II. Criteria: Body habitus

  1. Age: 18-36 months
  2. Length: 84.5 to 97.5 cm
  3. Weight: 12-14 kg (mean 13 kg)

III. Findings: Vital Signs (normal)

  1. Heart Rate: 90-150/minute
  2. Respiratory Rate: 20-30/minute
  3. Systolic Blood Pressure: 70-110 mmHg

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

  1. Induction (Sedation)
    1. Etomidate 4 mg
    2. Ketamine 26 mg
    3. Propofol 40 mg
  2. Paralytic
    1. Succinylcholine 26 mg
    2. Rocuronium 13 mg
    3. Vecuronium 1.3 mg
  3. Sedation Maintenance
    1. Lorazepam 0.6 mg
  4. Equipment
    1. ET Size cuffed (preferred): 4.0 mm
    2. ET Size uncuffed: 4.5 mm
    3. ET Insertion depth (at lips): 12.5-13.5 cm
    4. Laryngoscope Blade: 2 Miller (straight) or Macintosh (curved)
    5. Suction catheter: 10 F
    6. LMA: 2
    7. Tidal Volume: 80-130 cc
    8. Breath rate: 15-25/min
    9. Inspiratory time: 0.7 sec

V. Protocol: Miscellaneous Equipment

VI. Protocol: Fluids

  1. IV Fluid Crystalloid Bolus (20 cc/kg NS, LR): 240-280 ml
  2. IV Fluid Crystalloid Maintenance: 45-49 ml/h

VII. Medications: Resuscitation

  1. Cardioversion
    1. First (1 J/kg): 13 J
    2. Next (2 J/kg): 26 J
  2. Defibrillation
    1. First (2 J/kg): 26 J
    2. Next (4 J/kg): 52 J
    3. Next (4-10 J/kg): 52-130 J
  3. Lidocaine
    1. Intravenous (100 mg/5 ml = 2%): 13 mg (0.65 ml)
    2. Endotracheal (100 mg/5 ml = 2%): 26-40 mg (1.3 to 2 ml)
  4. Epinephrine
    1. Intravenous (1:10,000): 0.13 mg (1.3 ml)
    2. Endotracheal (1:1000): 1.3 mg (1.3 ml)
  5. Atropine
    1. Intravenous (0.1 mg/ml): 0.26 mg (2.6 ml)
    2. Endotracheal (0.4 mg/ml) 0.65 mg (1.7 ml)
  6. Naloxone
    1. Intravenous (0.4 mg/ml) 0.13 mg (0.33 ml)
    2. Endotracheal (0.4 mg/ml) 0.13 mg (0.33 ml)
  7. Adenosine
    1. Initial dose (6 mg/2ml): 1.3 mg (0.43 ml)
    2. Next dose (6 mg/2ml): 2.6 mg (0.86 ml)
  8. Amiodarone
    1. Intravenous (50 mg/ml): 65 mg (1.3 ml)
  9. Calcium Chloride
    1. Intravenous (100 mg/ml = 10%): 260 mg (2.6 ml)
  10. Magnesium Sulfate
    1. Intravenous (5 g/10 ml = 500 mg/ml = 4 meq Mg/ml = 50%) 650 mg (1.3 ml)
  11. Sodium Bicarbonate
    1. Intravenous (1 meq/ml = 84 mg/ml = 8.4%) 13 meq (13 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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