Conduct primary survey and correct life-threatening problems FIRST:
a. Airway patency
b. Respiratory distress
c. Unstable vital signs
d. Major bleeding or injuries
Full spinal immobilization should be considered for all non-ambulatory trauma patients who sustain a mechanism of injury with the potential for spinal injury and have any of the following clinical findings:
a. Spinal pain or tenderness
b. Altered level of consciousness
c. Significantly distracting painful injuries (i.e. femur fracture)
d. Neurologic deficits
Conduct secondary survey:
a. Injury survey
b. Neurological evaluation
i. Level of consciousness (AVPU) OR Glasgow Coma Score
ii. Pupillary status
iii. Extremity movement
Initiate O2 therapy and cardiac monitoring.
Start a large-bore IV (preferably 2) and begin Isotonic Solution (NS or LR) 0.9% NORMAL SALINE 20 mL/kg bolus. DO NOT delay transportation unnecessarily to obtain IV.
Treat specific injuries as dictated in Adult Trauma protocols.
PEDIATRIC PAIN MANAGEMENT
a. Ask patient &/or family members about allergies to any medications.
b. Requirements for pain medication usage:
No allergies to pain medications
Continuous cardiac monitoring
IV access
b. FENTANYL 1 – 2 mcg/kg IV/IN every 5 - 10 minutes as needed for effective pain control. Contact Medical Control if repeated doses required.
Option: MORPHINE incremental doses of 1 - 2 mg IV every 5 – 10 minutes.
c. If level of consciousness decreases OR RR < 10 OR SBP < 80, cease administration of fentanyl and administer NALOXONE (Narcan) 2 mg IV. If this is successful, you may repeat as needed enroute.
d. If SEVERE pain not adequately controlled with narcotics, you may consider KETAMINE 0.5 - 1 mg/kg IV/IO.
e. Consult Medical Control if any concerns.