PoisoningSubstance AbuseOverdose (Pediatric)
Poisoning / Substance Abuse / Overdose - Pediatric
EMT Standing Order:
- Routine patient Care.
- Assist inadequate ventilations with BVM (bag-valve-mask) ventilation.
- If the patient is in cardiac arrest, begin immediate chest compressions (See Cardiac Arrest Protocol - Pediatric).
- For suspected opioid overdose with severe respiratory depression & CO toxicity or isolated cyanide poisoning, apply 100% oxygen via a non-rebreather.
- For hypoglycemia, see Diabetic Emergencies (Hypoglycemia) Protocol - Pediatric.
- For seizures, see Seizures Protocol - Pediatric.
- Consider contacting Poison Control as soon as practical for consultation.
- Call for AEMT/Paramedic intercept, if available & assist them in patient care.
AEMT/Paramedic Standing Order
- Establish IV \ IO access.
- For severe respiratory depression, administer naloxone 0.1 mg/kg IV/IO/IM/SQ/ intranasal. Maximum initial dose 2 mg. Minimum initial dose 0.4 mg.
- If there is no response, may repeat the initial dose every 3 - 5 minutes to a total of 12 mg. Ingested Poison:
- Contact Medical Direction to consider activated charcoal per length-based occurred within the last 60 minutes and if the patient is awake/alert and protecting airway resuscitation tape if ingestion is a non-caustic substance and occurred within the last 60 minutes and if the patient is awake/alert and protecting airway.
Suggested Treatments for some substance
- Beta Blocker and Ca Channel Blocker: see Bradycardia Protocol - Pediatric (9 Cardiac)
- Dystonic Reaction: Diphenhydramine 0.5 mg/kg IV/IM up to maximum dose 50 mg.
- Narcotic: Naloxone 0.1 mg/kg IV/IO/IM/SQ/intranasal. Maximum initial dose 2 mg. Repeat every 2 minutes as needed (maximum dose 12 mg).
- Organophosphates: see Nerve Agent/Organophosphate Protocol - Pediatric (25 Medical).
- Tricyclic with symptomatic dysrhythmias: (e.g., tachycardia and wide QRS > 110 ms)
- Sodium bicarbonate : 1 to 2 mEq/kg IV.
Signs & Symptoms
- Acetaminophen: Initially normal or nausea/vomiting. If not detected and treated, may cause irreversible liver failure.
- Anticholinergic: Tachycardia, fever, dilated pupils, mental status changes.
- Aspirin: Abdominal pain, vomiting, pulmonary edema, tachypnea, fever, tinnitus and/ or altered mental status. Renal dysfunction, liver failure, and/or cerebral edema among other things can take place later. Consider in elderly with altered mental status.
- Cardiac Medications: Dysrhythmias, altered mental status, hypotension, hypoglycemia.
- Carbon Monoxide (CO) Poisoning: A colorless, oderless gas causing headache, dizziness, weakness, nausea, mental changes, seizure, coma, death.
- Sedatives/Depressants: Bradycardia, hypotension, decreased temperature, decreased respirations, pinpoint or non-specific pupils (miosis).
- Dystonic Reaction: Neurological movement disorder, in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures. This may be induced.
- by antipsychotics, such as haloperidol, or anti-emetics such as prochlorperazine or metoclopramide.
- Akathisia: May consist of feelings of anxiety, agitation, and jitteriness, as well as inability to sit still / pacing. This may be induced by antipsychotics, such as haloperidol, or anti-emetics such as prochlorperazine or metoclopramide.
- Opioids: Respiratory arrest or hypoventilation, evidence of opiate use (bystander report, drug paraphernalia, opioid prescription bottles, “track marks”), depressed mental status, miosis (constricted or “pinpoint” pupils).
- Organophosphates: Bradycardia, increased secretions, nausea, vomiting, diarrhea, pinpoint pupils, SLUDGEM, BBB.
- Solvents: Nausea, coughing, vomiting, and mental status change.
- Sympathomimetic/Stimulants: Tachycardia, hypertension, increased temperature, dilated pupils, anxiety, paranoia, diaphoresis. Examples are bath salts, cocaine, caffeine, methamphetamine, ecstasy, ADHD drugs, thyroid meds (rarely), albuterol.
- Tricyclic (Cyclic): Seizures, dysrhythmias, hypotension, decreased mental status or coma.