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Criteria for Insulin Drip Discontinuation
Discontinue insulin when: Bicarbonate level is ≥17mmol/L. Anion gap is normalized. And/or blood ketones are negative to small. Once the insulin drip is stopped, discontinue D10NS with additives ...
Dihydroergotamine (DHE)
In the pediatric patient diagnosed with a refractory migraine, what is the efficacy of DHE IV to decrease migraine pain in the Emergency Department? Plain language summary from the office of evidence based...
Triptan
DHE cannot be given if the patient has received triptans with the previous 24 hours (Lexi-Comp, 2016). These pathways do not establish a standard of care to be followed in every case. It is recognized that...
Migraine Therapy in the ED
Guideline inclusion criteria: Children up to 18 years of age. Physical exam normal. History consistent with primary headache. Guideline exclusion criteria: Abnormal physical exam normal. History...
Myelomeningocele: Antibiotics
UTI prophylaxis if any hydronephrosis on renal US: Amoxicillin 20 mg/kg/dose enterally once a day. Cephalexin 20 mg/kg/day either once or divided twice a day. If patient is NPO the IV equivalents are...
High Dose Systemic Thrombolysis
tPA 0.1-0.6 mg/kg/hr x6 hrs Adult dosing for pts >16 yrs and > 60 kg: Alteplase 100 mg over 2 hrs IV (if no concurrent anticoagulation therapy). These pathways do not establish a standard of care to...
Shock
Shock is defined as use of vasoactive agents such as: -Epinephrine/norepinephrine, dopamine, dobutamine, milrinone, nitroprusside.
Nonviable Tissue
Children’s Mercy obtained permission to use this picture for educational purposes. These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is...
Toddler Tibia Fracture: Evidence Supporting 3rd View
Noe, M. C., Jarka, D. E., Sinclair, M. K., & Grote, C. W. (2025). Toddler’s fracture: an updated guide on evaluation and management. Journal of Pediatric Orthopaedics B, 34(2), 193-197. Tenenbein...
Sepsis
Clinical Pathways promote evidence based, safe, and high-value care for patients by providing clinical recommendations and standard processes. They are developed by multidisciplinary committees of subject...
Bronchiolitis Feeding
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Antihypertensive(s) and/or Lifestyle Modifications
Severe BP elevation means a BP consistently ≥ 99th percentile. Consult Nephrology if ≥ 2 doeses in 24 hours required to normalize BP.
Anticoagulation Therapies and Venous Thromboembolism (VTE) Prophylaxis Care Process Model
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Genital Ulcers (Painful, Aphthous) in Females
Clinical Pathways promote evidence based, safe, and high-value care for patients by providing clinical recommendations and standard processes. They are developed by multidisciplinary committees of...
Post-Dural Puncture Headache
Clinical Pathways promote evidence based, safe, and high-value care for patients by providing clinical recommendations and standard processes. They are developed by multidisciplinary committees of subject...
Vancomycin Clinical Pathway
Clinical Pathways promote evidence based, safe, and high-value care for patients by providing clinical recommendations and standard processes. They are developed by multidisciplinary committees of subject...
Initiation, Maintenance and Duration of Therapy
This clinical pathway is not intended for patients on ECMO, cardiac bypass pump, hemodialysis or continuous renal replacement therapy. Refer to specific guidelines for these situations. Initiation of...
Colorectal ERAS
Enhanced Recovery After Surgery (ERAS) pathways promote an evidence based, multidisciplinary approach to patient care aimed at facilitating faster recovery from surgery, decreasing hospital length of stay...
ADHD Treatment: Training Interventions
"Behavioral therapy involves training adults to influence the contingencies in an environment to improve the behavior of a child or adolescent in that setting. It can help parents and school personnel...
Safe Medication Storage and Disposal
Information from Children's Mercy about safely storing and disposing of medication.