Pediatric Medical Section Protocols / ) OD Exit to Carbon .1 mg/kg IN Cyanide / Monoxide if indicated Cyanide Protocol Carbon Monoxide Maximum 2 mg if indicated AirwayProtocol (s) Naloxone 0 Appropriate Pediatric (organophosphates tidepressants ophen es I nts linergic , Alcohols ts, , Cleaning agents iac medications ressants / if available Exit to Antidote Kit Antidote Nerve Agent Tricyclic an Acetamin Dep Stimula Anticho Card Solven Insecticid if indicated if s) / NerveWMD / Severity Arms ( Agent Protocol Follow Symptom Organophosphate Differential · · · · · · · · NO Pediatric ; Behavioral Protocol Appropriate ; as indicated Diabetic / AMS NO , Toxic Ingestion / Toxic , Urination I Upset GI , YES IO ProcedureIO cramping / sec hypertension dysrhythmias P Protocol 60 Lacrimation, loss of control .09 QRS ia, YES uscleTwitching d ECG Procedured ECG Tricyclic M Notify Destination or ≥ 0 Ventilation status changes status Contact Medical Control es Lea ased respiratory rateased respiratory / Antidepressant tension / Cardiac Monitor NO NO

12 YES Status

alivation, Contact Hypo Decre Tachycard Seizur S increased, Abdominal pain Mental Defecation / Diarrhea Emesis, Age Specific Hypotension AlteredMental P IV Procedure 1-800-222-1222 · Signs and Symptoms Signs · · · · · I P Adequate Respirations / B Oxygenation Carolinas Poison Control , YES Pediatric Overdose Overdose Pediatric route, YES Calcium isimportant Channel Blocker past psychiatric l history, Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and be approved by OEMS , ce ingested n or suspected ingestionn or suspected Safe Scene If noimprovementIf ble medications inhome Protocol Pediatric , son (suicidalaccidental, Cardiac External Pacing if indicated resources Procedure for Severe Cases Availa Past medica medications, history Substan quantity Time of Ingestion Rea criminal) Ingestio of potentiallytoxic substance Hypotension / Shock Revised 4/16/2014 NO Stage until scene safe I Callhelp for / additional · · · · History · · Beta Blocker P Pediatric Overdose / Toxic Ingestion Pediatric Medical Section Protocols Section Pediatric Medical

Pearls · Recommended Exam: Mental Status, Skin, HEENT, Heart, Lungs, Abdomen, Extremities, Neuro · Do not rely on patient history of ingestion, especially in suicide attempts. Make sure patient is still not carrying other medications or has any weapons. Bring bottles, contents, emesis to ED. · Age specific blood pressure 0 – 28 days > 60 mmHg, 1 month - 1 year > 70 mmHg, 1 - 10 years > 70 + (2 x age)mmHg and 11 years and older > 90 mmHg. · Tricyclic: 4 major areas of toxicity: seizures, dysrhythmias, hypotension, decreased mental status or coma; rapid progression from alert mental status to death. · Acetaminophen: initially normal or nausea/vomiting. If not detected and treated, causes irreversible liver failure · Aspirin: Early signs consist of abdominal pain and vomiting. Tachypnea and altered mental status may occur later. Renal dysfunction, liver failure, and or cerebral edema among other things can take place later. · Depressants: decreased HR, decreased BP, decreased temperature, decreased respirations, non-specific pupils · Stimulants: increased HR, increased BP, increased temperature, dilated pupils, seizures · Anticholinergic: increased HR, increased temperature, dilated pupils, mental status changes · Cardiac Medications: dysrhythmias and mental status changes · Solvents: nausea, coughing, vomiting, and mental status changes · Insecticides: increased or decreased HR, increased secretions, nausea, vomiting, diarrhea, pinpoint pupils · Consider restraints if necessary for patient's and/or personnel's protection per the Restraint Procedure. · Nerve Agent Antidote kits contain 2 mg of Atropine and 600 mg of pralidoxime in an autoinjector for self administration or patient care. These kits may be available as part of the domestic preparedness for Weapons of Mass Destruction. · MR and EMT-B may administer naloxone by IN route only and may administer from EMS supply. Agency medical director may require Contact of Medical Control prior to administration and may restrict locally. · When appropriate contact the North Carolina Poison Control Center for guidance, reference Policy 18.

Revised Protocol 60 4/16/2014 Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and be approved by OEMS