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Pediatric Pocket Reference Card ... standard of practice since publication of this reference card. Simple forumula to predict weight from age:.
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Peds E1 2-0442 Adult E1 2-0447 Call Resident 2-
OR front desk 6-1018 Peds Preop 6-1020 Peds PACU 6-
MRI 6-1071 iMRI 6-0466 Blood Bank 6-
ICN 3-1565 PICU 3-1352 Peds CICU 3-
TCUP 4-4089 Med-Surg (5) 3-1921 Heme-Onc (6) 3-
OR ## = 2 - 98## Prefixes : 35 3 -xxxx 51 4 -xxxx 47 6 -xxxx 50 2 -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 %)
Preterm 120-170 40-60 30s 50-
0-3 months 2.5-7.5 100-150 65-85 45-60 30-
3-6 months 4.8-9.5 90-120 70-90 50-60s 24-
6-12 months 6.5-12.5^ 80-120^ 80-100^ 60s^ 22-
1-3 years 8.75-17 70-110 70-100 50-60s 18-
3-6 y 15.5-25 65-110 80-110 55-70 16-
6-12 y 17-55 60-95 80-120 60-80 12-
>12 y 30-86 55-85 90-130 70-80s 10-
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-
6-8y 20-30^ 5-5.5c^ 17cm^ Miller 2/Mac 2^ 2.5^ bubble gum^ 70- 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-
“4-2-1” Rule: Hourly fluid maintenance rate 4 mL/kg/hr for each kg up to 10 kg
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/ 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
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
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, 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
Plain (mg/kg)
With epi 1:200, (mg/kg)
Lidocaine 5 7
Bupivacaine 2.5 3
Ropivacaine 2.5 3
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
Signs: increased EtCO2, muscle rigidity, cardiac arrest, arrhythmias, hyperthermia, acido- sis, myoglobinuria
Oxygen Ventilate with 100% O 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
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
At risk conditions
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
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
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
Diazepam (Valium) PO 0.25-0.5 mg/kg Max 20mg IV: 0.1 mg/kg/dose
Ketamine IM: 3-5 mg/kg with atropine 20 mcg/kg and PO: 4-6 mg/kg with Midazolam
Lorazepam (Ativan) IV/IM/PO: 0.05 mg/kg/dose
Midazolam (Versed) PO: 0.25-0.5 mg/kg Max = 20mg Rectal: 0.5-1.0 mg/kg diluted to 3mL saline Intranasal: 0.2-0.3 mg/kg (use nasal atomizer) IM: 0.25 mg/kg (be wary of injection site pain) IV: 0.05-0.1 mg/kg/dose to max of 0.25 mg/kg
ACETAMINOPHEN PO/IV: 10-15 mg/kg PR: 40 mg/kg Max: 75 mg/kg/24 hour
ADENOSINE 0.1-0.2 mg/kg fast IV push with flush, may repeat 0.2 mg/kg IV after 2 minutes
ALBUTEROL Nebulized: 2.5 mg in 3mL every 20 min or continuous
AMINOCAPROIC ACID 75 mg/kg (max 5 gram) dilute IV load and in CPB prime. 30-75 mg/kg/hr infusion
AMIODARONE 5 mg/kg IV load (max 150 mg) over 30 minutes then 5- mcg/kg/min
ATROPINE IV: 10-20 mcg/kg IM/PO: 20-30 mcg/kg
BUPIVACAINE 0.25% (with 1:200,000 epi)
Caudal 1st dose: 0.5-1 mL/kg Repeat dose: 2/3 of initial dose q 90-120 minutes
CALCIUM CHLORIDE 5-10 mg/kg IV slowly Arrest: 10 mg/kg IV
CALCIUM GLUCONATE 30 mg/kg IV slowly
CISATRACURIUM 0.1-0.2 mg/kg IV for paralysis in 1-2 minutes, 20-40 minutes until reversible
DANTROLENE see Malignant Hyperthermia algorithm
DESMOPRESSIN DDAVP Hemophilia: 0.3 mcg/kg IV slowly Diabetes Insipidus: 1-2 mcg IV/SQ q 12 hours
DEMEDETOMIDINE Infusion: 0.2-1 mcg/kg/hr IV Load: 0.2 -1 mcg/kg IV load (over 10 - 20 min)
DEXAMETHASONE Airway edema: 0.25-0.5 mg/kg IV q6 hours ICP: 0.5-1.5 mg/kg IV PONV: 0.1 mg/kg IV
DEXTROSE (50%) 0.5 g/kg = 1 mL/kg of D
DIPHENHYDRAMINE 0.5-1 mg/kg IV q 4-6 hours; Max 50 mg/dose
DOBUTAMINE 0.5-20 mcg/kg/min IV infusion
DOPAMINE 0.5-20 mcg/kg/min IV infusion
EPINEPHRINE Arrest: 10 mcg/kg IV/ETT Vasopressor: 0.5-5 mcg/kg IV Infusion: 0.02 - 1 mcg/kg/min IV
EPHEDRINE IV: 0.1-0.2 mg/kg prn hypotension/bradycardia
ESMOLOL Bolus: 0.5 mg/kg IV PRN Infusion: 50-150 mcg/kg/min IV
ETOMIDATE Induction: 0.2-0.3 mg/kg IV Maintenance: 5-20 mcg/kg/min IV infusion
FACTOR VIIa 90 mcg/kg q 2 hours until hemostasis achieved. Get hema- tology consult
FENTANYL Analgesia: 0.5-1 mcg/kg IV, 1-2 mcg/kg intranasal Infusion: 1-5 mcg/kg/hr IV
FUROSEMIDE 0.5-1 mg/kg/dose IV/IM q 6-12 hours
GLUCAGON 0.1 mg/kg IV; Max 1 mg
GLYCOPYRROLATE NMB reversal: 0.01-0.15 mg/kg IV Antisialogogue: 0.05-0.2 mg IV/IM
HUMATE P FVIII deficiency: 40-60 U/kg IV then 20-30 U/kg IV q8h (in severe disease with major surgery) vWF deficiency: 40-80 U/kg IV then 40-60 U/kg q8h (Types 2/3) or q24h (Type 1)
HYDROCORTISONE Stress dose: 1-2 mg/kg IV then 150-250 mg/day (<1y = 25-150 mg/day) q6-8h
HYDROMORPHONE IV: 5-10 mcg/kg IV PO/PR: 50-80 mcg/kg q3-6h prn
INTRALIPID Local anesthetic toxicity: 1.5 mL/kg followed by infusion 0.25 mL/kg/min up to 0.5 mL/kg/min
KETAMINE IV induction: 2-3 mg/kg IM (full) induction: 5-8 mg/kg PR induction: 5-10 mg/kg Preemptive analgesia: 4-12 mcg/kg/min
KETOROLAC 0.5-1 mg/kg IV/IM then 0.5 mg/kg q6h
LABETALOL 0.1 mg/kg IV increments q5-10min per BP
LIDOCAINE 1-1.5 mg/kg IV/ETT
MAGNESIUM 25-50 mg/kg/dose IV (watch hypotension)
MANNITOL 0.25-1 g/kg IV (typically) slowly Maintenance: 0.25-0.5g/kg IV q4-6h
METHADONE 0.05-0.1 mg/kg PO/IM/IV/SQ; t1/2 = 18-24 hours
METHOHEXITAL IV induction: 1-3 mg/kg PR induction: 20-30 mg/kg
METHYLPREDNISOLONE Asthma 2 mg/kg IV then 2 mg/kg/day / q4-6h
MILRINONE Load: 25-50 mcg/kg IV over 15 min Maintenance: 0.25-1 mcg/kg/min IV
METOCLOPRAMIDE 0.1-0.15 mg/kg IV/PO q6h prn
MORPHINE Analgesia: 0.05-0.1 mg/kg/dose IV/IM
NALOXONE End case sleepy: 0.5-1 mcg/kg IV prn Opioid intoxication: 10 mcg/kg IV/IM/ETT
NEOSTIGMINE 30-70 mcg/kg IV; Max 5mg Add atropine 20 mcg/kg or glycopyrrolate 15 mcg/kg IV
NICARDIPINE Adult loading dose: 5 mg IV over 5-10 min Infusion: 2.5-15 mg/hr or 0.5-5 mcg/kg/min (a t1/2 = 2-5 min, b t1/2 = 45 min)
NITROGLYCERINE 0.5-20 mcg/kg/min IV infusion
NITROPRUSSIDE 0.5-20 mcg/kg/min IV infusion
NOREPINEPHRINE 0.05-0.1 mcg/kg/min IV; Max = 2 mcg/kg/min
ONDANSETRON PONV: 0.15 mg/kg IV; Max 4 mg
OXYCODONE PO: 0.1 mg/kg q3-6h PRN
PANCURONIUM 0.1 mg/kg IV for full paralysis in 3 min, 60-90 min until reversible (80% renal)
PHENOBARBITAL Status epilepticus: 15-20 mg/kg SLOW IV then add 5 mg/kg q20h; Max 30 mg/kg IV
PHENYLEPHRINE 0.5-1 mcg/kg IV bolus PRN hypotension 0.1-0.5 mcg/kg/min IV infusion
PHENYTOIN Loading dose: 15-20 mg/kg IV over 30 min (Do not exceed 0.5 mg/kg/min IV)
POTASSIUM 0.5-1 mEq/kg SLOW IV infusion
PROCHLORPERAZINE 0.1-0.15 mg/kg PO/IM/PR/IV q6-8h; Max 10 mg/dose
PROMETHAZINE 0.2-0.5 mg/kg IV/PO/PR/IM q6-8h PRN Max 25 mg/dose (Not for kids < 2 y)
PROPOFOL Induction: 2-3 mg/kg (higher in children) Infusion 50-250 mcg/kg/min
RANITIDINE IV: 1 mg/kg PO: 2 mg/kg (3o min pre-induction)
REMIFENTANIL IV bolus: 0.5-1 mcg/kg IV IV infusion: 0.05-0.5 mcg/kg/min IV
ROCURONIUM 0.6-1.2 mg/kg IV for paralysis in 1-2 min 20-40 min until reversible (80% hepatic)
ROPIVACAINE Caudal: 1st dose = 0.5-1 mL/kg Repeat dose: 2/3 of 1st dose q 90-120 min
SCOPOLAMINE 0.02 mg/kg IV; Max 0.4 mg
SODIUM BICARBONATE 1-2 mEq/kg IV
SUCCINYLCHOLINE IV: 1-2 mg/kg for full paralysis in 30 sec; < 1 year: 2-3 mg/kg IM: 3-5 mg/kg; Max 5 mL at injection site Intralingual: 1-3 mg/kg
SUFENTANIL Analgesia: 0.5-2 mcg/kg IV Typical: 10-20 mcg/kg total dose
SUGAMMADEX Reversal of rocuronium/vecuronium 2 twitches on TOF: 2 mg/kg IV 1-2 twitches on PTC but none on TOF: 4 mg/kg IV Immediate reversal: 16 mg/kg IV
TERBUTALINE 5-10 mcg/kg IV q15 min (max 250 mcg)
THIOPENTAL 5-8 mg/kg IV (full induction)
TRANEXEMIC ACID Craniosynostosis: 50 mg/kg load over 15 min followed by 5 mg/kg/hr (Goobie 2011) Spine surgery: 100 mg/kg load followed by 10 mg/kg/hr Cardiac surgery: Variable regimens
VASOPRESSIN Adult VF/VT arrest: 40 U IV x 1 dose Peds infusion: 0.2-3 milliunits/kg/min IV Diabetes Insipidus: 0.5-10 milliunits/kg/hr
VECURONIUM 0.1 mg/kg IV for full paralysis in 2-3 min 30-45 min until full reversible (80% hepatic)
IV (mg) PO (mg)
Morphine 10 mg 30 mg
Fentanyl (Sublimaze)
~0.1 mg ~0.2 mg
Hydromorphone (Dilaudid)
1.5 mg 7.5 mg
Oxycodone (Oxycontin)
20 mg
Meperidine 75 mg 300 mg
Methadone ~5-10 ~
Tramadol (Ultram)
Sufentanil 0.5 mg
Alfentanil 0.02 mg
Remifentanil 0.1 mg
Clears 2
Breast milk 4
Formula, milk, light meals (cereals)
Full meals 8
Fiberoptic Scope Smallest Smallest LMA
Noodle 2.2 mm 2.5 ETT 1
Pediatric 2.8 mm 3.5-4.0 1
Adult 4.1 mm 5.5 1.
LMA Largest ETT to fit through
1 3.5 uncuffed
1.5 4 uncuffed
2 4.5 uncuffed
2.5 5 uncuffed
3 6 cuffed
4 6 cuffed
5 7 cuffed
Age (yrs)
(mm)
(Fr)
Univent (mm)
(Fr)
0.5-1 3.5-4.0 5
1-2 4.0-4.5 5
2-6 4.5-5.5 5
6-8 5.5-6 6 3.
8-10 6.0 c 6 4.5 26
10-12 6.5 c 6 4.5 26-
12-14 6.5-7.0 c 7 6.0 32
14-16 7.0 c 7 7.0 35
16-18 7.0- 8.0 c 7-9 35