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
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.
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.
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.
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.
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
Flumazenil
5 mcg/kg every 60 seconds to a maximum total of 40 mcg/kg then 210 mcg/kg/hr
Antidote for benzodiazepines
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)
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)
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
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
Procainamide
10-15 mg/kg IV over 30-60 mins
Haemodynamically stable SVT and VT
Rocuronium
0.6-1.2 mg/kg stat, then 0.1-0.2 mg/kg boluses or 5-15 mcg/kg/min
Emergency Calculations
Davis, T. Emergency Calculations, Don't Forget the Bubbles, 2013. Available at:
http://doi.org/10.31440/DFTB.4073
All your important calculations in one place…
Resus Drugs
ETT Size
DC shock
VF, pulseless VT – 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
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
For example a 22kg child – (100 x 10) + (50 x 10) + (20 x 2) = 1540 ml/day
References
Australian Resus Council
NETS
Life in the Fast Lane