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Pediatric Pocket Reference Card, Slides of Pharmacology

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 2-0450
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
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Download Pediatric Pocket Reference Card and more Slides Pharmacology in PDF only on Docsity!

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 %)

HR SBP MAP RR

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-

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-

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-

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/ 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, 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, (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
  8. Sodium bicarbonate 1-2 mEq/kg max 50 mEq to maintain pH > 7.
  9. Maintain 2 mL/kg/hr urine output (with diuretics if necessary)

ANAPHYLAXIS

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

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
  5. Dental procedures involving manipulation of gingival tissue or perforation of oral mucosa
  6. Invasive procedure of respiratory tract involving incision or biopsy of respiratory mucosa
  7. GI or GU procedures involving contaminated or dirty/infected tissue or in patients septic due to GI or GU infection
  8. 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

PREOPERATIVE SEDATIVES

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

MEDICATIONS

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)

OPIOID CONVERSION

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

NPO GUIDELINES (hr)

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

SINGLE LUNG VENTILATION

Age (yrs)

ETT

(mm)

BB

(Fr)

Univent (mm)

DLT

(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

DIFFICULT AIRWAY