Support breathing, identify the exposure, and use the toxin-specific pediatric pathway.
OCEMS source summary · Updated 2026-09-16
Key cautions & base contact
Naloxone should not delay ventilation. Monitor for recurrent respiratory depression.
Atropine doses for poisoning differ from bradycardia doses.
Airway, glucose & exposure
Assist ventilation with BVM and suction as needed. Determine the likely substance, dose, time, route, and any co-exposures; bring useful packaging when safe.
Check glucose. At 60 mg/dL or less, oral glucose requires intact airway reflexes; D10 is 5 mL/kg IV, maximum 250 mL, or glucagon 0.5 mg IM when IV is unavailable. The IO dextrose exception has additional criteria.
Opioids or stimulants
For suspected opioid toxicity with respiratory rate at or below 12/min: naloxone 0.1 mg/kg IN/IM/IV, maximum 1 mg per dose, every 3 minutes as needed. The 4 mg/0.1 mL preloaded nasal spray is a separate fixed product.
For stimulant toxicity, continuously assess ventilation and SpO₂. Sudden hypoventilation, desaturation, or apnea requires BVM and oxygen. The source lists saline 20 mL/kg IV/IO, maximum 250 mL, with up to three total boluses; assess for hyperthermia and begin cooling when indicated.
Other named exposures
Extrapyramidal reaction: diphenhydramine 1 mg/kg IM/IV once, maximum 50 mg.
Organophosphate/chemical-agent poisoning: atropine 0.02 mg/kg IV, repeat once as needed; alternate IM dose 0.1 mg/kg, repeat after 5 minutes as needed, maximum single dose 2 mg.
For suspected CO or cyanide exposure, provide high-flow oxygen. PR-130 adds base-ordered hydroxocobalamin for its cyanide indications; do not treat every exposure as cyanide poisoning.
Reassess & transport
SO-P-085 permits its listed medications by IO; preserve the separate dextrose exception and indication-specific directions.
All suspected pediatric overdose/poisoning victims receive ALS escort to the nearest appropriate ERC. Report airway support, serial ventilation findings, exposure details, and all medication totals.