II. Criteria: Body habitus

  1. Age: 7-10 months
  2. Length: 66.5 to 74 cm
  3. Weight: 8-9 kg (mean 8.5 kg)

III. Findings: Vital Signs (normal)

  1. Heart Rate: 110-185/minute
  2. Respiratory Rate: 25-40/minute
  3. Systolic Blood Pressure: 65-105 mmHg

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

  1. Pretreatment
    1. Atropine 0.17 mg
  2. Induction (Sedation)
    1. Etomidate 2.5 mg
    2. Ketamine 17 mg
    3. Propofol 25 mg
  3. Paralytic
    1. Succinylcholine 17 mg
    2. Rocuronium 9 mg
    3. Vecuronium 0.9 mg
  4. Sedation Maintenance
    1. Lorazepam 0.4 mg
  5. Equipment
    1. ET Size cuffed (preferred): 3.0 mm
    2. ET Size uncuffed: 3.5 mm
    3. ET Insertion depth (at lips): 10.5-11 cm
    4. Laryngoscope Blade: 1 Miller (straight)
    5. Suction catheter: 8 F
    6. LMA: 1.5
    7. Tidal Volume: 50-85 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): 160-180 ml
  2. IV Fluid Crystalloid Maintenance: 33-37 ml/h

VII. Medications: Resuscitation

  1. Cardioversion
    1. First (1 J/kg): 9 J
    2. Next (2 J/kg): 17 J
  2. Defibrillation
    1. First (2 J/kg): 17 J
    2. Next (4 J/kg): 33 J
    3. Next (4-10 J/kg): 33-80 J
  3. Lidocaine
    1. Intravenous (100 mg/5 ml = 2%): 8.5 mg (0.425 ml)
    2. Endotracheal (100 mg/5 ml = 2%): 17-26 mg (0.85 to 1.3 ml)
  4. Epinephrine
    1. Intravenous (1:10,000): 0.085 mg (0.85 ml)
    2. Endotracheal (1:1000): 0.85 mg (0.85 ml)
  5. Atropine
    1. Intravenous (0.1 mg/ml): 0.17 mg (1.7 ml)
    2. Endotracheal (0.4 mg/ml) 0.45 mg (1.1 ml)
  6. Naloxone
    1. Intravenous (0.4 mg/ml) 0.085 mg (0.21 ml)
    2. Endotracheal (0.4 mg/ml) 0.085 mg (0.21 ml)
  7. Adenosine
    1. Initial dose (6 mg/2ml): 0.85 mg (0.28 ml)
    2. Next dose (6 mg/2ml): 1.7 mg (0.56 ml)
  8. Amiodarone
    1. Intravenous (50 mg/ml): 42 mg (0.84 ml)
  9. Calcium Chloride
    1. Intravenous (100 mg/ml = 10%): 170 mg (1.7 ml)
  10. Magnesium Sulfate
    1. Intravenous (5 g/10 ml = 500 mg/ml = 4 meq Mg/ml = 50%) 425 mg (0.85 ml)
  11. Sodium Bicarbonate
    1. Intravenous (1 meq/ml = 84 mg/ml = 8.4%) 8.5 meq (8.5 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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