Adenosine
Albuterol
Atropine
Bicarbonate
Calcium chloride
Calcium gluconate
Charcoal
Dexamethasone
Diazepam
Diazoxide
Digibind
Diphenhydramine
Dopamine
Dobutamine
Epinephrine
Fentanyl
Fosphenytoin
Glucagon
Glucose
Haloperidol
Insulin
Ipecac
Kayexalate
Ketamine
Lidocaine
Lorazepam
Mannitol
Meperidine
Methylprednisolone
Midazolam
Morphine sulfate
Naloxone
Nitroprusside
Oxygen
Pancuronium
Phenobarbital
Phenylephrine
Phenytoin
Procainamide
Propranolol
Prostaglandin E
Rocuronium
Succinylcholine
Thiopental
Vecuronium
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DRUGS FOR PEDIATRIC EMERGENCIES
Albuterol
Indication: Status asthmaticus, bronchospasm
Dosage: 0.1 to 0.15 mg/kg by nebulization. Repeat as needed.
Note: 0.02 to 0.03 mL/kg of 5 mg/mL solution with normal saline to make 3 mL total in nebulizer; maximum
single dose, 2.5 mg.
Note: Administration can be repeated and dose adjusted until desired clinical effect or symptomatic tachycardia.
Note: Oxygen is the preferred gas source for nebulization. Supplemental oxygen should be considered when
compressed air driven nebulizers are used or when oxygen flow rate dictated by nebulizer is inadequate.
Blended oxygen may be required for premature newborns who are still at risk for retinopathy of
prematurity.
Atropine Sulfate
Indication: 1) Symptomatic bradycardia
Dosage: Intramuscular (IM): 0.02 to 0.04 mg/kg
Intratracheal: 0.02 to 0.04 mg/kg
IV: 0.02 mg/kg.
Minimum single dose, 0.1 mg
Maximum single dose, 0.5 mg for child, 1.0 mg for adolescent. This dose may be repeated once.
Note: Oxygenation and ventilation are essential first maneuvers in the treatment of symptomatic bradycardia.
Epinephrine is the drug of choice if oxygen and adequate ventilation are not effective in the treatment
of hypoxia-induced bradycardia.
Note: If administered through an endotracheal tube, follow the dose with or dilute in saline flush (1 to 5 mL)
based on patient size.
Indication: 2) Anticholinesterase poisoning.
Dosage: IV: 0.05 mg/kg
Repeat as needed for clinical effect.
Note: Anticholinesterase poisonings may require large doses of atropine or the addition of pralidoxime.
Indication: 3) To prevent succinylcholine-induced bradycardia.
Dosage: 0.02 mg/kg IV or 0.02 to 0.04 mg/kg IM just before or simultaneously with succinylcholine
Bicarbonate, Sodium
Indication: 1) Metabolic acidosis
2) Tricyclic antidepressant overdose.
Dosage: IV: 1 to 2 mEq/kg
WARNING: Only 0.5 mEq/mL concentration should be used for newborns; dilution of available stock
solutions may be necessary.
Note: Routine initial use of sodium bicarbonate in cardiac arrest is not recommended. However, sodium
bicarbonate may be used in cases with documented metabolic acidosis
established.
Administer slowly because bicarbonate solution is hyperosmotic.after effective ventilation has been
Calcium Chloride
Indication: 1) Ionized hypocalcemia
2) Hyperkalemia
3) Hypermagnesemia
4) Calcium channel blocker toxicity
Dosage: IV: 20 mg/kg (if using 10% CaCl
desired clinical effect.
2, dose is 0.2 mL/kg). Inject slowly. Repeat dose as necessary for
WARNING: Stop injection if symptomatic bradycardia occurs. Extravascular administration can result in
severe skin injuries.
Note: Calcium is recommended for cardiac resuscitation only in cases of documented hyperkalemia, hypocalcemia,
or calcium channel blocker toxicity.
Calcium Gluconate
Indication: 1) Ionized hypocalcemia
2) Hyperkalemia
3) Hypermagnesemia
4) Calcium channel blocker toxicity
Ionizes as rapidly as calcium chloride and may be substituted using three times the dose of calcium
chloride (mg/kg).
Dosage: IV: 60 mg/kg (if using 10% gluconate, dose is 0.6 mL/kg). Inject slowly. Repeat dose as necessary
for desired clinical effect.
WARNING: Stop injection if symptomatic bradycardia occurs. Extravascular administration can result in
severe skin injuries.
Note: Calcium is recommended for cardiac resuscitation only in cases of documented hyperkalemia, hypocalcemia,
or calcium channel blocker toxicity.
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Charcoal, Activated
Indication: Acute ingestion of selected toxic substances
Dosage: 1 to 2 g/kg
Note: Administer as a slurry or down a nasogastric tube. Note that iron, lithium, alcohols, ethylene glycol,
alkalies, fluoride, mineral acids, and potassium do not bond to activated charcoal.
WARNING: Commercially available preparations of activated charcoal often contain a cathartic, such
as sorbitol. Fatal hypernatremic dehydration has been reported after repeated doses of
charcoal with sorbitol. Nonsorbitol-containing products should be used if repeated doses are
necessary.
Dexamethasone
Indication: 1) Emergency treatment of elevated intracranial pressure due to brain tumor
Dosage: IV: 1 to 2 mg/kg as a loading dose
Maintenance dose, 1 mg/kg/24 h
Indication: 2) Croup
Dosage: IV, IM, or PO: 0.6 mg/kg dexamethasone, 1 dose/d, or 2 mg/kg/24 h of prednisone. Further dosing
and route of administration determined by clinical course.
Diazepam
Indication: Status epilepticus
Dosage: IV: 0.1 mg/kg every 2 minutes. Maximum dose, 0.3 mg/kg (maximum 10 mg/dose).
Dosage: Rectal: 0.5 mg/kg up to 20 mg
Note: Do not give as IM injection.
WARNING: There is an increased incidence of apnea when combined with other sedative agents or
when given rapidly. One must be prepared to provide respiratory support. Monitor oxygen
saturation.
Diazoxide
Indication: Hypertensive crisis
Dosage: IV: 1 to 3 mg/kg rapid IV push.
Note: Alternative regimen: 3 to 5 mg/kg IV over 30 minutes. This is reported to result in fewer problems with
hypotension or hyperglycemia.
Digoxin Immune FAB (Digibind)
Indication: Digoxin or digitoxin toxicity
Dosage: 1) Administer digoxin immune FAB intravenously in an amount equimolar to the total body load
of digoxin or digitoxin.
2) 38 mg digoxin immune FAB binds 0.5 mg digoxin or digitoxin
Dosing methods:
A: Based on amount ingested:
1) For digoxin tablets, oral solution, IM injection
Dose in mg
5
dose ingested (mg)
0.5
3 0.8
3
2) For digitoxin tablets, digoxin capsules, IV digoxin or IV digitoxin
Dose in mg
38;5
dose ingested (mg)
0.5
3
B: Based on serum digoxin or digitoxin concentration (SDC)
1) Digoxin
Dose in mg
38;5
SDC (ng/mL)
100
3 weight (kg)
3
2) Digitoxin
Dose in mg
385
SDC (ng/mL)
1000
3 weight (kg)
3
C: If neither amount ingested nor serum concentration is known, 760 mg of digoxin immune FAB should be
administered.
38
Diphenhydramine
Indication: 1) Acute hypersensitivity reactions
2) Dystonic reactions
Dosage: V or IM: 1 to 2 mg/kg.
Maximum dosage, 50 mg.
Note: May cause sedation, especially if other sedative agents are being used.
May cause hypotension.
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DRUGS FOR PEDIATRIC EMERGENCIES
Dopamine
Indication: Continued shock after volume resuscitation
Dosage: IV infusion: 2 to 20
A widely recommended starting dosage is 10
Note: Preparation of infusion solution: 6 mg
mg/kg/min.mg/kg/min. Titrate to desired clinical effect.3 body weight (kg) diluted to 100 mL. Infuse at 10 mL/h 5 10
m
g/kg/min using a constant infusion pump.
WARNING: Extravascular administration can result in severe skin injuries.
Dobutamine
Indication: Impaired cardiac contractility
Dosage: IV infusion: 5 to 25
A widely recommended starting dosage is 10
Note: Preparation of infusion solution: 6 mg
mg/kg/min.mg/kg/min. Titrate for desired clinical effect.3 body weight (kg) diluted to 100 mL. Infuse at 10 mL/h 5 10
m
g/kg/min using a constant infusion pump.
Epinephrine
Indication: 1) Cardiac arrest or profound bradycardia, asystole, ventricular fibrillation, or pulseless electrical
activity
Initial Dose: IV: 10
Intraosseous: 10
Endotracheal: 100
Note: 10
100
Note: If administered through an endotracheal tube, follow the dose with saline flush or dilute in isotonic
saline flush (1 to 5 mL) based on patient size.
Subsequent doses: given every 3 to 5 minutes
IV: 100
Intraosseous: 100
Endotracheal: 100
Note: For subsequent doses of epinephrine, a dosage up to 200
Indication: 2) Anaphylaxis
Dosage: Subcutaneous (SC): 10
IV: 10
10
Note: Repeat the SC dose every 20 minutes while attempting IV access. Some anaphylactic reactions, eg, latex
allergy, require large doses of epinephrine. A continuous infusion of epinephrine may be necessary.
Indication: 3) Continued shock after volume resuscitation
Dosage: IV infusion: 0.1 to 3.0
Start at lowest dose and titrate for desired clinical effect.
Note: Preparation of infusion solution: 0.6 mg
mg/kg (0.01 mg/kg)mg/kg (0.01 mg/kg)mg/kg (0.10 mg/kg)mg/kg 5 0.1 mL/kg of 1:10 000 dilutionmg/kg 5 0.1 mL/kg of 1:1000 dilutionmg/kg (0.1 mg/kg)mg/kg (0.1 mg/kg)mg/kg (0.1 mg/kg)mg/kg (0.2 mg/kg) may be given.mg/kg per dose (maximum 3 doses)mg/kg per dose:mg/kg 5 0.01 mL/kg of 1:1000 dilution or 0.1 mL/kg of a 1:10 000 dilutionmg/kg/min.3 body weight (kg) diluted to 100 mL. Infuse at 1 mL/h 5 0.1
m
Note: Extravasation can result in tissue necrosis injuries.
Indication: 4) Status asthmaticus, bronchospasm
Dosage: SC: 10
10
Maximum single dose, 300
Note: Albuterol administered by inhalation is now considered the agent of choice for treatment of acute
exacerbations of asthma.
Note: Repeat SC dose every 20 minutes if needed for clinical effect. Total of 3 doses.
Indication: 5) Laryngotracheobronchitis:
Dosage: Racemic epinephrine, 2.25% inhalation solution
0–20 kg: 0.25 mL in 2 mL with normal saline administered by nebulizer
20–40 kg: 0.50 mL in 2 mL with normal saline administered by nebulizer
g/kg/min using a constant infusion pump.mg/kg per dosemg/kg 5 0.01 mL/kg of 1:1000 dilutionmg (0.3 mL of 1:1000 dilution).
.
Note: L-Epinephrine: An equal volume of 1% L-epinephrine (1:100) is approximately equivalent in biologic
activity to 2.25% racemic epinephrine; one can be substituted for the other in equal volumes for
inhalation.
Alternatively, 5 mL of 1:1,000 L-epinephrine is equivalent to 0.5 mL of 1:100.
40 kg: 0.75 mL in 2 mL with normal saline administered by nebulizer
Fentanyl
Indication: Pain
Dosage: IV: 0.5
Note: Higher doses may be necessary if the patient is tolerant.
Note: Rapid administration of fentanyl has been associated with both glottic and chest wall rigidity even with
dosages as low as 1
mg to 2.0 mg/kg. Repeat dose as necessary for clinical effect.mg/kg. Therefore, fentanyl should be titrated in slowly over several minutes.
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WARNING: There is an increased incidence of apnea when combined with other sedative agents, particularly
benzodiazepines. Be prepared to administer naloxone. Monitor the patient’s vital signs
and oxygen saturation. Be prepared to provide respiratory support.
Flumazenil
Indication: Benzodiazepine intoxication
Dosage: IV: 5 to 10
Maximum dose, 1 mg
Note: Useful only for benzodiazepine intoxication.
mg/kg (up to 100 mg/kg has been used)
WARNING: Duration of action is shorter than most clinically important benzodiazepines. Resedation may
occur. May precipitate acute withdrawal in dependent patients; use drug with caution as its use
may be associated with seizures. Patients who receive flumazenil should be continuously
observed for resedation for at least 2 hours after the last dose of flumazenil.
Fosphenytoin
Indication: Status epilepticus (same as phenytoin)
Dosage: ALWAYS IN PHENYTOIN EQUIVALENTS (PE)
10 to 20 mg PE/kg (same as phenytoin)
Route of administration: IM or IV: 1 to 3 mg PE/kg/min; maximum rate 150 mg PE/min
Note: Data are currently being collected on children less than 6 years of age.
Itching is a common and controllable by reducing flow rate.
WARNING: Rate of infusion should not exceed 3mg PE/kg/min. Heart rate should be monitored and the rate
of infusion reduced if the heart rate decreases by 10 beats/minute (same as phenytoin).
Furosemide
Indication: 1) Fluid overload
2) Congestive heart failure
Dosage: IV, IM: 1 mg/kg
Glucagon
Indication: 1) Hypoglycemia due to insulin excess
Dosage: Adult and adolescent: 0.5 to 1.0 mg SC, IM, IV; repeat every 20 minutes
Pediatric: 0.025 mg/kg up to 1.0 mg SC, IM, IV; repeat the dose every 20 minutes if needed for clinical
effect. Total of 3 doses.
Note: An attempt should be made to provide a simultaneous IV glucose infusion.
Indication: 2) Beta-blocker or calcium channel blocker overdose
Dosage: Adolescent
IV: 2 to 3 mg followed by a 5 mg/h infusion.
Pediatric
IV: 0.025 to 0.05 mg/kg followed by 0.07 mg/kg/h infusion.
Glucose
Indication: Hypoglycemia
Initial Dose: IV: 250 to 500 mg/kg
Maintenance
Dose: Constant infusion of 10% dextrose in water at a rate of 100 mL/kg/24 h (7 mg/kg/min). Older children
may require a substantially lower dose. The rate should be titrated to appropriate glucose values.
Note: 250 to 500 mg/kg
250 to 500 mg/kg
250 to 500 mg/kg
Note: Neonates should receive 10% to 12.5% glucose administered slowly.
Note: Glucose levels should be determined before and during administration. If large volumes of dextrose are
administered, include electrolytes to prevent hyponatremia and hypokalemia.
5 2.5 to 5.0 mL/kg of D10%5 1.0 to 2.0 mL/kg of D25%5 0.5 to 1.0 mL/kg of D50%
Haloperidol
Indication: Psychosis with agitation
Dosage: IM, IV: 0.1 mg/kg, may repeat hourly as necessary. Maximum single dose, 5 mg.
Note: Hypotension and dystonic reactions may occur.
Insulin, Regular
Indication: 1) Diabetic ketoacidosis
Dosage: SC: 0.25 to 0.5 unit/kg per dose
IV infusion dose: 0.05 to 0.1 unit/kg/h
Neonatal dose: 0.05 unit/kg/h
Note: Blood glucose levels should be closely monitored. Appropriate fluid and electrolyte therapy are also
required in treating diabetic ketoacidosis.
Indication: 2) Hyperkalemia
Dosage: IV: 0.1 unit/kg with 400 mg/kg glucose. Ratio of 1 unit of insulin for every 4 g of glucose.
Note: Potassium levels in blood or serum should be monitored.
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DRUGS FOR PEDIATRIC EMERGENCIES
Ipecac Syrup
Indication: Acute ingestion of selected toxic substances
Dosage: Oral (PO): 6-month-old to 1-year-old
5 10 mL
.
Adolescent/young adult
1 year old 5 15 mL5 30 mL
WARNING: Do not use when patient is suffering from central nervous system depression or if having
seizures. Contraindicated in caustic and hydrocarbon ingestion. Patients who ingest pesticides
or other chemicals that may have a hydrocarbon base may need to have emesis induced. Consult
your regional poison control center.
Note: Administer with 120 to 180 mL of fluid; 90% effective in inducing vomiting within 25 minutes of first dose.
May repeat once.
Note: Activated charcoal is now considered the first line therapy for most oral ingestions treated in the hospital
setting.
Kayexalate (Sodium Polystyrene Sulfonate)
Indication: Treatment of hyperkalemia
Dosage: Adults and adolescents
PO: 15 g (60 mL) 1 to 4 times/day
Rectal: 30 to 50 g every 6 hours
Children
PO: 1.0 g/kg every 6 hours
Rectal: 1.0 g/kg/dose every 2 to 6 hours (for small children and infants use lower doses by using the
practical exchange ratio of 1 mEq K
1/g of resin).
WARNING: Avoid using the commercially available liquid preparation in neonates due to the hyperosmolar
preservative (Sorbitol) content. Extremely premature newborns may develop intestinal hemorrhage
(hematochezia) from rectal Kayexalate.
Ketamine
Indication: 1) Sedation/analgesia
Dosage: IM: 1 to 2 mg/kg
IV: 0.5 to 1 mg/kg
Indication: 2) Adjunct to intubation
Dosage: IV: 1 to 2 mg/kg
Note: Laryngospasm associated with ketamine is usually reversed with oxygen administration and positive
pressure ventilation.
Note: Atropine or other antisialogogue should be used to prevent increased salivation.
WARNING: Be prepared to provide respiratory support. Monitor oxygen saturation. Avoid use in patients
with increased intracranial pressure or increased intraocular pressure.
Lidocaine
Indication: 1) Ventricular arrhythmia
Dosage: IV: 1 mg/kg as a single dose slowly, repeat every 5 to 10 minutes to desired effect or until maximum
dose of 3 mg/kg is given
IV infusion: 20 to 50
Endotracheal: 1 mg/kg
Note: If administered through an endotracheal tube, follow the dose with saline flush or dilute in isotonic
saline flush (1 to 5 mL) based on patient size.
Note: Preparation of infusion solution: add 120 mg (6 mL of a 2.0% concentration) to 100 mL of 5% glucose
in water. Infusion of 1.0 to 2.5 mL/kg/h will deliver 20 to 50
Note: A reduced infusion rate should be used in patients with a low cardiac output.
mg/kg/minmg/kg/min.
WARNING: Contraindicated in complete heart block and wide complex tachycardia due to accessory
conduction pathways.
Note: Excessive dosage may result in myocardial depression, hypotension, central excitation, and seizures.
Indication: 2) To attenuate airway reflexes before endotracheal intubation or airway manipulation in patients
with elevated intracranial pressure
Dosage: 1 mg/kg IV as a single dose 30 seconds before airway instrumentation.
Lorazepam
Indication: 1) Status epilepticus
2) Adjunct for intubation
Dosage: IM or IV: 0.05 to 0.1 mg/kg
Repeat doses every 10 to 15 minutes for clinical effect.
WARNING: There is an increased incidence of apnea when combined with other sedative agents. Be
prepared to provide respiratory support. Monitor oxygen saturation.
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Mannitol
Indication: Increased intracranial pressure
Dosage: IV: 0.25 g/kg given over a 15-minute infusion.
Note: A larger dose (0.5 g/kg given over 15 minutes) may be appropriate in an acute intracranial hypertensive
crisis. In conjunction with mannitol, other measures to control intracranial pressure such as hyperventilation,
barbiturates, and muscle relaxation (using a neuromuscular blocking agent) should be considered.
WARNING: Rapid administration may cause hypotension, hyperosmolality, and elevated intracranial pressure.
Meperidine
Indication: Pain
Dosage: IV or IM: 1 to 2 mg/kg
Repeat dose is necessary for clinical effect.
Note: Higher doses may be necessary if patient is tolerant.
WARNING: There is an increased incidence of apnea when combined with other sedative agents, particularly
benzodiazepines. Be prepared to administer naloxone. Monitor the patient’s vital signs
and oxygen saturation. Be prepared to provide respiratory support.
Methylprednisolone
Indication: 1) Asthma/allergic reaction
Dosage: IV: 1 to 2 mg/kg every 6 hours
Indication: 2) Spinal cord injury
Dosage: IV: 30 mg/kg over 15 minutes. In 45 minutes begin a continuous infusion of 5 to 6 mg/kg/h for 23
hours.
Indication: 3) Croup
Dosage: IV: 1 to 2 mg/kg of methylprednisolone, then 0.5 mg/kg every 6 to 8 hours.
Midazolam
Indication: Adjunct for endotracheal intubation or for sedation/anxiolysis
Dosage: IV: 0.05 to 0.2 mg/kg given over several minutes.
WARNING: There is an increased incidence of apnea when combined with other sedative agents. Be
prepared to provide respiratory support. Monitor oxygen saturation.
Morphine Sulfate
Indication: Pain, infundibular spasm (“Tet Spell”)
Dosage: IV (slowly) or IM: 0.05 to 0.1 mg/kg.
Repeat dose as necessary for clinical effect.
Note: Higher doses may be necessary if patient is tolerant.
WARNING: There is an increased incidence of apnea when combined with other sedative agents, particularly
benzodiazepines. Be prepared to administer naloxone. Monitor the patient’s vital signs
and oxygen saturation. Be prepared to provide respiratory support.
Naloxone
Indication: Respiratory depression induced by opioid
Dosage: IV, IM: 0.1 mg/kg from birth (including premature infants) until age 5 years or 20 kg of weight.
Thereafter, the minimum dose is 2.0 mg. Doses may be repeated as needed to maintain opiate
reversal. IM absorption may be erratic.
Note: This dosage is indicated for acute opiate intoxication. Titration to effect with lower initial doses (0.01
mg/kg or 10
pain management.
mg/kg) should be considered for other clinical situations, eg, respiratory depression during
WARNING: May induce acute withdrawal in opioid dependency. Patients who receive naloxone should be
continuously observed for renarcotization for at least 2 hours after the last dose of naloxone.
Nitroprusside
Indication: Hypertensive crisis
Dosage: IV: 0.5 to 10
Start at the lowest dosage and titrate for the desired clinical effect. Administer through low dead
space system or as close to IV catheter as possible to prevent accidental bolus injection.
Note: Preparation of infusion solution: 6 mg
mg/kg/min.3 body weight (kg) diluted to 100 mL D5W. Infuse at 1 mL/h
5
Note: Bottle, burette, or syringe pump but not the IV tubing should be covered with protective foil to avoid
breakdown by light.
1 mg/kg/min using a constant infusion pump.
WARNING: Administration may result in profound hypotension. Patients should be closely monitored.
Blood pressure should be continuously monitored with an arterial line.
WARNING: Cyanide toxicity can result from large doses and/or prolonged infusions. Patients should be
closely monitored for the development of metabolic acidosis. Patients with decreased renal
function may be at increased risk.
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DRUGS FOR PEDIATRIC EMERGENCIES
Oxygen
Indication: 1) Hypoxemia and/or respiratory distress
2) Carbon monoxide poisoning
3) Shock
Dosage: 100% by nonrebreather mask initially or endotracheal tube; wean as tolerated.
Note: The administration of supplemental oxygen should be considered during
EVERY pediatric emergency.
Pancuronium
Indication: 1) Neuromuscular blockade to facilitate mechanical ventilation
2) Emergency intubation
Dosage: IV: 0.1 mg/kg
Note: This drug does not alter the level of consciousness or provide analgesia or amnesia.
Note: This agent can be used when succinylcholine is contraindicated. Pancuronium is a long-acting neuromuscular
blocker that requires ventilatory assistance for at least 1 hour. Satisfactory conditions for
endotracheal intubation will generally occur 2 to 3 minutes after administration.
WARNING: Ventilatory support will be necessary. Personnel with skills in advanced airway management
must be present and prepared to respond when this agent is administered. Age-appropriate
equipment for suctioning, oxygenation, intubation, and ventilation should be immediately
available.
Phenobarbital
Indication: Status epilepticus
Dosage: IV: 20 mg/kg. Maximum dose, 1000 mg.
Repeat dose once if necessary for clinical effect after 15 minutes.
WARNING: There is an increased incidence of apnea when combined with other sedative agents. Be
prepared to provide respiratory support. Monitor oxygen satura
Phenylephrine
Indication: Infundibular spasm (“Tet Spell”)
Dosage: 5 to 20
mg/kg push then followed by infusion at 0.1 to 5.0 mg/kg/min.
WARNING: Blood pressure must be carefully followed and dose titrated to effect.
Phenytoin
Indication: Status epilepticus
Dosage: IV: 10 to 20 mg/kg initial dose.
Maximum initial dose, 1000 mg.
Maximum rate of administration, 50 mg/min or 1 mg/kg/min, whichever is less.
Note: The lower dose is indicated in neonates because of increased risk of toxicity due to decreased protein
binding. Should be diluted in normal saline to avoid precipitation.
WARNING: Rate of infusion should not exceed 0.1 mL of undiluted preparation per kg/min. Heart rate
should be monitored and the rate of infusion reduced if the heart rate decreases by 10
beats/minute.
Procainamide
Indication: Wide complex tachycardia
Dosage: IV: Start at 3 to 6 mg/kg/dose over 5 minutes not to exceed 100 mg to a titrated maximum of 15
mg/kg/loading dose.
Maintenance dose, 20 to 80
mg/kg/min (0.02 to 0.08 mg/kg/min); maximum, 2 g/24 h.
WARNING: If 50% QRS widening or hypotension occurs during loading dose, the remainder of the loading
dose is held, and the maintenance dose is delayed until these signs have resolved.
Propranolol
Indication: Infundibular spasm (“Tet Spell”)
Dosage: IV: 0.01 to 0.02 mg/kg per dose infused over 10 min in 5% dextrose in water.
Maximum initial dose, 1.0 mg
Note: Oxygen should be administered first. Morphine is also an effective treatment for infundibular spasms.
Phenylephrine is another adjunct for reversal of infundibular spasm. Use is contraindicated in congestive
heart failure. Avoid in patients with a history of bronchospasm.
Prostaglandin E
1
Indication: Possible ductal-dependent cardiac malformation in the neonatal period
Dosage: 0.05 to 0.10
Note: Preparation of infusion solution: 250
mg/kg/min as an infusion in 5% dextrose in water.mg in 80 mL of D5W infuse at 1 mL/kg/h 5 0.05 mg/kg/min.
WARNING: Apnea, hyperthermia, and seizures may occur. Be prepared to provide respiratory support.
Monitor oxygen saturation.
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Rocuronium
Indication: 1) Neuromuscular blockade to facilitate mechanical ventilation
2) Emergency intubation
Dosage: IV: 0.8 to 1.2 mg/kg
Note: This drug does not alter the level of consciousness or provide analgesia or amnesia.
Note: Alternative to succinylcholine for rapid intubation when succinylcholine is contraindicated. Duration of
block is generally 30 to 45 minutes and is dose-dependent. Satisfactory conditions for endotracheal
intubation will generally occur 45 to 60 seconds after administration.
WARNING: Ventilatory support is necessary. Personnel with skills in airway management must be
present and prepared to respond when this agent is administered. Age-appropriate
equipment for suctioning, oxygenation, intubation, and ventilation should be immediately
available.
Succinylcholine
Indication: Neuromuscular blockade for emergency intubation or treatment of laryngospasm
Dosage: 1 to 2 mg/kg IV
4 to 5 mg/kg IM
WARNING: Contraindicated with previous history of malignant hyperthermia, severe burns, spinal cord
injury, neuromuscular disease, or myopathies. When these contraindications exist use a nondepolarizing
muscle relaxant such as rocuronium. Despite reports of acute rhabdomyolysis,
hyperkalemia, and cardiac arrest with succinylcholine, this agent remains the drug of choice
when immediate securing of an airway is indicated.
WARNING: Ventilatory support is necessary. Personnel with skills in airway management must be present
and prepared to respond when this agent is administered. Age-appropriate equipment for
suctioning, oxygenation, intubation, and ventilation should be immediately available.
Note: Atropine, 0.02 mg/kg (minimum dose, 0.1 mg), should be combined with or precede succinylcholine to
prevent bradycardia or asystole. Satisfactory conditions for endotracheal intubation generally occur 30
to 45 seconds after IV administration and 3 to 5 minutes after IM administration.
Note: If cardiac arrest occurs immediately after administration of succinylcholine, hyperkalemia must be
suspected and treatment for this condition initiated. Hyperkalemia is especially likely to be responsible
for cardiac arrest occurring in male children 8 years of age or younger.
Thiopental
Indication: 1) Adjunct to intubation
Dosage: IV: 4 to 6 mg/kg
Note: A lower dose may be used if other sedatives/narcotics have been administered.
WARNING: IM administration leads to tissue necrosis.
WARNING: Be prepared to provide respiratory support. Monitor oxygen saturation. High doses are associated
with hypotension and apnea. Use with caution in patients with cardiac compromise or
hypovolemia.
Indication: 2) Control of intracranial hypertension
Dosage: 1 to 2 mg/kg, repeated as necessary
Vecuronium
Indication: 1) Neuromuscular blockade to facilitate mechanical ventilation
2) Emergency intubation
Dosage: IV: 0.1 mg/kg
Note: This drug does not alter the level of consciousness or provide analgesia or amnesia.
Note: This agent may be used for emergency intubation when succinylcholine is contraindicated. Satisfactory
conditions for endotracheal intubation generally occur 1.5 to 2.0 minutes after administration.
WARNING: Ventilatory support is necessary. Personnel with skills in airway management must be
present and prepared to respond when this agent is administered. Age-appropriate equipment
for suctioning, oxygenation, intubation, and ventilation should be immediately available.
Filed under: 03.EMERGENCY DRUG
