PEDIATRIC EMERGENCY REFERENCE

These medication dosages are recommendations for initial emergency care of

patients over one month of age. They do not preclude use of alternative dosages
based on provider clinical assessment.

PEDIATRIC ASSESSMENT TRIANGLE

Appearance Breathing Circulation

Wo athi
br

appropriate cry/speech, responds easy, quiet, rate consistent with warm, dry, capillary refill time
e

Normal
a ra l

e
nc
pe era

to stimuli, moves well age (see pediatric normals chart) ≤ 2 seconds

rk ng
ap Gen

of

inconsolable or absent cry/speech, retractions, stridor, grunting, mottled, cyanotic, absent

Abnormal decreased responsiveness, floppy/ wheezing, gasping, rate <12 or peripheral pulses, capillary refill
rigid body >30 breaths/minute time > 2 seconds

Circulation to Any abnormal signs during initial assessment require prompt airway management, oxygen, warmth and more help.
the skin

AIRWAY
Key Rapid sequence intubation
ET Endotracheal tube PO By mouth Have appropriate size mask, ET tubes, O and suction ready. Monitor with pulse oximeter and
2

ECTO . Use cricoid pressure only if needed for positioning.

IM Intramuscular PR Rectal
2

Generic Dose/Route Notes

IN Intranasal VF Ventricular fibrillation
Premedication
IV-IO Intravenous-Intraosseous VT Ventricular tachycardia
• Atropine 0.02 mg/kg IV-IO Up to age 8 years. Max 1 mg
NG Nasogastric
Not routinely used if
high risk of bradycardia
Pediatric normals Sedation options
Age Wt (kg) HR RR Sys BP Hypotension ET ID mm • Etomidate 0.2–0.3 mg/kg IV-IO
1 month 4 85–205 30–60 <60 3.5 (cuffed) • Ketamine 1–2 mg/kg IV-IO
6 months 7 100–190 30–60 <60 3.5 (cuffed) • Propofol 3 mg/kg; Max 100 mg
• Midazolam 0.1–0.3 mg/kg IV-IO
1 year 10–11 100–190 30–60 <70 3.5 (cuffed) Max dose 10 mg
Given simultaneously
2–3 years 12–14 60–140 24–40 <74–76 4.0 (cuffed) • Fentanyl 2 mcg/kg
Max dose 200 mcg
4.5–5.0
4–5 years 15–18 60–140 22–34 <78–80 Muscle relaxant options
(cuffed) Induction
5.0–5.5 • ROCuronium 1 mg/kg IV-IO or IM
6–8 years 20–25 60–140 18–30 <82–86
(cuffed)
6.0–6.5 Maintenance Dose as needed when movement is observed.
9–13 years 30–40 60–100 18–30 <90
(cuffed) • ROCuronium 0.1–0.2 mg/kg IV-IO
14 and over 50 60–100 12–16 <90 7.0 (cuffed)
VECuronium is not recommended due to high risk of overdose.

BREATHING CIRCULATION
Acute asthma/anaphylaxis Shock
Generic Dose/Route Notes Generic Dose/Route Notes
Albuterol < 2 years = 2.5 mg Crystalloid 20 mL/kg IV-IO repeat Give in 10 mL/kg IV-IO
>/= 2 years = 5 mg Nebulize together (NS, LR) PRN up to 3 times. increments for heart history or
Ipratropium < 2 years = 0.25 mg as needed x3 cardiogenic shock
>/= 2 years = 0.5 mg
EPInephrine (1mg/ml) 0.01 mL/kg IM Max dose 0.3 mL, Vasoactive infusions (use pump)
q 20 min PRN x3
Generic Dose/Route Notes
DiphenhydrAMINE 1 mg/kg IM, IV-IO, PO Max dose 50 mg DOBUTamine 2–20 mcg/kg/min IV-IO Start low; titrate to effect
methylPREDNISolone, 2 mg/kg IV-IO or Max 80 mg/day DOPamine 2–20 mcg/kg/min IV-IO Start low; titrate to effect
EPInephrine 0.1–1 mcg/kg/min IV-IO Consider higher dose if needed
PredniSONE or 2 mg/kg PO Max 60 mg/day NORepinephrine 0.1–1 mcg/kg/min IV-IO
PREDNISolone

Reconstitute vasoactive infusions according to infusion guidelines.

Croup See Children’s Medication Manual for infusion concentration and dosing.

Generic Dose/Route Notes

Dexamethasone 0.6 mg/kg IV-IO, IM, PO Max dose 12 mg
Racemic Epinephrine 0.25–0.5 mL Neb Nebulize with NS
(2.25%)

Disclaimer: This guideline is designed for general use with most patients; each clinician should use his or her own independent judgment
to meet the needs of each individual patient. This guideline is not a substitute for professional medical advice, diagnosis or treatment.
CIRCULATION continued
Cardiac arrest Dysrhythmias
Generic Dose/Route Notes Generic Dose/Route Notes
EPInephrine 0.01 mg/kg IV-IO Max single dose 1 mg Adenosine 0.1 mg/kg rapid IV-IO Max 1st dose 6 mg,
(1 mg/10 mL) push, if no response, Max 2nd dose 12 mg
increase 0.2 mg/kg
After airway and breathing are managed, rule out reversible causes (Hs and Ts):
AMIODARone 5 mg/kg IV-IO 300 mg max dose for VF or
• Hypovolemia • Tamponade, cardiac pulseless VT
• Hypoxia • Tension pneumothorax For tachycardias with pulses,
• Hypothermia • Thrombosis: lungs dilute in D5W to 2 mg/mL
(prevents precipitate) and
• Hypo-/Hyperkalemia • Thrombosis: heart give over 1 hour, max 150mg
• Hydrogen ion (acidosis) • Toxins: drug overdose
Lidocaine 1mg/kg IV-IO load, then May repeat bolus if delay
• Hypomagnesia 20–50 mcg/kg/min IV-IO until infusion is >15 minutes
• Hypoglycemia infusion
Procainamide 15 mg/kg in D5W IV-IO, Max dose 500 mg
then 20–80 mcg/kg/min Infuse over 30-60 min; may
Electrical therapy IV-IO infusion cause hypotension,
bradycardia, widening QRS
Type of therapy Dose Notes
— if so, stop infusion
Cardioverson 0.5–2 j/kg 0.5 to 1 j/kg 1st dose 2 j/kg for
(synchronized) 2nd and subsequent doses Hypertensive crisis
Defibrillation 2–4 or more j/kg 2 j/kg 1st dose, 4 j/kg 2nd dose. Generic Dose/Route Notes
May increase subsequent doses to
max of 10j/kg NIFEdipine 0.1–0.25 mg/kg PO Max dose 10 mg; for use in
DISABILITY inpatient tertiary setting after
alternatives have been tried
Seizures Labetalol 0.25 mg/kg IV-IO, Repeat in 10 min with
over 2 min 0.5 mg/kg IV-IO if BP still
Generic Dose/Route Notes elevated Max dose 40 mg
Levetiracetam 60mg/kg loading Max dose 4500 mg Hydralazine 0.25 mg/kg PO Max PO dose 25 mg
dose; infuse over May give IV push if required. Max IM/IV dose 20 mg
15 min. Levetiracetam dosing 20 mg/kg if 0.1-0.2 mg/kg IM/IV
patient is already taking this
medication.
Diazepam 0.2 mg/kg IV-IO Max dose 10 mg
Metabolic
Diazepam 0.5 mg/kg PR 2-5 years: 0.5mg/kg (max 20kg)
PR preferred. 6-11 years: 0.3mg/kg (max 20kg) Generic Dose/Route Notes
May use IV product >/= 12 years: 0.2mg/kg (max 20kg) Hyperkalemia
for PR administration. Max dose 20 mg Calcium Chloride 10% 20 mg/kg IV-IO Max dose 1000 mg
OR
LoraZEPAM 0.1 mg/kg IV-IO Max dose 4 mg* Calcium Gluconate 60 mg/kg IV-IO Max dose 2000 mg
IV/IO preferred AND
Central line if possible.
Midazolam 0.2 mg/kg IM, IN Max dose 10 mg* Dextrose 25% 2 mL/kg IV-IO Administer together.
IM/IN preferred May premedicate with IN lidocaine to Use dextrose to flush insulin in line.
Regular Insulin 0.1 units/kg IV-IO
minimize burning sensation. Dextrose max dose 25 g.
FOSphenytoin 20 mgPE/kg If IV-IO, infuse over 10 min, Insulin max dose 10 units.
load IV-IO or IM monitor for ↓HR and ↓BP for Sodium Bicarbonate 1 mEq/kg IV-IO Max dose 50 mEq
30 min*
PHENObarbital 15–20 mg/kg load Infuse over 30 min, monitor for ↓HR Diabetic 10 mL/kg IV-IO over
IV-IO and ↓BP* Ketoacidosis 1 hr unless
Normal Saline hypotensive shock,
*Monitor respiratory status with administration of all anticonvulsants
then 20 mL/kg
IV-IO bolus
Ingestions Poison control 1-800-222-1222 Regular Insulin 0.05–0.1 units/kg/hr 0.05 units/kg/hr preferred for
IV-IO patients <3 years and/or those
Generic Dose/Route Notes more insulin sensitive
Activated Charcoal <12 years of age: Dilute in water if needed Hypoglycemia
0.5–1 g/kg PO Dextrose 50% 1 mL/kg Patient >40 kg; Max dose 25 g
Adolescents/adults: Dextrose 25% 2 mL/kg Patient 10-40 kg; Max dose 25 g
25–100 g PO
Dextrose 10% 2 mL/kg Patient <10 kg; Max dose 25 g
Naloxone 0.1 mg/kg IM, IN, Max dose 2 mg
IV-IO, ET
Increased intracranial pressure (ICP)
Sepsis/Meningitis Fluid resuscitation to maintain cerebral perfusion pressure
Generic Dose/Route Notes
Generic Dose/Route Notes
3% Sodium Chloride 5 mL/kg over 10-20 min Max dose 300 mL
Ampicillin 50–75 mg/kg IV-IO Give q 6 hrs; Max dose 3 g/dose, 12
g/day Mannitol 0.5 g/kg IV-IO 5 micron filter. Use only if
perfusion adequate.
Ceftazidime 50 mg/kg IV-IO Every 8 hrs; Max dose 2 g/dose
Furosemide 1 mg/kg IV-IO Use only if perfusion adequate
Dexamethasone 1 mg/kg IV-IO as a Max dose 10 mg
CefTRIAXone 50 mg/kg IV-IO, IM Give q 12–24 hours.
single dose
Max 2 g/dose. For IM doses, reconsti-
tute with 1% Lidocaine
Vancomycin 15 mg/kg IV-IO Infuse over 1 hr, Give q 6 hrs

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Adjunct
Dexamethasone 0.15 mg/kg IV Max dose 10 mg
Not routinely used for meningitis.
Best given before antibiotics. CHILDREN’S MINNESOTA PHYSICIAN ACCESS
Disclaimer: This guideline is designed for general use with most patients; each clinician Your resource for 24/7 referral, admission and
should use his or her own independent judgment to meet the needs of each individual patient. neonatal transport assistance.
This guideline is not a substitute for professional medical advice, diagnosis or treatment.
M0055 09/23