Pediatric Code Meds

General Code Meds

Allergy
Analgesia
Asthma/Croup
Drips
Hyperkalemia
Hypocoagulation
Hypertension
Hypoglycemia
Ingestion
Intubation
Meningitis/Sepsis
Sedation
Seizures/Increased ICP
 

General Code Meds:
 
 
Drug Dose Route
Epinephrine 0.01 mg/kg (1:10000) IM IV IO
Epinephrine 0.1 mg/kg (1:1000) (ET)
Atropine 0.02 mg/kg 
min: 0.1 mg/dose; 
max 0.5 mg/dose child 
max 1 mg/dose adolescent
IM IV ET IO
Bretylium 5-10 mg/kg IV IO
Bicarbonate 1-2 mEq/kg IV IO
CaCl2 10-20 mg/kg Central IV, IO
Calcium gluconate 30-60 mg/kg IV IO
25% dextrose 2-4 cc/kg IV IO
10% dextrose 5-10 cc/kg IV IO
Diazepam 0.1-0.3 mg/kg IV IO
3% NaCl 2 cc/kg IV IO
Lidocaine 1 mgkg IV IO
Naloxone 0.1 mg/kg IV IM ET IO
 

Drips
 
Dopamine 2 - 20 mcg/kg/min
Dobutamine 2 - 20 mcg/kg/min
Epinephrine 0.05 - 2 mcg/kg/min
Isoproterenol 0.05 - 2 mcg/kg/min
Nitroprusside 0.2 - 5 mcg/kg/min
Lidocaine 20 - 50 mcg/kg/min
Prostaglandin E1 0.05 - 2 mcg/kg/min
 

 
Allergy
 
Epinephrine 0.01cc/kg SC 1:1000 (max 0.3cc)
Diphenhydramine 1-2 mg/kg IV
Hydrocortisone 1-2 mg IV
 

Analgesia
 
Acetaminophen 10-15 mg/kg/dose q 4-6 hours
Codeine 0.5-1 mg/kg/dose IM SC PO q 4-6 hours
Fentanyl 1-2 mcg/kg/dose IV IM q 1-2 hours
Ketorolac Load 1 mg/kg (max 30 kg) 
Maintain at 0.5 mg/kg/dose q 6 hours, no more than 5 days 
Adult dose = 60 mg load, then 30 mg q 6 hours
Meperedine 1-1.5 mg/kg/dose q 3-4 hours PO, IM, IV, SC
Morphine 0.05-0.2 mg/kg IV q 2-4 hours (max 15 mg)
 
Asthma/Croup
 
Nebulized Solutions  
Solution Formulation < 10 kg 10-20 kg > 20 kg
Albuterol 0.5% 0.15 cc 0.25-0.5 cc 0.75 cc
Alupent 0.5% 0.10 cc 0.20 cc 0.30 cc
Terbutaline 0.1% 0.25 cc 0.5 cc 1.0 cc
Racemic Epi 2.0% 0.25 cc 0.50 cc 0.75 cc
Nebulize above solutions in 3 cc NS
Continuous Nebs 0.15-0.5 mg/kg/hour of Albuterol or Terbutaline
 
Aminophylline Load with 5-8 mg/kg IV followed by 1.0 mg/kg IV drip and titrate for approximate levels (10-20)
Solumedrol 1-2 mg/kg IV bolus followed by 1-2 mg/kg/dose
Atropine 0.05 mg/kg/dose neb (max 1 mg)
Epinephrine (1:1000) 0.01 mg/kg SC (max 0.3 cc)
Terbutaline 0.01 mg/kg/dose SC or 0.03 mg/kg/dose (max 0.4 mg) NEB
IV Terbutaline load 10 mcg/kg (5 minutes) then 0.4 mcg/kg/min
 

Hypocoagulation
 
FFP 10 cc/kg IV to restore coagulation
Protamine For heparin reversal:  1mg for q 100 Units heparin (max 50 mg)
Vitamin K For coumadin OD:  1-2 mg/dose IM SC q 4-8 or FFP as above
Cryoprecipitate 10 cc/kg IV (provides fibrinogen as well as factors)
 
Hypoglycemia (consider drawing blood for insulin, glucagon and GH levels)
 
Dextrose 2-3 cc/kg D25 IV or 5-10 cc (0.5 - 1 cc/gk) of D10
Glucagon 0.1 mg/kg IM IV SC q 30 min (max 1 mg)
 
Hyperkalemia
 
NaHCO3 1-3 mEq/kg IV over 3-5 minutes
Calcium Gluconate (10%) 0.2-0.5 cc/kg IV over 2-5 minutes
Glucose 0.5 g/kg (1cc of D50/kg or equivalent) with 0.3 units insulin per gram glucose IV over 1-2 hours
Kayexelate 1-2 g/kg/dose with 3 cc sorbitol/g q 6 hours PO (or PR q 4-6 hours)
 
Hypertension
 
Diazoxide 3-5 mg/kg/dose IV FAST q 5-15 minutes x 2-3 doses
Labetalol 1-3 mg/kg/hr IV drip
Nifedipine 0.25 - 0.5 mg/kg/dose PO
Nitroprusside 0.5-10 mg/kg/min IV drip
Phentolamine 0.1-0.2 mg/kg IV (pheochromocytoma)
 

Ingestion
 
Charcoal 0.5-1 g/kg 1:40 with 70% sorbitol PO/NG
Ipecac Syrup
< 1 yr 10 cc
1-12 yr 15-30 cc
> 12 yr 30-60 cc
q20 minutes x 2, not for caustics
 
 
Intubation
 
Atropine 0.01-0.02 mg/kg
Midazolam 0.1 - 0.3 mg/kg
Ketamine 1-2 mg/kg
Fentanyl 5 mcg/kg
Thiopental 2-4 mg/kg
Etomidate
Succinylcholine 1-2 mg/kg
Atracurium 0.5 mg/kg
Vecuronium 0.3 mg/kg
Pancuronium 0.1-0.2 mg/kg
Rocuronium
 
 

Meningitis/Sepsis
 
Ampicillin 200-400 mg/kg/day div q4-6h (max 2-4 g/d)
Cefotaxime 150 mg/kg/day div q8h
Ceftriaxone 100 mg/kg/day div q 24h (max 4g/d)
Decadron 0.15 mg/kg/dose IV q 6 hours x 4 days (prior to abx if possible)
Gentamicin 2.5 mg/kg/dose q 8 hours (pk 6-10, tr < 2)
Vancomycin 10-15 mg/kg/dose IV q 8-24h (pk 25-40, tr <10)
 
Sedation
 
Chloral Hydrate 50-100 mg/kg PO/PR max 2 grams
Diazepam 0.05-0.2 mg/kg/dose IV
Ketamine 0.5-1 mg/kg IV or 3-7 mg/kg IM
Midazolam 0.05-0.2 mg/kg/dose IV
Thiopental 2-4 mg/kg IV
 
Seizures/Increased ICP
 
Diazepam 0.05-0.2 mg/kg/dose IM or IV
Midazolam 0.05-0.2 mg/kg/dose IM or IV
Phenytoin 15-20 mg/kg/dose IV (max 1g/24 hours)
Lorazepam 0.05-0,1 mg/kg/dose IV q15-20 minutes
Mannitol 0.25-1 g/kg IV q 5 minutes
Decadron 0.5-1.0 mg/kg IV
 
Emergency Pediatrics
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Last modification: September 27, 1998