Pediatric Emergent Medications

See all 2010 PALS algorithms here.

Shock & Bradycardia

Epi 0.01 mg/kg
Atropine 0.02 mg/kg, minimum dose 0.1 mg, maximum 0.5 mg

Tachycardia w/ Pulse

- sinus tach:
rate in infants usually < 220, in children < 180
- pSVT:
Adenosine 0.1 mg/kg first dose, then 0.2 mg/kg
- V Tach, or SVT not responding to Adenosine:
Amiodarone 5 mg/kg over ~ 30 mins
Procainamide 15 mg/kg over ~ 30 mins
Cardioversion 0.5-1 J/kg, then 2 J/kg
pre-cardioversion sedation with, e.g., Midazolam IN 0.5 mg/kg, max of 10 mg (but if give IV 0.05-0.1 mg/kg, to max of 2 mg)

Cardiac Arrest

CPR at 100/min
If advanced airway, 8-10 bpm with continuous compressions
If no airway, 2 breaths every 15 compressions
- VFib / VT
Defibrillate 2 J/kg, then 4 J/kg, then >4 J/kg up to 10 J/kg or adult dose
Epi 0.01 mg/kg
Amio 5 mg/kg bolus, MR x 2
- PEA / Asystole
Epi only

Seizure

- benzos
Lorazepam (Ativan) 0.03 - 0.1 mg/kg IV
Midazolam (Versed) buccal or IN 0.5 mg/kg, or if IM 0.2 mg/kg
Diazepam (Valium) 0.5 mg/kg PR in ages 2-5
- second-line ACs
Fos-Phenytoin at 20 "phenytoin equivalents" / kg IV / IM
- or, alternatively, Phenytoin 20 mg/kg (slow infusion of 50 mg/min as propylene glycol dilutent -> hypotension)
Phenobarbitol 20 mg/kg IV
Levetiracetam (Keppra) 20 mg/kg IV

RSI

- Pre-Medication
Atropine (< 7 years old) 0.02 mg/kg
- Sedatives
Etomidate 0.3 mg/kg
Ketamine 0.5-2 mg/kg
Midazolam 0.1 mg/kg
- Paralytics
Rocuronium 0.6-1.2 mg/kg
Succinylcholine 1-2 mg/kg (if < 1 year old, use 2 mg/kg doses)
Vecuronium 0.05-0.2 mg/kg/hour for sustained paralysis

Sepsis

20 cc/kg IVF boluses
- Pressors
Norepinephrine 0.05-1 mcg/kg/min
Dopamine 5-20 mcg/kg/min
Milrinone 50 mcg/kg x 1, then 0.25-1 mcg/kg/min

Procedural Sedation

Midazolam IN 0.5 mg/kg, max of 10 mg (but if give IV 0.05-0.1 mg/kg, to max of 2 mg)
Ketamine 1-2 mg/kg IV or 4-5 mg/kg IM (if higher doses, give with Atropine)
Fentanyl 1-2 mcg/kg

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