II. Criteria: Body habitus

  1. Age: 0-2 months
  2. Length: 52-57 cm
  3. Weight: 4 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 1.2 mg
    2. Ketamine 8 mg
    3. Propofol 12 mg
  3. Paralytic
    1. Succinylcholine 8 mg
    2. Rocuronium 4 mg
    3. Vecuronium 0.4 mg
  4. Sedation Maintenance
    1. Lorazepam 0.2 mg
  5. Equipment
    1. ET Size cuffed (preferred): 3.0 mm
    2. ET Size uncuffed: 3.5 mm
    3. ET Insertion depth (at lips): 9.5 to 10 cm
    4. Laryngoscope Blade: 1 Miller (straight)
    5. Suction catheter: 8 F
    6. LMA: 1
    7. Tidal Volume: 24-40 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): 80 ml
  2. IV Fluid Crystalloid Maintenance: 16 ml/h

VII. Protocol: Resuscitation

  1. Cardioversion
    1. First (1 J/kg): 4 J
    2. Next (2 J/kg): 8 J
  2. Defibrillation
    1. First (2 J/kg): 8 J
    2. Next (4 J/kg): 16 J
    3. Next (4-10 J/kg): 16-40 J
  3. Lidocaine
    1. Intravenous (100 mg/5 ml = 2%): 4 mg (0.2 ml)
    2. Endotracheal (100 mg/5 ml = 2%): 8-12 mg (0.4 to 0.6 ml)
  4. Epinephrine
    1. Intravenous (1:10,000): 0.04 mg (0.4 ml)
    2. Endotracheal (1:1000): 0.4 mg (0.4 ml)
  5. Atropine
    1. Intravenous (0.1 mg/ml): 0.1 mg (1 ml)
    2. Endotracheal (0.4 mg/ml) 0.2 mg (0.5 ml)
  6. Naloxone
    1. Intravenous (0.4 mg/ml) 0.04 mg (0.1 ml)
    2. Endotracheal (0.4 mg/ml) 0.04 mg (0.1 ml)
  7. Adenosine
    1. Initial dose (6 mg/2ml): 0.4 mg (0.13 ml)
    2. Next dose (6 mg/2ml): 0.8 mg (0.26 ml)
  8. Amiodarone
    1. Intravenous (50 mg/ml): 20 mg (0.4 ml)
  9. Calcium Chloride
    1. Intravenous (100 mg/ml = 10%): 80 mg (0.8 ml)
  10. Magnesium Sulfate
    1. Intravenous (5 g/10 ml = 500 mg/ml = 4 meq Mg/ml = 50%) 200 mg (0.4 ml)
  11. Sodium Bicarbonate (use 4.2% bicarbonate for under age 3 months)
    1. Intravenous (2.5 meq/5ml = 42 mg/ml = 4.2%) 4 meq (8 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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