Epinephrine: IV 0.01 mg/kg, 0.1 cc/kg of 1:10,000 or 0.01 cc/kg of 1:1,000. if IV. IT 0.1 mg/kg. Repeat q3-5min in CPR.
For anaphylaxis: SC 1:1000, 0.01cc/kg, repeat q15-20minx3-4 times, max 0.4cc.
Midazolam: IV 0.1-0.2 mg/kg per dose over 20-30 sec, Onset - 1 to 2 min, Duration - 30 to 60 min, q5min for status, Max 5mg for a child, 10 mg for an adult. IM 0.2-0.3 mg/kg, IN 0.3 mg/kg (max. 7.5mg) q15min. PO 0.5-0.75 mg/kg (max. 15 mg).
Lorazepam: IV 0.05-0.1 mg/kg, slowly over 2-5 min, Max dose 4mg, q15-20minx2 for status.
PR 0.1mg/kg diluted 1:1 with NS. Refrigirated.
Diazepam: IV 0.1-0.3 mg/kg, q15-30minx2-3 for status, Max dose 5 mg for a child, 10 mg for an adult. PR 0.5 mg/kg, up to 20mg.
Succinylcholine: IV 1-2 mg/kg per dose, Onset - 30 to 60 sec, Duration - 5 to 12 min.
IM 3-4 mg/kg (max 150mg), onset 2-3 min, C/I burns, crush injury or spinal trauma > 3 days after trauma, history or family history of neuromuscular disease, hyperkalemia, myotonia, muscular dystrophy, pseudocholine estrase deficiency. Give Atropine before.
- Rocuronium: 1 (0.6 to 1.2) mg/kg per dose. Onset - 30 to 60 sec, Duration - 30 to 60 min. May be administered undiluted by rapid IV. Repeat 0.2mg/kg q20-30min. Refrigirated.
- Pancuronium (Pavulon): IV 0.04-0.1 mg/kg per dose, repeat 0.05 mg q0.5-4h (long acting, should be used if assisted ventilation
is required for at least 1 hour)
- Vecuronium (Narcuron): IV 0.2 mg/kg, onset: 1.5-4 min.; duration: 30-60 min, Repeat 0.1mg/kg q20-30min,
Ketamine: IV 1-2 mg/kg per dose, slowly over at least 60 sec, Onset <1 min, Duration - 10 to 20 min.
IM 3-4 mg/kg, C/I - elevated ICP, hypertension, glaucoma, open eye injury
Atropine: IV/IM 0.01-0.02 mg/kg per dose. Minimum dose 0.15 mg. Max dose 0.5 mg in a child, 1mg in an adult. Recommended when Succinylcholine is used.
Thiopenthal (Penthotal): IV 3-5 mg/kg per dose. Dilute to 25mg/kg, administer slowly. Onset - 10 to 20 sec, Duration - 10 to 30 min. Max dose 250mg. C/I hypotension/Shock.
Fentanyl: IV 1-2 mcg/kg per dose, slowly undiluted over 3-5 min, Onset < 1 min,
Duration - 30-60 min, q1-2h, Max 500mcg. (rapid bolus infusion may cause chest wall rigidity)
Morphine: IV/SC 0.05-0.1 mg/kg q2-4h, undiluted injection.
Sodium Bicarbonate: Indication: 1) Severe Metabolic acidosis 2) Hyperkalemia 3) Tricyclic antidepressant overdose.
IV 1 to 2 mEq/kg. WARNING: Only 0.5 mEq/mL concentration should be used for newborns; dilution of available stock solutions may be necessary. Administer slowly, bicarbonate solution is hyperosmotic
Calcium Chloride: Indication: 1) Hypocalcemia 2) Hyperkalemia 3) Hypermagnesemia 4) Calcium channel blocker toxicity
IV: 20 mg/kg (if using 10% CaCl2, dose is 0.2 mL/kg). Inject slowly. Repeat dose as necessary for desired clinical effect.
Nifedipine: For hypertension. 0.25-0.50 mg/kg sublingual, max 10 mg per dose.
Labetalol: For hypertensive crisis. 0.1-1 mg/kg, max 20mg, slow IV over 5 min, followed by infusion 1mg/kg/h
Hydrocortisone: For anaphylaxis IV 10mg/kg per dose, IV push, 50mg/cc over 3-5 min. For asthma IV 4-8 mg/kg.
For adrenal crisis Bolus of 100mg/M2/dose, maintenance - 100mg/M2/day, qid.
Methylprednisolone (Solumedrol): IV 1-2 mg/kg, loading dose for asthma or for anaphylaxis.
Diphenhydramine (Benadryl): For anaphylaxis IV push, 1 mg/kg/dose. Repeat: q4-6h.
Dopamine: Indication: Continued shock after volume resuscitation
IV infusion: 2 to 20 µg/kg/min. A widely recommended starting dosage is 10 µg/kg/min. Titrate to desired clinical effect.
Note: Preparation of infusion solution: 6 mg × body weight (kg) diluted to 100 mL. Infuse at 10 mL/h = 10 µg/kg/min using a constant infusion pump.
Dobutamine: Indication: Impaired cardiac contractility
IV infusion: 5 to 25 µg/kg/min. A widely recommended starting dosage is 10 µg/kg/min. Titrate for desired clinical effect.
Preparation of infusion solution: 6 mg × body weight (kg) diluted to 100 mL. Infuse at 10 mL/h = 10 µg/kg/min using a constant infusion pump.
Naloxone (Narcan): IV, IM: 0.1 mg/kg from birth until age 5 years or 20 kg of weight. Thereafter, the minimum dose is 2.0 mg. Doses may be repeated as needed to maintain opiate reversal. IM absorption may be erratic. Note: This dosage is indicated for acute opiate intoxication. Titration to effect with lower initial doses (0.01 mg/kg or 10 µg/kg) should be considered for other clinical situations, eg, respiratory depression during pain management. WARNING: May induce acute withdrawal in opioid dependency. Patients who receive naloxone should be continuously observed for renarcotization for at least 2 hours after the last dose of naloxone.
Phenytoin: IV: 15 to 20 mg/kg initial dose. Max initial dose, 1000 mg. Max total dose 20 mg). Maximum rate of administration, 50 mg/min or 1 mg/kg/min, whichever is less. Note: 10mg/kg is indicated in neonates because of increased risk of toxicity due to decreased protein binding. Should be diluted in NS to avoid precipitation. WARNING: Rate of infusion should not exceed 0.1 mL of undiluted preparation per kg/min. Heart rate should be monitored and the rate of infusion reduced if the heart rate decreases by 10 beats/minute.
Fosphenytoin: Dosage is always Phenytoin Equivalents (PE)
IV 15 to 20 mg PE/kg (same as phenytoin). IM or IV: 1 to 3 mg PE/kg/min; maximum rate 150 mg PE/min. Can be diluted in D5W or NS. Itching is a common and controllable by reducing flow rate. WARNING: Rate of infusion should not exceed 3 mg PE/kg/min. Heart rate should be monitored and the rate of infusion reduced if the heart rate decreases by 10 beats/minute (same as phenytoin).
Phenobarbital: IV 15-20 mg/kg per dose. Max total dose of 30mg. Undiluted at rate not to exceed 1 mg/kg/min.
Note: There is an increased incidence of apnea when combined with other sedative agents. Be prepared to provide respiratory support. Monitor oxygen saturation.
Indication: 1) Diabetic ketoacidosis
SC: 0.25 to 0.5 unit/kg per dose. IV infusion dose: 0.05 to 0.1 unit/kg/h. Neonatal dose: 0.05 unit/kg/h
Note: Blood glucose levels should be closely monitored. Appropriate fluid and electrolyte therapy are also required in treating diabetic ketoacidosis.
Indication: 2) Hyperkalemia
IV: 0.1 unit/kg with 400 mg/kg glucose. Ratio of 1 unit of insulin for every 4 g of glucose.
Note: Potassium levels in blood or serum should be monitored.
Mannitol: For increased intracranial pressure
IV: Loading dose of IV 1 g/kg given over a 20-30 min infusion, then 0.25g/kg q3-4h. Note: In conjunction with mannitol, other measures to control intracranial pressure such as hyperventilation, barbiturates, and muscle relaxation (using a neuromuscular blocking agent) should be considered.
WARNING: Rapid administration may cause hypotension, hyperosmolality, and paradoxical elevated intracranial pressure.
Glucose: Bolus of IV D25W 4 cc/kg, or IV D10W 10 cc/kg. Note: Neonates should receive 10% to 12.5% glucose administered slowly. Note: Glucose levels should be determined before and during administration. If large volumes of dextrose are administered, include electrolytes to prevent hyponatremia and hypokalemia.