II. Criteria: Body habitus

  1. Age: 0-2 months
  2. Length: 57-61 cm
  3. Weight: 5 kg

III. Findings: Vital Signs (normal)

  1. Heart Rate: 120-180/minute
  2. Respiratory Rate: 40-60/minute
  3. Systolic Blood Pressure: 65-95 mmHg

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

  1. Pretreatment
    1. Atropine 0.1 mg
  2. Induction (Sedation)
    1. Etomidate 1.5 mg
    2. Ketamine 10 mg
    3. Propofol 15 mg
  3. Paralytic
    1. Succinylcholine 10 mg
    2. Rocuronium 5 mg
    3. Vecuronium 0.5 mg
  4. Sedation Maintenance
    1. Lorazepam 0.25 mg
  5. Equipment
    1. ET Size cuffed (preferred): 3.0 mm
    2. ET Size uncuffed: 3.5 mm
    3. ET Insertion depth (at lips): 10-10.5 cm
    4. Laryngoscope Blade: 1 Miller (straight)
    5. Suction catheter: 8 F
    6. LMA: 1
    7. Tidal Volume: 30-50 cc
    8. Breath rate: 20-25/min
    9. Inspiratory time: 0.6 sec

V. Protocol: Miscellaneous Equipment

VI. Protocol: Fluids

  1. IV Fluid Crystalloid Bolus (20 cc/kg NS, LR): 100 ml
  2. IV Fluid Crystalloid Maintenance: 20 ml/h

VII. Protocol: Resuscitation

  1. Cardioversion
    1. First (1 J/kg): 5 J
    2. Next (2 J/kg): 10 J
  2. Defibrillation
    1. First (2 J/kg): 10 J
    2. Next (4 J/kg): 20 J
    3. Next (4-10 J/kg): 20-50 J
  3. Lidocaine
    1. Intravenous (100 mg/5 ml = 2%): 5 mg (0.25 ml)
    2. Endotracheal (100 mg/5 ml = 2%): 10-15 mg (0.5 to 0.75 ml)
  4. Epinephrine
    1. Intravenous (1:10,000): 0.05 mg (0.5 ml)
    2. Endotracheal (1:1000): 0.5 mg (0.5 ml)
  5. Atropine
    1. Intravenous (0.1 mg/ml): 0.1 mg (1 ml)
    2. Endotracheal (0.4 mg/ml) 0.25 mg (0.63 ml)
  6. Naloxone
    1. Intravenous (0.4 mg/ml) 0.05 mg (0.13 ml)
    2. Endotracheal (0.4 mg/ml) 0.05 mg (0.13 ml)
  7. Adenosine
    1. Initial dose (6 mg/2ml): 0.5 mg (0.17 ml)
    2. Next dose (6 mg/2ml): 1.0 mg (0.33 ml)
  8. Amiodarone
    1. Intravenous (50 mg/ml): 25 mg (0.5 ml)
  9. Calcium Chloride
    1. Intravenous (100 mg/ml = 10%): 100 mg (1.0 ml)
  10. Magnesium Sulfate
    1. Intravenous (5 g/10 ml = 500 mg/ml = 4 meq Mg/ml = 50%) 250 mg (0.5 ml)
  11. Sodium Bicarbonate (use 4.2% bicarbonate for under age 3 months)
    1. Intravenous (2.5 meq/5ml = 42 mg/ml = 4.2%) 5 meq (10 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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