Emergency Medicine Book

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Emergency Pediatric Dosing 4 kilogram

Aka: Emergency Pediatric Dosing 4 kilogram, Broselow Grey 4 kg
  1. See Also
    1. Emergency Pediatric Dosing (Broselow Tape)
    2. Advanced Airway
    3. Adult Resuscitation
    4. Pediatric Resuscitation
    5. Newborn Resuscitation
    6. Obstetrical Resuscitation
  2. Criteria: Body habitus
    1. Age: 0-2 months
    2. Length: 52-57 cm
    3. Weight: 4 kg
  3. Findings: Vital Signs (normal)
    1. Heart Rate: 120-180/minute
    2. Respiratory Rate: 40-60/minute
    3. Systolic Blood Pressure: 65-95 mmHg
  4. 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
  5. Protocol: Miscellaneous Equipment
    1. Urinary Catheter: 5-6 F
    2. Nasogastric Tube: 5-6 F
    3. Chest Tube: 10-12 F
  6. Protocol: Fluids
    1. IV Fluid Crystalloid Bolus (20 cc/kg NS, LR): 80 ml
    2. IV Fluid Crystalloid Maintenance: 16 ml/h
  7. 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)
  8. 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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