Maine:Prehospital protocol pediatric shock: Difference between revisions
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Revision as of 15:41, 25 October 2015
Perform general assessment
- Attempt to identify cause of shock (i.e. allergic reaction)
- O2 and airway management as appropriate
- Keep child warm and dry
- Request ALS transport
Consider causes
Follow individual associated protocols
- Hypovolemic Shock:
- Vomiting/diarrhea
- GI bleed
- Cardiogenic Shock:
- Anaphylaxis
- Sepsis or Undifferentiated shock
Fluid bolus
- Assess for pulmonary edema before administration (crackles)
- Administer 20mL/kg NS bolus over 5-15 minutes and immediately reasses
- For cardiogenic shock, administer 10mL/kg NS per bolus
- If needed repeat bolus 2 times
- If available and trained perform point of care lactate
- Notify receiving hospital
If no treatment response
- Contact medical for additional fluid bolus or norepinephrine infusion
- Norepinephrine infusion must be infused by a pump
Norepinephrine
- Concentration: 8mg in 250 mL NS
- Starting Dose: 0.03 mcg/kg/min
- Usual Dose: 0.03 - 0.25 mcg/kg/min. Max dose is 3 mcg/kg/min
- Titration: Goal SBP > 80 mm Hg. 0.03 mcg/kg/min every 3-5 min