Pharmacological Tools
Use of any of the medications listed in Table 9 should be done within your scope of practice and after a thorough study of the actions and side effects. This table provides only a brief reminder for those who are already knowledgeable in the use of these medications. Moreover, Table 9 contains only pediatric doses, indications, and routes of administration (intravenous/intraosseous) for the most common PALS drugs. Although cited for reference, routine administration of drugs via an ET tube is discouraged. Rapid access and drug delivery through an IO are preferred to ET administration as drug absorption from the ET tube route is unpredictable.
| DRUG | MAIN PALS USE | PEDIATRIC DOSE (IV/IO) | NOTES |
|---|---|---|---|
| Adenosine | Supraventricular Tachycardia | First dose: 0.1 mg/kg (MAX DOSE 6 mg)Second dose: 0.2 mg/kg (MAX DOSE 12 mg) | Rapid IV/IO bolus (no ET)Flush with salineMonitor ECG |
| Amiodarone | Tachyarrhythmia | 5 mg/kg over 20 to 60 minutesRepeat up to 15 mg/kg(MAX DOSE 300 mg) | Very long half-lifeMonitor ECG & BP |
| Atropine | Bradycardia | 0.02 mg/kgET: 0.03 mg/kgRepeat once if needed(MAX single dose 0.5 mg) | Also used to treat specific toxins(e.g. organophosphatepoisoning) |
| Epinephrine | Cardiac Arrest/Shock | IV/IO: 0.01 mg/kg (MAX DOSE 1 mg)ET: 0.1 mg/kg (MAX DOSE 2.5 mg) | Multiple uses, multiple routesRepeat every 3 to 5 min if needed |
| Glucose | Hypoglycemia | 0.5 to 1 g/kg | Newborn: 5 to 10 mL/kg D10WInfants/Children: 2 to 4 mL/kg D25WAdolescents: 1 to 2 mL/kg D50W |
| Lidocaine | Tachyarrhythmia | Initial: 1 mg/kgInfusion: 20 to 50 mcg/kg/min(MAX DOSE 100 mg)ET: 2 to 3 mg | |
| Magnesium Sulfate | Torsades de PointesRefractory Asthma | 20 to 50 mg/kg over 10 to 20 min(MAX DOSE 2 grams) | May run faster for Torsades |
| Milrinone | Cardiogenic Shock | Initial: 50 mcg/kg over 10 to 60 minMaintain: 0.5 to 0.75 mcg/kg/min | Longer infusion times and euvolemiawill reduce risk of hypotension |
| Naloxone | Opioid Reversal | Less than 5 y/o OR under 20 kg: 0.1 mg/kgOver 5 y/o OR over 20 kg: 2 mg IV q 2 to 3 min prn | Decrease dose to reverse respiratorydepression due to therapeutic opioid use(1 to 5 mcg/kg, titrate to effect) |
| Procainamide | Tachyarrhythmia | 15 mg/kg over 30 to 60 minutes | Do NOT give with amiodaroneMonitor ECG & BP |
| Sodium Bicarbonate | Metabolic Acidosis Hyperkalemia | 1 mEq/kg slow bolus(MAX DOSE 50 mEq) | Monitor ABG & ECGAfter adequate ventilation |
Table 9