II. Criteria: Body habitus

  1. Age: 7-9 years
  2. Length: 122-137 cm
  3. Weight: 24-28 kg (mean 27 kg)

III. Findings: Vital Signs (normal)

  1. Heart Rate: 60-120/minute
  2. Respiratory Rate: 12-25/minute
  3. Systolic Blood Pressure: 90-115 mmHg

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

  1. Induction (Sedation)
    1. Etomidate 8 mg
    2. Ketamine 53 mg
    3. Propofol 80 mg
  2. Paralytic
    1. Succinylcholine 53 mg
    2. Rocuronium 27 mg
    3. Vecuronium 2.7 mg
  3. Sedation Maintenance
    1. Lorazepam 1.3 mg
  4. Equipment
    1. ET Size cuffed: 6 mm
    2. ET Insertion depth (at lips): 17-18 cm
    3. Laryngoscope Blade: 2-3 Miller (straight) or Macintosh (curved)
    4. Suction catheter: 10 F
    5. LMA: 2.5
    6. Tidal Volume: 160-265 cc
    7. Breath rate: 12-20/min
    8. Inspiratory time: 0.8 sec

V. Protocol: Miscellaneous Equipment

  1. Urinary Catheter: 12 F
  2. Nasogastric Tube: 14-18 F
  3. Chest Tube: 28-32 F

VI. Protocol: Fluids

  1. IV Fluid Crystalloid Bolus (20 cc/kg NS, LR): 500-540 ml
  2. IV Fluid Crystalloid Maintenance: 66-68 ml/h

VII. Medications: Resuscitation

  1. Cardioversion
    1. First (1 J/kg): 27 J
    2. Next (2 J/kg): 53 J
  2. Defibrillation
    1. First (2 J/kg): 53 J
    2. Next (4 J/kg): 106 J
    3. Next (4-10 J/kg): 106-250 J
  3. Lidocaine
    1. Intravenous (100 mg/5 ml = 2%): 27 mg (1.35 ml)
    2. Endotracheal (100 mg/5 ml = 2%): 54 to 80 mg (2.7 to 4 ml)
  4. Epinephrine
    1. Intravenous (1:10,000): 0.27 mg (2.7 ml)
    2. Endotracheal (1:1000): 2.7 mg (2.7 ml)
  5. Atropine
    1. Intravenous (0.1 mg/ml): 0.5 mg (5 ml)
    2. Endotracheal (0.4 mg/ml) 1 mg (2.5 ml)
  6. Naloxone
    1. Intravenous (0.4 mg/ml) 0.27 mg (0.65 ml)
    2. Endotracheal (0.4 mg/ml) 0.27 mg (0.65 ml)
  7. Adenosine
    1. Initial dose (6 mg/2ml): 2.7 mg (0.9 ml)
    2. Next dose (6 mg/2ml): 5.4 mg (1.8 ml)
  8. Amiodarone
    1. Intravenous (50 mg/ml): 130 mg (2.6 ml)
  9. Calcium Chloride
    1. Intravenous (100 mg/ml = 10%): 530 mg (5.3 ml)
  10. Magnesium Sulfate
    1. Intravenous (5 g/10 ml = 500 mg/ml = 4 meq Mg/ml = 50%) 1325 mg (2.65 ml)
  11. Sodium Bicarbonate
    1. Intravenous (1 meq/ml = 84 mg/ml = 8.4%) 27 meq (27 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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