Emergency Medicine Book

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Emergency Pediatric Dosing over 36 kilogram

Aka: Emergency Pediatric Dosing over 36 kilogram, Broselow Over 36 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: 13 years and older
    2. Weight >36 kg
  3. Findings: Vital Signs (normal)
    1. Heart Rate: 60-120/minute
    2. Respiratory Rate: 12-18/minute
    3. Systolic Blood Pressure: 100-130 mmHg
  4. Medications: Rapid Sequence Intubation (RSI) and intubation and ventilation
    1. Pretreatment
      1. Lidocaine 1.5 mg/kg
      2. Fentanyl 3 mcg/kg
    2. Induction (Sedation)
      1. Etomidate 0.3 mg/kg (most common induction agent)
      2. Ketamine 1.5 mg/kg (preferred in Asthma or COPD)
      3. Propofol 1.5 mg/kg (avoid in Hypotension)
      4. Thiopental 3 mg/kg (rarely used for induction)
      5. Midazolam 0.3 mg/kg (rarely used for induction)
    3. Paralytic
      1. Succinylcholine 1.5 mg/kg
      2. Rocuronium 1 mg/kg
      3. Vecuronium 0.1 mg/kg
    4. Sedation Maintenance
      1. Lorazepam 0.05 mg/kg
    5. Equipment
      1. ET Size cuffed
        1. Women: 7.0 - 8.0 mm
        2. Men: 8.0 - 8.5 mm
      2. ET Insertion depth (at lips)
        1. Women: 21 cm (maximum)
        2. Men: 23 cm (maximum)
      3. Laryngoscope Blade: 3-4 curved blade (Macintosh)
      4. Suction catheter: 12-14 F
      5. LMA: 4
      6. Tidal Volume: 5-10 ml/kg (ideal is closer to 5 ml/kg to prevent barotrauma)
      7. Breath rate: 12-20
      8. Inspiratory time: 0.8 - 1.0 sec
  5. Protocol: Miscellaneous Equipment
    1. Urinary Catheter: 14 F
    2. Nasogastric Tube: 18 F
    3. Chest Tube: 32-40 F
  6. Protocol: Fluids
    1. IV Fluid Crystalloid Bolus (20 cc/kg NS, LR): 750-1000 ml
    2. IV Fluid Crystalloid Maintenance: 80-125 ml/h
  7. Medications: Resuscitation
    1. Cardioversion
      1. First: 50 J
      2. Next: 100 J
    2. Defibrillation
      1. First: 100 J
      2. Next: 120-200 J
    3. Lidocaine
      1. Intravenous (100 mg/5 ml = 2%): 1 mg/kg
      2. Endotracheal (100 mg/5 ml = 2%): 2-3 mg/kg
    4. Epinephrine
      1. Intravenous (1:10,000): 1 mg
      2. Endotracheal (1:1000): 3-10 mg
    5. Atropine
      1. Intravenous (0.1 mg/ml): 0.5-1 mg
      2. Endotracheal (0.4 mg/ml) 2 mg
    6. Naloxone
      1. IV or ET (0.4 mg/ml) 0.4 to 2mg
    7. Adenosine
      1. Initial dose (6 mg/2ml): 6 mg
      2. Next dose (6 mg/2ml): 12 mg
    8. Amiodarone
      1. Intravenous (50 mg/ml): 150-300 mg
    9. Calcium Chloride
      1. Intravenous (100 mg/ml = 10%): 500 to 1000 mg (5-10 ml)
    10. Magnesium Sulfate
      1. Intravenous (5 g/10 ml = 500 mg/ml = 4 meq Mg/ml = 50%) 1-2 g
    11. Sodium Bicarbonate
      1. Intravenous (1 meq/ml = 84 mg/ml = 8.4%) 50 meq (or 1 ampule)
  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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