Emergency Pediatric Dosing 4 kilogram

1. See Also
   1. Emergency Pediatric Dosing (Broselow Tape)
   2. Advanced Airway
   3. Adult Resuscitation
   4. Pediatric Resuscitation
   5. Newborn Resuscitation
   6. Obstetrical Resuscitation
2. Criteria: Body habitus
   1. Age: 0-2 months
   2. Length: 52-57 cm
   3. Weight: 4 kg
3. Findings: Vital Signs (normal)
   1. Heart Rate: 120-180/minute
   2. Respiratory Rate: 40-60/minute
   3. Systolic Blood Pressure: 65-95 mmHg
4. Medications: Rapid Sequence Intubation (RSI) and intubation and ventilation
   1. Pretreatment
      1. Atropine 0.1 mg
   2. Induction (Sedation)
      1. Etomidate 1.2 mg
      2. Ketamine 8 mg
      3. Propofol 12 mg
   3. Paralytic
      1. Succinylcholine 8 mg
      2. Rocuronium 4 mg
      3. Vecuronium 0.4 mg
   4. Sedation Maintenance
      1. Lorazepam 0.2 mg
   5. Equipment
      1. ET Size cuffed (preferred): 3.0 mm
      2. ET Size uncuffed: 3.5 mm
      3. ET Insertion depth (at lips): 9.5 to 10 cm
      4. Laryngoscope Blade: 1 Miller (straight)
      5. Suction catheter: 8 F
      6. LMA: 1
      7. Tidal Volume: 24-40 cc
      8. Breath rate: 20-25/min
      9. Inspiratory time: 0.6 sec
5. Protocol: Miscellaneous Equipment
   1. Urinary Catheter: 5-6 F
   2. Nasogastric Tube: 5-6 F
   3. Chest Tube: 10-12 F
6. Protocol: Fluids
   1. IV Fluid Crystalloid Bolus (20 cc/kg NS, LR): 80 ml
   2. IV Fluid Crystalloid Maintenance: 16 ml/h
7. Protocol: Resuscitation
   1. Cardioversion
      1. First (1 J/kg): 4 J
      2. Next (2 J/kg): 8 J
   2. Defibrillation
      1. First (2 J/kg): 8 J
      2. Next (4 J/kg): 16 J
      3. Next (4-10 J/kg): 16-40 J
   3. Lidocaine
      1. Intravenous (100 mg/5 ml = 2%): 4 mg (0.2 ml)
      2. Endotracheal (100 mg/5 ml = 2%): 8-12 mg (0.4 to 0.6 ml)
   4. Epinephrine
      1. Intravenous (1:10,000): 0.04 mg (0.4 ml)
      2. Endotracheal (1:1000): 0.4 mg (0.4 ml)
   5. Atropine
      1. Intravenous (0.1 mg/ml): 0.1 mg (1 ml)
      2. Endotracheal (0.4 mg/ml) 0.2 mg (0.5 ml)
   6. Naloxone
      1. Intravenous (0.4 mg/ml) 0.04 mg (0.1 ml)
      2. Endotracheal (0.4 mg/ml) 0.04 mg (0.1 ml)
   7. Adenosine
      1. Initial dose (6 mg/2ml): 0.4 mg (0.13 ml)
      2. Next dose (6 mg/2ml): 0.8 mg (0.26 ml)
   8. Amiodarone
      1. Intravenous (50 mg/ml): 20 mg (0.4 ml)
   9. Calcium Chloride
      1. Intravenous (100 mg/ml = 10%): 80 mg (0.8 ml)
   10. Magnesium Sulfate
       1. Intravenous (5 g/10 ml = 500 mg/ml = 4 meq Mg/ml = 50%) 200 mg (0.4 ml)
   11. Sodium Bicarbonate (use 4.2% bicarbonate for under age 3 months)
       1. Intravenous (2.5 meq/5ml = 42 mg/ml = 4.2%) 4 meq (8 ml)
8. 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