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Resus Drugs
| Drug | Dose | Indication | Side effects/other info |
|---|---|---|---|
| Vasopressin | 0.5-0.8 units/kg IV | Alternative vasopressor to adrenaline | |
| Suxamethonium | Neonate: 3mg/kg IVnChild: 2mg/kg IV | Muscle relaxant for RSI | Bradycardia and asystole. Should give with atropine. |
| Sodium bicarbonate | 1 mmol/kg IV (1 ml/kg of 8.4%) over 5 mins | Severe metabolic acidosis (pH <7.1) | S/E - hypernatraemia, hyperosmolality, myocardial dysfunction |
| Rocuronium | 0.6-1.2 mg/kg stat, then 0.1-0.2 mg/kg boluses or 5-15 mcg/kg/min | Muscle relaxant | |
| Procainamide | 10-15 mg/kg IV over 30-60 mins | Haemodynamically stable SVT and VT | |
| Potassium | 0.03-0.07 mmol/kg IV by slow injection; or infusion of 0.2-0.5 mmol/kg/hr (max 1 mmol/kg/hr) | Hypokalaemia | |
| Naloxone | For post-operative respiratory depression or over-sedation, give 0.002 mg/kg/dose (i.e. dilute 0.4mg to 20ml and then give 0.1ml/kg/dose). Repeat every 2 minutes x4 if required, then commence infusion by adding 0.3mg/kg to 30ml 5% dextrose and running at 0-1ml/hr (0.01mg/kg/hr).nnFor opiate overdose, give 0.01 mg/kg (max 0.4 mg) (i.e. dilute 0.4mg to 10ml and give 0.25ml/kg/dose). Repeat every 2 minutes x4 if required, then commence infusion by adding 0.3 mg/kg to 30ml 5% dextrose and running at 0-1 ml/hr (0.01mg/kg/hr) | For reversal of post-op respiratory depression or opiate overdose | |
| Magnesium | 0.1-0.2 mmol/kg IV bolus 25-50 mg/kg n(this is the same as 0.05-0.1 ml/kg of 50% (2 mmol/ml) | Hypomagnesaemia; antidysrhythmic for polymorphic ventricular tachycardia (due to long QT) | |
| Lignocaine | 1 mg/kg IV of 1% lignocaine | Only recommended in cardiac arrest if amiodarone is not available (or when IV/IO access is impossible as can be given via ETT) | |
| Flumazenil | 5 mcg/kg every 60 seconds to a maximum total of 40 mcg/kg then 210 mcg/kg/hr | Antidote for benzodiazepines | |
| Dextrose | 0.5 ml/kg of 50% dextrose IV; or 2 ml/kg of 10% dextrose IV | Hypoglycaemia | Maintenance requirement is usually 5-8 mg/kg/min |
| Calcium | 0.2 ml/kg of 10% calcium chloride IV; or 0.7 ml/kg of 10% calcium gluconate IV (20 mg/kg). For calcium channel blocker antidote. | Management of arrhythmia caused by hyperkalaemia, hypocalcaemia, hypermagnesaemia or calcium channel blocker. | S/E - extravasation; myocardial and cerebral injury, coronary artery vasospasm, bradycardia with rapid administration. Don't give routinely in cardiac arrest. |
| Atropine | 20 mcg/kg IV; 30 mcg/kg via ETT | Bradycardia caused by vagal stimulation or cholinergic drug toxicity | Use adrenaline instead for bradycardia with hypotension. |
| Amiodarone | 5 mg/kg IV bolus (usually diluted with 5% dextrose to a concentration of 15mg/ml over 3 mins) | Good for ventricular arrhythmias - shock-resistant VF and pulseless VT. Also SVT, JET, atrial tachycardias. | S/E - hypotension, bradycardia, heart block. Lignocaine can be used as an alternative. |
| Adrenaline | 10 mcg/kg (0.1 ml/kg of 1 in 10,000) IV; 100 mcg/kg via ETT; or 0.1-0.2 mcg/kg/min infusion into a large vein. | Asystole, bradycardia, VF, EMD. | S/E - vasoconstriction, hypertension, tachdysrrhythmias |
| Adenosine | 0.05-0.1 mg/kg IV bolus; repeat after 1-2 mins if not reverted to sinus increasing the amount given by 0.05-0.1 mg/kg until sinus rhythm or dose of 0.3 mg/kg is reached. Adult dose is 6mg then 12mg | SVT |
ETT Size
| Neonates (up to 4kg) | Infants (up to 1 year) | Children (1-16 years) | |
|---|---|---|---|
| Nasal length (cm) | weight + 7 | weight/2 + 9 | age/2 + 14 |
| Oral length (cm) | weight + 6 | weight/2 + 8 | age/2 + 12 |
| ETT Size (mm) | 3.0-4.0 | 4.0 | age/4 + 4 |
DC shock
VF, pulseless VT Â – all shocks 4J/kg unsynchronised
Pulsatile VT – 2J/kg synchronised
SVT – 1J/kg synchronised
Fluid management
Option 1 – 4:2:1 rule for the hourly requirement
4 ml/kg/hr for the first 10 kg, then 2 ml/kg/hr for the second 10 kg, then 1 ml/kg/hr for each subsequent kg
For example a 22kg child – (4 x 10) + (2 x 10) + (1 x 2) = 62 ml/hr
Option 2 – 100:50:20 rule for the daily requirement
100 ml/kg/hr for the first 10 kg, then 50 ml/kg/hr for the second 10kg, then 20 ml/kg/hr for each subsequent kg
For example a 22kg child – (100 x 10) + (50 x 10) + (20 x 2) = 1540 ml/day
References
Australian Resus Council
