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Medical

Pediatric TOXIC INGESTIONS

Signs and Symptoms: Differential Diagnosis:
• Mental Status Changes • Cyclic Antidepressants
• Hypo/Hypertension • Acetaminophen
• Respiratory Depression • Depressants
• Tachycardia/Arrhythmias • Stimulants
• Seizure • Anticholinergic
• Cardiac Medications
• Solvents/Cleaners
• Organophosphates/Carbamate
• Medical Cause (hyperthyroidism)
Universal Patient Care Guideline
Continued from: O2 (if Hypoxemic) Blood Glucose: <65?
Tactical Evacuation Guideline IV/IO Guideline
Cardiac Monitor (ASAP)
Beta Blocker Overdose: NO YES
AV Block (especially, 1 st Degree), Altered Mental Status Guideline
Bradycardia, and Hypotension: NS 20mL/kg IV Bolus prn n (25% Dextrose 2mL/kg IV OR
r
p
Consider giving: Glucagon 1mg IV/IM Glucagon 0.05mg/kg IM if NO IV,
Activated Charcoal 1g/kg PO (if Max 1mg)
/
Tricyclic Overdose: alert/protecting airway and time
QRS > 100 = Predictive of seizures of ingestion <1hr)
QRS > 160 = Predictive of VT (via NG OK if airway protected)
Opiates Tricyclic Antidepressant Organophosphate/Carbamate Other
(Respiratory
Depression) 12-lead EKG Atropine 0.02mg IV/IO q5min 12-lead EKG
(No max dose: give until
improving with ↓ secretions)
Naloxone 0.1mg/kg IV QRS >100ms or Hypotensive? Hypotension, Seizures,
(every 2-3 mins as 2-PAM 25mg/kg IV/IM Ventricular Dysrhythmias,
needed) Sodium Bicarbonate 1mEq/kg (Atropine + 2-PAM = Mark 1 Kit) Altered Mental Status, Chest
May repeat to maintain QRS <100 If in Seizure give: Pain.
Start Maintenance Infusion:
Pediatric Airway 100-150mEq (2-3 amps) in 1L D5/NS
Guideline @ 100-200 mL/hr IV Lorazepam 0.1mg/kg IV Appropriate Guideline
Pediatric Seizure Guideline
Continuous Monitoring, reassess q5min
Pearls:
• Anticholinergic: Altered mental status (mad as a hatter), hyperthermia (hot as a hare), mydriasis (blind as a bat), Flushing (red as a
beet), anhidrosis (dry as a bone), Full Bladder (full as a flask).
o Treat as with Tricyclic overdose pathway (including EKG and Sodium Bicarb for prolonged QRS and/or arrhythmias)
o LORAZEPAM for agitation and seizures and Hyperthermia Guideline if hyperthermic.
• Beta Blocker: HypOglycemia.
• Calcium Channel Blocker: HypERglycemia.
• Cyclic Antidepressant: Hypotension, depressed mental status, respiratory depression, cardiac arrhythmias.
• Opioid: Depressed mental status, pinpoint pupils, N/V, respiratory depression, hypotension possible.
• Organophosphate/Carbamate (cholinergic): Salivation, lacrimation, urination, diarrhea, emesis, altered mental status.
• Sympathomimetic/Stimulant (Methamphetamine/Cocaine): Altered mental status, tachycardia, diaphoresis, mydriasis, and
hyperthermia. Treat with Benzodiazepine (LORAZEPAM) and prn cooling or Hyperthermia Guideline.
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