<p> VIRGINIA COMMONWEALTH UNIVERSITY MEDICAL CENTER PEDIATRIC CODE BLUE EMERGENCY DRUGS PATIENT LABEL (BY AGE AND WEIGHT) PATIENT’S WEIGHT (kg): ______</p><p>EPINEPHRINE AMIODARONE EPINEPHRINE ADENOSINE ATROPINE Calcium NALOXONE Intravenous (IV) [50 mg/mL] Endotracheal (ET) [3 mg/mL] [0.1 mg/mL] WEIGHT Chloride 10% [1 mg/mL] [1:10,000] 5 mg/kg [1:1000] 4.2% NaHCO3 8.4% NaHCO3 0.1 mg/kg to 0.02 mg/kg to (KG) [100 mg/mL] 0.1 mg/kg (T’, S) AGE 0.01 mg/kg to Dilute prior to 0.1 mg/kg to MAX [0.5 mEq/mL] [1 mEq/mL] MAX 6 mg (A) MAX 0.5 mg (T) Round 20 mg/kg Complete MAX of 1 mg (R) administration of 2.5mg (R) 1 mEq/kg 1 mEq/kg {2nd dose {max total dose up {Give via central reversal {repeat every for PERFUSING Flush with 5 mL 0.2 mg/kg or 0.04 mg/kg} line} {Max 2 mg/dose} 3-5 min} VT/VF only (D) 0.9% NaCl 12 mg MAX} (Bradycardia) 0.02 mg = ______10 mg = 0.2 40 mg = 0.4 Use 1:10,000 2 mEq= 4 0.21 mg = 0.07 0.04 mg = 0.4 0.2 mg= 0.2 NBN 2 0.2mL (ET: 0.2 mg = 2 mL mL  ET Dose mL mL mL mL mL) 0.03 mg = ______15 mg = 0.3 60 mg = 0.6 Use 1:10,000 3 mEq = 6 0.3 mg = 0.1 0.06 mg = 0.6 0.3 mg= 0.3 NBN 3 0.3mL (ET: 0.3 mg = 3 mL mL  ET Dose mL mL mL mL mL) 0.04 mg = 0.4 20 mg = 0.4 80 mg = 0.8 4 mEq = 8 ______0.4 mg = 0.13 0.08 mg = 0.8 0.4 mg = 0.4 1 MO 4 0.4 mg = 0.4 mL mL mL mL mL mL mL mL 0.05 mg = 0.5 25 mg = 0.5 5 mEq = 10 ______0.5 mg = 0.16 0.5 mg = 0.5 2 MO 5 100 mg = 1 mL 0.5 mg = 0.5 mL 0.1 mg = 1 mL mL mL mL mL mL 0.06 mg = 0.6 30 mg = 0.6 120 mg = 1.2 6 mEq = 12 0.6 mg = 0.2 0.12 mg = 1.2 0.6 mg = 0.6 3 MO 6 0.6 mg = 0.6 mL ______mL mL mL mL mL mL mL 0.07 mg = 0.7 35 mg = 0.7 140 mg = 1.4 ______7 mEq = 7 0.7 mg = 0.23 0.14 mg = 1.4 0.7 mg = 0.7 6 MO 7 0.7 mg = 0.7 mL mL mL mL mL mL mL mL 0.08 mg = 0.8 40 mg = 0.8 160 mg = 1.6 ______8 mEq = 8 0.8 mg = 0.27 0.16 mg = 1.6 0.8 mg = 0.8 9 MO 8 0.8 mg = 0.8 mL mL mL mL mL mL mL mL ______10 mEq = 10 1 YR 10 0.1 mg = 1 mL 50 mg = 1 mL 200 mg = 2 mL 1 mg = 1 mL 1 mg = 0.33 mL 0.2 mg = 2 mL 1 mg = 1 mL mL 0.12 mg = 1.2 60 mg = 1.2 240 mg = 2.4 ______12 mEq = 12 1.2 mg = 0.4 0.24 mg = 2.4 1.2 mg = 1.2 2 YR 12 1.2 mg = 1.2 mL mL mL mL mL mL mL mL 0.14 mg = 1.4 70 mg = 1.4 280 mg = 2.8 ______14 mEq = 14 1.4 mg = 0.46 0.28 mg = 2.8 1.4 mg = 1.4 3 YR 14 1.4 mg = 1.4 mL mL mL mL mL mL mL mL 0.16 mg = 1.6 80 mg = 1.6 320 mg = 3.2 ______16 mEq = 16 1.6 mg = 0.53 0.32 mg = 3.2 1.6 mg = 1.6 4 YR 16 1.6 mg = 1.6 mL mL mL mL mL mL mL mL 0.18 mg = 1.8 90 mg = 1.8 360 mg = 3.6 ______18 mEq = 18 1.8 mg = 0.6 0.36 mg = 3.6 1.8 mg = 1.8 5 YR 18 1.8 mg = 1.8 mL mL mL mL mL mL mL mL 100 mg = 2 ______20 mEq = 20 6 YR 20 0.2 mg = 2 mL 400 mg = 4 mL 2 mg = 2 mL 2 mg = 0.66 mL 0.4 mg = 4 mL 2 mg = 2 mL mL mL 0.22 mg = 2.2 110 mg = 2.2 440 mg = 4.4 ______22 mEq = 22 2.2 mg = 0.73 0.44 mg = 4.4 7 YR 22 2.2 mg = 2.2 mL 2 mg = 2 mL mL mL mL mL mL mL 0.25 mg = 2.5 125 mg = 2.5 ______25 mEq = 25 2.5 mg = 0.83 8 YR 25 500 mg = 5 mL 2.5 mg = 2.5 mL 0.5 mg = 5 mL 2 mg = 2 mL mL mL mL mL 150 mg = 3 ______30 mEq = 30 9 YR 30 0.3 mg = 3 mL 600 mg = 6 mL 2.5 mg = 2.5 mL 3 mg = 1 mL 0.5 mg = 5 mL 2 mg = 2 mL mL mL 0.34 mg = 3.4 170 mg = 3.4 680 mg = 6.8 ______34 mEq = 34 3.4 mg = 1.1 10 YR 34 2.5 mg = 2.5 mL 0.5 mg = 5 mL 2 mg = 2 mL mL mL mL mL mL 200 mg = 4 ______40 mEq = 40 12 YR 40 0.4 mg = 4 mL 800 mg = 8 mL 2.5 mg = 2.5 mL 4 mg = 1.3 mL 0.5 mg = 5 mL 2 mg = 2 mL mL mL 250 mg = 5 1000 mg = 10 ______50 mEq = 50 14 YR 50 0.5 mg = 5 mL 2.5 mg = 2.5 mL 5 mg = 1.6 mL 0.5 mg = 5 mL 2 mg = 2 mL mL mL mL EPINEPHRINE AMIODARONE EPINEPHRINE ADENOSINE ATROPINE Calcium NALOXONE Intravenous (IV) [50 mg/mL] Endotracheal (ET) [3 mg/mL] [0.1 mg/mL] WEIGHT Chloride 10% [1 mg/mL] [1:10,000] 5 mg/kg [1:1000] 4.2% NaHCO3 8.4% NaHCO3 0.1 mg/kg to 0.02 mg/kg to (KG) [100 mg/mL] 0.1 mg/kg (T’, S) AGE 0.01 mg/kg to Dilute prior to 0.1 mg/kg to MAX [0.5 mEq/mL] [1 mEq/mL] MAX 6 mg (A) MAX 0.5 mg (T) Round 20 mg/kg Complete MAX of 1 mg (R) administration of 2.5mg (R) 1 mEq/kg 1 mEq/kg {2nd dose {max total dose up {Give via central reversal {repeat every for PERFUSING Flush with 5 mL 0.2 mg/kg or 0.04 mg/kg} line} {Max 2 mg/dose} 3-5 min} VT/VF only (D) 0.9% NaCl 12 mg MAX} (Bradycardia) USUAL 300 mg = 6 1000 mg = 10 50 mEq = 50 ADULT 1 mg = 10 mL 2.5 mg = 2.5 mL ______6 mg = 2 mL 0.5 mg = 5 mL 2 mg = 2 mL DOSE 70 mL mL mL R = REPEAT SAME DOSE FOR 2ND AND SUBSEQUENT DOSES A = GIVE RAPID IV PUSH, FOLLOW BY RAPID NS FLUSH T = FOR ET, GIVE 2-3 X IV DOSE (0.04-0.06 MG/KG). FLUSH WITH 5 mL NS T’ = FOR ET, GIVE 2-3 X IV DOSE (0.2-0.3 MG/KG), FLUSH WITH 5 mL NS S = REVERSAL of RESP DEPRESSION (THERAPEUTIC OPIOID), MAY USE SMALL REPEATED DOSES OF 0.04 MG. (DILUTE 0.4 MG IN 10 ML NS, GIVE IN 1 ML INCREMENTS) D = FOR PULSELESS VT/VF, MAY GIVE IV PUSH UNDILUTED. FOR PERFUSING TACHYCARDIAS, DILUTE ≤50 MG IN 10 ML AND >50 MG IN 50 ML OF D5W AND INFUSE OVER 20-60 MIN. MAX 15 MG/KG/DAY</p><p>Miscellaneous Medications IV Dose Comments</p><p>CALCIUM GLUCONATE 10% (100 mg/mL) 60-100 mg/kg Uncuffed ETT size (mm ID) > 1 yo = (Age in years/4) + 4 Newborn: 5-10 mL/kg D10W DEXTROSE 10% (0.1 g/mL) = D10W 0.5 – 1 g/kg Infant/Child: 2 - 4 mL/kg D25W Cuffed ETT size (mm ID) for > 1 yo = (Age in years/4) + 3 DEXTROSE 25% (0.25 g/mL) = D25W Max dose = 25 g Adolescent: 1 - 2 mL/kg D50W DEXTROSE 50% (0.5 g/mL) = D50W May dilute D50W with equal volume of SWI to make ETT insertion depth (cm) for > 2 yo = (Age in years/2) + 12 D25W ID = Internal FLUMAZENIL (0.1 mg/mL) 0.01 mg/kg May repeat every 1 min up to Diameter of ETT (benzodiazepine reversal) Max dose = 0.2mg total dose of 0.05 mg/kg or 1mg FOSPHENYTOIN 100 mg vial 10 – 20 PEDIATRICmg PE/kg CONTINUOUSDilute with D5W INFUSIONS or NS to 2-10 – Formg/mL. Emergency Use (50 mgDRUG PE/mL) AMOUNT/VOLUPE = phenytoin equiv FINALMax infusion rate: 3DILUENT mg PE/kg/min orSTANDARD 150 mg PE/ min DOSE DOSE RANGE ME CONCENTRATION RATE HYDROCORTISONE 100 mg (50 mg/mL) 2-6 mg/kg Anaphylaxis dose DELIVERED AMIODARONE* 360 mg/200 mL 1800 mcg/mLAlternate dosing: 1 D5Wunit for every 4-50.17 g DextrosemL/kg/hr 5 – 15 mcg/kg/min INSULIN – REGULAR (100 units/mL) 0.1 units/kg 5 mcg/kg/min NOTE: May require dilution to measure dose May (hyperkalemia)DOBUTAMINE* 500 mg/250Max mLdose = 10 units2000 mcg/mL D5W / NS 0.3 mL/kg/hr dilute 10 units in 10 mL to make 1 unit/mL 10 mcg/kg/min 5 – 20 mcg/kg/min LIDOCAINE 1% bristojet (10 mg/mL) 1 mg/kg ET dose – 2-3 mg/kg DOPAMINE* 400 mg/250 25-50mL mg/kg 1600 mcg/mL D5W / NS 0.4 mL/kg/hr MAGNESIUM SULFATE (500 mg/mL) Over 10-20 mins; faster for torsades 10 mcg/kg/min 2 – 50 mcg/kg/min Max dose = 2000 mg EPINEPHRINE 5 mg/250 mL 20 mcg/mL NS 0.3 mL/kg/hr MANNITOL 20% (0.2 g/mL) 0.25 – 1 g/kg Use in-line filter (≤ 5 micron) 0.1 mcg/kg/min 0.05 – 1 mcg/kg/min VASOPRESSIN (20 units/mL) 0.4 units/kg MAX dose = 40 units FUROSEMIDE 100 mg/100 mL 1 mg/mL NS/D5W 0.08 mL/kg/hr 0.04-0.2 mg/kg/hr 0.08 mg/kg/hr 20 – 50 mcg/kg/min LIDOCAINE 1000 mg/250 mL 4000 mcg/mL D5W / NS 0.3 mL/kg/hr 20 mcg/kg/min 25 mg/250 mL 0.37 – 0.75 mcg/kg/min MILRINONE 100 mcg/mL D5W / NS 0.3 mL/kg/hr 0.5 mcg/kg/min 20 mg/200 mL NICARDIPINE 20 mg/200 mL 0.1 mg/mL NS 0.3 mL/kg/hr 0.5 mcg/kg/min 0.25-5 mcg/kg/min</p><p>NITROGLYCERIN 50 mg/250 mL 200 mcg/mL D5W 0.3 mL/kg/hr 1 mcg/kg/min 1 – 20 mcg/kg/min NITROPRUSSIDE 50 mg/250 mL 200 mcg/mL D5W 0.3 mL/kg/hr 1 mcg/kg/min 0.5 – 12 mcg/kg/min NOREPINEPHRINE (LEVOPHED) 4 mg/250 mL 16 mcg/mL D5W 0.3 mL/kg/hr 0.08 mcg/kg/min 0.05 – 2 mcg/kg/min</p><p>PHENYLEPHRINE 10 mg/250 mL 40 mcg/mL D5W / NS 0.15 mL/kg/hr 0.1 mcg/kg/min 0.1 – 0.5 mcg/kg/min (NEO-SYNEPHRINE) D5W = Dextrose 5% in water NS = 0.9% NaCl SWI = Sterile water of injection * Premix in peds code tray DEFIBRILLATION (VF or pulseless VT) – give 1st shock at 2 J/kg and resume CPR immediately. If shockable rhythm persists after 5 CPR cycles, give subsequent defibrillations at 4 J/kg. SYNCHRONIZED CARDIOVERSION (SVT or VT with pulse) – start with 0.5 – 1 J/kg, may increase to 2 J/kg for subsequent attempts if necessary. July 2015 2</p>