II. Criteria: Body habitus

  1. Age: 3-6 months
  2. Length: 59.5 to 66.5 cm
  3. Weight: 6-7 kg (mean 6.5 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 0.13 mg
  2. Induction (Sedation)
    1. Etomidate 2 mg
    2. Ketamine 13 mg
    3. Propofol 20 mg
  3. Paralytic
    1. Succinylcholine 13 mg
    2. Rocuronium 7 mg
    3. Vecuronium 0.7 mg
  4. Sedation Maintenance
    1. Lorazepam 0.5 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: 1.5
    7. Tidal Volume: 40-65 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): 120-140 ml
  2. IV Fluid Crystalloid Maintenance: 25-29 ml/h

VII. Medications: Resuscitation

  1. Cardioversion
    1. First (1 J/kg): 7 J
    2. Next (2 J/kg): 13 J
  2. Defibrillation
    1. First (2 J/kg): 13 J
    2. Next (4 J/kg): 26 J
    3. Next (4-10 J/kg): 26-60 J
  3. Lidocaine
    1. Intravenous (100 mg/5 ml = 2%): 6.5 mg (0.325 ml)
    2. Endotracheal (100 mg/5 ml = 2%): 13-20 mg (0.65 to 1 ml)
  4. Epinephrine
    1. Intravenous (1:10,000): 0.065 mg (0.65 ml)
    2. Endotracheal (1:1000): 0.65 mg (0.65 ml)
  5. Atropine
    1. Intravenous (0.1 mg/ml): 0.13 mg (1.3 ml)
    2. Endotracheal (0.4 mg/ml) 0.35 mg (0.9 ml)
  6. Naloxone
    1. Intravenous (0.4 mg/ml) 0.065 mg (0.16 ml)
    2. Endotracheal (0.4 mg/ml) 0.065 mg (0.16 ml)
  7. Adenosine
    1. Initial dose (6 mg/2ml): 0.65 mg (0.22 ml)
    2. Next dose (6 mg/2ml): 1.3 mg (0.44 ml)
  8. Amiodarone
    1. Intravenous (50 mg/ml): 32 mg (0.64 ml)
  9. Calcium Chloride
    1. Intravenous (100 mg/ml = 10%): 130 mg (1.3 ml)
  10. Magnesium Sulfate
    1. Intravenous (5 g/10 ml = 500 mg/ml = 4 meq Mg/ml = 50%) 325 mg (0.65 ml)
  11. Sodium Bicarbonate (only use 8.4% bicarbonate if over age 3 months; otherwise use 4.2%)
    1. Intravenous (1 meq/ml = 84 mg/ml = 8.4%) 6.5 meq (6.5 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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