Paramedic Pediatric Scenario 2017

Instructions Read to Employee:

You will be given a scenario. It will be similar to information given by dispatch. You are to work
your way through the scenario verbally. Any questions you would ask the family or patient are
to be directed towards me, the evaluator. I will give answers just as you would expect on the
scene when dealing with a real patient. You will be evaluated on how you handle the scenario.
There will not be any discussion on how to perform any skills or discussion of treatment. Any
mistakes or missed treatments will be addressed at the end of the scenario. Most skills will be
verbalized unless prompted by me, the evaluator. Do you have any questions?

Instructions to Evaluator:
This will be a Pediatric Cardiac Arrest scenario. Please pay special attention to dosages of
medications and proper CPR for the patient.

Let’s Begin

Evaluator: You and your AEMT partner have been dispatched to a residence for a 3 y/o male
patient not breathing.

Evaluator: Upon arrival, you enter to find a 3 y/o male patient lying on the floor in the bedroom.
Mom is attempting CPR with help from dispatch. Child does not have any signs of prolonged down
time. When Paramedic asks for what happened from the mother, please state the following: The
mother laid the child down for his nap approximately 10 minutes prior. She stated that he had been
sick with a respiratory infection for the past 3-4 days. She stated she went in to check on him and
found him not breathing.

Initial Patient Assessment Information:

ABCs
A: patent airway
B: Apneic
C: >4 seconds

Body System Assessment

HEAD: Eyes - Pupils are dilated; Pupils size - 7mm

SKIN: Warm to the touch; skin is pale and dry
CHEST: Intact chest wall
ABDOMEN: soft
PELVIS: Stable
UPPER EXTREMITIES: Unremarkable
LOWER EXTREMITIES: Unremarkable
BACK: Unremarkable
NECK: Unremarkable
 Paramedic Pediatric Scenario 2017

OPQRST
O - Onset approximately 10 minutes prior to EMS arrival.

P - N/A

Q - N/A

R - N/A

S - N/A

T - N/A

AMPLE

A - Allergies - NKDA

M - Medications - None
P - History - None

L - Last Oral Intake - Lunch approximately 45 minutes prior

E - Respiratory Infection for 2-3 days; laid down for nap

Weight - 35 lbs. / 16 kg
Height / Length - 37” or 3’1’’

Broselow Color - White

Mega Code Rhythms

1. Beginning rhythm - V-Fib

1. Immediate shock - 2 J/kg (Total: 18 joules)
2. CPR - 2 min
3. IV/IO Access
4. Epi 0.01 mg/kg (0.1 ml/kg of 1:10,000 concentration) Total: 0.18 mg/kg or 1.8 ml
2. V-Fib
1. Immediate shock - 4 J/kg (Total: 36 joules)
2. Amiodarone or Lidocaine
1. Amiodarone - 5 mg/kg (Total: 80 mg)
2. Lidocaine - 1 mg/kg (Total: 16mg)
3. Asystole
1. Epi 0.01 mg/kg (0.1 ml/kg of 1:10,000 concentration) Total: 0.18 mg/kg or 1.8 ml
2. H’s and T’s
1. hypovolemia, hypoxia, hydrogen ion (acidosis), hypoglycemia, hypo-/hyperkalemia,
hypothermia, tension pneumothorax, tamponade, toxins, thrombosis (pulmonary or
coronary)
4. V-Fib
1. Immediate shock - 4 J/kg (Total: 36 joules)
2. Amiodarone or Lidocaine
1. Amiodarone - 5 mg/kg (Total: 80 mg)
 Paramedic Pediatric Scenario 2017

2. Lidocaine -
1. Maintenance Dose: 20-50 mcg/kg/min Total: 320-800 mcg/min or 32-80 mg/min
5. V-Fib
1. Immediate shock - 4 J/kg (Total: 36 joules)
6. Sinus Rhythm @ 90 bpm
1. Confirm Pulse
7. Follow ROSC treatment protocol
8.

Vital Signs during Scenario

1st Set after ROSC
Blood Pressure 86/50

Heart Rate 90 Regular, Strong

Respiratory Rate PT is apneic unless

paramedic voiced tube
placement

SpO2 91% good capture on pulse ox

Glucose 114 mg/dl

Order of Actions - Critical Criteria

Application of oxygen
Obtain SAMPLE
Quick defibrillation when V-Fib is recognized
Defibrillates PT quickly at each rhythm check that shows V-fib or Pulseless V-Tach
Correctly identifies all rhythms in a timely manner
Epi given at appropriate times and dosages
Amiodarone or Lidocaine as anti-arrhthymic with correct dosages
Glucose check
Establishes advanced airway and ensures EtCO2 usage
Knows values of EtCO2 during CPR and what to expect when you achieve ROSC
Verbalizes IV or IO access