Key cautions & base contact

The TBI section has different fluid-repeat wording from the hemorrhage section; do not merge them into a single universal rule.
Confirm the source pathway and account for all prior analgesic doses.

Bleeding control

Apply direct pressure. If controlled, secure a pressure dressing. For persistent bleeding, consider a hemostatic dressing with direct pressure.
For uncontrolled extremity bleeding despite these measures, apply a tourniquet under the relevant procedure. Begin transport promptly when hypotension or serious injury is present.

For hypotension, establish IV/IO and give saline 20 mL/kg, maximum 250 mL per bolus, with base contact. The hemorrhage pathway allows two repeats for three total boluses.
Base contact is required for hypotensive hemorrhage and patients meeting trauma-triage criteria; a pediatric-capable base is preferred.

For severe pain in the listed eye, extremity, or impaled-object pathways: morphine 0.1 mg/kg IV/IM, maximum 5 mg, OR fentanyl 2 mcg/kg IN/IV/IM, maximum 50 mcg. May repeat once after 3 minutes; total limits 10 mg morphine or 100 mcg fentanyl.
Base contact is required at age 2 or younger. Splint as appropriate, document distal pulse/sensation, and protect an injured eye without globe pressure. Do not remove face/neck impaled objects unless breathing is compromised.

Continuously monitor SpO₂ and ETCO₂. The source targets SpO₂ above 90% and ETCO₂ 35–45 mmHg where possible, with airway repositioning/BVM escalation when oxygen alone is insufficient.
Recheck systolic BP every 5 minutes. TBI targets are above 70 + 2 × age for ages 0–9 and above 90 for age 10 and older; use the TBI-specific fluid and repeat instructions in the source. Assess GCS, using pediatric GCS at age 2 or younger.
Transport to a trauma center, preferably a Level 1 or 2 pediatric trauma center when possible under source/destination direction.