Emergency Drug Card - Pediatric
Emergency Drug Card - Pediatric
PALS
| Drug | Indication / Dose |
|---|---|
| Adenosine | Pediatric tachycardia with a pulse and poor perfusion: 0.1 mg/kg IV rapid bolus (max 6 mg), second dose 0.2 mg/kg (max 12 mg) |
| Amiodarone | Cardiac Arrest (pulseless): 5 mg/kg IV/IO (max 300 mg), repeat twice to a max of 15 mg/kg/day Wide complex tachycardia (stable): 5 mg/kg IV over 20-60 minutes (max 300 mg), may repeat to a max of 15 mg/kg/day |
| Atropine | Pediatric bradycardia with pulse and poor perfusion: 0.02 mg/kg (max dose 0.5 mg); May repeat once. |
| Calcium Chloride 10% | 20 mg/kg IV/IO (0.2 ml/kg) (max dose 2 g) For non-cardiac arrest, use calcium gluconate, push slowly |
| Dextrose 25% | 0.5-1 g/kg (2-4 ml/kg) slow IV/IO push (for newborns, use dextrose 10% 5-10 ml/kg) |
| Epinephrine 1:10,000 | Cardiac Arrest (pulseless): 0.01 mg/kg (0.1 ml/kg of 1:10,000 concentration) IV/IO every 3-5 min (max 1 mg) |
| Magnesium Sulfate | Pulseless VT with torsades de pointes: 25-50 mg/kg (max 2 g) IV/IO Torsades de pointes with a pulse: 25-50 mg/kg IV, push slowly Asthma: 25-50 mg/kg IV over 10-20 minutes (max single dose 2 g) |
| Procainamide | Pediatric tachycardia with a pulse and poor perfusion: 15 mg/kg IV/IO over 30-60 minutes Infusion: 20-80 mcg/kg/min |
| Sodium Bicarbonate | 1 mEq/kg slow IV/IO (Use 4.2% concentration if <5 kg) |
Rapid Sequence Intubation
| Drug | Dose |
|---|---|
| Etomidate | 0.3 mg/kg IV push over 30-60 sec; onset 10-20 sec |
| Lidoocaine 2% | 1-2 mg/kg IV push over 1 min (20 mg = 1 mL) |
| Rocuronium | 0.6-1.2 mg/kg IV push; onset 1-2 min |
| Succinylcholine | Infants: 2 mg/kg IV push over 10-30 sec; onset 30-60 sec (Consider atropine) Children: 1-1.5 mg/kg IV push over 10-30 sec (Consider atropine) IM: 3-4 mg/kg (max 150 mg); onset 1-4 min |
| Vecuronium | 0.1 mg/kg IV push; onset 2-3 min |
Psychiatric
| Drug | Dose |
|---|---|
| Haloperidol | 0.025-0.05 mg/kg per dose IV/IM |
Vasopressors & Inotropes
| Drug | Dose |
|---|---|
| Dobutamine | 5-20 mcg/kg/min IV |
| Dopamine | 5-20 mcg/kg/min IV |
| Epinephrine | 0.05-1 mcg/kg/min IV |
| Norepinephrine | 0.1-2 mcg/kg/min IV |
| Phenylephrine | Bolus: 5-20 mcg/kg/dose IV every 10-15 min Infusion: 0.1-0.5 mcg/kg/min IV |
| Vasopressin | Limited Data |
Seizure
| Drug | Dose |
|---|---|
| Diazepam | 0.2-0.5 mg/kg PR |
| Fosphenytoin | 20 mg/kg IV over 20 minutes |
| Levetiracetam | 20 mg/kg IV over 20 minutes |
| Lorazepam | 0.1 mg/kg IV |
| Midazolam | 0.2 mg/kg IN using the 5 mg/ml concentration |
| Phenobarbital | 10-20 mg/kg IV (max dose 800 mg) IV over 20-60 min, (see pharmacist for dilution recommendations) |
Vasodilators
| Drug | Dose |
|---|---|
| Nitroglycerin | 0.25-0.5 mcg/kg/min, increase by 0.5-1 mcg/kg/min q3-5 min (max 20 mcg/kg/min) |
| Nitroprusside | 0.2-8 mcg/kg/min |
Allergic Reactions
| Drug | Dose |
|---|---|
| Dexamethasone | IV or oral: 0.6 mg/kg (max 12 mg) (may use IV solution PO) |
| Diphenhydramine | IV: 1-1.25 mg/kg |
| Epinephrine | IM: 0.01 mg/kg every 5-15 minutes as needed (1:1,000 concentration) Continuous infusion: 0.1-1 mcg/kg/min IV |
| Famotidine | IV: 0.25 mg/kg |
| Methylprednisolone | IV: 1-2 mg/kg IV (max 125 mg) |
| Ranitidine | Oral: 2 mg/kg PO (max 150 mg) IV: 0.5-1 mg/kg IV (max 50 mg) |
Sedation & Analgesia
| Drug | Dose |
|---|---|
| Fentanyl | IV: 1 mcg/kg IV Intranasal: 1-2 mcg/kg (max 100 mcg) using the 50 mcg/ml concentration (no more than 1 ml/nare) |
| Ketamine | Procedural sedation: 0.5-2 mg/kg IV push over 1 min, may repeat with half dose every 5-10 min PRN IM: 3-8 mg/kg IM PO: 6-10 mg/kg (mix with cola, give 30 min. prior to procedure) |
| Lorazepam | IV: 0.05-0.1 mg/kg IV |
| Midazolam | IV: 0.1 mg/kg IV Intranasal: 0.4 mg/kg (max 10 mg) using the 5 mg/ml concentration |
| Morphine | IV: 0.1 mg/kg IV |
| Propofol | Bolus (procedural sedation): 0.5-1 mg/kg IV push, may repeat with 0.5 mg/kg every 3-5 min PRN |
Overdose & Unresponsive
| Drug | Dose |
|---|---|
| N-acetylcysteine | 1st dose: 150 mg/kg IV over 1 hour 2nd dose: 50 mg/kg IV over 4 hour 3rd dose: 100 mg/kg IV over 16 hour |
| Dextrose | Infants ≤ 6 months: 0.25-0.5 g/kg/dose slow IV push (1-2 ml/kg/dose of D25 or 2.5-5ml/kg/dose of D10) Children > 6 months: 0.5-1 g/kg/dose slow IV push (2-4 ml/kg/dose of D25, 5-10 ml/kg/dose D10) |
| Flumazenil | Benzodiazepine reversal: 0.01 mg/kg (up to 0.2 mg) IV over 15 seconds. May repeat 0.01 mg/kg (up to 0.2 mg) every min to max cumulative dose of 0.05 mg/kg or 1 mg. |
| Fomepizole | Loading dose: 15 mg/kg IV over 30 min |
| Morphine | Total reversal required: 0.1 mg/kg IV/IO/IM/SC/IN every 2 min PRN (max 2 mg) Infusion: 0.002-0.16 mg/kg/hr IV |
Miscellaneous
| Drug | Dose |
|---|---|
| Alprostadil (prostaglandin E1) | Patent ductus arteriosus: 0.05-0.1 mcg/kg/min; once therapeutic response is achieved reduce rate to lowest effective dose. |
| Factor VIII | Minor bleeding: 10-15 IU/kg IV push over 3-5 min Moderate bleeding: 10-30 IU/kg IV push over 3-5 min Life-threatening bleeding: 30-50 IU/kg IV push over 3-5 min |
| Unfractionated Heparin | VTE: Bolus 75 U/kg given over 10 min, infusion 15-20 U/kg/hr |
| Ondansetron | IV or oral: 0.15 mg/kg (max 4 mg) |
Acknowledgements
Prepared by: Amie Hatch, PharmD, BCPS and Jeremy Bair, PharmD, BCPS. Updated AUG 2013.
This document presents an evidence-based approach that is appropriate for most patients. It should be adapted to meet the needs of individual patients and situations, and should not replace clinical judgment.
