Download pediatric code blue emergency drugs patient label

VIRGINIA COMMONWEALTH UNIVERSITY MEDICAL CENTER
PEDIATRIC CODE BLUE EMERGENCY DRUGS
(BY AGE AND WEIGHT) PATIENT’S WEIGHT (kg): _____________
EPINEPHRINE
Intravenous (IV)
[1:10,000]
0.01 mg/kg to
MAX of 1 mg (R)
{repeat every
3-5 min}
AMIODARONE
[50 mg/mL]
5 mg/kg
Dilute prior to
administration
for PERFUSING
VT/VF only (D)
Calcium
Chloride 10%
[100 mg/mL]
20 mg/kg
{Give via central
line}
10 mg = 0.2 mL
40 mg = 0.4 mL
15 mg = 0.3 mL
60 mg = 0.6 mL
EPINEPHRINE
Endotracheal (ET)
[1:1000]
0.1 mg/kg to MAX of
2.5mg (R)
Flush with 5 mL
0.9% NaCl
PATIENT LABEL
AGE
WEIGHT
(KG)
Round up
NBN
2
NBN
3
1 MO
4
0.04 mg = 0.4 mL
20 mg = 0.4 mL
80 mg = 0.8 mL
0.4 mg = 0.4 mL
4 mEq = 8 mL
2 MO
5
0.05 mg = 0.5 mL
25 mg = 0.5 mL
100 mg = 1 mL
0.5 mg = 0.5 mL
5 mEq = 10 mL
3 MO
6
0.06 mg = 0.6 mL
30 mg = 0.6 mL
120 mg = 1.2 mL
0.6 mg = 0.6 mL
6 mEq = 12 mL
6 MO
7
0.07 mg = 0.7 mL
35 mg = 0.7 mL
140 mg = 1.4 mL
0.7 mg = 0.7 mL
9 MO
8
0.08 mg = 0.8 mL
40 mg = 0.8 mL
160 mg = 1.6 mL
0.8 mg = 0.8 mL
1 YR
10
0.1 mg = 1 mL
50 mg = 1 mL
200 mg = 2 mL
1 mg = 1 mL
2 YR
12
0.12 mg = 1.2 mL
60 mg = 1.2 mL
240 mg = 2.4 mL
1.2 mg = 1.2 mL
3 YR
14
0.14 mg = 1.4 mL
70 mg = 1.4 mL
280 mg = 2.8 mL
1.4 mg = 1.4 mL
4 YR
16
0.16 mg = 1.6 mL
80 mg = 1.6 mL
320 mg = 3.2 mL
1.6 mg = 1.6 mL
5 YR
18
0.18 mg = 1.8 mL
90 mg = 1.8 mL
360 mg = 3.6 mL
1.8 mg = 1.8 mL
6 YR
20
0.2 mg = 2 mL
100 mg = 2 mL
400 mg = 4 mL
2 mg = 2 mL
7 YR
22
0.22 mg = 2.2 mL
110 mg = 2.2 mL
440 mg = 4.4 mL
2.2 mg = 2.2 mL
8 YR
25
0.25 mg = 2.5 mL
125 mg = 2.5 mL
500 mg = 5 mL
2.5 mg = 2.5 mL
9 YR
30
0.3 mg = 3 mL
150 mg = 3 mL
600 mg = 6 mL
2.5 mg = 2.5 mL
10 YR
34
0.34 mg = 3.4 mL
170 mg = 3.4 mL
680 mg = 6.8 mL
2.5 mg = 2.5 mL
12 YR
40
0.4 mg = 4 mL
200 mg = 4 mL
800 mg = 8 mL
2.5 mg = 2.5 mL
14 YR
50
0.5 mg = 5 mL
250 mg = 5 mL
1000 mg = 10 mL
2.5 mg = 2.5 mL
USUAL
ADULT
DOSE
70
1 mg = 10 mL
300 mg = 6 mL
1000 mg = 10 mL
2.5 mg = 2.5 mL
0.02 mg = 0.2mL
(ET: 0.2 mg = 2 mL)
0.03 mg = 0.3mL
(ET: 0.3 mg = 3 mL)
Use 1:10,000
 ET Dose
Use 1:10,000
 ET Dose
4.2% NaHCO3
[0.5 mEq/mL]
1 mEq/kg
2 mEq= 4 mL
3 mEq = 6 mL
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8.4% NaHCO3
[1 mEq/mL]
1 mEq/kg
_________
ADENOSINE
[3 mg/mL]
0.1 mg/kg to
MAX 6 mg (A)
{2nd dose
0.2 mg/kg or
12 mg MAX}
ATROPINE
[0.1 mg/mL]
0.02 mg/kg to
MAX 0.5 mg (T)
{max total dose
0.04 mg/kg}
(Bradycardia)
NALOXONE
[1 mg/mL]
0.1 mg/kg (T’,
S)
Complete
reversal
{Max 2 mg/dose}
0.21 mg = 0.07 mL
0.04 mg = 0.4 mL
0.2 mg= 0.2 mL
0.3 mg = 0.1 mL
0.06 mg = 0.6 mL
0.3 mg= 0.3 mL
0.4 mg = 0.13 mL
0.08 mg = 0.8 mL
0.4 mg = 0.4 mL
0.5 mg = 0.16 mL
0.1 mg = 1 mL
0.5 mg = 0.5 mL
_________
0.6 mg = 0.2 mL
0.12 mg = 1.2 mL
0.6 mg = 0.6 mL
7 mEq = 7 mL
0.7 mg = 0.23 mL
0.14 mg = 1.4 mL
0.7 mg = 0.7 mL
8 mEq = 8 mL
0.8 mg = 0.27 mL
0.16 mg = 1.6 mL
0.8 mg = 0.8 mL
10 mEq = 10 mL
1 mg = 0.33 mL
0.2 mg = 2 mL
1 mg = 1 mL
12 mEq = 12 mL
1.2 mg = 0.4 mL
0.24 mg = 2.4 mL
1.2 mg = 1.2 mL
14 mEq = 14 mL
1.4 mg = 0.46 mL
0.28 mg = 2.8 mL
1.4 mg = 1.4 mL
16 mEq = 16 mL
1.6 mg = 0.53 mL
0.32 mg = 3.2 mL
1.6 mg = 1.6 mL
18 mEq = 18 mL
1.8 mg = 0.6 mL
0.36 mg = 3.6 mL
1.8 mg = 1.8 mL
20 mEq = 20 mL
2 mg = 0.66 mL
0.4 mg = 4 mL
2 mg = 2 mL
22 mEq = 22 mL
2.2 mg = 0.73 mL
0.44 mg = 4.4 mL
2 mg = 2 mL
25 mEq = 25 mL
2.5 mg = 0.83 mL
0.5 mg = 5 mL
2 mg = 2 mL
30 mEq = 30 mL
3 mg = 1 mL
0.5 mg = 5 mL
2 mg = 2 mL
34 mEq = 34 mL
3.4 mg = 1.1 mL
0.5 mg = 5 mL
2 mg = 2 mL
40 mEq = 40 mL
4 mg = 1.3 mL
0.5 mg = 5 mL
2 mg = 2 mL
50 mEq = 50 mL
5 mg = 1.6 mL
0.5 mg = 5 mL
2 mg = 2 mL
50 mEq = 50 mL
6 mg = 2 mL
0.5 mg = 5 mL
2 mg = 2 mL
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_________
_________
R = REPEAT SAME DOSE FOR 2ND AND SUBSEQUENT DOSES
A = GIVE RAPID IV PUSH, FOLLOW BY RAPID NS FLUSH
T = FOR ET, GIVE 2-3 X IV DOSE (0.04-0.06 MG/KG). FLUSH WITH 5 mL NS
T’ = FOR ET, GIVE 2-3 X IV DOSE (0.2-0.3 MG/KG), FLUSH WITH 5 mL NS
S = REVERSAL of RESP DEPRESSION (THERAPEUTIC OPIOID), MAY USE SMALL REPEATED DOSES OF 0.04 MG. (DILUTE 0.4 MG IN 10 ML NS, GIVE IN 1 ML INCREMENTS)
D = FOR PULSELESS VT/VF, MAY GIVE IV PUSH UNDILUTED. FOR PERFUSING TACHYCARDIAS, DILUTE ≤50 MG IN 10 ML AND >50 MG IN 50 ML OF D5W AND INFUSE OVER 20-60 MIN. MAX 15 MG/KG/DAY
Miscellaneous Medications
IV Dose
CALCIUM GLUCONATE 10% (100 mg/mL)
DEXTROSE 10% (0.1 g/mL) = D10W
DEXTROSE 25% (0.25 g/mL) = D25W
DEXTROSE 50% (0.5 g/mL) = D50W
FLUMAZENIL (0.1 mg/mL)
(benzodiazepine reversal)
FOSPHENYTOIN 100 mg vial
(50 mg PE/mL)
HYDROCORTISONE 100 mg (50 mg/mL)
Comments
60-100 mg/kg
0.5 – 1 g/kg
Max dose = 25 g
Newborn: 5-10 mL/kg D10W
Infant/Child: 2 - 4 mL/kg D25W
Adolescent: 1 - 2 mL/kg D50W
May dilute D50W with equal volume of SWI to make D25W
0.01 mg/kg
Max dose = 0.2mg
May repeat every 1 min up to
total dose of 0.05 mg/kg or 1mg
10 – 20 mg PE/kg
PE = phenytoin equiv
Dilute with D5W or NS to 2-10 mg/mL.
Max infusion rate: 3 mg PE/kg/min or 150 mg PE/ min
2-6 mg/kg
0.1 units/kg
Max dose = 10 units
LIDOCAINE 1% bristojet (10 mg/mL)
1 mg/kg
25-50 mg/kg
Max dose = 2000 mg
0.25 – 1 g/kg
MAGNESIUM SULFATE (500 mg/mL)
MANNITOL 20% (0.2 g/mL)
VASOPRESSIN (20 units/mL)
DRUG
Alternate dosing: 1 unit for every 4-5 g Dextrose
NOTE: May require dilution to measure dose May
dilute 10 units in 10 mL to make 1 unit/mL
ET dose – 2-3 mg/kg
Over 10-20 mins; faster for torsades
Use in-line filter (≤ 5 micron)
0.4 units/kg
360 mg/200 mL
DOBUTAMINE*
500 mg/250 mL
DOPAMINE*
400 mg/250 mL
5 mg/250 mL
Dose
0.1-0.2 mg/kg
0.5-1 mg/kg
1 -2 mg/kg
0.1 mg/kg
Dose
1 – 4 mcg/kg
0.2-0.5 mg/kg
0.1 mg/kg (max of 4 mg/dose)
Uncuffed ETT size (mm ID) > 1 yo = (Age in years/4) + 4
Cuffed ETT size (mm ID) for > 1 yo = (Age in years/4) + 3
ETT insertion depth (cm) for > 2 yo = (Age in years/2) + 12
MAX dose = 40 units
ID = Internal Diameter of ETT
PEDIATRIC CONTINUOUS INFUSIONS – For Emergency Use
FINAL
STANDARD
DOSE
AMOUNT/VOLUME
DILUENT
CONCENTRATION
RATE
DELIVERED
AMIODARONE*
EPINEPHRINE
Lorazepam
Anaphylaxis dose
INSULIN – REGULAR (100 units/mL)
(hyperkalemia)
Neuromuscular
blockers
Cisatracurium
Rocuronium
Succinylcholine
Vecuronium
Narcotics
Fentanyl
Diazepam
DOSE RANGE
5 – 15 mcg/kg/min
1800 mcg/mL
D5W
0.17 mL/kg/hr
5 mcg/kg/min
2000 mcg/mL
D5W / NS
0.3 mL/kg/hr
10 mcg/kg/min
5 – 20 mcg/kg/min
1600 mcg/mL
D5W / NS
0.4 mL/kg/hr
10 mcg/kg/min
2 – 50 mcg/kg/min
20 mcg/mL
NS
0.3 mL/kg/hr
0.1 mcg/kg/min
0.05 – 1 mcg/kg/min
0.04-0.2 mg/kg/hr
FUROSEMIDE
100 mg/100 mL
1 mg/mL
NS/D5W
0.08 mL/kg/hr
0.08 mg/kg/hr
LIDOCAINE
1000 mg/250 mL
4000 mcg/mL
D5W / NS
0.3 mL/kg/hr
20 mcg/kg/min
MILRINONE
25 mg/250 mL
20 mg/200 mL
100 mcg/mL
D5W / NS
0.3 mL/kg/hr
0.5 mcg/kg/min
NICARDIPINE
20 mg/200 mL
0.1 mg/mL
NS
0.3 mL/kg/hr
0.5 mcg/kg/min
0.25-5 mcg/kg/min
NITROGLYCERIN
50 mg/250 mL
200 mcg/mL
D5W
0.3 mL/kg/hr
1 mcg/kg/min
1 – 20 mcg/kg/min
50 mg/250 mL
200 mcg/mL
D5W
0.3 mL/kg/hr
1 mcg/kg/min
0.5 – 12 mcg/kg/min
4 mg/250 mL
16 mcg/mL
D5W
0.3 mL/kg/hr
0.08 mcg/kg/min
0.05 – 2 mcg/kg/min
10 mg/250 mL
40 mcg/mL
D5W / NS
0.15 mL/kg/hr
0.1 mcg/kg/min
0.1 – 0.5 mcg/kg/min
NITROPRUSSIDE
NOREPINEPHRINE
(LEVOPHED)
PHENYLEPHRINE
(NEO-SYNEPHRINE)
20 – 50 mcg/kg/min
0.37 – 0.75 mcg/kg/min
D5W = Dextrose 5% in water
NS = 0.9% NaCl
SWI = Sterile water of injection
* Premix in peds code tray
DEFIBRILLATION (VF or pulseless VT) – give 1st shock at 2 J/kg and resume CPR immediately. If shockable rhythm persists after 5 CPR cycles, give subsequent defibrillations at 4 J/kg.
SYNCHRONIZED CARDIOVERSION (SVT or VT with pulse) – start with 0.5 – 1 J/kg, may increase to 2 J/kg for subsequent attempts if necessary.
July 2015
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