Pediatric Donor Management Guidelines

Pediatric Glascow Coma Scale
Child / Infant / Score
MOTOR RESPONSE / Obeys Commands
Localizes
Withdraws (Pain)
Flexion (Pain)
Extension (Pain)
None / Spontaneous Movement
Withdraws to touch
Withdraws to pain
Flexion (Pain)
Extension (Pain)
None / 6
5
4
3
2
1
VERBAL RESPONSE / Oriented
Confused
Inappropriate Words
Incomprehensible
None / Coos and Babbles
Irritable Cry
Cries to pain
Moans to pain
None / 5
4
3
2
1
EYE OPENING / Opens spontaneous
Opens to speech
Opens to pain
None / Opens spontaneous
Opens to speech
Opens to pain
None / 4
3
2
1
Normal Pediatric Vital Signs
Age / Heart Rate
(beats/min) / Respirations
(breaths/min) / Blood Pressure
Systolic Diastolic
Newborns and Infants / 120-160 / 30-60 / 74-100 / 50-70
Toddlers / 90-140 / 24-40 / 80-112 / 50-80
Preschoolers / 80-110 / 22-34 / 82-110 / 50-78
School-Aged Children / 75-100 / 18-30 / 84-120 / 54-80
Adolescents / 60-90 / 12-16 / 94-140 / 62-88
Hemodynamics
Parameter / Normal Value / Formula
Central Venous Pressure (CVP)
(Right Atrial Pressure) / 4-8 mmHg
6-11 mmH2O
Left Atrial Pressure (LAP)
(Pulmonary Wedge Pressure) / 6-12 mmHg
Mean Arterial Pressure (MAP) / 2 x diastolic pressure + systolic pressure ÷ 3
Pulmonary Artery Pressure (PAP) / Systolic 15-30 mmHg
Diastolic 5-10 mmHg
Mean 12-18 mmHg
Temperature Conversions
Fahrenheit = (9/5 x Centigrade Temperature) + 32
Centigrade = (Fahrenheit Temperature – 32) x 5/9
Centigrade Fahrenheit
34.093.2
35.095.0
36.096.8
37.098.6 / Centigrade Fahrenheit
38.0100.4
39.0102.2
40.0104.0
41.0105.8

Toe Temperature monitoring is common in Pediatrics…TT should be >30C

It is an indicator of perfusion-if TT is low CO may also be low or pt may be febrile and clamped down

Average Dimensions of Endotracheal Tubes
Age / Internal Diameter (mm) / Oral: mouth to mid trachea / Nasal: nares to mid trachea
Premature / 2.5-3.0 / 9 / 10
Full term / 3.0-3.5 / 10 / 11
6 months / 4.0 / 11 / 13
12-24 months / 4.5 / 13-14 / 16-17
4y / 5.0 / 15 / 17-18
6y / 5.5 / 17 / 19-20
8y / 6.0 / 19 / 21-22
10y / 6.5 / 20 / 22-23
12y / 7.0 / 21 / 23-24
14y / 7.5 / 22 / 24-25
Adults / 8.0-9.5 / 23-25 / 25-28

**The above sizes are baseline average sizes for age of uncuffed tubes. If a

tube is cuffed it should be 0.5-1 size smaller. Ex: Average 6yo would require 5.5 uncuffed

or 4.5-5.0 cuffed. In pediatrics most used to be uncuffed (kids have an anatomical cuff with

their cricoid cartilage anatomy) however, most current practice is to place cuffed tubes

(for VAP) though keep in mind, not all facilities are doing this yet

Serologies

For any child <18 months- do disease marker testing on mother

Children >18 months- only do disease marker testing on mother if child has been breast-fed within the last 12 months. Otherwise, testing can be done only on child’s pre-transfusion blood

Blood from pediatric donors should not exceed 10% of total blood volume

Total blood volume is 80 ml blood/kg of body weight

Example 11.7 kg child 80x11.7=936 ml total blood volume

10% of 936= 93.6 ml of blood

Med/Soc History

Ask full med/soc of both child and mother for children less than 18months

of age or for those children older than 18 months of age who have been

breast fed within the past 12 months

Donor Management Initial Orders:

  • Transfer care to Gift of Life with time noted
  • D/C all previous orders, except pressors, antibiotics, and insulin
  • VS with CVP and U/O q 1 hour
  • Maintain body temp 36.5-37.5 (97-99.5)- use warming or cooling blanket
  • NGT-LIWS
  • SCD’s
  • HOB elevated to at least 30 degrees if hemodynamically stable
  • Q 1-2 hour tilting side to side, ET Tube suctioning, Oral care, Chest PT
  • Place patient on specialty bed if possible. (Percussion and rotation)
  • No ETT cuff leak
  • Place Central line and Arterial Line (no PA catheter under 15 years of age-Patients ages 15-18 yrs evaluate on a case by case basis and consult intensivist at facility, medical manager, and resource.)
  • Vasoactive drugs to maintain normal SBP for age
  • EKG
  • Consult Cardiology for echo and official EKG read

Before Initial ECHO

See Cardiac Algorithm

  • Correct metabolic abnormalities
  • Correct Anemia
  • Correct Volume Status: CVP: 6-10
  • Adjust Inotropes: Wean off Neo/Levo, in favor of T4/Dopamine/Dobutamine (MM contact)
  • Bronch with gram stain immediately after consent is obtained and CXR 1 hour after (We should try to bronch peds pts when the proper equipment is available)
  • Call Pharmacy after sputum gram stain result is returned to see if antibiotic adjustments need to be made
  • Per Lung Management Protocol
  • Hydrocortisone (Solu-Cortef) No loading dose. Maintenance dose is 6 mg/kg IV every 6 hour
  • Ancef (Cephazolin): Infants and Children: 50-100mg/kg/day IV divided into 3 doses given q8h. Max dose is 6gm/day. Neonates: Postnatal age less than 7 days: 40 mg/kg/day q12h; Postnatal age greater than 7 days and less than 2 kg: 40 mg/kg/day q12h; Postnatal age greater than 7days and greater than 2 kg: 60 mg/kg/day q8h
  • NO NARCAN FOR KIDS UNDER 15 YEARS OF AGE. Narcan at BEGINNING of case.Children >15years give 8mg.Narcan Rationale: Used in effort to prevent or minimize Neurogenic Pulmonary Edema
  • Norcuron can be given before or after Narcan.Do Not Give Norcuron if Narcan was not given. Dose is 0.1mg/kg/dose (no max dose). May be repeated prn. (Half-Life is 25-40 minutes). Norcuron rationale: Helps to decrease spinal reflexes and relaxes the diaphragm and other respiratory muscles to help ventilate
  • Albuterol 2.5 mg or 5 mg Q 4 hours. In-line nebulizer is first choice, if unavailable use unit/dose puff. Observe for Sinus Tachycardia
  • Mucomyst nebulizer, 3-5cc of 20% solution or 10cc of 10% solution Q 4 hours. Use ONLY in conjunction with Albuterol, never alone. Use only if patient has thick secretions

T-4 Policy 5-09

For Pediatric donors (<16 years of age)

A. Add 200 mcg Levothyroxine (T4) 500 ml of 0.9% normal saline. Administer the following bolus over 30 to 45 minutes, then start I.V. infusion as follows:

AGE / BOLUS / INFUSION
0-6 months / 5 mcg/kg / 1.4 mcg/kg/hr
>6-12 months / 4 mcg/kg / 1.3 mcg/kg/hr
>1-5 years / 3 mcg/kg / 1.2 mcg/kg/hr
6-12 years / 2.5 mcg/kg / 1.0 mcg/kg/hr
>12-16 years / 1.5 mcg/kg / 0.8 mcg/kg/hr

(T4 can be concentrated as needed to decrease IV rate and volume)

B. If T4 therapy is being initiated early in donor management (prior to, or immediately following brain death) do not give bolus and immediately start the infusion.

C. DO NOT administer Insulin, Vasopressin or Solu-Medrol as rapid succession boluses prior to the T4 bolus, but rather administer Insulin (per hospital protocol) and/or Solu-Medrol or Solu-Cortef and/or Vasopressin as clinically indicated.

D. Administer Hydrocortisone (Solu-Cortef) or Methylprednisolone (Solu-medrol) in the following manner: 6mg/kg every 6 hours maintenance.

NOTE: “clinically indicated” in C refers to treatment for Hyperglycemia, DI or for the lung protocol as appropriate-not for initiating the T4 protocol

LABS

  • Type and Screen (if not already done)
  • Labs-Initial and every 4 hours or as needed for specific organ placement:

Lytes, CBC with Diff, Mg, Phos, BUN, Cr, Glucose, Albumin, Total Protein, PT/PTT, Fibrinogen or FSP, Amylase, Lipase, Serum Troponin, CPK with MB bands, ABG with ICa, AST, ALT, ALK PHOS, Total and Direct bili, LDH, UA. One time Labs (order with initial set of labs): GGT, LDH, Cholesterol, Sputum Culture with bronch

  • T/C for 2 units PRBC’s on hold in blood bank. Obtain pre-transfusion

sera if applicable (>2ml)

Electrolyte Replacement Guide

K<3.01mEq/kg over 2 hours-recheck K after infusion and repeat prn

K 3.0-3.90.5mEq/kg over 2 hours-recheck K after infusion and repeat prn

*Max 20 mEq/dose. Max rate 0.5 mEq/kg/h. Peripheral IV dilute 20% solution

ICa <1.1 10ml/kg CaCl over 30 minutes-repeat prn or CaGluconate 100mg/kg over

1 hour. Recheck ICa after infusion and repeat prn

*Max dose 1 gram/dose

Mg 1.0-1.925mg/kg MagSulfate over 1 hour repeat prn Q4-6h

Mg <1.050mg/kg MagSulfate over 1hour repeat prn Q4-6h

*Max dose 2 grams/dose

Phos 2.0-2.9K Phos 0.1 mMol/kg/dose IV over 4-6 h

Phos 1.0-1.9KPhos 0.2 mMol/kg/dose IV over 4-6 h

Phos<1.0KPhos 0.3mMol/Kg/dose

(3 mMol Kphos= 4.4 mEq K)

If pt is hyperkalemic use NaPhos (if pt is not hypernatremic as well)
FLUIDS

  • IV maintenance solutions should contain Na (if serum Na levels are normal), D5% (unless pt is having uncontrolled hyperglycemia) and KCl (unless there is hyperkalemia present). Sodium concentrations are based on patient wt and serum sodium levels.For maintenance solution consider:

<10kgD5% / 0.2NaCl/20Meq/L KCl

10-20kgD5%/0.3NaCl/20Meq/L KCl

>20kgD5%/0.45NaCl/20Meq/KCl

*NOTE: Infants less than 6 months should have 10% Dextrose for maintenance solution.

**Infants and children have increased fluid and electrolyte requirements and losses from those of an adult and therefore require dextrose and electrolytes included in their maintenance fluid.

Using Patient’s kg Weight to Calculate Hourly Maintenance:

10 kg or less = 100 mL/kg/24hrs.

10-20 kg = 1000 mL + 50 mL/kg for each kg over 10 kg/24 hrs.

Over 20 kg = 1500 mL + 20 mL/kg for each kg over 20 kg/24 hrs.

(Insensible = 20-40 mL/kg/24 hrs-already figured into maintenance)

OR:

1st 10 kg = 4 ml/kg (ex: 7kg=28ml/h)

2nd 10 kg = 2 ml/kg (ex: 12kg=44ml/h)

>20 kg = wt (kg) + 40 (ex: 24kg=64ml/h)

**Insensible loss is the loss of water by diffusionthrough the skin and by evaporation from the respiratorytract. It is called “insensible” because we do not know that we are actually losing water at the time that it is leaving the body.The fluid for maintenance therapy replaces losses from 2 processes: evaporative (ie, insensible) losses and urinary losses. Evaporative losses consist of solute-free water losses through the skin and lungs. Under ordinary conditions, insensible losses account for approximately 30-35% of total maintenance volume. Ambient humidity and temperature affect insensible losses. Patients receiving humidified air have less insensible loss than those not receiving humidified air. Patients with hyperthermia or tachypnea have exaggerated (greater) insensible losses. Clinically this significant if your pt is febrile, diaphoretic and/or tachypneic he may require slightly higher maintenance fluids.

Fluid Resuscitation

10-20 ml/kg ofNormal Saline. Reassess, repeat as needed

NOTE: If Serum Na is elevated, consider 0.2NS bolus of 5-10ml/kg

Transfusion Therapy

Packed red blood cells 10-15 cc’s/kg Administer over 2-3 hours. May be administered faster if hypotension or bleeding requires more aggressive correction of anemia

Fresh frozen plasma 10-15 cc’s/kg Administer over 1-2 hours.

May be administered faster if correction of coagulopathy is associated with volume depletion or hypotension

Cryoprecipitate 5-10 cc’s/kg Administer for hypofibrinogenemiaOr 1 unit for every 10 kg of body weight

Platelets < 15 kg: 10-20 cc’s/kg Administer slowly over 2-3 hours, >15 kg: single unit of platelets

**For Pediatric pts, blood products are ordered according to wt-example: 10kg pt with hgb of 8.8 you would order 100ml (10ml/kg) of PRBC’s. Then recheck Hgb. If repeat hgb is 9.5 you would order another 100ml of PRBC’s. The blood bank should keep the original unit, allocate it to that pt and then use it again for the 2ndtransfusion, saving your pt from being exposed to multiple units.

Ordering PRBC’s for low Hgb
Hemoglobin PRBC’s
8-10 / 10ml/kg
6-8 / 15ml/kg
<6 / 20ml/kg
Gift of Life Medication List
Medications / For Pediatrics <40kg or 16 years of age
Albuterol Nebulizer / 0.5cc/3cc NS
Amiodarone / Pulseless V-Fib or V-Tach: 5 mg/kg rapid IV bolus and do not exceed 300 mg
Perfusing Tachycardia: 5 mg/kg IV over 50 min; repeat twice up to a total loading dose of 15 mg/kg
{Additional Note-infusion rate is 5-15mg/kg/min}
Ancef (avoid w/ PCN allergy) / 50-100 mg/kg/day IV q8h
Calcium Chloride / 10 mg/kg IV
Calcium Gluconate / 100 mg/kg IV
Clindamycin (give w/ PCN allergy) / 25-50 mg/kg/day IV q6-8h
Desmopressin (DDAVP) / 2-4 mcg/day IV in 2 divided doses
Diltiazem (Cardizem) / 0.25 mg/kg IV for 2 minutes then 5-15 mg/hr
Dobutamine (MM contact required) / 3-20 mcg/kg/min IV
Dopamine / 3-20 mcg/kg/min IV
Epinephrine (Epi) / 0.05-0.3 mcg/kg/min IV
Furosemide (Lasix) / 0.5-1 mg/kg IV
Glucose 25% / 1-2 cc/kg IV
Hydrocortisone / 6 mg/kg IV Q6
Hydralazine / 0.1-0.2 mg/kg/dose IV
q4-6h up to 1.7-3.5 mg/kg/day; Initial dose not to exceed 20 mg
Insulin-regular / 0.1 unit/kg then 0.05-0.2 unit/kg/hr IV
Lidocaine / 1 mg/kg IV then repeat in 15 min x2 then 20-50 mcg/kg/min
Mannitol / 0.25-0.5 g/kg IV every 4-6 hr
Methylprednisolone / 6 mg/kg IV Q6
Narcan (age 15 and older) / 8 mg IVP x1
Nitroprusside (Nipride) / 0.5-8 mcg/kg/min IV
Norcuron (Vecuronium) / 0.08-0.1 mg/kg IV then 0.05-0.1 mcg/kg/min maintenance
Norepinephrine (Levophed, NE) / 0.05-0.3 mcg/kg/min IV
Potassium Chloride / 0.25-0.5 mEq/kg by central line or IV (20 mEq/hr)
Potassium Phosphate / 0.08-0.36 mMol/kg/dose IV
over 4-6 h; 3mMol Phos= 4.4 mEq K
Sodium Bicarbonate / 1 mEq/kg/dose over 20-30 minutes
Solu-medrol / 25 mg/kg IV
Vasopressin (aqueous pitressin) / 0.5 - 10 milliunits/kg/hr IV
{Additional Note-Vaso dosing for DI-0.5 milliunits/kg/hr for Shock-0.3-2 milliunits/kg/min
Additional Drips and Doses
Non Formulary per GOLM Policy
Consult Medical Manager for approval or hospital physician prior to use
DRUG / DILUTION / CONCENTRATION / USUAL DOSERANGE
Esmolol / 2500 mg in 250mL
5000 mg in 250mL
7500 mg in 250mL / 10 mg/mL
20 mg/mL
30 mg/mL / Loading: 500 mcg/kg
Infusion: 50-500 mcg/kg/min
Labetalol / 250 mg in 50 mL / 5 mg/mL / 0.4-1 mg/kg/hour
MAX 3 mg/kg/hour
Milrinone / undiluted / 1 mg/mL / Loading: 50 mcg/kg
Infusion: 0.375-0.75 mcg/kg/min
Phenylephrine / 10 mg in 250ml / 40 mcg/ml / 0.1-0.5 mcg/kg/min
Procainamide / 500 mg in 250mL
1 g in 250 mL
2 g in 250 mL / 2000 mcg/mL
4000 mcg/mL
8000 mcg/mL / Loading: 3-6 mg/kg/dose (Max 100 mg) over 5 min May repeat until controlled, up to a max load of 15 mg/kg. MAX 500 mg in 30 minutes. Initiate infusion at 20-80 mcg/kg/min (MAX 2 gm/day)
Prostaglandin E1 / 0.25 mg in 50 mL
0.50 mg in 50 mL
0.50 mg in 25 mL / 5 mcg/mL
10 mcg/mL
20 mcg/mL / 0.05-0.2 mcg/kg/min
Terbutaline / Undiluted / 1mg/ml / Loading: 2-10 mcg/kg
Infusion: 0.1-0.4 mcg/kg/min
Cardiovascular Agents (Expected Hemodynamic Changes)
Cardiac Output / PCWP / SVR / Mean BP / Heart Rate / CVP / PVR
Norepinephrine / ↑ / ↑ / ↑ / ↑ / ↔ / ↑ / ↑
Epinephrine / ↑ / ↑ / ↑ / ↑ / ↑ / ↑ / ↑
Dobutamine / ↑ / ↓ / ↓ / ↑ (with increased CO) / ↑ (slight) / ↓ / ↓
Dopamine
< 6mcg
> 6mcg / ↑
↑ / ↑
↑↑ / ↑slight
↑↑ / ↑slight
↑↑ / ↑
↑ / ↑
↑↑ / ↔
↑
Digoxin / ↑ / ↔ / ↔ / ↔ / ↓ / ↔ / ↔
Milrinone / ↑ / ↓ / ↓ / ↔(↓ in preload sensitive pt) / ↑ / ↓ / ↓
Nitroglycerin (IV)
20-40 mcg/min
50-250 mcg/min / ↔
↑ / ↓
↓ / ↔
↓ / ↔
↓ / ↔
↑ / ↓
↓ / ↔
↓
Nitroprusside / ↑ / ↓ / ↓ / ↓ / ↑ / ↓ / ↓

↑ = increase ↓ = decrease ↔ = no change

Additional Medications
Non-formulary per GOLM Policy
Consult Medical Manager or hospital physician prior to use
Medications / Dosages / Comments
Acetaminophen (Tylenol) / 10-15 mg/kg/dose PO/PR q4h
Acetazolamide (Diamox) / diuretic dose: 5 mg/kg/dose IV daily
Acyclovir (Zovirax) / 30 mg/kg/day IV q8h
HSV meningitis dose: 20mg/kg/dose for pts <12years
Adenosine / 1st dose 0.05 mg/kg/dose Max 6mg
2nd dose 0.1 mg/kg
Subsequent doses 0.2 mg/kg
Max 12 mg / Rapid IV push
Altepase (Activase) / 0.1-0.6 mg/kg bolus or 0.3-0.5 mg/kg/hr
PICC line: 1 mg/mL 0.5 mL at a time / Dose is frozen and will need time to thaw. May repeat doses
Aminophylline / No previous hx 6 mg/kg IV over 30 min.
Previous hx 3 mg/kg IV over 30 min
low levels 0.5 mg/kg for every 1 mg/L-increase needed in level goal12 mg/L / Check levels 30 min after infusion
Amphotericin B / test dose: 0.1 mg/kg/dose
0.25 mg/kg/day over 4-6h / Max of 1 mg
Increase daily as tolerated
Amphotericin B Lipid (Abelcet) / 2.5-5 mg/kg/day daily
Ampicillin / 100-200 mg/kg/day IV q4-6h
200-400 mg/kg/day IV q4-6h (meningitis dose)
Ampicillin/Sulbactam (Unasyn) / 100-200 mg/kg/day IV q4-6h / Ampicillin component
Bumetanide (Bumex) / >6 mths: 0.015-0.1 mg/kg/dose
PO/IV/IM q6-24h / Max 0.1 mg/kg/day or 10 mg
Cefepime / 50 mg/kg/dose q12h / q8h for febrile neutropenia
Cefotaxime / 100-200 mg/kg/day q6h / Neonate use only
Ceftazidime / 150 mg/kg/day q8h / Needs ID approval
Ceftriaxone (Rocephin) / 50-75 mg/kg/day q12-24h
Meningitis 100 mg/kg/day q12-24h
Charcoal (Actidose) / Infant <1yr: 1 gm/kg/dose NG/PO q4-6h
Children 1-12 yrs: 1-2 gm/kg/dose or 15-30 gm
Adults: 25-50 gms or 1-2 gm/kg / Children and adults q2-6h NG/PO/PR single dose with sorbitol
Chlorothiazide (Diuril) / IV: 2-8 mg/kg/day q8-24h
PO: 20-80 mg/kg/day q12h / Give with lasix per CVS
Cisatracurium / IV: 0.1mg/kg q1h
Co-trimoxazole (Bactrim) / >2 months: 8 mg TMP/kg/day IV
May increase up to 20 mg TMP/kg/day / >1 mg/mL must be filtered
for serious gram neg. infections
Dexamethasone (Decadron) / cerebral edema: 1-1.5 mg/kg/day
airway edema/extubation:
2 mg/kg/day / Max 10 mg/dose x 6 doses
Diphenhydramine(Benadryl) / 5 mg/kg/day PO/IV q6-8h
Epinephrine Lavage / 0.1 mg in 19 mL NS
Erythromycin / 20-40 mg/kg/day IV q6h / Max 4 gm/day
Fibrin Glue / Mix Equal parts of Thrombin and Ca Gluconate to make 10 mL
Draw up 10 mL of cryoprecipitate
and squirt both solutions simultaneouslyonto site to beglued
Fluconazole (Diflucan) / 3-6 mg/kg/day PO/IV daily
Flumazenil (Romazicon) / Initial: 0.01 mg/kg (Max 0.2 mg) May repeat for total of 1 mg / Reverses Benzodiazepines
Gentamicin / 5-7.5 mg/kg/day q8h / Check levels
Ibuprofen (Motrin) / 5-10 mg/kg/dose PO q6-8h
Magnesium Sulfate / 25-50 mg/kg/dose IV / dilute to 20% solution
Metolazone (Zaroxolyn) / 0.2-0.4 mg/kg/day PO q12-24h
Metronidazole / IV: 30 mg/kg/day q6h
PO: 15-35 mg/kg/day q8h / Max dose 4 g/day
Infuse over 1 hour
Milrinone / Loading: 50 mcg/kg
gtt: 0.375-0.75 mcg/kg/min
Oxacillin / 100-200 mg/kg/day IV q4-6h / Max 12 g/day
Pancuronium Bromide (Pavulon) / 0.1 mg/kg/dose IV q1hslowly
Phytonadione (Vitamin K) / Children:1-2 mg/dose
Procainamide (Pronestyl) / Loading: 3-6 mg/kg/dose over 5 min
gtt: 20-80 mcg/kg/min / Not to exceed 100 mg/dose
May repeat q5-10 min to
max 17 mg/kg/load
Max 2g/24h
3% Sodium Chloride / 5 mL/kg IV to raise Na by 4 mEq/L / Check Na before repeating
Spironolactone / 1.5-3.3 mg/kg/day q6-24h
Tromethamine (THAM) / 1 mEq/kg / Severe acidosis
Tobramycin / 5-7.5 mg/kg/day IV/IM q8h / Max 300 mg/day
Check levels
Vancomycin / 10-40 mg/kg/day IV q6h
60 mg/kg/day for neurosurgical pts / Max 2 gm/day
Infuse over 1 hr
Zarolxolyn (Metolazone) / 0.2-0.4 mg/kg/day divided q12-24h / Max adult dose 2.5-5 mg/day

CODE DRUGS

Commonly Used Emergency Drugs
Drug / Route / Dose / Frequency
Adenosine / IV / 0.05-0.25mg/kg IV rapid push, followed by rapid 0.9 NS flush / ↑ by 0.05 mg/kg q 2 min up to 0.25 mg/kg
Amiodarone / IV / 5 mg/kg over 30 min followed by continuous infusion 5-15 mcg/kg/min
Bumetanide / IV / 0.015-0.1 mg/kg/dose / q 6-24 hrs
Calcium chloride 10% / IV / 10-30 mg/kg MAX 1 gm / q 15-30 min
CalciumGluconate 10% / IV / 100 mg/kg MAX 1 gm / q 15-30 min
Corticosteroids, stress dose; Hydrocortisone / IV / Bolus 1-2 mg/kg (MAX100mg)
Maint 1mg/kg/dose (MAX 100 mg/dose) / Once
q 6-8h
25% Dextrose / 2-4 ml/kg / Dilute 50% 1:1 with sterile water
Enalaprilat / IV / 5-10 mcg/kg/dose / q 8-24h
Epinephrine (1:10,000) / IV / 0.1 mL/kg / q 5-15 min
Epinephrine(1:1000) / ET / 0.1 mL/kg
Etomidate / IV / 0.1-0.4 mg/kg/dose
Flumazenil / IV / Initial dose 0.01 mg/kg MAX 0.2 mg, then 0.005-0.01 mg/kg MAX 3 mg in 1h / q 1 min initial
q20min subsequent
Hydralazine / IV / 0.15 mg/kg / q 4-6 h
Insulin/glucose infusion for hyperkalemia / IV / 5 units regular insulin in 100 mL of 25% dextrose, infuse at 0.1 unit insulin/kg/hr / check serum K+, d/c when K+ < 6 mEq/L
Ketamine / IV / 0.5-3 mg/kg / single dose
Lidocaine / IV / 1 mg/kg / q 5-10 min
Lorazepam / IV / 0.03-0.1 mg/kg MAX 4 mg / q 15 min
Magnesium Sulfate / IV / 25-50mg/kg
MAX 2 gm / May be given over 10-20 minutes. Check with MD first
Mannitol / IV / 0.25-1 g/kg / q 2-8 h
Naloxone / IV / 0.1 mg/kg / q 15-30 min
Nifedipine / SL/NG / 0.25-0.5 mg/kg / q 6-8 h
Pancuronium / IV / 0.1 mg/kg / q 1 h
Sodium Bicarbonate / IV / 1 mEq/kg/dose-dilute 1:1 with NS / Infuse over 20 minutes
Sodium chloride, 3% / IV / 5 mL/kg (to ↑serum Na+ by 4 mEq/L) / x 1, check serum Na+
THAM(buffer, 0.3mEq/mL) / IV / according to base deficit: 0.3 x body wt in kg x base deficit / x 1, check ABG
Vecuronium / IV / 0.1 mg/kg / q 30-60 min

Defibrillation

Cardioversion 0.5 joules/kg

Defibrillating 2 joules/kg