FIELD REFERENCE
Full criteria & treatment guidance
Key cautions & base contact
- Do not give oral glucose to a child who cannot protect the airway.
- Use the glucose threshold in this condition order; the seizure order has different threshold wording.
Initial assessment
- Protect the airway and assist ventilation with BVM when needed. Monitor rhythm and document a strip.
- Check SpO₂; below 95% on room air, provide high-flow mask oxygen or nasal cannula/direct blow-by as tolerated. Obtain history, medication access, onset, and a measured or appropriately estimated weight.
Poor perfusion
- For poor perfusion or systolic BP below 80, establish IV/IO and give normal saline 20 mL/kg, maximum 250 mL, with base contact.
- May repeat twice for three total boluses. Reassess BP, lung sounds, skin signs, and mental status rather than giving repeats automatically.
Hypoglycemia
- Measure and document glucose. Below 60 mg/dL, use oral glucose only if tolerated with intact airway reflexes, or D10 5 mL/kg IV, maximum 250 mL.
- If IV cannot be established, glucagon is 0.5 mg IM. IO dextrose under this order requires unconsciousness, glucose below 60, inability to obtain IV, and no response to IM glucagon.
Suspected opioid toxicity & transport
- For suspected narcotic toxicity with a respiratory rate at or below 12/min, support ventilation and give naloxone 0.1 mg/kg IN/IM/IV, maximum 1 mg, every 3 minutes as needed. A preloaded 4 mg/0.1 mL nasal spray is also listed.
- Reassess and document response to every treatment. Provide ALS escort to an appropriate ERC; contact base as needed, with a pediatric-capable base preferred.
UNDERSTAND THE CARE
How to make the pediatric reassessment useful
The child’s baseline interaction, onset and exposure history help interpret a change in consciousness. Obtain a measured or appropriately estimated weight and keep it visible to the team. Breathing, perfusion and glucose assessment proceed together; a suspected cause does not remove the need to support the airway.
Applying the guidance
After treatment, repeat the same observations rather than recording only “improved.” Describe the child’s interaction, respiratory effort, pressure and skin findings. Oral glucose requires intact airway reflexes, and the IO dextrose exception has specific additional conditions. Separate weight-based injectable naloxone instructions from the fixed preloaded nasal product.
Putting it together
Teaching example: a child becomes more interactive after glucose treatment but continues breathing inadequately. Continue ventilatory assessment and support and report both the improvement and the unresolved finding.
Diagram text & teaching checkpoints
- Baseline
- Usual interaction and onset.
- Immediate support
- Airway, ventilation and perfusion.
- Cause-specific care
- Glucose, exposure and correct weight.
- Response
- Repeat the original observations.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.