Resuscitation
Medication
|
| Atropine: 0.01-0.03 mg/kg IM, IV, ET, IC, IO |
| Bicarbonate: 1-2 mEq/kg (0.3 x kg x BE) IV, IC, IO |
| Calcium Chloride 10% (27 mg Ca++/ml): 0.1 - 0.3 ml/kg) IV, IC slowly (max 1 g/dose) |
| Calcium Gluconate 10% (9 mg Ca++/ml): 0.6-1 ml/kg (max 2 g/dose) IV, IC |
| Dextrose 0.5-1 g/kg IV = 1-2 ml/kg D50
2-4 ml/kg D25W
5-10 ml/kg D10W
10-20 ml/kg D5NS
|
| Diltiazem (Cardizem): 0.25 mg/kg over 2 min;
May repeat in 15 min @ 0.35 mg/kg over 2 min
|
| Ephedrine: 0.2-0.3 mg/kg/dose |
| Epinephrine (1:10,000) 10 mcg/kg = 0.1 ml/kg IV, IC, IO;
[ET = 0.1 mg/kg (0.1 ml/kg of 1:1,000)]
|
| Lidocaine: 1 mg/kg IV, IC, ET, IO |
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| Cardioversion |
| Atrial arrhythmias: 0.5-1 joule/kg;
adult dose begins at 20 joules
|
| Ventricular Fibrillation: 2 joules/kg
(unsynchronized) using the largest paddles that fit
|
| Ventricular Tachycardia: 1-2 joules/kg |
| Adenosine: 0.1 mg/kg (Max 6 mg)
Repeat 0.2 mg/kg (Max 12 mg)
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| Anticonvulsants |
| Diazepam: 0.1-0.3 mg/kg IV, IO (adult dose 10 mg) |
| Lorazepam: 0.05 mg/kg IV, IO, IM (Max 4 mg) |
| Phenobarbital: 10-20 mg/kg IV;
Maintenance 2.5 mg/kg/dose BID
|
| Phenyltoin: 10-20 mg/kg IV over 20 min in NS;
Maintenance 2.5 mg/kg/dose BID (Max 1 g)
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| Antibiotics |
| Ampicillin: 25 mg/kg/dose q4-6h |
| Cefazolin: 30 mg/kg/dose IV q6h |
| Clindamicin: 5-10 mg/kg/dose q6-8h (Max 4g/day) |
| Gentamicin: 2-2.5 mg/kg/dose q8h (Max dose 80 mg) |
| Metronidazole (Flagyl): 15 mg/kg/load;
Maintenance: 7.5 mg/kg/dose IV, PO q6h
|
| Vancomycin: 10 mg/kg/dose slowly IV |
| Unasyn: 75 mg/kg/dose slowly IV over 10-15min |
| Zosyn:
<6mos: 150-300 mg/kg/day/q6-8h
>6mos: 240-400 mg/kg/day/q6-8h
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| Antihypertensives |
| Captopril: 0.1-5 mg/kg/d PO q8h |
| Diazoxide: 5 mg/kg/dose rapid IV push (Max 10 mg/kg) |
| Esmolol: 0.5 mg/kg bolus over 1 min;
Maintenance: 50-300 mcg/kg/min
|
| Hydralazine: 0.1-0.2 mg/kg/dose IM, IV q4-6h |
| Labetolol: 0.25 mg/kg IV q1-2h |
| Nifidepine: 0.01-0.02 mg/kg IV or 1-2 mg/kg/d
PO, SL (adult dose 10-30 mg PO)
|
| Phentolamine: 0.1 mg/kg/dose IV |
| Propranalol: 0.01-0.15 mg/kg IV slowly |
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Analgesics
NSAID |
| Acetaminophen: PO 10-15 mg/kg/dose q4h
PR (1st dose only) 30-40 mg/kg followed by PO dose 6 h later
(max 30mg/kg/d in newborn,
60 mg/kg/d in infants,
90 mg/kg/d in children,
4 gm/d in adults)
|
| Ibuprofen: 10 mg/kg PO q6h |
| Ketorolac: 0.5 mg/kg IV q6h (with normal Cr & no bleeding diathesis; Max 5 days) |
| Celecoxib (Celebrex): >12 yrs 100-200 mg q12h |
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Analgesics
Opioids |
| Alfentanil: 30-50 mcg/kg induction;
Supplemental Bolus: 10-15 mcg/kg
Maintenance: 0.5-1.5 mcg/kg/min
|
| Codeine: 0.5-1.0 mg/kg PO q4h
Tylenol #1: acetaminophen 300 mg + codeine 7.5 mg
Tylenol #2: acetaminophen 300 mg + codeine 15 mg
Tylenol #3: acetaminophen 300 mg + codeine 30 mg
Tylenol #4: acetaminophen 300 mg + codeine 60 mg
|
| Fentanyl: 0.5-1 mcg/kg/dose IV q1h prn |
| Hydrocodone/Oxycodone: 0.05-0.15 mg/kg PO
q4h (usual start dose 0.1 mg/kg)
|
| Hydromorphone: 0.03 mg/kg/dose PO q4h
0.015 mg/kg/dose IV q2-4h prn
|
| Meperidine: 1 mg/kg/dose IV q2h prn
For rigors 0.1 mg/kg/dose IV once
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| Methadone:
Mild pain: 25 mcg/kg/dose)
Moderate pain: 50 mcg/kg/dose) IV q4h
Severe pain: 75 mcg/kg/dose)
Or 0.1 mg/kg q8-12h (beware of cumulative effects after 48-72 h)
|
| Morphine: 0.05-0.15 mg/kg/dose IV q2-4h prn
0.2-0.3 mg/kg/dose PO q4h
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| Remifentanil: 0.1-0.5 mcg/kg/min infusion |
| Sufentanil: 10-25 mcg/kg induction |
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| Antiemetics/H2 Blockers |
| Granisetron: 10 mcg/kg/dose IV/PO q12h |
| Lorazepam: 0.05 mg/kg/dose IV/PO q8h |
| Metoclopramide (Reglan): 0.1-0.2 mg/kg/dose
IV/PO q6h (caution re: extrapyramidal signs)
(max 0.15 mg/kg/dose)
|
| Omeprazole (Prilosec): 0.6-0.7 mg/kg/dose PO
qday to BID
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| Ondansetron: 0.15 mg/kg IV/SL/PO q8h slowly
(max 8 mg/dose; 32 mg/day)
|
| Prochlorperazine (Compazine): >2y 0.1
mg/kg/dose IM/PO q8h (caution re: extrapyramidal signs)
|
| Promethazine (Phenergan): >2y 0.5 mg/kg/dose
PO/IV/IM q6h (caution re: extrapyramidal signs)
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| Ranitidine (Zantac): 1-2 mg/kg/dose BID PO, IV
(Max 150 mg BID)
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| Trimethobenzamide (Tigan): <14kg = 100mgPR
q8h; >14 kg = 200 mg PR q8h
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| Antipuritics |
| Diphenhydramine: 0.5 mg/kg/dose PO/IV q6h |
| Hydroxyzine: 0.5 mg/kg/dose PO/IV q6h |
| Nalbuphine: 0.1 mg/kg/dose q6h IV slowly (max 5 mg/dose) |
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| Bronchodilators |
| Albuterol nebulizer (0.5% soln): 0.01 ml/kg/2.5 ml NS
(Max 0.5 ml = 2.5 mg)
|
| Aminophylline: 7 mg/kg slowly over 30 min IV;
Maintenance: 0.5-1.5 mg/kg/h
|
| Epinephrine(1:1,000): 0.01 ml/kg SC(max0.4ml)
Racemic epi: 0.25-0.5 ml/5 ml NS nebulized
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| Isoproterenol: 0.05 mcg/kg/min increasing by 0.1mcg/kg/min to effect
or tachycardia is too fast
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| Metaproterenol nebulizer (5% soln): 0.01 ml/kg/2.5 ml NS
(Max dose 0.3 ml = 15 mg)
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| Terbutaline(1 mg/ml): 0.01 ml/kg SC (max 0.25 ml) |
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| Amiodarone (Cordarone): V Fib: 5 mg/kg IV load over 20 min
then 5 – 15 mcg/kg/min; be prepared with volume & Ca++; (max 15 mg/kg/d)
SVT: 5 mg/kg over 10 min X 5 doses
|
| Amrinone (Inamrinone): 0.75-1.0-mg/kg load over 3 min
then 5-10 mcg/kg/min in normal saline
|
| Aprotinin (Trasylol): 0.1-1.0 ml test dose;
Load: 2 ml/kg over 10-15 min
Maintenance: 1 ml/kg/hr
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| Digitalis: 20-40 mcg/kg given over 24 h (adult dose 1 mg);
Maintenance 5 – 10 mcg/kg/dose BID
IV dose = 2/3 PO dose
|
| Diltiazem (Cardizem): 0.25 mg/kg over 2 min;
May repeat in 15 min @ 0.35 mg/kg over 2 min
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| Dopamine, Dobutamine: 2-20 mcg/kg/min |
| Epinephrine, Isoproterenol, Norepinephrine:
0.05-1 mcg/kg/min
|
| Esmolol: 0.5 mg/kg bolus over 1 min;
Maintenance: 50-300 mcg/kg/min
|
| Lidocaine: 1-2 mg/kg/dose IV (Max. 10 mg)
Maintenance: 20-50 mcg/kg/min (adult dose 1-4 mg/min)
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| Magnesium sulfate for Torsades de Pointe:
25-50 mg/kg (max. 2gm) over 10-20 min
|
| Milrinone (Primacor): 20-50 mcg/kg load;
Maintenance: 0.3-0.7 mcg/kg/min
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| Nitroglycerin: 0.5-5 mcg/kg/min |
| Nitroprusside: 0.5-10 mcg/kg/min |
| PGE1: 0.05-0.1 mcg/kg/min |
| Phenylephrine: 0.5-10 mcg/kg/min |
| Procainamide: 10-20 mg/kg over 45 min load;
Maintenance 20-60 mcg/kg/min (adult 1-4 mg/min)
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| Propranolol: 0.05-0.15 mg/kg IV slowly (Max 5 mg) |
| Vasopressin: Bolus 0.4-1 U/kg;
BP maintenance: Mix 1.5 U/kg in 50 ml so 1 ml/hr = 0.0005 U/kg/min. Double q 10 min until response achieved or until 4 U/hr (adult dose) is reached.
GI Bleed: 0.002-0.005 U/kg/min
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| Verapamil: 0.05-0.2 mg/kg IV over 2 min (Max 5 mg) |
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| Diuretics |
| Aldactone: 0.25-0.8 mg/kg/dose PO BID-QID |
| Chlorthiazide: 10-15 mg/kg/dose PO BID |
| Furosemide: 0.5-1 mg/kg/dose PO, IM, IV |
| Mannitol: 0.25-1 g/kg/dose IV |
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| Fluids and Electrolytes |
| Maintenance: 4 ml/kg/h for 1st 10 kg + 2 ml/kg/h
for 2nd 10 kg + 1 ml/kg/h for every kg >20 kg
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| Potassium: 2-3 mEq/kg/d |
| Calcium: 200-300 mEq/kg/d |
| Glucose: 8 mg/kg/min |
| Hyperkalemia: Dextrose 0.5-1 g/kg IV over 15 min
with 0.2-0.3 U Reg Insulin/g Dextrose;
Ca++ = 4-5 mg/kg IV over 5-10 min;
Kayexelate: 1-2 gm/kg PO, PR (with 20% Sorbitol)
|
| NaHCO2 = 1-2 mEq/kg |
| Shock: 10-20 ml/kg of NS, RL or 5% albumin |
| PRBC: 10 ml/kg will raise Hg by 1 gm |
| Platelets: 5-10 ml/kg will raise count 50-100x109/L; for >10 kg patient 1 U/10 kg |
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| Laxatives |
| Bisacodyl Suppository (Dulcolax):
<2y 5 mg PR
>2y 10 mg PR
|
| Docusate sodium (Colace):
<3y: 10 mg PO q8h
3 - 6y: 15 mg PO q8h
6 - 12y: 50 mg PO q8h
>12y: 100 mg PO q8h
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| Senna Syrup (218 mg/5ml): > 3y 5 ml @ bedtime |
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| Miscellaneous |
| Dantrolene: 2.4 mg/kg IV load;
If no response, 4.8 mg/kg until symptoms are controlled;
Maintenance: 1.2 mg/kg IV q6h as needed
|
| Heparin: 50-100 U/kg IV bolus then 10-20 U/kg/h;
Cardiopulmonary bypass: 300 U/kg IV
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| Insulin: 0.02-0.1 U/kg/h |
| Magnesium sulfate: 25-50 mg/kg (max 2g) over 10-20 min;
Maintenance: 16 mg/kg/h to achieve plasma levels of 0.8-1.2 mmol/L (max 2g)
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| Muscle Relaxants |
| Cisatracurium: 0.1-0.2 mg/kg/dose IV; lasts 15 - 45 min |
| Metubine: 0.1-0.4 mg/kg/dose IV; lasts 1-2 h |
| Mivacurium: 0.2-0.3 mg/kg/dose IV; lasts 15-20 min |
| Pancuronium: 0.1 mg/kg/dose IV; lasts 1-2 h |
| Rocuronium: 0.4-1.0 mg/kg/dose IV; lasts 20-45 min |
| Succinylcholine: 1-2 mg/kg IV; 4 mg/kg IM;
consider giving atropine first
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| Vecuronium: 0.1 mg/kg/dose IV; lasts 30 min |
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| PCA |
| Hydromorphone (0.2 mg/ml):
Demand: 0.003 mg/kg/dose q 10 min
Night basal (optional): 0.003 mg/kg/h
Nursing boluses: 0.006 mg/kg/dose up to 3 times q4h
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| Morphine (1 mg/ml); if under 10 kg (0.5 mg/ml):
Demand: 0.015 mg/kg/dose q 10 min;
Night basal (optional): 0.015 mg/kg/h
Nursing Boluses: 0.03 mg/kg/dose q15min up to 3 times q 4h
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| PCEA |
Bupivacaine (0.625 or 1.25 mg/ml NS + Fentanyl
2 mcg/ml + Clonidine 0.1 mcg/ml): 0.1-0.4 ml/kg/h;
Do not to exceed:
Neonates 0.2 mg/kg/h of bupivacaine
Older Children 0.4 mg/kg/h of bupivacaine
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| Reversals |
| Atropine: 0.01-0.02 mg/kg IV |
| Edrophonium: For PAT & myasthenia: 0.2 mg/kg IV;
For muscle relaxants: 1 mg/kg IV with anticholinergic
|
| Flumazenil: Sedation reversal: 0.01 mg/kg IV
Overdose: 0.01 mg/kg then 0.005-0.01 mg/kg/h
(Max 0.2 mg/dose; 0.05 mg/kg or 1 mg)
|
| Glycopyrrolate: 0.005-0.01 mg/kg IV |
| Narcan: 0.01-0.1 mg/kg/dose IV, ET; lasts 20 Min |
| Neostigmine: 0.05-0.07 mg/kg IV with anticholinergic |
| Physostigmine: 0.01 mg/kg slowly IV with anticholinergic (adult dose 2 mg) |
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| Sedative/IV Anesthetics |
| Chloral Hydrate: 30-80 mg/kg/dose PO, PR |
| Clonidine: 0.004 mg/kg PO (Max 0.1 mg) |
| Diphenhydramine: 0.2-2 mg/kg/dose IV q4-6h;
or 1.25 mg/kg/dose q6h (Max 400 mg/d)
|
| Etomidate: 0.3 mg/kg IV |
| Haloperidol: 0.4-5 mg/dose |
| Ketamine: 1-2 mg/kg IV;
3-6 mg/kg PO;
6-10mg/kg PR;
3 mg/kg intranasal
|
| Methohexital: 1-2 mg/kg/dose IV;
30-40 mg/kg PR
|
| Midazolam: 0.05-0.3 mg/kg IV, IM;
Infusion: 0.4 mcg/kg/min
PO: 0.5-0.75 mg/kg
PR: 0.5-1 mg/kg
Intranasal: 0.2 mg/kg
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| Pentobarbital: 2 mg/kg IM, IV, PO |
| Propofol: 2-3 mg/kg IV;
Maintenance: 50-300 mcg/kg/min
|
| Thiopental: 3-7 mg/kg IV
PR: 20-40 mg/kg
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| Steroids |
| Dexamethasone: 0.3-1 mg/kg/dose IV |
| Hydrocortisone (Solu-Cortef): 0.2-1 mg/kg/dose q6h (anti-inflammatory);
Status asthmaticus: load 4-8 mg/kg then 2-4 mg/kg/dose q4-6h
|
| Methylprednisolone (Solu-Medrol): 0.04-0.2 mg/kg q6h (anti-inflammatory);
Status asthmaticus: load 2 mg/kg then 0.5-1 mg/kg/dose q4-6h
Spinal Shock: 30 mg/kg IV over 1 h then 5.4 mg/kg/h x 23 h
Liver Transplantation: 20 mg/kg
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| ETT Information |
| Endotracheal tube size = 4 + Age/4 |
| Endotracheal depth > 1 yr = 12 + Age/2 or 10 + Age |
| Blade Size:
Newborn = #0 Miller
1-18 mos = #1 Miller
18 mos – 8 yrs = #2 Mac/Miller
>8 yrs = #3 Mac/Miller
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| Single Lung Ventilation |
| Age (yrs) |
ETT (ID in mm) |
BB (Fr) |
Univent® |
DLT (Fr) |
| 0.5-1 |
3.5-4.0 |
5 |
|
|
| 1-2 |
4.0-4.5 |
5 |
|
|
| 2-4 |
4.5-5.0 |
5 |
|
|
| 4-6 |
5.0-5.5 |
5 |
|
|
| 6-8 |
5.5-6 |
5 |
3.5 |
|
| 8-10 |
6.0 cuffed |
5 |
3.5 |
26 |
| 10-12 |
6.5 cuffed |
5 |
4.5 |
26-28 |
| 12-14 |
6.5-7.0 cuffed |
5 |
4.5 |
32 |
| 14-16 |
7.0 cuffed |
5 |
6.0 |
35 |
| 16-18 |
7.0-8.0 cuffed |
5 or 9 |
7.0 |
35 |
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| LMA Classic |
Mask
Size |
Patient Size |
Max Cuff
Vol (air) (ml) |
Largest ETT
ID (mm) |
| 1 |
Neonates/infants up to 5 kg |
4 |
3.5 |
| 1½ |
Infants 5-10 kg |
7 |
4.0 |
| 2 |
Infants/children 10-20 kg |
10 |
4.5 |
| 2½ |
Children 20-30 kg |
14 |
5.0 |
| 3 |
Children 30-50 kg |
20 |
6.0 |
| 4 |
Adults 50-70 kg |
30 |
6.0 |
| 5 |
Adults 70-100 kg |
40 |
7.0 |
| 6 |
Large adults over 100 kg |
50 |
7.0 |
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| LMA Flexible |
Mask
Size |
Patient Size |
Max Cuff
Vol (air) (ml) |
Internal
diameter (mm) |
| 2 |
Infants/children 10-20 kg |
10 |
5.1 |
| 2½ |
Children 20-30 kg |
14 |
6.1 |
| 3 |
Children 30-50 kg |
20 |
7.6 |
| 4 |
Adults 50-70 kg |
30 |
7.6 |
| 5 |
Adults 70-100 kg |
40 |
8.7 |
| 6 |
Large adults over 100 kg |
50 |
8.7 |
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