Patient Care Protocols - Hardin County Government

Head Trauma – Pediatric continuedAdvanced Standing Order►►►A►►Children can present with signs of shock secondary to severe scalplacerations. If a child with a severe scalp laceration is showing signsof shock, be sure to gain IV or IO access and give a 20 cc/kg bolusof normal saline or lactated Ringer’s. Be sure to evaluate thepediatric patient to rule out internal bleeding.Check blood glucose, if hypoglycemic see Diabetic Emergencies:Hypoglycemia Protocol.Obtain intravenous or intraosseous access and, if needed,administer isotonic solution, (e.g. normal saline or lactated Ringer’s).Avoid the use of dextrose-containing IV fluids in TBI patients (Treathypoglycemia as indicated.).In patients with multi-organ trauma with an associated TBI, titrate IVsto maintain systolic blood pressure above 90. A systolic BP below 90has been shown to increase morbidity and mortality in the patientwith a TBI.Child: Administer fluid bolus 20 ml/kg, may repeat x 2 (maximumtotal 60 ml/kg to maintain SBP above. 12-16 years: 90 mmHg 5-12: 80 mmHg 1-5 years: 75 mmHg 2seconds.Paramedic Standing OrdersP► If end-tidal CO2 is available, ventilate to maintain an end-tidal CO2 of30-35 mmHg only if signs of herniation present.► If intubation required, consider administration of lidocaine 1 mg/kg IV(maximum dose 100 mg) prior to intubation.134 | P age