Peds E1 2-0442 Adult E1 2-0447 Call Resident 2-0450
OR front desk 6-1018 Peds Preop 6-1020 Peds PACU 6-1035
MRI 6-1071 iMRI 6-0466 Blood Bank 6-1404
ICN 3-1565 PICU 3-1352 Peds CICU 3-1955
TCUP 4-4089 Med-Surg (5) 3-1921 Heme-Onc (6) 3-1631
OR ## = 2 - 98## Prefixes : 353-xxxx 514-xxxx 476-xxxx 502-xxxx
ETT Size = (Age/4) + 4 orsize of 5th finger ETT Depth = 3 x ETT size or Age + 11 cm at lip
Neonatal Rules: The Neonatal “1-2-3 / 7-8-9” Rule
For preterm + term newborns:
MAP = # of weeks PCA
Ex: By DOL 5, MAP = # weeks PCA + 5
Wt range
(10-90th %)
HR SBP MAP RR
Preterm 120-170 40-60 30s 50-60
0-3 months 2.5-7.5 100-150 65-85 45-60 30-60
3-6 months 4.8-9.5 90-120 70-90 50-60s 24-30
6-12 months 6.5-12.5 80-120 80-100 60s 22-26
1-3 years 8.75-17 70-110 70-100 50-60s 18-24
3-6 y 15.5-25 65-110 80-110 55-70 16-22
6-12 y 17-55 60-95 80-120 60-80 12-20
>12 y 30-86 55-85 90-130 70-80s 10-16
NORMAL HEMODYNAMIC INDICES
Pediatric Pocket Reference Card
Age Weight
(kg)
ETT ETT
@ lips
(cm)
Laryngoscope
blade
LMA Mask Oral
Airway
Neonate <1 2.5u 7cm Miller 0 1 neonate 30
Neonate 1-2 3.0u 8cm Miller 0 1 neonate 30
Neonate 2-3 3c/3.5u 9cm Miller 0-1 1 neonate 30
Neonate >3 3c/3.5u 10cm Miller 0-1 1 infant 40
1-6 mo 4-6 3c/3.5 12cm Miller 1/Wis 1.5 1-1.5 infant 40
6mo-1y 6-10 3.5c/4u 13cm Wis 1.5 1.5 toddler 50
1-2y 10-12 4-4.5c 14cm Wis 1.5 2 toddler 60
2-4y 12-16 4.5c 15cm Wis 1.5/Mac 2 2 child/bubble gum 60
4-6y 16-20 4.5-5c 16cm Miller 2/Mac 2 2 bubble gum 60-70
6-8y 20-30 5-5.5c 17cm Miller 2/Mac 2 2.5 bubble gum 70-80
9-12y 30-45 5.5-6c 18cm Miller/Mac 2-3 3 small adult 80
>14y >50 6.5-7c 20-22 Miller/Mac 2-3 4 med/large adult 80-90
PEDIATRIC AIRWAY EQUIPMENT
MAINTENANCE FLUID REQUIREMENTS
“4-2-1” Rule: Hourly fluid maintenance rate
4 mL/kg/hr for each kg up to 10 kg
+ 2 mL/kg/hr for each additional kg up to 20 kg
+ 1 mL/kg/hr for each additional kg above 20 kg
Replace the 1st 1/2 of the pre-op volume deficit (hourly maintenance IVF x hrs NPO +
bowel prep) over the 1st hour of surgery
Replace the 2nd 1/2 of deficit over the remainder of the procedure
Fluid boluses: 10-15 mL/kg/bolus for hypovolemic patients
GLUCOSE REQUIREMENTS FOR NEONATES AND INFANTS
Normal blood glucose for newborns 40-60 mg/dL. Typical newborn basal glucose require-
ment is 5-8 mg/kg/min. (D10 at 1 mL/hr = 1.67 mg/kg/min of dextrose). Start at D10 1/4
NS at 3 mL/kg/hr which approximates hourly maintenance rate, leaving them slightly dry to
administer IV meds.
Consider intraop glucose administration to NPO infants under 6 months of age, especially
for long procedures. Recommended for infants with:
Prematurity/SGA Already on TPN or glucose (D10)
Suspected inborn errors of metabolism Sepsis
Myochondrial myopathies Born to diabetic mothers
ESTIMATED BLOOD VOLUME
Premature 90-100 ml/kg
Term neonate 80-90 ml/kg
Infant 3 months -
1 year
70-80 ml/kg
Child > 1 year 70 ml/kg
BLOOD PRODUCT TRANSFUSION GUIDELINES
pRBC 10-15 mL/kg should raise Hgb 2-3 g/dL, Hct by 6-9%
For > 20 mL/kg transfusion or cardiac cases, request < 5 day old or washed RBCs
FFP 10-15 mL/kg should raise factor levels 15-20%
Platelets 10-15 mL/kg should raise platelet count by 30-50,000
Cryoprecipitate: 1-2 units/kg should increase fibrinogen level to 60-100 mg/dL
DDAVP 0.1-0.3 mcg/kg given 30 min prior to procedure
Criteria for irradiated blood: prematurity, fetus in utero, bone marrow transplant recipi-
ent, critically ill child, patient with decreased cellular immunity, patient receive chemo that
results in severe immune suppression
Neonates (< 6 months) bupivacaine/ropivacaine max dose = 0.2 mg/kg/kr
Children (> 6 months) bupivacaine/ropivacaine max dose = 0.3-0.4 mg/kg/hr
Hydromorphone infusion: 20 mcg/mL, hourly rate 3 mcg/kg/hr; max 5 mcg/kg/hr
Test dose 0.1 mL/kg (1:200000 epi)
Single shot caudal local anesthetic: 1 mL/kg 0.25% ropiv/bupivacaine; max 20 mL
Single shot caudal opioids: morphine 50 mcg/kg or hydromorphone 5-10 mcg/kg
Local Anesthetic Systemic Toxicity Treatment: 1.5 mL/kg 20% Intralipid followed by
continuous infusion 0.25 mL/kg/min up to 0.5 mL/kg/min until hemodynamics restored
Reduced doses of epinephrine < 1 mcg/kg for hypotension
Start CPR/PALS
Avoid vasopressin, calcium channel blockers, beta blockers
EPIDURAL INFUSION RATES & DOSAGES
LOCAL ANESTHETIC MAX
DOSE
Plain
(mg/kg)
With epi
1:200,000
(mg/kg)
Lidocaine 5 7
Bupivacaine 2.5 3
Ropivacaine 2.5 3
RESUSCITATION
Defibrillation
vfib and pulseless vtach
2 Joules/kg ASYNCHRONOUS
repeat up to 4 Joules/kg
Synchronous Cardioversion
unstable SVT, vtach, a fib/flutter
0.5 Joules/kg SYNCHRONOUS
repeat up to 2 Joules/kg
Epinephrine 1 mcg/kg to treat hypotension/bronchospasm
10 ug/kg IV for cardiac arrest
Atropine 20 mcg/kg IV (for symptomatic bradycardia or pre-treatment) max
dose 1 mg for child and 2mg for adolescent
Bicarbonate 1-2 mEq/kg IV to be guided by blood gas analysis
Calcium Chloride 10-20 mg/kg IV (0.1-0.2 mL/kg of a 10% solution)
Adenosine first dose: 100 mcg/kg rapid IV push and flush (max 6 mg)
second dose: 200 ug/kg (max 12 mg)
Magnesium 25-50 mg/kg IV for Torsades de Pointes (max 2 g)
Amiodarone 5 mg/kg IV, max 300mg for vfib and/or vtach
Procainamide 5-15 mg/kg IV loading dose over 30-60 min, then 20-80 ug/kg/min
infusion
MALIGNANT HYPERTHERMIA MH Hotline - 1-800-MH-HYPER
Signs: increased EtCO2, muscle rigidity, cardiac arrest, arrhythmias, hyperthermia, acido-
sis, myoglobinuria
1. Call for help
2. Stop all triggering anesthetics, convert to TIVA, exchange anesthesia machine
3. Dantrolene 2.5 mg/kg IV (mix with sterile H2O)
4. Hyperventilate with 100% O2 to normalize EtCO2 (2-4x patient’s minute ventilation)
5. Treat hyperkalemia
6. Avoid calcium channel blockers for dysrhythmias
7. Cool patient: NG lavage with cold water, apply ice externally, infuse cold saline IV
8.. Arterial line: ABG, lytes, Ca++, CPK, AST/ALT, CK, myoglobin
9. Sodium bicarbonate 1-2 mEq/kg max 50 mEq to maintain pH > 7.2
10. Maintain 2 mL/kg/hr urine output (with diuretics if necessary)
ANAPHYLAXIS
Oxygen Ventilate with 100% O2
Epinephrine 10 mcg/kg IM, max 300 ug
1 mcg/kg IV, repeat with increasing doses every 3-5 min PRN,
may need continuous infusion 0.02-0.2 mcg/kg/min
Fluid bolus 20 mg/kg isotonic fluids, repeat as necessary
Albuterol 10 puffs if bronchospasm present
Hydrocortisone 2-3 mg/kg IV
Diphenhydramine 1-2 mg/kg IV, max 50 mg
Ranitidine 1.5 mg/kg IV, max 50 mg
HYPERKALEMIA TREATMENT
Signs: Peaked T waves, Wide QRS, Cardiac Arrest
Risk factors: ARF/CRF, Transfusion, Burns, Trauma, GI bleeds, hemolysis
Calcium chloride 5-10 mg/kg IV until NSR
Hyperventilation
Sodium bicarb 1 mEq/kg/dose IV
D50 1 mL/kg + insulin 0.2 U/kg IV
Albuterol 5-20 mg via nebulizer
Furosemide 1 mg/kg IV PRN
Kayexalate 1-2 g/kg PO/PR
ENDOCARDITIS PROPHYLAXIS GUIDELINES AHA 2007
At risk conditions
1. Presence of prosthetic valve or prosthetic material used for cardiac valve repair
2. A history of endocarditis
3. A heart transplant with abnormal heart valve function
4. Congenital heart disease: Uncorrected or palliated cyanotic CHD, completely repaired
CHD with prosthetic material or device during the first 6 months after repair procedure,
repaired CHD with residual defects adjacent to prosthetic patch or device
Procedures requiring prophylaxis in at risk patients
1. Dental procedures involving manipulation of gingival tissue or perforation of oral mucosa
2. Invasive procedure of respiratory tract involving incision or biopsy of respiratory mucosa
3. GI or GU procedures involving contaminated or dirty/infected tissue or in patients septic
due to GI or GU infection
4. Procedure involving infected skin or musculoskeletal tissue
Route Antibiotic Dose
Oral Amoxicillin 50 mg/kg PO max 2g
IV (unable to take oral) Ampicillin 50 mg/kg IV/IM max 2g or
Cefazolin 50 mg/kg IV/IM max 1g or
Ceftriaxone 50 mg/kg IV/IM max 2g
Allergic to penicillin
* Cephalosporins not recom-
mended for PCN anaphylaxis
due to cross-reactivity
Clindamycin 20 mg/kg IV/PO max 600 mg or
Cephalexin* 50 mg/kg IV/PO max 2g or
Cephazolin* 50 mg/kg IV/IM max 1-2g
Vancomycin 20mg/kg IV max 1 g
MRSA+ Vancomycin 20 mg/kg IV max 1g
ANTIBIOTICS
Antibiotic Pediatric Dosing Adult Dosing Dose Freq
Ampicillin 25-50 mg/kg 2 g Q2H
Ampicillin/Sulbactam
(Unasyn)
25-37.5 mg/kg 3 g Q2H
Cefotaxime 50 mg/kg 1 g Q3H
Cefazolin (Ancef) 25-50 mg/kg 2 g, 3 g for > 120kg Q4H
Ceftriaxone (Ro-
cephin)
50-75 mg/kg 2 g Q12-24H
Clindamycin (Cleocin) 10 mg/kg 900mg Q6H
Gentamicin 2-2.5 mg/kg 5 mg/kg based on IBW Q8H
Metronidazole (Flagyl) 7.5 mg/kg 500 mg Q6H
Nafcillin 25-50 mg/kg 2 g Q6H
Piperacillin/Tazobac-
tam (Zosyn)
37.5-75 mg/kg 3.375 g Q2H
Vancomycin 10-15 mg/kg 1 g, 1.5 g for > 80kg
Disclaimer: Author not responsible for any errors. It remains the responsibility of the physi-
cian to evaluate the appropriateness of a particular therapy or intervention in the context
of each clinical situation with consideration to their knowledge, skill and changes to the
standard of practice since publication of this reference card.
Simple forumula to predict weight from age:
< 8years: weight (kg) = 2 x age + 9
>= 8 years: weight (kg) = 3 x age
