1
Q
Erythromycin Ointment
A
Neonatal Stabilization
neonate: upon discussion with sending of NICU, 0.5% opthalmic ointment to both eyes
2
Q
Vitamin K
A
Neonatal Stabilization
neonate: upon discussion with sending of NICU, 1mg IM
3
Q
Clevidipine
A
Hemorrhagic Stroke; Subarachnoid Hemorrhage, Non-Traumatic; Hypertensive Emergency; Thoracic Aortic Dissection
adult infusion: 1-32mg/hr; usual infusion 1-2mg/hr, titrate every 2min by doubling rate until approaching BP goal, then every 5min; usual effective range 4-6mg/hr
pedi: not listed
4
Q
Cis-Atracurium
A
RSI - Paralysis
adult & pedi: 0.2mg/kg IV
*only if there is a Rocuronium & Vecuronium shortage
5
Q
Whole Blood
A
Blood Products Administration
adult: transfuse a single unit
pedi (>1 to <18 or per local trauma definition): 20ml/kg up to a single unit
infant (1 month - 1 year): 15ml/kg
neonate (<29 days): 10ml/kg
6
Q
Dextrose 5% in Normal Saline
A
(D5NS)
Peds General Mngmt
pedi: maintenance using the the 4:2:1rule
Adult Diabetic Ketoacidosis; Pediatric Diabetic Ketoacidosis
adult: 100ml/hr
pedi: “at maintenance rate per Air Methods approved pediatric reference” (i.e. using 4:2:1 rule)
7
Q
Pralidoxime
A
(2-Pam)
Overdose/ Poisoning/ Toxic Exposure, Organophosphate/ Cholinergic Poisoning
adult: 600mg IV or one auto-injector IM, may repeat x2 for persistent symptoms to total of 1800mg
pedi: 20-50mg/kg IV or one auto-injector, may repeat x2 for persistent symptoms to total of 1800mg
8
Q
Hydroxocobalamin
A
Burns: Thermal and Chemical, Cyanide Toxicity
adult: 5g mixed in total of 200ml NS infused over 15min, a second 5g may be considered
pedi: 70mg/kg IV (max single dose 5g), may repeat once if needed
9
Q
Electricity
A
Cardioversion
(AFib/ AFlutter; PSVT; VTach with Pulse; Pedi SVT; Pedi VTach with Pulse; Cardioversion)
adult: doses per manufacturer (see below)
pedi: 0.5J/kg, then 1J/kg, and then 2J/kg
Defibrillation
(Cardiac Arrest; Hypothermia; Pedi Cardiac Arrest; CentriMag VAD; Impella; IABP; Defibrillation)
adult: doses per manufacturer
pedi: 2J/kg, then 4J/kg, then keep going by 2j/kg up to 10J/kg max (or adult dose as max)
Pacing
(Bradycardia; Pediatric Bradycardia; Transcutaneous External Pacing; VADs)
adult & pedi: per Bradycardia: start 10-20bpm above intrinsic rate or 60 if no rate exists, and increase by 10mA until electrical and mechanical capture
Clarification(s) in Transcutaneous External Pacing: low end of normal for starting rate, so 60 for adults and higher for pedis; optimum threshold 10% above lowest mA needed for capture
see also Transvenous Pacing
10
Q
Cefazolin
A
General/ Multi-System Trauma; Musculoskeletal Trauma
adult & pedi: 50mg/kg IV up to max dose 2g
11
Q
Packed Red Blood Cells
A
(PRBCs)
Blood Products Administration
adult: transfuse a single unit
pedi (>1 to <18 or per local trauma definition): 15-20ml/kg up to a single unit
infant (1 month - 1 year): 15ml/kg
neonate (<29 days): 10ml/kg
12
Q
Plasma
A
(FFP)
Blood Products Administration
adult: transfuse a single unit
pedi (>1 to <18 or per local trauma definition): 10-20ml/kg up to a single unit
infant (1 month - 1 year): 15ml/kg
neonate (<29 days): 10ml/kg
13
Q
Vecuronium
A
RSI - Paralysis
adult & pedi: 0.1mg/kg IV
*only if there is a Rocuronium shortage
14
Q
Succinylcholine
A
RSI - Paralysis; Neonatal/ Infant RSI
adult & pedi: 1.5-2mg/kg IV
15
Q
Ibuprofen
A
(Motrin)
Pediatric Infectious Respiratory Distress, Fever; Pediatric Sepsis/ Meningitis
pedi: 10mg/kg PO up to max single dose 800mg
16
Q
Prostaglandin E1
A
Pediatric Cyanotic Congenital Heart Disease
pedi: infusion if initiated by sending, 0.1-0.4mcg/kg/min
17
Q
Terbutaline
A
Bronchospasm (Asthma & COPD); Pediatric Reactive Airways Disease
adult: 0.25mg SQ
pedi: 0.005-0.01mg/kg SQ
Tocolytics
mom: 0.25mg SQ every 15-30min up to a max of 1mg or until Magnesium Sulfate is ready; infusion if initiated by sending at 5-80mcg/min
18
Q
Betamethasone
A
(Celestone, Diprolene)
Pre-Term Labor, <37wks
mom: 12mg IM
*if available at sending
19
Q
Calcium Chloride
A
PIH/ Pre-Eclampsia/ Eclampsia/ HELLP Syndrome, Magnesium Toxicity
mom: 500mg slow IV injection (not to exceed 1ml/min)
Potassium Imbalance
central line, adult only: 20mEq/hr
peripheral line, adult and pedi: 10mEq/hr
*and consider replacing magnesium also
20
Q
Tranexemic Acid
A
Tranexamic Acid
adult: 2g in 100ml IV wide open
pedi: 15mg/kg (max 2g) IV over 10min (if acceptable by local peds trauma center)
referenced inPost-Partum Hemorrhage; Blood Products Administration; Abdominal Trauma
21
Q
Oxytocin
A
(Pitocin)
Post-Partum Hemorrhage
mom: 20u/1000ml NS/LR at 20-40mu/min (60-120ml/hr) - or -10u IM
22
Q
Lithium Carbonate
A
Thyroid Storm
adult: 300mg PO (given every 6 hours)
pedi: not listed
23
Q
Potassium Iodide
A
Thyroid Storm
adult: 3-5 drops PO at least one hour after Propylthiouracil (given every 6 hours)
pedi: not listed
24
Q
Propylthiouracil
A
Thyroid Storm
adult: 500-1000mg PO loading dose followed by 250mg PO every 4hrs
pedi: not listed
25
Propanolol
Thyroid Storm
adult: 1-2mg IV over 10min, repeat once (given every 4hrs) - or - 60-80mg PO (also given every 4hrs)
pedi: not listed
*if available at sending
26
Liothyronine
(T3)
Myxedema Coma
adult: 25-50mcg IV
pedi: not listed
27
Levothyroxine
(Synthroid, T4)
Myxedema Coma
adult: 4mcg/kg lean body weight
pedi: not listed (h/e consider weight-based dose if necessary)
28
Esmolol
(Brevibloc)
Hypertensive Emergency; Thoracic Aortic Aneurysm
adult loading dose: 500mcg/kg IV over 1min
adult infusion: 50mcg/kg/min IV; if no response repeat loading dose and increase infusion by 50mcg/kg/min every 5-15min up to max 300mcg/kg/min
pedi: not listed
*if initiated by sending
29
Hydralazine
Hypertensive Emergency
adult: 10mg slow IV push, may repeat in 20min up to max dose of 40mg
pedi: not listed
PIH, Pre-Eclampsia, Eclampsia, HELLP
mom: 5-10mg IV repeated as needed every 20min at a dose of 5-10mg for a total dose of 40mg
30
Mannitol
Hemorrhagic Stroke, Herniation; Subarachnoid Hemorrhage, Non-Traumatic with Herniation; Traumatic Brain Injury with Herniation
adult & pedi: 1g/kg IV over 10min (filter must be used)
*for head stuff, only if receiving facility prefers (over 3%)
*for peds DKA, cerebral edema, only with physician order
31
Hypertonic 3% Saline
Hemorrhagic Stroke, Herniation; Subarachnoid Hemorrhage, Non-Traumatic with Herniation
adult: 250ml IV over 10min
pedi: 3ml/kg over 10min (max 250ml)
Sodium Imbalance, Severe Hyponatremia
adult: 100ml IV over 10min, then a second 100ml over 50min
pedi: 3-4ml/kg over 10min
Traumatic Brain Injury with Herniation
adult: 250ml IV over 10min
pedi: 3ml/kg IV over 10min (max 250ml)
32
Labetalol
(Trandate, Normodyne)
Hemorrhagic Stroke, Hypertension; Hypertensive Emergency; Subarachnoid Hemorrhage, Non-Traumatic with Hypertension; Thoracic Aortic Dissection; PIH/ Pre-Eclampsia/ Eclampsia, HELLP Syndrome; Abdominal Aortic Aneurysm, SBP >110
adult bolus: 10-20mg slow IV (over 2min), may repeat every 10min with additional doses of 40mg and then 80mg until a max dose of 300mg is administered
adult infusion: 1-2mg/min
pedi: not listed
33
Nicardipine
(Cardene)
Hemorrhagic Stroke, Hypertension; Hypertensive Emergency; Subarachnoid Hemorrhage, Non-Traumatic with Hypertension; Thoracic Aortic Aneurysm; Abdominal Aortic Dissection, SBP >120
adult: 2.5mg/hr IV, increase by 2.5mg/hr every 5-15min up to max 15mg/hr; once target achieved, titrate down by 2.5mg/hr to target of 3mg/hr
pedi: not listed
*mix in NS
34
Normal Saline & Lactated Ringers
***Adult/ Adult & Pedi***
IV Fluid Therapy, Hemodynamic Instability
adult: wide open until appropriate BP reached
pedi: 20ml/kg NS/LR, may repeat
Hypotension
adult: 250ml NS/LR and re-evaluate, repeat as necessary up to 30ml/kg
peds: 20ml/kg NS IV bolus, repeat as needed (see below)
General/ Multi-System Trauma
adult: NS/LR warmed to maintain SBP 80-90
pedi: 20ml/kg NS/LR warmed and repeat
Abdominal Trauma
adult: 250ml NS/LR warmed to maintain SBP 80-90
pedi: 20ml/kg NS/LR warmed and repeat
Allergic Reaction/ Anaphylaxis
adult: 250ml NS/LR, repeat as necessary
peds: 20ml/kg NS IV bolus, repeat as needed (see below)
DKA
adult: 1L NS over 1hr, then 500ml/hr x3-4hrs
peds: 10ml/kg NS, then 1.5-2x maintenance rate with NS (see below)
Sodium Imbalance, Hypernatremia
adult: 150-200ml/hr NS
pedi: 2x maintenance rate (per 4:2:1Rule) NS
Sodium Imbalance, Hyponatremia & Hypovolemic
adult: 125-150ml/hr NS
pedi: 2x maintenance rate (per 4:2:1Rule) NS
Thyroid Storm
adult: 1L NS/LR or 500ml NS/LR with significant peripheral edema
peds: none listed
Overdose/ Poisoning/ Toxic Exposure, Na-Channel Blocker Overdose with Hypotension
adult: 500-1000ml NS/LR, may repeat 2x
pedi: 20ml/kg, may repeat 2x
Burns: Electrical and Lightning Injury
adult & pedi: infuse crystalloids to maintain adequate SBP and UOP to goal
adult UOP goal: 0.5-1ml/kg/hr
pedi UOP goal: 1-2ml/kg/hr
Burns: Thermal and Chemical
adult & pedi: replace loss via Consensus for partial/ full thickness >20%: 2ml NS/LR x %TBSA x kg; 1/2 in 8 hours, 1/2 in the following 16hrs
maintain the following with crystalloids:
- adequate SBP
--adult: SBP >90
--pedi (<10): SBP >70 + 2x age in years
- UOP to goal
-- adult: 0.5-1ml/kg/hr
-- pedi: 1-2ml/kg/hr
(+maintenance D5NS with peds)
Crush Syndrome
adult: infuse NS/LR wide open for 1L, then KVO; limit total fluid administration to 1.5L
pedi: infuse NS/LR wide open for 20ml/kg, then KVO
Spinal Cord Injury
adult: administer a 1000ml fluid bolus, repeat up to 30ml/kg of NS/LR IV as needed
peds: none listed
***OB & Neo***
General Obstetrics
mom bolus: 500ml NS/LR
mom maintenance: 150ml/hr NS/LR
Abruptio Placentae; Retained Placenta; Uterine Rupture
mom bolus: volume resuscitate as needed with IV fluid boluses
mom maintenance: NS/LR at 125ml/hr
Fetal Heart Rates/ Decelerations
mom: increase IV rate to 250ml/hr for one hour until FHR return to normal except with pulmonary edema
Hemorrhage During Pregnancy
mom: infuse IVF to maintain urine output >30ml/hr; for hypotension, repeat boluses of 250ml NS/LR
Pre-Term Labor; Tocolytics
mom bolus: 500-1000ml NS over 30-60min
mom maintenance: 125ml/hr NS
Neonatal Resuscitation; Neonatal Stabilization
neonate: 10ml/kg NS
***Peds***
(peds maintenance fluids with D5NS, see there)
Pediatric Altered Mental Status, Non-Traumatic; Pediatric Cardiac Arrest , PEA; Pediatric Infectious Respiratory Distress; Pediatric Reactive Airway Disease; Pediatric Sepsis/ Meningitis; Pediatric Shock; Pediatric SVT; Pedi VTach with Pulse
pedi: 20ml/kg NS IV bolus, repeat as needed
Pediatric Cardiogenic Shock
pedi: 10ml/kg warm NS/LR over 5-10min, repeat as needed
Pediatric Cyanotic Congenital Heart Disease
pedi: 20ml/kg warm NS/LR over 5-10min; repeat up to two times for a total of 60ml/kg
Pediatric Diabetic Ketoacidosis
pedi bolus: 10ml/kg NS, may repeat once
pedi maintenance: 1.5-2x 4-2-1 maintenance rate with NS
35
Ceftriaxone
(Rocephin)
Sepsis; Pediatric Sepsis/ Meningitis; Eye Injuries
adult & pedi: 50mg/kg up to max dose 2g IV
36
Acetaminophen
(Tylenol)
Sepsis, Febrile; Pediatric Infectious Respiratory Distress, Fever; Pediatric Sepsis/ Meningitis; Thyroid Storm
adult & pedi: 10-15mg/kg PO/PR up to max single dose 1000mg
37
Levetiracetam
(Keppra)
Seizures, Refractory; PIH/ Pre-Eclampsia/ Eclampsia/ HELLP Syndrome; Pediatric Seizure/ Status Epilepticus
adult & pedi: 40mg/kg (max dose 2000mg) IV over 10min (dilute in NS or D5W)
38
Potassium Chloride
Potassium Imbalance, Hypokalemia
adult & pedi w/ PIV: 10mEq/hr
adult w/ central line: 20mEq/hr
DKA with normal K (via Potassium Imbalance, Hypokalemia PCG)
adult & pedi: 10mEq/hr
Pediatric Diabetic Ketoacidosis, K <4.5
pedi: 10 mEq/hr
*with physician order only
39
Heparin
Peripheral Arterial Occlusion/ Ischemic Limb; Pulmonary Embolism
adult bolus: 80u/kg IV (max 7500u)
adult infusion: 18u/kg/hr IV (max 1800u/hr)
pedi: not listed
40
Alteplase
(Activase, TPA)
Ischemic Stroke/ TIA
adult: 0.9mg/kg (max 90mg), give 10% as IV bolus over 1min, infuse remainder over 1hr
pedi: not listed
*if initiated by sending facility
41
Dobutamine
(Dobutrex)
Hypotension, as Inotrope with Cardiogenic Shock; Pulmonary Edema/ CHF, for Inotropic Support
adult & pedi: 2-20mcg/kg/min IV
*pedi inidcation(s) not explicitly listed in Pediatric Shock nor Pediatric Cardiogenic Shock
42
Phenylephrine
Hypotension
adult: 100-180mcg/min IV
pedi: not indicated
Adult Push Dose Pressor; Airway Management Using RSI
adult: 200mcg IV and repeat every 2min
pedi: not indicated
43
Dopamine
Bradycardia
adult: 2-10mcg/kg/min IV
pedi: not indicated, see Pediatric Bradycardia
Hypotension, Neurogenic Shock; Pediatric Cardiogenic Shock; Pediatric Shock
adult & pedi: 2-20mcg/kg/min IV
*mix in D5W
44
Norepinephrine
(Levophed)
Hypotension, Septic & Cardiogenic Shock; Sepsis; Pediatric Shock, Warm/ Sepsis; Pediatric Cardiogenic Shock, Third Choice
adult, non weight-based: 2-30mcg/min (0.01-1mcg/kg/min)
adult & pedi, weight-based: 0.05-2mcg/kg/min
*only for peds >2 years of age
*mix in D5W
45
Glucagon
Hypoglycemia; Pediatric Altered Mental Status
adult: 1mg SQ/IM/IN
pedi: 0.5mg SQ/IM
neonate <5kg: 0.25mg IM
Overdose/ Poisoning/ Toxic Exposure, Beta Blocker Overdose
adult: 3-10mg IV/IN
pedi: 0.1mg/kg IV/IN, max single dose 10mg
46
Dextrose
Hypoglycemia; Pediatric Altered Mental Status; Neonatal Stabilization, BGL <40mg/dL
adult: 10g IV (D10 100ml)
pedi >2yrs: 0.2-0.5g/kg IV (D10 2-5ml/kg)
pedi <2yrs: 0.5-1g/kg IV (D10 5-10ml/kg)
- alternative not listed in PCGs would be D5 10-20ml/kg
neonate: 0.2g/kg IV (D10 2ml/kg)
- alternative not listed in PCGs would be D5 4ml/kg
*see below for D10 maintenance for neonates
Potassium Imbalance, Hyperkalemia
adult: 10% 10g IV (D10 100ml) with Regular Insulin
pedi: not mentioned
Neonatal Stabilization, BGL <40mg/dL
neonate bolus: 0.2g/kg IV (D10 2ml/kg)
- alternative not listed in PCGs would be D5 4ml/kg
neonate maintenance: 0.333g/kg/hr IV (D10 80ml/kg/day or 3.33 ml/kg/hr)
IV Fluid Therapy
adult & pedi: following acute resuscitation, consier dextrose containing maintenance fluid infusions
47
Vasopressin
(Vasostrict)
GI Bleed
adult: 0.2u/min IV
pedi: not listed
Hypotension, Refractory Septic Shock; Sepsis
adult: 0.03u/min IV
pedi: not listed
*mix in D5W or NS
48
Octreotide
(Sandostatin)
GI Bleed
adult: 50mcg IV bolus then infusion 50mcg/hr
pedi: not listed
*requires an order
49
Pantoprazole
(Protonix)
GI Bleed
adult: 80mg IV bolus then 8mg/hr
pedi: not listed
*requires an order
50
Famotidine
(Pepcid)
Allergic Reaction/ Anaphylaxis; Pediatric Allergic Reaction/ Anaphylaxis; GI Bleed
adult: 20mg IV
pedi: 0.25-0.5mg/kg up to 20mg IV
*administered by sending facility
51
Epoprostenol
(Flolan)
Epoprostenol Nebulization; Pulmonary Embolism
adult: usual dose 50ng/kg/min (based on IBW), approx 8ml/hr
pedi: not listed
*if initiated at sending
52
Racemic Epinephrine
Bronchospasm (Asthma & COPD); Pediatric Infectious Respiratory Distress, Stridor
adult: 2.25% 0.05ml/kg nebulized; max single dose 0.5ml in 3ml NS; may repeat every 20min PRN
pedi: 2.25% 0.05ml/kg nebulized; max single dose 0.5ml in 3ml NS; may repeat in 20min x1
also discussed in Inhalation Therapy
53
Ipratropium Bromide
(Atrovent)
Bronchospasm (Asthma & COPD); Pediatric Reactive Airway Disease
adult: 0.02% 0.5mg (2.5ml) nebulized, may be repeated x3 doses
pedi: 0.02% 0.5mg (2.5ml) to the initial albuterol, x1 dose
also discussed in Inhalation Therapy
54
Naloxone
(Narcan)
Altered Mental Status; Overdose/ Poisoning/ Toxic Exposure
adult: 0.4-2mg IV/IN; if no response, repeat dose
pedi >20kg: 0.1mg/kg IV/IN, max single dose 2mg
pedi <20kg: 0.01-0.1mg/kg IV/IN, max single dose 2mg
55
Regular Insulin
Adult DKA; Peds DKA
adult: 0.1u/kg/hr IV
pedi: 0.05-0.1u/kg/hr IV
Potassium Imbalance, Hyperkalemia
adult: 10u IV with Dextrose
pedi: not listed
Sepsis
adult & pedi: up to 0.1u/kg/hr
*if initiated at sending
56
Albuterol
Bronchospasm (Asthma & COPD); Allergic Reaction/ Anaphylaxis; Pediatric Reactive Airway Disease
adult & pedi: 2.5mg via nebulizer, repeat as needed
adult continuous: 5-10mg/hr via nebulizer
pedi continuous: 0.3mg/kr/hr via nebulizer, max 10mg
Near Drowning; Burns: Thermal and Chemical
adult & pedi: 2.5mg via nebulizer
Potassium Imbalance, Hyperkalemia
adult: 5mg via nebulizer, may repeat
pedi: not listed
also discussed in Inhalation Therapy
57
Dexamethasone
(Decadron)
Bronchospasm (Asthma & COPD)
adult: 10mg IV
*see pedi doses below
Allergic Reaction/ Anaphylaxis; Pediatric Infectious Respiratory Distress, Croup; Pediatric Reactive Airway Disease
adult & pedi: 0.6mg/kg IV up to max dose 10mg
Sodium Imbalance, Hyponatremia w/ Adrenal Insufficiency
adult: 10mg IV every 12hrs
pedi: not listed
Adrenal Insufficiency/ Addisonian Crisis
adult: 4mg every 12hrs
pedi: not listed
Thyroid Storm w/ Sepsis
adult: 2mg IV/PO every 6hrs
pedi: not listed
Sepsis & Pediatric Sepsis, Refractory Hypotension
adult: 10mg IV
pedi: 0.6mg/kg IV up to max single dose 10mg
58
Procainamide
Wide Complex Tachycardia with a Pulse
adult: 20mg/min IV, may repeat; max total dose 17mg/kg
adult infusion with conversion: 2-4mg/min IV
pedi: not listed
Pediatric SVT, Unstable & After Cardioversion
pedi: 15mg/kg IV over 30-60min, max single dose 100mg
59
Enalapril
Pulmonary Edema/ CHF
adult: 1.25mg IV
pedi: not listed
*DO NOT administer if inferior wall changes are note don 12-lead EKG
60
Furosemide
(Lasix)
Pulmonary Edema/ CHF; Pediatric Cardiogenic Shock; Pediatric Cyanotic Congenital Heart Disease, with Fluid Overload
adult: 40mg IV single dose
pedi: 1mg/kg IV, max dose 20mg
*for Pulm Edema/ CHF: third line of therapy; DO NOT give if patient hypotensive
61
Milrinone
Pulmonary Edema/ CHF; Pediatric Cardiogenic Shock
adult & pedi: 0.25-0.75mcg/kg/min
*if initiated by sending
62
Adenosine
(Adenocard)
PSVT, Stable, Narrow; Pediatric SVT
adult: 6mg rapid IV push with 20ml flush; if SVT persists, repeat at 12mg; may repeat a second 12mg dose
pedi: 0.1mg/kg rapid IV push, max dose 6mg, with 20ml flush; may be repeated at 0.2mg/kg, max dose 12mg; may repeat once at this dose
Wide Complex Tachycardia, Regular, Monomorphic
adult: 6mg rapid IV push with 20ml flush; no repeat dose info listed
pedi: not listed
63
Magnesium Sulfate
Cardiac Arrest, Torsades; Pediatric Cardiac Arrest; Overdose/ Poisoning/ Toxic Exposure, Na-Channel Blocker Overdose with Torsades
adult: 2g IV over 2min
pedi: 50mg/kg IV, max dose 2g
Magnesium Imbalance, Hypomagnesemia
adult: 2g IV over 30min
pedi: 50mg/kg, max 2g, over 30min
VTach with Pulse, Torsades or Hypomagnesemic State; Pediatric Vtach with Pulse - Torsades
adult: 2g IV over 2min
pedi: 50mg/kg IV as an initial therapy, max dose 2g, then proceed with traditional VT therapies
Bronchospasm (Asthma & COPD); Pediatric Reactive Airway Disease
adult: 2g IV over 10min
pedi: 50mg/kg IV over 10min, max single dose 2mg
PIH/ Pre-Eclampsia/ Eclampsia, HELLP
- Seizure Prevention
mom: 4g IV bolus over 20min, then 2-4g/hr
- Seizure Activity
mom: 4g IV bolus, then 2-4g/hr
Tocolytics
mom: 4g IV bolus over 20min, then 2-4g/hr; may be increased every 10-15min to max 4g/hr
*random fact: can be mixed with either D5W or D5NS
64
Calcium Gluconate
Cardiopulmonary Arrest, PEA
adult: 1g IV push
pedi: not listed
Potassium Imbalance, Hyperkalemia
adult: 1g slow IV over 5min, repeat every 10min
pedi: not listed
*with digitalis toxicity, add dose to 100ml NS and infuse over 20min
Magnesium Imbalance, Hypermagnesemia
adult: 1-2g IV over 1-2min
pedi: not listed
*with digitalis toxicity, more caution is required
Overdose/ Poisoning/ Toxic Exposure, Ca-Channel Blocker Overdose
adult: 1g slow IV over 5min, repeat every 10min
pedi: 60mg/kg, max dose 1g, administered over 30min
PIH/ Pre-Eclampsia/ Eclampsia/ HELLP Syndrome, Magnesium Toxicity; Tocolysis, Magnesium Toxicity
mom: 1-2g over 1-2min
Pediatric Shock, Hypocalcemia
pedi: 60-100mg/kg IV via peripheral line, over 30min, max dose 1g
Blood Products Administration, After 2 Units Any Product
adult: 2g IV over 10min
pedi: 60-100mg/kg, max 2g, at 200mg/min
65
Sodium Bicarbonate
Cardiac Arrest, PEA; Potassium Imbalance, Hyperkalemia
adult: 8.4% 50mEq IV
pedi: not listed
Overdose/ Poisoning/ Toxic Exposure, Na-Channel Blocker Overdose
adult & pedi: 1mEq/kg IV, max 50mEq
adult: mix 40mEq of 8.4% (40ml) into 210ml D5W (remove 40ml from the 250ml bag before adding) and administer 250ml over 1hr
pedi: mix 40mEq of 8.4% (40ml) into 210ml D5W (remove 40ml from the 250ml bag before adding) and administer at maintenance fluid rate (per 4:2:1 Rule)
*note that there is conflicting information on dose in this PCG
Crush Syndrome
- Prior to Extrication
adult: 8.4% 50mEq IV x1
pedi: 8.4% 1mEq/kg IV x1, max 50mEq
neonate: 4.2% 1mEq/kg IV x1 (50% dilution)
- Following Extrication
adult: mix 40mEq of 8.4% (40ml) into 210ml D5W (remove 40ml from the 250ml bag before adding) and administer 250ml over 1hr
pedi: mix 40mEq of 8.4% (40ml) into 210ml D5W (remove 40ml from the 250ml bag before adding) and administer at maintenance fluid rate (per 4:2:1 Rule)
also mentioned in both Burns: Thermal & Chemical & Burns: Electrical & Lightning Injury to alkalinize the urine in rhabdo, no specifics given
66
Lidocaine
(all of these refer to 2% as found in pre-loads unless otherwise noted)
Cardiac Arrest, VFib/ pVTach; Pediatric Cardiac Arrest, VFib/ pVTach
adult bolus: 1.5mg/kg IV, may repeat in 3-5min; max dose 3mg/kg
adult infusion with conversion: 1-4mg/min IV
pedi bolus: 1mg/kg IV, max dose 100mg, repeated every 5min as needed at 0.5mg/kg IV until dysrhythmia is suppressed or 3mg/kg have been given (initial + 4 repeat doses)
pedi infusion with conversion: 20-50mcg/kg/min IV
Wide Complex Tachycardia with Pulse, WT with Pulse; Pedi VTach with Pulse
adult bolus: 1-1.5mg/kg IV, may repeat every 5min; max dose 3mg/kg
adult infusion with conversion: 1-4mg/min IV
pedi bolus: 1mg/kg IV, max dose 100mg, repeated every 5min as needed at 0.5mg/kg IV until dysrhythmia is suppressed or 3mg/kg have been given (initial + 4 repeat doses)
pedi infusion with conversion: 20-50mcg/kg/min IV
Intraosseous Infusion - Adult & Pediatric
adult: 40mg IO over 120s, then allow to dwell in IO space for 60s more before flush
pedi: 0.5mg/kg, max 40mg, over 120s, then allow to dwell in IO space for 60s more before flush
also mentioned in Tube Thorocostomy Insertion: 1-2%, 4-7ml total
67
Epinephrine
Push Dose Pressors (PDP); Pediatric Push Dose Pressor (PDP)
adult & pedi: 1mcg/kg, max 10mcg (1ml), q 2min
*to mix: begin with Epi 0.1mg/ml (1:10,000); add 1ml to 9ml NS --> 10mcg/ml
Bradycardia; Pediatric Bradycardia
adult infusion (non weight-based): 2-10mcg/min IV
adult & pedi infusion (weight-based): 0.05-1mcg/kg/min IV
pedi bolus: 0.01mg/kg IV (0.1ml/kg of 0.1mg/1ml or 1:10,000 concentration), max dose 1mg, repeated every 3-5min
Cardiopulmonary Arrest; Pediatric Cardiac Arrest
1mg/10ml (0.1mg/ml; 1:10,0000)
adult: 1mg IV, repeat every 3-5min
pedi: 0.01mg/kg IV (0.1ml/kg), max dose 1mg, repeated every 3-5min
pedi ETT dose: 0.1mg/kg
Adult Allergic Reaction/ Anaphylaxis; Pediatric Allergic Reaction/ Anaphylaxis; Pediatric Reactive Airways Disease, Allergic Reaction
- bolus w/ 1mg/1ml (1:1000)
adult: 0.3-0.5mg IM every 15min x3 doses
pedi: 0.01mg/kg (0.01ml/kg) IM up to max single dose 0.3mg, every 3-5min, anterior thigh is preferred
*in Peds Reactive Airways, Allergic Reaction, max dose is 0.5mg and can be repeated q 20min PRN x3 total doses
- bolus w/ 1mg/10ml (0.1mg/ml; 1:10,000)
adult: 0.1-0.5mg (1-5ml) over 5min
pedi: 0.01mg/kg (0.1ml/kg) IV up to a max single dose of 1mg, may repeat as needed
- infusion w/ concurrent shock or bradycardia (adult) or severe distress (pedi)
adult infusion (non weight-based): 2-10mcg/min IV
adult & pedi infusion (weight-based): 0.1-1mcg/kg/min IV
Bronchospasm (Asthma & COPD)
1mg/1ml (1:1000)
adult: 0.3mg (0.3ml) IM
pedi: only in allergic reaction as noted above
Hypotension, Anaphylactic & Septic Shock; Sepsis; Pediatric Shock; Pediatric Cardiogenic Shock
adult infusion (non weight-based): 2-10mcg/min IV
adult & pedi infusion (weight-based): 0.05-1mcg/kg/min IV
Neonatal Resuscitation
1mg/10ml (0.1mg/1ml; 1:10,000)
neonate: 0.02mg/kg (0.2ml/kg) IV/IO
neonate ETT dose: 0.1mg/kg (1ml/kg), max 0.3mg (3ml), repeat every 3-5min
68
Atropine
Bradycardia; Pediatric Bradycardia
adult: 0.5-1mg IV may repeat to max dose 0.04mg/kg
pedi: 0.02mg/kg IV to max 1mg, may repeat x1 to max dose 0.04mg/kg
RSI, Premedication (Pedi <1y/o & HR <160); Neonatal/ Infant RSI
pedi & neonate: 0.02mg/kg IV to max 1mg, may repeat x1 to max dose 0.04mg/kg
Overdose/ Poisoning/ Toxic Exposure, Organophosphate/ Cholinergic Poisoning
adult: 2mg repeated until symptoms reversed
pedi: 0.05mg/kg, max 2mg, repeated until symptoms reversed
69
Amiodarone
Atrial Fibrillation/ Atrial Flutter
adult: 150mg IV over 10min
pedi: not listed, refer to Pediatric SVT
PSVT, Stable & Wide (after Adenosine); Pediatric SVT, Unstable & After Cardioversion;
Wide Complex Tachycardia with Pulse; Pedi VTach with Pulse
adult bolus: 150mg IV over 10min
adult infusion: wirth conversion, 60mg/hr IV x6hrs, then 30mg/hr x18hrs; if SVT recurs, may repeat 150mg IV over 10min one time
pedi bolus: 5mg/kg IV, max 150mg, over 20min, may repeat 2x to max daily of 15mg/kg
pedi infusion: not listed
Cardiac Arrest, VFib/ pVTach; Pediatric Cardiac Arrest,
adult bolus: 300mg IV push, may repeat at 150mg
adult infusion: with conversion, 60mg/hr IV x6hrs, then 30mg/hr x18hrs
pedi bolus: 5mg/kg IV, max 300mg, may repeat to max daily dose of 15mg/kg
pedi infusion: not listed
70
Metoprolol
(Lopressor)
Atrial Fibrillation/ Atrial Flutter; Thoracic Aortic Dissection; Thyroid Storm
adult: 5mg IV over 2min, may repeat x2 until a total of 15mg
pedi: not listed
71
Diltiazem
(Cardizem)
Atrial Fibrillation/ Atrial Flutter
adult initial dose: 0.25mg/kg IV over 2min, max 20mg; if not effective in 15min a second dose
adult second dose: 0.35mg/kg IV pver 2min, max 25mg
adult infusion: if bolus doe(s) effective, 5mg/hr IV and titrate to max 15mg/hr
pedi: not listed
72
Nitroglycerin
(Nitrostat)
ACS; STEMI
adult bolus: 0.4mg SL every 5min
adult infusion: 10mcg/min and titrate to max 200mcg/min
pedi: not listed
Pulmonary Edema/ CHF
adult bolus: 0.4mg SL every 5min
adult infusion: 40mcg/min and titrate to max 200mcg/min
pedi: not listed
*mix in D5W
73
Acetylsalicylic Acid
(Aspirin)
ACS; STEMI
adult: 162-324mg PO
pedi: not listed
74
Etomidate
(Amidate)
Sedation of the Patient, Severe Agitation
adult & pedi: 10mg IV x1 dose
RSI - Induction; Neonatal/ Infant RSI
adult & pedi: 0.3mg/kg IV, max 40mg
neonate: 0.2-0.3mg/kg, max 40mg
75
Rocuronium
(Zemuron)
RSI - Paralysis; Neonatal/ Infant RSI; Post-Intubation
adult & pedi: 0.6-1.2mg/kg IV, usual dose is 1mg/kg
76
Lorazepam
(Ativan)
Seizures; Pediatric Seizures/ Status Epilepticus
adult: 4mg IV, repeat as necessary every 2-5min
pedi: 0.1mg/kg IV, max 4mg, may repeat every 2-5min as needed
PIH/ Pre-Eclampsia/ Eclampsia/ HELLP Syndrome, Seizure Activity >2min
mom: 2-4mg IV, repeat as necessary every 2-5min
Sedation of the Patient
adult: 1-2mg IV, may repeat in 15min as necessary
pedi: 0.05-0.1mg/kg IV, max 2mg, may repeat in 3-5min
Post-Intubation Sedation
adult: 1-2mg IV, may repeat in 15min as necessary
pedi: 0.05-0.1mg/kg IV, may repeat in 3-5min; max single dose 2mg for >5y/o and 1mg for <5y/o
infusion: if initiated by sending, 0.05-0.1mg/kg/hr
Hypertensive Emergency, Sympathomimetic Use
adult: 1-4mg IV, may repeat in 15min as necessary
pedi: not listed
77
Midazolam
(Versed)
Seizures; PIH/ Pre-Eclampsia/ Eclampsia/ HELLP Syndrome, Seizure Activity >2min; Pediatric Seizures/ Status Epilepticus
adult: 5mg IV/IN or 10mg IM, repeat as necessary every 2-5min
pedi: 0.05-0.2mg/kg IV/IM/IN, max single dose 5mg IV/IN or 10mg IM
Sedation of the Patient
adult: 2.5-5mg IV/IM/IN, may repeat in 3-5min
pedi: 0.05-0.1mg/kg IV/IM/IN, max 5mg
Post-Intubation Sedation
adult: 2.5-5mg IV, may repeat in 3-5min; consider lower dose in age >60 or chronically ill
pedi: 0.05-0.1mg/kg IV, max 5mg, may repeat in 3-5min
infusion: if initiated by sending, 0.05-0.1mg/kg/hr
ROSC/ Targeted Temperature Management
adult: 2mg IV every 10min to a max total dose of 10mg
pedi: not listed
Hypertensive Emergency, Sympathomimetic Use
adulti: 2.5-5mg IV/ IM/ IN, may repeat in 3-5min
pedi: not listed
78
Propofol
(Diprovan)
Post-Intubation Sedation
adult & pedi: if initiated by sending, 5-200mcg/kg/min; usual dose is 5mcg/kg/min; titrate by 5mcg/kg/min every 5-10min; usual maintenance 5-80mcg/kg/min
*no Propofol IV bolus allowed
79
Hydromorphone
(Dilaudid)
Pain Management
adult: 0.5-1mg IV
pedi: not listed
*if available at sending and only with shortage of other agents
80
Morphine
Pain Management
adult: 2-5mg IV, may repeat every 5-10min
pedi: 0.1mg/kg IV, max 5mg, may repeat every 5-10min
81
Ketamine
Pain Management
adult & pedi: 0.1-0.25mg/kg IV, may repeat every 10 minutes
Post-Intubation Sedation
adult & pedi: 0.5-1mg/kg IV, may repeat every 10min
adult infusion: if initiated by sending, 0.1-0.5mg/min
Sedation of the Patient, Severe Agitation
adult & pedi: 0.5-1mg/kg IV, may repeat x1 or 4mg/kg IM x1 dose
RSI - Induction; Neonatal/ Infant RSI; Pediatric Reactive Airways Disease, RSI
adult & pedi: 1-2mg/kg IV or 4 mg/kg IM
General/ Multi-System Trauma, Extrication
adult & pedi: 1-2mg/kg IV/IN or 4mg/kg IM
82
Fentanyl
Pain Management
adult & pedi bolus: 0.5-1mcg/kg slow IV/IN, max 100mcg, may repeat every 3-5min
adult & pedi infusion: for intubated patients only, if started by sending facility, 1-2mcg/kg/hr
ROSC/ Targeted Temperature Management, for Shivering
adult: 25-50mcg IV push every 10min as needed to max total dose of 2mcg/kg IV (then proceed to non-depolarizing neuromuscular blocker)
pedi: not listed
83
Diphenhydramine
(Benadryl)
Allergic Reaction/ Anaphylaxis
adult: 50mg IV or deep IM
pedi: 1mg/kg, max single and total dose 50mg
neonates: do not give to premature infants/ newborns
Management of the Nauseated Patient, Reaction after Metoclopramide
adult: 25-50mg IV
pedi: 1mg/kg IV, max 50mg
neonates: do not give to premature infants/ newborns
84
Metoclopramide
(Reglan)
Management of the Nauseated Patient
adult: 10mg IV slow
pedi: 0.1-0.2mg/kg IV slow, max single dose 10mg
85
Ondansetron
(Zofran)
Management of the Nauseated Patient
adult: 4mg IV/IM/SL, may repeat after 10 min as needed
pedi: 0.1mg/kg IV, max 4mg
*also mentioned in Eye Injuries, conssider prophylactic treatment for nausea and vomiting
Flight Program Medications
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