# OCMedic clinical source review — November 14, 2026 18 findings checked: 9 source-resolved, 5 partly resolved and 4 unresolved. Nine findings still have explicit source or implementation questions; all revised teaching awaits clinical sign-off. One additional naloxone repeat question is recorded separately. No clinical reviewer or agency adoption is recorded. ## Decisions still needed ### Bicarbonate timing and concentration need reconciliation **Source conflict / gap remains; clinical sign-off pending.** The complete released C-010 confirms a source conflict, rather than supplying one consistent replacement regimen. Page 2 and the page 8 flowchart use 50 mL of 7.5% or 8.4% solution and include 10-minute arrest timing; page 3 describes targeted use, 50 mEq and a repeat after 10 minutes; page 6 gives a base-hospital renal-failure/hyperkalemia repeat after 5 minutes if there is a response. A volume is not automatically the same dose across those formulations. The website does not merge the competing branches into a new bedside regimen. **Decision still needed:** Obtain a controlling OCEMS clarification for adult bicarbonate indication, formulation, dose units, initial timing, repeat timing/limit and standing-order versus base-order authority. Reconcile C-010 pages 2, 3, 6 and 8 with I-15 page 10. [C-010 pp. 2, 3, 6, 8](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/C-010%20Cardiac%20Arrest%20%2810-2026%29.pdf#page=2) · [I-15 pp. 10](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=10) ### Several pediatric routes changed **Partly resolved · decision needed; clinical sign-off pending.** Epinephrine IO is supported in the pediatric arrest and bradycardia orders and explicitly in released PR-205 for push-dose use. PR-205 still requires Base Hospital contact AND an order; an IO route printed in I-20 does not waive that requirement. P-060 supports IM diphenhydramine for an isolated allergic reaction and IM/IV as an anaphylaxis adjunct after epinephrine. That resolves the allergy-context chart question. It does not settle IO use for dystonia: SO-P-085 lists IM/IV diphenhydramine but also permits all drugs in that order by IO. Released P-015 still explicitly includes IN fentanyl for trauma, whereas I-20 omits IN. SO-P-070/BH-P-070 use 0.2 mg/kg IM/IN midazolam for toxic delirium, while I-20 prints IV/IO. BH-P-050’s pulsed-VT amiodarone instruction is IV under base authority in a specific AICD scenario; the chart’s IO entry alone does not establish broader pulsed-VT authorization. **Decision still needed:** Clarify pediatric fentanyl IN availability despite the I-20 omission; midazolam toxic-delirium route and dose; amiodarone IO and its pulsed-VT indication/authority; and whether diphenhydramine IO remains permitted for the SO-P-085 extrapyramidal-reaction pathway. Keep each indication separate. [P-060 pp. 2, 3](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/P-060%20Ped%20Allergic%20Reaction%20%2810-2026%29.pdf#page=2) · [P-015 pp. 3](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/P-015%20Ped%20General%20Injury%20%2810-2026%29.pdf#page=3) · [SO-P-070 pp. 2](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/SO-P-070%20Peds%20Behavioral%2004-2026.pdf#page=2) · [BH-P-070 pp. 1](https://www.ochealthinfo.com/sites/healthcare/files/2026-01/BH-P-70%20Ped%20Behavioral%201-2026.pdf#page=1) · [BH-P-050 pp. 1](https://www.ochealthinfo.com/sites/healthcare/files/2024-09/BH-P-050%20V-tach%20with%20pulse%208-2024.pdf#page=1) · [SO-P-085 pp. 1](https://www.ochealthinfo.com/sites/healthcare/files/2023-09/SO-P-85%20OD%2010-2023.pdf#page=1) · [SO-P-040 pp. 1](https://www.ochealthinfo.com/sites/healthcare/files/2025-11/SO-P-40%20Cardiac%20Arrest%2011-25.pdf#page=1) · [SO-P-045 pp. 1](https://www.ochealthinfo.com/sites/healthcare/files/2024-07/SO-P-45%20Bradycardia%20peds.pdf#page=1) · [PR-205 pp. 1](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/PR-205%20Ped%20PDE%20%2810-2026%29.pdf#page=1) · [I-20 pp. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf#page=1) ### Pediatric IV ondansetron added; ODT age wording changed **Partly resolved · decision needed; clinical sign-off pending.** P-015 page 3 confirms a parenteral pediatric ondansetron pathway in trauma: 0.1 mg/kg IV/IO once for age >3 months, and 4 mg ODT once for age >4 years with intact airway reflexes. SO-P-090/BH-P-090 still describe 4 mg ODT at age 4 years or greater for general nausea/vomiting. I-20 includes a 3-month IV row, ODT in the 3–4-year band and a 4 mg upper-band IV entry. The trauma order’s existence does not authorize extrapolating IV/IO treatment to every pediatric vomiting encounter. **Decision still needed:** Clarify eligibility at exactly 3 months and exactly 4 years, ODT below age 4, the parenteral maximum dose (including the chart’s 4 mg upper band), IV versus IO, and whether parenteral dosing applies outside trauma. [P-015 pp. 3](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/P-015%20Ped%20General%20Injury%20%2810-2026%29.pdf#page=3) · [SO-P-090 pp. 1](https://www.ochealthinfo.com/sites/hca/files/2021-12/SO-P-90%20vomiting.pdf#page=1) · [BH-P-090 pp. 1](https://www.ochealthinfo.com/sites/hca/files/import/data/files/63556.pdf#page=1) · [I-20 pp. 3, 6, 10](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf#page=3) ### Black-band morphine dose and volume disagree **Source conflict / gap remains; clinical sign-off pending.** The released I-20 black-band 4 mg/mL morphine cell pairs 4.5 mg with 1 mL. Those values are not equivalent. P-015’s 0.1 mg/kg explains 4.5 mg at the representative 45 kg weight, but does not establish that 1 mL is an approved rounding choice. Arithmetic check only: 4.5 mg divided by 4 mg/mL is 1.125 mL. This calculation is evidence of the discrepancy, not an authorized replacement volume. **Decision still needed:** Obtain the corrected black-band morphine dose/volume pair for the 4 mg/mL presentation and the approved rounding/measuring instruction. [I-20 pp. 10](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf#page=10) · [P-015 pp. 3](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/P-015%20Ped%20General%20Injury%20%2810-2026%29.pdf#page=3) ### Neonatal IO lidocaine dose/volume question persists **Source conflict / gap remains; clinical sign-off pending.** PR-115 confirms pediatric IO analgesia with 2% lidocaine 0.5 mg/kg, maximum 40 mg, slowly IO with a 60-second dwell. I-20’s gray-band cell pairs 2 mg with 0.15 mL. Arithmetic check only: 2% is 20 mg/mL, so 2 mg corresponds to 0.10 mL and 0.15 mL contains 3 mg. The full procedure confirms the weight-based dose but does not resolve the chart cell or authorize a rounding rule. **Decision still needed:** Obtain a corrected gray-band lidocaine dose/volume pair and a clinically approved small-volume rounding and measurement method. [PR-115 pp. 2](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/PR-115%20IO%20%2810-2026%29.pdf#page=2) · [I-20 pp. 1](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf#page=1) ### Pediatric TXA added in every band **Partly resolved · decision needed; clinical sign-off pending.** PR-081 resolves the preparation question: pediatric TXA is Base Hospital order only, 15 mg/kg IV/IO over 10 minutes, maximum 1 g. The stock vial is 100 mg/mL. Draw the calculated stock volume, then add saline to a TOTAL syringe volume of 10 mL; give that entire syringe evenly over 10 minutes (1 mL/min). Do not confuse stock withdrawal volume with final administration volume. The source’s 20 kg example is 300 mg: 3 mL stock plus 7 mL saline, final volume 10 mL. The procedure calls for a line flush, blood-pressure monitoring, documentation and communication to base and the trauma center. PR-081 requires traumatic hemorrhagic shock and ongoing bleeding despite basic control. Its printed age intervals overlap at 1, 3 and 5 years. Those boundaries need clarification; the separate normal-vital-sign table is not authority to silently rewrite TXA eligibility. **Decision still needed:** Clarify which TXA SBP/shock-index threshold applies at exactly 1, 3 and 5 years. Confirm the implementation teaching follows the explicit 10 mL final-syringe steps, rather than reading the page 3 footer as administration of undiluted stock volume. [PR-081 pp. 1, 2, 3](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/PR-081%20Ped%20TXA%20%2810-2026%29.pdf#page=1) · [P-015 pp. 5](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/P-015%20Ped%20General%20Injury%20%2810-2026%29.pdf#page=5) · [I-20 pp. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf#page=1) ### Hydroxocobalamin rows omitted **Source conflict / gap remains; clinical sign-off pending.** Hydroxocobalamin is omitted from the released I-20. Released PR-130 is labeled Adult/Adolescent and supplies an adult/adolescent 5 g preparation under Base Hospital order; it does not establish a pediatric weight-based replacement. The current pediatric poisoning standing order supplies supportive measures for suspected cyanide exposure but does not provide a pediatric hydroxocobalamin regimen. An adult procedure cannot fill that pediatric authorization gap. **Decision still needed:** Obtain explicit OCEMS clarification of pediatric hydroxocobalamin availability/authorization, indication, dose, dilution, infusion instructions and base-order requirements. Do not infer either withdrawal or continued pediatric authorization from the omission alone. [PR-130 pp. 1, 2](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/PR-130%20Hydroxocobalamin%20%2810-2026%29.pdf#page=1) · [SO-P-085 pp. 1](https://www.ochealthinfo.com/sites/healthcare/files/2023-09/SO-P-85%20OD%2010-2023.pdf#page=1) · [I-20 pp. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf#page=1) ### Preparation labels and dilution notes changed **Partly resolved · decision needed; clinical sign-off pending.** PR-205 explicitly preserves push-dose epinephrine at 10 mcg/mL: 0.1 mL/kg IV/IO, maximum 1 mL per dose, with repeat dosing every 3 minutes to its age-based SBP targets. Base Hospital contact and order are required before administration. The abbreviated chart’s missing preparation label does not change the concentration. Released P-065 and P-075 confirm 10% dextrose, 5 mL/kg IV/IO, maximum 250 mL, within their hypoglycemia pathways. D10 is 100 mg/mL; the earlier 0.1 mg/mL chart label was not a usable concentration. The patient’s condition, glucose criterion and route remain part of the order. The indexed pediatric arrest standing and base orders do not supply the missing bicarbonate preparation pathway. The omission of old dilution notes from I-20 is not a new preparation instruction. **Decision still needed:** Confirm pediatric bicarbonate indication and authority, stock and final concentrations, whether dilution is required, and whether each I-20 volume means stock withdrawal or final administered solution. Do not infer a universal dilution rule or its removal. [PR-205 pp. 1](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/PR-205%20Ped%20PDE%20%2810-2026%29.pdf#page=1) · [P-065 pp. 1](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/P-065%20Ped%20Altered%20Mental%20Status%20%2810-2026%29.pdf#page=1) · [P-075 pp. 2](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/P-075%20Ped%20Seizure%20%2810-2026%29.pdf#page=2) · [SO-P-040 pp. 1, 2](https://www.ochealthinfo.com/sites/healthcare/files/2025-11/SO-P-40%20Cardiac%20Arrest%2011-25.pdf#page=1) · [BH-P-040 pp. 1, 2, 3, 4](https://www.ochealthinfo.com/sites/healthcare/files/2025-11/BH-P-040%20cardiac%20arrest%2012-2025.pdf#page=1) · [I-20 pp. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf#page=1) ### Neonatal albuterol discrepancy remains unresolved **Partly resolved · decision needed; clinical sign-off pending.** Released P-060 explicitly gives 2.5 mg/3 mL for neonates 0–30 days and 5 mg/6 mL at 31 days or older in anaphylaxis-associated wheezing. Epinephrine remains first-line. This supports the new I-20 neonatal entry in that specific pathway. The indexed SO-P-035/BH-P-035 wheezing/suspected-asthma pathway still prints 5 mg/6 mL without that neonatal split. Do not silently apply the anaphylaxis-specific change to every neonatal respiratory presentation. **Decision still needed:** Clarify whether 2.5 mg is the intended neonatal albuterol dose outside anaphylaxis and reconcile the general respiratory standing/base orders with I-20. [P-060 pp. 2](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/P-060%20Ped%20Allergic%20Reaction%20%2810-2026%29.pdf#page=2) · [SO-P-035 pp. 1](https://www.ochealthinfo.com/sites/healthcare/files/2025-10/SO-P-35%20Respiratory%2010-2025.pdf#page=1) · [BH-P-035 pp. 1](https://www.ochealthinfo.com/sites/healthcare/files/2025-10/BH-P-035%20Resp%20distress%2010-2025.pdf#page=1) · [I-20 pp. 1, 2](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf#page=1) ## Additional question found C-010 page 3 prints 2 mg IV/IO or 4 mg IN, permits one repeat and gives a 6 mg maximum. Repeating the full 4 mg IN dose would exceed that maximum. The permitted repeat amount/route after an initial IN dose is not explicit. Clarify the allowed naloxone repeat amount and route within the printed 6 mg maximum. Keep CPR priority and do not publish an inferred repeat schedule. [C-010 p. 3](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/C-010%20Cardiac%20Arrest%20%2810-2026%29.pdf#page=3). ## Source questions answered ### IO lidocaine dose and dwell time changed **Source question resolved; clinical sign-off pending.** PR-115 page 2 confirms 2% lidocaine 40 mg slowly IO for adults when IO is used outside cardiopulmonary arrest. Allow a 60-second dwell before the saline flush. The purpose is to address infusion pain before other medications or fluids enter the IO. If pain occurs with medication administration or flushing after the initial dose, PR-115 permits half the initial dose. I-15 specifies a 20 mg repeat after 3 minutes. Keep the pain trigger, dwell time and chart timing attached to the instruction. **Clinical sign-off:** approve teaching and record agency adoption. [PR-115 pp. 2](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/PR-115%20IO%20%2810-2026%29.pdf#page=2) · [I-15 pp. 5](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=5) ### Poisoning atropine repeat interval is now explicit **Source question resolved; clinical sign-off pending.** The released I-15 poisoning row specifies atropine 2 mg IV or IM with one repeat after 5 minutes. The currently indexed SO-M-050 and BH-M-050 permit one repeat but do not give an interval in that row. This is a newly explicit chart interval, not permission for unlimited repeat doses. Use the organophosphate pathway for the exposure and presentation. Do not carry its dose or repeat timing into the separate bradycardia indication. **Clinical sign-off:** approve teaching and record agency adoption. [I-15 pp. 2](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=2) · [SO-M-050 pp. 2](https://www.ochealthinfo.com/sites/hca/files/2021-10/SO-M-50%20Poisoning%20OD.pdf#page=2) · [BH-M-050 pp. 3](https://www.ochealthinfo.com/sites/healthcare/files/2024-09/BH-M-50%20OD-Poisoning%20%288-2024%29.pdf#page=3) ### Epinephrine indication wording changed **Source question resolved; clinical sign-off pending.** PR-230 confirms the released adult push-dose pathway: ROSC, shock unresponsive to the initial fluid bolus, bradycardia refractory to atropine and pacing, or deterioration with unknown shock etiology. Hemorrhagic shock is contraindicated. Its preparation is 10 mcg/mL, with 1 mL (10 mcg) IV/IO every 3 minutes, titrated to SBP >90. Condition-specific base-contact requirements still apply. M-015 makes epinephrine first-line for anaphylaxis; diphenhydramine and albuterol are adjuncts. Its initial dose is 0.5 mg IM using 1 mg/mL; do not duplicate that initial dose when epinephrine was self-administered before arrival. After 5 minutes, persistent hypotension, respiratory distress or impending airway obstruction leads to 0.5 mg IM OR 0.3 mg IV/IO using 0.1 mg/mL. Base Hospital contact is required for anaphylaxis. The indication tells you which preparation belongs in the syringe. Push-dose, anaphylaxis and arrest epinephrine are separate pathways; their concentrations and doses are not interchangeable. **Clinical sign-off:** approve teaching and record agency adoption. [PR-230 pp. 1](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/PR-230%20PDE%20%2810-2026%29.pdf#page=1) · [M-015 pp. 1, 2](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/M-015%20Allergic%20Reaction%20%2810-2026%29.pdf#page=1) · [I-15 pp. 2, 3](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=2) ### Calcium, magnesium and TXA need complete guide coverage **Source question resolved; clinical sign-off pending.** C-010 supplies the missing context for calcium gluconate and magnesium. Calcium gluconate 10% 3 g IV/IO is a targeted adjunct for the listed causes (hyperkalemia, hypocalcemia, calcium-channel-blocker overdose or hypermagnesemia), not a routine medication for every arrest. Confirm secure access and do not mix calcium and bicarbonate in the same line. The C-010 magnesium pathway is torsades-specific: 25 mg/kg IV/IO, maximum 2 g, over 2 minutes; may repeat once. It does not establish routine use in VF, pulseless VT or monomorphic VT. O-010 explicitly includes postpartum eclampsia up to 6 weeks after delivery. The compressed I-15 obstetric wording must not be read as excluding all postpartum patients. Magnesium is first-line for eclamptic seizures; the source gives 4 g in 100 mL saline IV over 15–20 minutes OR 10 g IM split between the gluteal muscles. Base contact is required; do not place an IO solely for magnesium. Watch for respiratory depression with rapid infusion and stop the infusion/support the patient/contact base if toxicity occurs. PR-080 ties adult TXA to traumatic or miscarriage/postpartum hemorrhagic shock, SBP <90 or shock index >1, and significant ongoing bleeding despite basic control measures. It specifies 1 g in a 100 mL premixed bag IV/IO over 10 minutes, with IV preferred. Check the full contraindications, continue bleeding control and transport, and communicate administration to base and the trauma center. These source questions are resolved in the existing arrest, obstetric and trauma lessons. Dedicated medication guides for calcium, magnesium and TXA are still a coverage gap; source reconciliation does not imply that new standalone guides were created. **Clinical sign-off:** approve teaching and record agency adoption. [C-010 pp. 2, 3](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/C-010%20Cardiac%20Arrest%20%2810-2026%29.pdf#page=2) · [O-010 pp. 1, 2](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/O-010%20Hypertensive%20Disorders%20of%20Pregnancy%20%2810-2026%29.pdf#page=1) · [PR-080 pp. 1](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/PR-080%20TXA%20%2810-2026%29.pdf#page=1) · [SO-ALS pp. 1, 2, 3](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/SO-ALS%20General%20%2810-2026%29.pdf#page=1) · [I-15 pp. 2, 6, 10](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=2) ### Shorter repeat and route text needs the full order **Source question resolved; clinical sign-off pending.** Short chart rows do not replace treatment sequence. SO-C-025 retains adenosine after attempted Valsalva in the regular narrow-complex pathway, with one repeat after 3 minutes. SO-C-040 places antiarrhythmic repeats within the unsuccessful-cardioversion sequence for unstable pulsed wide-complex tachycardia. C-010 permits one half-dose lidocaine repeat after approximately 3–5 minutes in arrest; the I-15 3-minute wording falls within that interval. It does not authorize repeated half-doses without a limit. SO-M-040 retains 10 mg IM midazolam once as the preferred seizure route, before starting IV/IO. Its alternate 5 mg IV/IN/IO pathway applies if IM cannot be delivered or access is already present, with one repeat after approximately 3 minutes. Base contact is required if seizure continues 5 minutes after the first IM or second alternate-route dose (10 mg total). Keep that escalation instruction even though the chart is shorter. **Clinical sign-off:** approve teaching and record agency adoption. [SO-C-025 pp. 1, 2](https://www.ochealthinfo.com/sites/hca/files/import/data/files/34670.pdf#page=1) · [SO-C-040 pp. 1](https://www.ochealthinfo.com/sites/healthcare/files/2025-10/SO-C-40%20VT%20with%20Pulse%20%2810-2025%29.pdf#page=1) · [SO-M-040 pp. 1](https://www.ochealthinfo.com/sites/hca/files/2021-07/SO-M-040%207-15-21.pdf#page=1) · [C-010 pp. 2](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/C-010%20Cardiac%20Arrest%20%2810-2026%29.pdf#page=2) · [I-15 pp. 1, 5, 6, 7](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=1) ### Oxygen indication list is shorter **Source question resolved; clinical sign-off pending.** E-010 is explicitly the decompression sickness / air embolism guideline and retains early 100% oxygen by mask in its BLS interventions, with Base Hospital contact required. The omission of air embolism from the short drug-chart row is not removal of that indication. Teach the condition-specific oxygen objective and delivery method. A general chart flow entry does not replace E-010’s 100% oxygen instruction. **Clinical sign-off:** approve teaching and record agency adoption. [E-010 pp. 1](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/E-010%20Decompression%20Sickness%20%2810-2026%29.pdf#page=1) · [I-15 pp. 9](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-15%20Adult%20SO%20Drug%20Guide%20%2810-2026%29.pdf#page=9) ### Defibrillation sequences are now printed explicitly **Source question resolved; clinical sign-off pending.** For the initial VF/pulseless-VT branch, SO-P-040 supports the I-20 first/second/third defibrillation sequence of 2, 4 and 4 J/kg, while retaining the source’s manufacturer/programmed-setting option. Follow the actual arrest branch and device guidance; a color-band entry is not a substitute for the complete sequence. PR-095 explicitly requires Base Hospital contact AND an order for pediatric synchronized cardioversion. BH-P-050/BH-P-055 provide the condition-specific base pathways. The missing chart-header marker does not remove that authority requirement. **Clinical sign-off:** approve teaching and record agency adoption. [SO-P-040 pp. 1](https://www.ochealthinfo.com/sites/healthcare/files/2025-11/SO-P-40%20Cardiac%20Arrest%2011-25.pdf#page=1) · [PR-095 pp. 1](https://www.ochealthinfo.com/sites/hca/files/import/data/files/38135.pdf#page=1) · [BH-P-050 pp. 1](https://www.ochealthinfo.com/sites/healthcare/files/2024-09/BH-P-050%20V-tach%20with%20pulse%208-2024.pdf#page=1) · [BH-P-055 pp. 1](https://www.ochealthinfo.com/sites/healthcare/files/2024-09/BH-P-055%20SVT%208-2024.pdf#page=1) · [I-20 pp. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf#page=1) ### Analgesic base-order markers need age clarification **Source question resolved; clinical sign-off pending.** Released P-015 page 3 explicitly requires a Base Hospital order for fentanyl or morphine when the trauma patient is younger than 2 years. Use the child’s actual age and the condition-specific order, not the presence or absence of a marker across a whole chart band. This resolves the trauma age-marker question. It does not waive separate base-contact requirements for trauma criteria or establish a new analgesia rule for every other pediatric indication. **Clinical sign-off:** approve teaching and record agency adoption. [P-015 pp. 3](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/P-015%20Ped%20General%20Injury%20%2810-2026%29.pdf#page=3) · [I-20 pp. 4, 5](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf#page=4) ### Vital-sign references require a separate cross-check **Source question resolved; clinical sign-off pending.** B-003 and PR-006 supply explicit age boundaries for the new reference ranges: 0–30 days, 31 days to <1 year, 1 to <3 years, 3 to <5 years, 5 to <10 years, and ≥10 years. Their SBP reference values are >60, >60, >70, >75, >80 and >90 respectively. In the same age order, B-003/PR-006 list pulse ranges of 100–180, 100–160, 90–150, 80–140, 70–120 and 60–100, and respiratory rates of 30–60, 30–60, 24–40, 22–34, 18–30 and 12–16. Keep the exact age interval attached to each range. Released PR-205 explicitly points to that age-based table for push-dose epinephrine titration. Use those targets when working from the adopted released PR-205, rather than combining its preparation with an older target formula. These are source-specific reference ranges and PR-205 targets. They do not automatically replace every condition’s hypotension criteria; the overlapping age intervals in PR-081 remain a separate TXA review question. **Clinical sign-off:** approve teaching and record agency adoption. [B-003 pp. 1](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/B-003%20Pediatric%20Vital%20Signs%20%2810-2026%29.pdf#page=1) · [PR-006 pp. 1](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/PR-006%20Pediatric%20Vital%20Signs%20%2810-2026%29.pdf#page=1) · [PR-205 pp. 1](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/PR-205%20Ped%20PDE%20%2810-2026%29.pdf#page=1) · [I-20 pp. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10](https://www.ochealthinfo.com/sites/healthcare/files/2026-10/I-20%20Pediatric%20Drug%20Guide%20%2810-2026%29.pdf#page=1) ## Sign-off record to complete - Qualified clinical reviewer name, role and review date. - Controlling source versions and written decisions/corrections for the nine original findings with remaining questions, plus the additional naloxone repeat question. - Agency adoption date, scope, stocked formulations, preparation/rounding methods and base-contact workflow. - Approval of the revised teaching and affected native/reference content; retain unresolved flags until decisions are documented.