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LCCH Emergency Resuscitation Infusion Guide

Drug & Presentation Reconstitution & Final drug Dosage range Route & Administration Comments Dilution concentration inj See N-Acetylcysteine (NAC) adrenaline 1:1000 1mg in 50mL 0.02mg/mL 0.01 to 2 microg/kg/min IV infusion Central Line with 0.9% NaCl / 5% glucose Incompatible with Bicarbonate alPROStadil (PGE1) 100microg in 50mL 2microg/mL 0.01 to 400 nanog/kg/min IV infusion Stored in fridge (prostaglandin) with 0.9% NaCl (equals 2000 nanog/mL) May cause apnoea amINOPHYLLIne inj LOAD 250mg in 50mL 5mg/mL Asthma LOAD: IV infusion of exact dose Alkaline (ph 8.6-9) with 5% Glucose / 5 mg/kg over 30 to 60 mins 0.9% NaCl amINOPHYLLIne INFUS 250mg in 50mL 5mg/mL 0.5 to 1.5 mg/kg/hr IV infusion of exact dose Alkaline (ph 8.6-9) with 5% Glucose / Usually 10mg/kg over 30- over 60 mins NOTE: Usually initiated at PICU 0.9% NaCl 60mins discretion amIODARone CVL(<45kg) 300mg in 50mL 6mg/mL 5 to 15 microg/kg/min IV infusion Incompatible with with 5% glucose solutions amIODARone CVL(>45kg) 300mg in 50mL 6mg/mL 0.01 to 37 mg/hr IV infusion Monitor ECG and with 5% glucose amIODARone PERIPH 100mg in 50mL 2mg/mL 5 to 15 microg/kg/min IV infusion Incompatible with sodium chloride (<45kg) with 5% glucose solutions

Monitor ECG and blood pressure amIODARone PERIPH 900mg in 450ml 2mg/mL 0.01 to 37 mg/hr IV infusion (>45kg) with 5% glucose CHLORide 6.8mmol in 10mL 0.68mmol/mL 0.01 to 0.61 mmol/kg/hr IV infusion Central Line only (CVL only) with 5% glucose / 0.9% NaCl

LCCH Emergency Resuscitation Infusion Guide - 1 - Version 3, 22 March 2015. Review date: 22 March 2017 Reviewed by: T Flanagan, F Thomson, K Trenoweth, S Leahy, C Furler, M Cree, A Paton Drug & Presentation Reconstitution & Final drug Dosage range Route & Administration Comments Dilution concentration calcium GLUCONate 2.2mmol in 20mL 0.11mmol/mL 0.01 to 0.61 mmol/kg/hr IV infusion Cease if bradycardic with 5% glucose / over 10-60 mins 0.9% NaCl Calcium concentration in is three times more than that in calcium gluconate desFERRioxamine 2000mg in 50mL 40mg/mL 1 to 15 mg/kg/hr IV infusion Rapid IV injection can cause severe with 5% glucose / and shock 0.9 % NaCl DOBUTamine 75mg in 50mL 1.5mg/mL 0.01 to 30 microg/kg/min IV infusion May be given via peripheral IV if (CVL preferred) with 5% glucose / no central access 0.9% NaCl

DOPamine 60mg in 50mL 1.2mg/mL 0.01 to 30 microg/kg/min IV infusion Central Line (CVL preferred) with 5% glucose / 0.9% NaCl eSMOlol 500mg in 50mL 10mg/mL 50 to 1000 microg/kg/min IV infusion with 5 % glucose / 0.9% NaCl fentanYL 500 microg in 50mL 10microg/mL 0.5 to 4 microg/kg/hr IV infusion with 5% glucose / 0.9% NaCl fentaNYL >45kg 1000microg in 20microg/mL 1 to 50 microg/hr IV infusion 50mL with 5% glucose / 0.9% NaCl frusemide 100mg in 50mL 2mg/mL 0.01 to 3 mg/kg/hr IV infusion of exact dose Alkaline (pH 8-9.3) with 5% glucose / over 20 min 0.9% NaCl insulin (ACTRAPID) 50units in 50mL 1unit/mL 0.01 to 0.3 units/kg/hr IV infusion STORED IN FRIDGE with 0.9% NaCl

Ketamine 200mg in 50mL 4mg/mL 0.5 to 10 microg/kg/min IV infusion See Ketamine Procedure with 5% glucose / http://qheps.health.qld.gov.au/childrenshealth/resources/proc/docs/proc_01004.pdf 0.9% NaCl 

LCCH Emergency Resuscitation Infusion Guide - 2 - Version 3, 22 March 2015. Review date: 22 March 2017 Reviewed by: T Flanagan, F Thomson, K Trenoweth, S Leahy, C Furler, M Cree, A Paton Drug & Presentation Reconstitution & Final drug Dosage range Route & Administration Comments

Dilution concentration magnesiumSULF INFUS 10mmol in 20mL 0.5mmol/mL 0.01 to 0.5 mmol/kg/hr IV infusion of exact dose properties and may with 5% glucose / over 30 min cause hypotension in high doses

0.9% NaCl MIDazolam 10mg in 50mL 0.2mg/mL 1 to 60 microg/kg/hr IV infusion with 5% glucose / 0.9% NaCl BB default bolus 20microg/kg MIDazolam STRONG 50mg in 50mL 1mg/mL 1 to 60 microg/kg/hr IV infusion Consider strong solution when with 5% glucose / weight is above 20kg or fluid 0.9% NaCl BB default bolus restriction is required 20microg/kg morphine 5mg in 50mL 0.1mg/mL 5 to 60 microg/kg/hr IV infusion with 5% glucose / 0.9% NaCl BB default bolus 20microg/kg morphine STRONG 30mg in 50mL 0.6mg/mL 5 to 60 microg/kg/hr IV infusion Consider strong solution when with 5% glucose / weight is above 20kg or fluid 0.9% NaCl BB default bolus restriction is required 20microg/kg N-Acetylcysteine inj 2g in 10mL vial diluted in 5% glucose per See below (See below for weight-based instructions infusion instructions) See Guidelines for the management of in Australia and New Zealand - explanation and elaboration available via QPIC website: http://www.health.qld.gov.au/poisonsinformationcentre/professionals.asp ALT and serum paracetamol monitoring required per guideline ST ND RD 1 DOSE 2 DOSE 3 DOSE N-Acetylcysteine inj (<20kg) Observe for anaphylactoid reaction 150mg/kg diluted in 50mg/kg diluted in 100mg/kg diluted in IV Infusion 3mL/kg over 15 mins 7mL/kg over 4 hours 14mL/kg over 16 hours BP, HR, O2 sat every 15 mins for the first hour of infusion N-Acetylcysteine inj 150mg/kg diluted in 50mg/kg diluted in 100mg/kg diluted in (Maximum concentration (20-50kg) 100mL over 15 mins 250mL over 4 hours 500mL over 16 hours 50mg/mL) N-Acetylcysteine inj (>50kg) 150mg/kg diluted in 50mg/kg diluted in 100mg/kg diluted in 200mL over 15 mins 500mL over 4 hours 1000mL over 16 hours

LCCH Emergency Resuscitation Infusion Guide - 3 - Version 3, 22 March 2015. Review date: 22 March 2017 Reviewed by: T Flanagan, F Thomson, K Trenoweth, S Leahy, C Furler, M Cree, A Paton Drug & Presentation Reconstitution & Final drug Dosage range Route & Administration Comments

Dilution concentration 200microg in 50mL 4microg/mL 0.01 to 40 microg/kg/hr IV infusion Consider bolus doses as an with 5% glucose / alternative 0.9% NaCl NORadrenaline 1mg in 50mL 0.02mg/mL 0.01 to 2 microg/kg/min IV infusion CENTRAL ACCESS (CVL preferred) with 5% glucose Octreotide 500microg in 10mL 50microg/mL 0.01 to 10 microg/kg/hr IV infusion Maximum 50microg/hr with 5% dextrose / 0.9% NaCl Chloride Pre-mixed bags 20 to 40 mmol/L 0.1 to 0.3mmol/kg/hr IV Infusion NOTE: See CHQ Potassium guideline available (Max 40mmol/L via up to max 20mmol/hr peripheral line) (Max 0.5mmol/kg/hr up to 40mmol/hr with PICU consult, ECG monitoring) propOFol 500mg in 50mL NEAT 10mg/mL 0.5 to 2 mg/kg/hr IV infusion NOTE: Ventilation usually required Caution in patients under 3 years old salBUTamol (obstetric 50mg in 50mL NEAT 1mg/mL 0.01 to 10 microg/kg/min IV infusion Cardiac and electrolyte monitoring solution) STRONG sodium BICARB CVL 25mmol in 50mL 0.5mmol/mL 0.01 to 2 mmol/kg/hr IV infusion CENTRAL ACCESS with 5% glucose / NOT compatible with other 0.9% NaCl medications sodium BICARB PERIPH 5mmol in 50mL 0.1mmol/mL 0.01 to 2 mmol/kg/hr IV infusion NOT compatible with other with 5% glucose / medications 0.9% NaCl thioPENTone 500mg in 50mL 10mg/mL 0.01 to 6 mg/kg/hr IV infusion NOTE: Ventilation usually required with 5% glucose / Monitor for hypotension 0.9% NaCl This Medication Guide is designed to support nursing staff in the preparation and delivery of medications and is aligned with Metavision and Bbraun medication safety drug profiles. It does not replace indepentant double checking of medication or prescriptions. Utilisation of medication references and resources is recommeneded.

References used in the preparation of this guide include: Paediatric Pharmacopeia ; British National Formulary, Trissels, Micromedex, Australian Injectable Handbook, Frank Shann Formulary, Up To Date, Teddy Bear Paediatric Medication Book, MIMS, Relevant protocols from Royal Children's Melbourne, Royal Children's Brisbane and Mater Children's Hospitals.

LCCH Emergency Resuscitation Infusion Guide - 4 - Version 3, 22 March 2015. Review date: 22 March 2017 Reviewed by: T Flanagan, F Thomson, K Trenoweth, S Leahy, C Furler, M Cree, A Paton