Pediatric Resuscitation (Dynamic Based Upon Pathology)

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  • Dosing:
    • Age – Weight – Broslow Estimation:
      • Formula:
        • Weight:
          • GA: add 2 digits in wks + 1  * 100g
          • age*3 + 7 = weight in kg (Luscombe forumla)
        • Vitals:
          • SBP (min) 70 + (2*age in yrs)
          • HR
            • Rule of 60’s
            • <1 y/o HR <160, BP > 60, RR <60
            • >1 y/o HR drops by 10 for each year from 2 – 5 years. >12 y/o = normal adult HR
        • Equipment:
          • ET = (age/4)+1 -1 for uncuffed (only uncuffed for neonate)
          • Tube, tape, tap:
            • Tube NG/OG/Foley = 2x ET
            • Tape Depth of ET = 3x ET
            • Tap Chest tube = 4x ET
          • Blade:
            • 00 premie (Miller)
            • 0 @ birth (Miller)
            • 1 @ 1 (Miller)
            • 2 @ 2 (Miller)
      • Intubation:
        • Paralytics:
          • succinylcholine
            • 1.5 – 2 mg/kg (atropine 0.02mg/kg IFF redosing)
          • rocuronium 1.2 mg/kg
        • Sedation (during RSI)
          • etomidate 0.3 mg/kg
          • midazolam 0.1 mg/kg
          • ketamine 2 mg/kg
          • fentanyl 1-2 mcg/kg
          • blue baby -> ketamine (R to L shunt, needs pinking up)
          • pink baby -> etomidate (L to R shunt, don’t rock the boat)
        • Post Intubation Sedation
          • propofol gtt 5 – 50 mcg/kg/min
          • midazaolam load 10 – 50 mcg/kg IV, maintenance 20-100 mcg/kg/hr
          • fentanyl 2mcg/kg/hr
      • Cardioversion:
        • Synchronized
          • 0.5-1 J/kg
        • Defibrillution
          • 2 J/kg, 2nd shock 4J/kg, max 10 J/kg or adult dose
      • Prostaglandin
        • 0.05 – 0.1 mcg/kg / min IV/IO infusion,
        • then 0.01 – 0.05 mcg/ kg / min IV/IO
      • Anti arrhythmics
        • Epinephrine:
          • Pulseless arrest:
            • 0.01mg/kg (0.1 mL/kg of of 1:10,000 IV/I0) q 3-5 min (max 1 mg)
            • 0.1 mg/kg (0.1 mL/kg of 1:1000 ET q 3-5 min)
          • Anaphylaxis:
            • 0.01 mg/kg (0.01 mL/kg) 1:1000 IM (into thigh) q 15 min (max 0.5mg)
            • auto-injector 0.3 mg (for >30kg) IM
            • auto-injector JUNIOR 0.15 (for 10-30kg) IM
            • 0.1 to 1 mcg/kg/min IV/IO invusion for hypotension refractory to IVF and IM epi
          • Asthma
            • 0.01 mg/kg (0.01 mL/kg) 1:1000 SQ q 15 min (max 0.5mg or 0.5mL)
          • Croup:
            • 0.25 – 0.5 ml racemic sol’n (2/25%) in 3L NS INH or 3mL 1:1000 INH
          • atropine 0.02 mg/kg,
            • (repeated PRN x1, min dose 0.1 mg, max single dose 0.5 mg)
          • adenosine 0.1 mg/kg IV/IO (max 6mg), rapid bolus
            • (second dose 0.2mg/kg (max 12mg)
          • amiodarone 5mg/kg IV/IO over 20-60 min
          • procainamide 15 mg/kg over 20-60 min
            • avoided procainamide and amiodarone together
          • magnesium 50 mg/kg IV/IO
            • bolus of pulses VT
            • over 10-20 min for VT with pulse
          • CaCl 20mg/kg IV/IO slow push during arrest
            • repeated PRN
          • Sodium Bicarb (NaHCO3) 1 mEq/kg IV/IO slow bolus
      • Vasopressors
        • epinephrine (for hypotension) 0.1 – 1 mcg/kg / min IV/IO
        • norepinephrine (for hypotension) 0.1 -2 mcg/kg / min IV/IO, titrate to effect
      • Seizure
        • lorazepam 0.1 mg/kg
        • midazolam 0.1 mg/kg
        • fosphenytoin 20 mg/kg (max 1g, rate 150 mg PE/min,
          • PE = phenytoin equivalents)
        • phenytoin (Dilantin 20 mg/kg) administered slow 1 mg/kg/min
        • levetiracetam (Keppra) 20 mg/kg (max 3g) administered at 5mg/kg/min)
        • valproate 20 mg/kg IV at 5 mg/kg/min
        • phenobarbital 20 mg/kg (at rate 1 mg/kg/min)
        • empirics:
          • thiamine 100mg IV
          • glucose
            • <2mo, D10W 5 mL/kg, then infused D10W at 6 mL/kg/min
            • 2 mo – 8 yr D25W 2 mL/kg, then
              • 6 mL/kg/h for first 10 kg
              • + 3 ml/kg/h for 11-20 kg
              • + 1.5 mL/kg/h for each additional kg
            • >8 y/o – adult D50W 50mL (1 amp) OR 1 mL/kg
            • glucagon
              • pediatric 0.03 mg/kg IM/SW/IV x1 (max 1 mg)
              • adult 1mg SC/IM/IV x1 q 20 min PRN
          • pyridoxine 100mg IV
        • Coma induction
          • midazolam 0.2 mg/kg (max 10mg) IV, then 0.1mg/kg/min
          • phenbarbital 5g/kg IV then 0.5 mg/kg/hr
          • ketamine 1.5 mg/kg IV, then infuse 1mg/kg/hr
          • propofol 2 mg/kg IV, then infuse 1 mg/kg/hr
      • Asthma
        • albuterol
          • <20kg  2.5 mg/dose INH
            • q 20 min x3
          • >20kg 5 mg/dose INH
            • q 20 min x3
        • ipratropium
          • <20 kg 0.25 mg INH
            • q 20 min x3
          • >20 kg 0.5mg INH
            • q 20 min x3
        • dexamethasome 0.6 mg/kg PO (max 12mg)
        • OR
        • methylprednisolone 2 mg/kg IV (max 125 mg)
        • prednisone 2mg/kg PO (max 60mg)
        • magnesium 50 mg/kg IV/IO slow infusion over 15-20 min (max 2g)
        • terbutaline
          • 0.1 – 10 mcg/kg / min IV/IO
          • OR
          • 10 mcg/kg subcutaneously 1 10 – 15 min until IV/IO infusion could be initiated (maxed at single dose of 0.4 mg)
        • Epi 0.01 mg/kg (0.01 mL/kg) 1:1000 SQ q 15 min (max 0.5mg or 0.5mL)
      • AMS
        • naloxone 0.1 mg/kg IV/IO/IM/sub q 2 min (max 2 mg)
          • total 1-5 mcg/kg
            • maintenance 0.16 mg/kg / hr IV/IO
      • IVF
        • 20 cc/kg bolus,
        • x3
      • Intranasal
        • analgesia
          • fentanyl 1-2 mcg/kg repeat q 15 min
          • (max wt of pt for practical use ~ 40 kg, when graduate from elementary school)
        • anxiolysis
          • midaolam 0.3 – 0.5 mg/kg repeat 1 15 min
            • (max wt of pt for practical use 20kg, when graduate from kindergarten)
      • Procedural Sedation
        • ketamine 1mg/kg,
          • additional 0.5-1mg PRN
        • propogol 1mg/kg
          • additional 0.5 mg/kg PRN
        • fentanyl 0.1 mcg/kg
        • midazolam 50 mcg/kg
      • PALS H’s and T’s:
        • hypovolemia
        • hypoxia
        • hypoglycemia
        • hypo/hyper-kalemia
        • hydrogen (acidosis)
        • hypothermia
        • toxins
        • tamponade
        • trauma
        • thrombosis, pulmonary
        • thrombosis, cardiac
  • Patient categorized for resuscitation:
    • 28 wk : 1kg
      • Weight used for resuscitation:
    • 28-34 wk : 1kg – 2kg
    • 34-38 wk : 2-3kg
    • 40 wk/term ~ 3.5kg: gray
      • Equipment
        • ET tube: 3
        • NG/OG/Foley: 6
        • Depth of ET: 9 cm
        • Chest tube: 12 French
        • Blade: 0
    • 2mo ~ 5 kg : gray
    • 4mo ~ 6 kg : pink
    • 6mo~ 8 kg : red
    • 1yr ~ 10 kg : purple
    • 2 yr ~ 12-14 kg : yellow
    • 3 yr ~ 15-18 kg : white
    • 5 yr ~ 19-23 kg : blue
    • 7 yr ~ 24- 29kg : orange
    • >9 yr ~ 30 – 36 kg : green