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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 _________ _________ _________ _________ _________ _________ _________ _________ _________ _________ _________ _________ _________ _________ _________ 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 _________ _________ _________ 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 2