Emergency Pediatric Dosing over 36 kilogram

Aka: Emergency Pediatric Dosing over 36 kilogram, Broselow Over 36 kg

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II. Criteria: Body habitus

  1. Age: 13 years and older
  2. Weight >36 kg

III. Findings: Vital Signs (normal)

  1. Heart Rate: 60-120/minute
  2. Respiratory Rate: 12-18/minute
  3. Systolic Blood Pressure: 100-130 mmHg

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

  1. Pretreatment
    1. Lidocaine 1.5 mg/kg
    2. Fentanyl 3 mcg/kg
  2. Induction (Sedation)
    1. Etomidate 0.3 mg/kg (most common induction agent)
    2. Ketamine 1.5 mg/kg (preferred in Asthma or COPD)
    3. Propofol 1.5 mg/kg (avoid in Hypotension)
    4. Thiopental 3 mg/kg (rarely used for induction)
    5. Midazolam 0.3 mg/kg (rarely used for induction)
  3. Paralytic
    1. Succinylcholine 1.5 mg/kg
    2. Rocuronium 1 mg/kg
    3. Vecuronium 0.1 mg/kg
  4. Sedation Maintenance
    1. Lorazepam 0.05 mg/kg
  5. Equipment
    1. ET Size cuffed
      1. Women: 7.0 - 8.0 mm
      2. Men: 8.0 - 8.5 mm
    2. ET Insertion depth (at lips)
      1. Women: 21 cm (maximum)
      2. Men: 23 cm (maximum)
    3. Laryngoscope Blade: 3-4 curved blade (Macintosh)
    4. Suction catheter: 12-14 F
    5. LMA: 4
    6. Tidal Volume: 5-10 ml/kg (ideal is closer to 5 ml/kg to prevent Barotrauma)
    7. Breath rate: 12-20
    8. Inspiratory time: 0.8 - 1.0 sec

V. Protocol: Miscellaneous Equipment

  1. Urinary Catheter: 14 F
  2. Nasogastric Tube: 18 F
  3. Chest Tube: 32-40 F

VI. Protocol: Fluids

  1. IV Fluid Crystalloid Bolus (20 cc/kg NS, LR): 750-1000 ml
  2. IV Fluid Crystalloid Maintenance: 80-125 ml/h

VII. Medications: Resuscitation

  1. Cardioversion
    1. First: 50 J
    2. Next: 100 J
  2. Defibrillation
    1. First: 100 J
    2. Next: 120-200 J
  3. Lidocaine
    1. Intravenous (100 mg/5 ml = 2%): 1 mg/kg
    2. Endotracheal (100 mg/5 ml = 2%): 2-3 mg/kg
  4. Epinephrine
    1. Intravenous (1:10,000): 1 mg
    2. Endotracheal (1:1000): 3-10 mg
  5. Atropine
    1. Intravenous (0.1 mg/ml): 0.5-1 mg
    2. Endotracheal (0.4 mg/ml) 2 mg
  6. Naloxone
    1. IV or ET (0.4 mg/ml) 0.4 to 2mg
  7. Adenosine
    1. Initial dose (6 mg/2ml): 6 mg
    2. Next dose (6 mg/2ml): 12 mg
  8. Amiodarone
    1. Intravenous (50 mg/ml): 150-300 mg
  9. Calcium Chloride
    1. Intravenous (100 mg/ml = 10%): 500 to 1000 mg (5-10 ml)
  10. Magnesium Sulfate
    1. Intravenous (5 g/10 ml = 500 mg/ml = 4 meq Mg/ml = 50%) 1-2 g
  11. Sodium Bicarbonate
    1. Intravenous (1 meq/ml = 84 mg/ml = 8.4%) 50 meq (or 1 ampule)

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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