeal or nasopharyngeal airway adjunct if the airway cannot be maintained with positioning and the patient is unconscious.
6. Assess patient breathing, including mental status rate, auscultation, inspection, respiratory effort, adequacy of ventilation as indicated by chest rise and obtain a pulse oximetry reading.
7. If signs of respiratory arrest or respiratory failure with inadequate breathing are present, assist ventilation using a B-V-M device with 100% oxygen.
8. If breathing is adequate, place the child in a position of comfort and administer high-flow 100% oxygen as tolerated.
9. Assess circulation and perfusion.
10. Look for the source of the toxic exposure. Collect any containers or medication bottles to transport with the patient to the hospital.
11. Call for ALS intercept  

EMT - Emergency Medical Technician  Perform/Confirm All Above Interventions

1. Check blood glucose and if less than 60 mg/dL, refer to pediatric hypoglycemia protocol.
2. Apply ECG monitor & run strip (if trained, if time allows and after all other interventions are completed).
3. Initiate transport and Contact MEDICAL CONTROL to discuss need for ALS intercept.

AEMT – Advanced Emergency Medicine Tech   Perform/Confirm All Above Interventions

1. Consider need for vascular access and administer NS at a TKO rate if indicated. If IV access unlikely or cannot be obtained in 2 attempts in a child less than 6 do not attempt further IV placement.
2. If access is obtained and signs of poor perfusion are present, administer 20 mL/kg NS bolus.
3. Initiate transport and Contact MEDICAL CONTROL to discuss need for ALS intercept and for further fluid orders, if indicated.
4. If patient has ingested an opiate and has signs or symptoms of respiratory depression or hypoperfusion, discuss administration of naloxone (Narcan) 0.1 mg kg to a maximum dose of 2 mg with medical control.

Intermediate - Perform/Confirm All Above Interventions

1. Establish vascular access. If IV access unlikely or cannot be rapidly established consider IO placement.
2. Evaluate need for advanced airway management and ventilatory support.
3. If patient has ingested an opiate and has signs or symptoms of respiratory depression or hypoperfusion, administer naloxone (Narcan) 0.1 mg kg to a maximum dose of 2 mg.
4. If the exposure is a hypoglycemic agent, check blood glucose and if less than 60 mg/dL, refer to pediatric hypoglycemia protocol
5. Transport and Contact MEDICAL CONTROL for further orders. Treatment for toxic exposures may be instituted by Medical Control, including the following:
   1. High dose atropine (0.05 mg mg/kg) for organophosphates
   2. Glucagon (50 mcg/kg over 1 minute) for Beta Blockers or calcium channel blockers

Paramedic - Perform/Confirm All Above Interventions

1. Transport and Contact MEDICAL CONTROL for further orders. Treatment for toxic exposures may be instituted by Medical Control, including the following:
   1. Sodium Bicarbonate for Tricyclic antidepressants
   2. Diphenhydramine (Benadryl) (1 mg/kg IV/IO Max dose 25 mg)for dystonic reactions