FIELD REFERENCE
Full criteria & treatment guidance
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. Give 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.
UNDERSTAND THE CARE
How exposure history helps without delaying support
The likely substance, amount, timing, route and co-exposures help identify the correct branch. Bring useful packaging when safe, but do not delay airway and ventilation support to complete an exposure history. Obtain the working weight and distinguish a known ingestion from an uncertain scene finding.
Applying the guidance
The same medication can appear under different indications with different limits. Keep the poisoning atropine instructions separate from bradycardia, and distinguish weight-based naloxone from a fixed nasal device. After any intervention, reassess breathing, consciousness, oxygenation, temperature and perfusion as relevant to the exposure.
Putting it together
Teaching example: opioid toxicity is suspected, but a second medication container is found. Continue the complete assessment and communicate possible co-exposure instead of treating the initial response as proof of a single cause.
Diagram text & teaching checkpoints
- Support
- Airway and effective ventilation.
- Exposure
- Substance, amount, time, route and co-exposures.
- Pathway
- Match the toxin and pediatric indication.
- Reassessment
- Watch for recurrence and additional problems.
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.
Separate confirmed exposure from a possible exposure
An exposure report should make uncertainty visible. Distinguish what a caregiver saw, what packaging was found and what the crew directly observed. Record the product name or concentration when available, the possible amount, route, time and whether other substances may be involved. An open container near a child is useful information, but it does not by itself establish what was taken or how much.
Give the receiving team the exposure history together with the child’s weight, initial respiratory findings, support provided and response. Label an unknown amount as unknown rather than converting a guess into a documented dose. Bring useful packaging only when safe, as described above.
Teaching example: the caregiver finds two open medications and cannot identify which was accessed. Report both possible exposures and the uncertainty while continuing the airway, glucose and perfusion assessment. A response to one treatment does not prove that the other possible exposure is irrelevant.
OCEMS source: SO-P-085: Substance Overdose / Poisoning - Pediatric.