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Emergency Pediatric Dosing over 36 kilogram
Aka: Emergency Pediatric Dosing over 36 kilogram, Broselow Over 36 kg
- See Also
- Emergency Pediatric Dosing (Broselow Tape)
- Advanced Airway
- Adult Resuscitation
- Pediatric Resuscitation
- Newborn Resuscitation
- Obstetrical Resuscitation
- Criteria: Body habitus
- Age: 13 years and older
- Weight >36 kg
- Findings: Vital Signs (normal)
- Heart Rate: 60-120/minute
- Respiratory Rate: 12-18/minute
- Systolic Blood Pressure: 100-130 mmHg
- Medications: Rapid Sequence Intubation (RSI) and intubation and ventilation
- Pretreatment
- Lidocaine 1.5 mg/kg
- Fentanyl 3 mcg/kg
- Induction (Sedation)
- Etomidate 0.3 mg/kg (most common induction agent)
- Ketamine 1.5 mg/kg (preferred in Asthma or COPD)
- Propofol 1.5 mg/kg (avoid in Hypotension)
- Thiopental 3 mg/kg (rarely used for induction)
- Midazolam 0.3 mg/kg (rarely used for induction)
- Paralytic
- Succinylcholine 1.5 mg/kg
- Rocuronium 1 mg/kg
- Vecuronium 0.1 mg/kg
- Sedation Maintenance
- Lorazepam 0.05 mg/kg
- Equipment
- ET Size cuffed
- Women: 7.0 - 8.0 mm
- Men: 8.0 - 8.5 mm
- ET Insertion depth (at lips)
- Women: 21 cm (maximum)
- Men: 23 cm (maximum)
- Laryngoscope Blade: 3-4 curved blade (Macintosh)
- Suction catheter: 12-14 F
- LMA: 4
- Tidal Volume: 5-10 ml/kg (ideal is closer to 5 ml/kg to prevent Barotrauma)
- Breath rate: 12-20
- Inspiratory time: 0.8 - 1.0 sec
- Protocol: Miscellaneous Equipment
- Urinary Catheter: 14 F
- Nasogastric Tube: 18 F
- Chest Tube: 32-40 F
- Protocol: Fluids
- IV Fluid Crystalloid Bolus (20 cc/kg NS, LR): 750-1000 ml
- IV Fluid Crystalloid Maintenance: 80-125 ml/h
- Medications: Resuscitation
- Cardioversion
- First: 50 J
- Next: 100 J
- Defibrillation
- First: 100 J
- Next: 120-200 J
- Lidocaine
- Intravenous (100 mg/5 ml = 2%): 1 mg/kg
- Endotracheal (100 mg/5 ml = 2%): 2-3 mg/kg
- Epinephrine
- Intravenous (1:10,000): 1 mg
- Endotracheal (1:1000): 3-10 mg
- Atropine
- Intravenous (0.1 mg/ml): 0.5-1 mg
- Endotracheal (0.4 mg/ml) 2 mg
- Naloxone
- IV or ET (0.4 mg/ml) 0.4 to 2mg
- Adenosine
- Initial dose (6 mg/2ml): 6 mg
- Next dose (6 mg/2ml): 12 mg
- Amiodarone
- Intravenous (50 mg/ml): 150-300 mg
- Calcium Chloride
- Intravenous (100 mg/ml = 10%): 500 to 1000 mg (5-10 ml)
- Magnesium Sulfate
- Intravenous (5 g/10 ml = 500 mg/ml = 4 meq Mg/ml = 50%) 1-2 g
- Sodium Bicarbonate
- Intravenous (1 meq/ml = 84 mg/ml = 8.4%) 50 meq (or 1 ampule)
- References
- eBroselow
- http://www.ebroselow.com
- Broselow (2011) Broselow Pediatric Emergency Tape, Vital Signs, Inc, Totowa, NJ
- LA County EMS Color Coded Pediatric Drugs
- http://ems.dhs.lacounty.gov/ManualsProtocols/3colordrug.pdf
- Difficult Airway Course
- http://www.theairwaysite.com
- (2008) Fairview University - Childrens Hospital, Pediatric Emergency Drug Guide