Emergency Pediatric Dosing 19-22 kilogram

Aka: Emergency Pediatric Dosing 19-22 kilogram, Broselow Blue

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II. Criteria: Body habitus

  1. Age: 5-6 years
  2. Length: 110 to 122 cm
  3. Weight: 19-22 kg (mean 21 kg)

III. Findings: Vital Signs (normal)

  1. Heart Rate: 65-135/minute
  2. Respiratory Rate: 20-30/minute
  3. Systolic Blood Pressure: 80-110 mmHg

IV. Medications: Rapid Sequence Intubation (RSI) and intubation and ventilation

  1. Induction (Sedation)
    1. Etomidate 6.3 mg
    2. Ketamine 42 mg
    3. Propofol 63 mg
  2. Paralytic
    1. Succinylcholine 40 mg
    2. Rocuronium 21 mg
    3. Vecuronium 2.1 mg
  3. Sedation Maintenance
    1. Lorazepam 1 mg
  4. Equipment
    1. ET Size cuffed (preferred): 5 mm
    2. ET Size uncuffed: 5.5 mm
    3. ET Insertion depth (at lips): 15.5-16.5 cm
    4. Laryngoscope Blade: 2 Miller (straight) or Macintosh (curved)
    5. Suction catheter: 10 F
    6. LMA: 2 to 2.5
    7. Tidal Volume: 125-210 cc
    8. Breath rate: 12-20/min
    9. Inspiratory time: 0.8 sec

V. Protocol: Miscellaneous Equipment

  1. Urinary Catheter: 10-12 F
  2. Nasogastric Tube: 12-15 F
  3. Chest Tube: 24-30 F

VI. Protocol: Fluids

  1. IV Fluid Crystalloid Bolus (20 cc/kg NS, LR): 380-420 ml
  2. IV Fluid Crystalloid Maintenance: 57-63 ml/h

VII. Medications: Resuscitation

  1. Cardioversion
    1. First (1 J/kg): 20 J
    2. Next (2 J/kg): 40 J
  2. Defibrillation
    1. First (2 J/kg): 40 J
    2. Next (4 J/kg): 80 J
    3. Next (4-10 J/kg): 80-200 J
  3. Lidocaine
    1. Intravenous (100 mg/5 ml = 2%): 20 mg (1 ml)
    2. Endotracheal (100 mg/5 ml = 2%): 40-60 mg (2-3 ml)
  4. Epinephrine
    1. Intravenous (1:10,000): 0.21 mg (2.1 ml)
    2. Endotracheal (1:1000): 2.1 mg (2.1 ml)
  5. Atropine
    1. Intravenous (0.1 mg/ml): 0.42 mg (4.2 ml)
    2. Endotracheal (0.4 mg/ml) 1 mg (2.5 ml)
  6. Naloxone
    1. Intravenous (0.4 mg/ml) 0.21 mg (0.53 ml)
    2. Endotracheal (0.4 mg/ml) 0.21 mg (0.53 ml)
  7. Adenosine
    1. Initial dose (6 mg/2ml): 2.1 mg (0.7 ml)
    2. Next dose (6 mg/2ml): 4.2 mg (1.4 ml)
  8. Amiodarone
    1. Intravenous (50 mg/ml): 105 mg (2.1 ml)
  9. Calcium Chloride
    1. Intravenous (100 mg/ml = 10%): 420 mg (4.2 ml)
  10. Magnesium Sulfate
    1. Intravenous (5 g/10 ml = 500 mg/ml = 4 meq Mg/ml = 50%) 1050 mg (2.1 ml)
  11. Sodium Bicarbonate
    1. Intravenous (1 meq/ml = 84 mg/ml = 8.4%) 21 meq (21 ml)

VIII. References

  1. eBroselow
    1. http://www.ebroselow.com
  2. Broselow (2011) Broselow Pediatric Emergency Tape, Vital Signs, Inc, Totowa, NJ
  3. LA County EMS Color Coded Pediatric Drugs
    1. http://ems.dhs.lacounty.gov/ManualsProtocols/3colordrug.pdf
  4. Difficult Airway Course
    1. http://www.theairwaysite.com
  5. (2008) Fairview University - Childrens Hospital, Pediatric Emergency Drug Guide

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