II. Criteria: Body habitus

  1. Age: 3-4 years
  2. Length: 97.5 to 110 cm
  3. Weight: 15-18 kg (mean 16.5 kg)

III. Findings: Vital Signs (normal)

  1. Heart Rate: 75-135/minute
  2. Respiratory Rate: 20-30/minute
  3. Systolic Blood Pressure: 80-110 mmHg

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

  1. Induction (Sedation)
    1. Etomidate 5 mg
    2. Ketamine 33 mg
    3. Propofol 50 mg
  2. Paralytic
    1. Succinylcholine 33 mg
    2. Rocuronium 17 mg
    3. Vecuronium 1.7 mg
  3. Sedation Maintenance
    1. Lorazepam 0.8 mg
  4. Equipment
    1. ET Size cuffed (preferred): 4.5 mm
    2. ET Size uncuffed: 5.0 mm
    3. ET Insertion depth (at lips): 14-15 cm
    4. Laryngoscope Blade: 2 Miller (straight) or Macintosh (curved)
    5. Suction catheter: 10 F
    6. LMA: 2
    7. Tidal Volume: 100-165 cc
    8. Breath rate: 15-25/min
    9. Inspiratory time: 0.7 sec

V. Protocol: Miscellaneous Equipment

  1. Urinary Catheter: 10-12 F
  2. Nasogastric Tube: 10-12 F
  3. Chest Tube: 22-24 F

VI. Protocol: Fluids

  1. IV Fluid Crystalloid Bolus (20 cc/kg NS, LR): 300-34- ml
  2. IV Fluid Crystalloid Maintenance: 51-55 ml/h

VII. Medications: Resuscitation

  1. Cardioversion
    1. First (1 J/kg): 17 J
    2. Next (2 J/kg): 33 J
  2. Defibrillation
    1. First (2 J/kg): 33 J
    2. Next (4 J/kg): 66 J
    3. Next (4-10 J/kg): 66-160 J
  3. Lidocaine
    1. Intravenous (100 mg/5 ml = 2%): 17 mg (0.85 ml)
    2. Endotracheal (100 mg/5 ml = 2%): 34-50 mg (1.7 to 2.5 ml)
  4. Epinephrine
    1. Intravenous (1:10,000): 0.17 mg (1.7 ml)
    2. Endotracheal (1:1000): 1.7 mg (1.7 ml)
  5. Atropine
    1. Intravenous (0.1 mg/ml): 0.33 mg (3.3 ml)
    2. Endotracheal (0.4 mg/ml) 0.85 mg (2.1 ml)
  6. Naloxone
    1. Intravenous (0.4 mg/ml) 0.17 mg (0.43 ml)
    2. Endotracheal (0.4 mg/ml) 0.17 mg (0.43 ml)
  7. Adenosine
    1. Initial dose (6 mg/2ml): 1.7 mg (0.57 ml)
    2. Next dose (6 mg/2ml): 3.3 mg (1.1 ml)
  8. Amiodarone
    1. Intravenous (50 mg/ml): 80 mg (1.6 ml)
  9. Calcium Chloride
    1. Intravenous (100 mg/ml = 10%): 330 mg (3.3 ml)
  10. Magnesium Sulfate
    1. Intravenous (5 g/10 ml = 500 mg/ml = 4 meq Mg/ml = 50%) 820 mg (1.6 ml)
  11. Sodium Bicarbonate
    1. Intravenous (1 meq/ml = 84 mg/ml = 8.4%) 16.5 meq (16.5 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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