see also: [[Neonatal life support|neoresus]], [[paediatric airway management]], [[Blood transfusion (paeds)#Paeds Massive haemorrhage in trauma|paeds massive haemorrhage APLS algorithm]] [APLS algorithms](https://www.apls.org.au/algorithms) > [!references]- > - [Paeds drug dose chart](x-devonthink-item://A89B9D23-92C1-446C-BCBB-8381A40E99F6) > - [drugs cameron](x-devonthink-item://E383FFBD-9FD8-4DE9-B350-0F6F60D3E600?page=185) > - [Duration of cardiopulmonary resuscitation and illness category impact survival and neurologic outcomes for in-hospital pediatric cardiac arrests.](bookends://sonnysoftware.com/ref/DL/249494) > - [paediatric airway Rosen](x-devonthink-item://E2A70D5A-9657-4EC9-B118-925065B4EA17) > - [Dunn - paediatric cardiac arrest](x-devonthink-item://91728AC1-7784-45DA-BA11-F6A6975A55BE) ![[Pasted image 20230824214435.png]] # Algorithms ## paeds bradycardia ![[Pasted image 20250306173658.png]] ## paeds VT see also [[Ventricular Tachycardia]] ![[Pasted image 20250306174043.png]] ## paeds hyperkalaemia see also: [[hyperkalemia#Paeds hyper-k treatment]] ![[Pasted image 20250306174258.png]] # Airway and breathing see: [[paediatric airway management]] ETT size = (Age/4) +4 +/-0.5 Depth: Age/2 + 12 # Circulation normal BP= (age x 2) + 80 **adrenaline** 1:10,000 ==10mcg/kg== (0.1mL/kg) eg 25kg = 2.5 mL of 1:10,000 4J/kg defibrillation (round up) 20 mL/kg fluid bolus 0.9% NaCl 10mL/kg more contemporary (eg in trauma where second set of volume is blood) **Amiodarone** 5mg/kg (flush with 5mL of 5% dextrose) - in 25kg patient, 130mg is 2.5 mL of 150mg/3mL **atropine** 20mcg/kg - can draw up 200mcg/mL so that every 10kg is 1mL # Glucose see [[Hypoglycaemia (paeds)]] 2mL/kg 10% dextrose # Bits and bobs **hypertonic sodium** 3mL/kg of 3% NaCl over 30 min raises Na by ~ 3mmol/L [[Paediatric fluids]] 4-2-1 rule - deficit over 24 hours added to maintenance # medication Table paeds resus #tables see also: [RCH Acute pain management](x-devonthink-item://6E020204-2DE3-4BC2-9E35-55D3E83C892D) | | dose | comment | | ------------------------------------ | ---------------------------------------------------------------- | ---------------------------------------------- | | **IV fluids** | | | | resus | 10-20 mL/kg 0.9% NaCl | | | oral or NGT<br>rehydration | - slow 10-20 mL/kg/hr<br>- rapid 25mL/kg/hr | =4 hours | | IV rehydration | replace 50% over 24 hours, rest over second 24 Hr | deficit (mL) = weight x % dehydration X 10<br> | | Total fluid replacement | maintenance + deficit + ongoing losses | | | maintenance fluid | 4-2-1 mL/hour<br>0.9% NaCl + 5% dextrose | | | **analgesia<br>/sedation** | | | | fentanyl | IN - 0.75-1.5 mcg/kg<br>IV - 1mcg/kg | analgesia dose<br>IN max 75 mcg | | morphine | IV/sc - 0.05 - 0.1 mg/kg | analgesia dose | | ketamine analgesia | IV - 0.1 - 0.3 mg/kg<br>IN - 1 - 1.5 mcg/kg | | | [[ketamine]] <br>procedural sedation | IV - 0.5 - 1.5 mg/kg<br>IM - 4mg/kg | | | oxycodone | 1 -12 months: po 0.05-0.1 mg/kg<br>>1 year: po 0.1-0.2 mg/kg Q4H | | | **Drugs** | | | | adrenaline | 10 mcg/kg IV/IO/IM<br>100 mcg/kg ETT<br> | infusion 0.05 - 0.2mcg/kg/min | | metaraminol | 10 mcg/kg (0.01 mg/kg) | | | noradrenaline | 0.05-0.2 mcg/kg/min | | | adenosine | 100 mcg/kg 1st<br>200 mcg/kg 2nd | | | flecanide | 2mg/kg IV | | | atropine | 20mcg/kg | | | glucose 10% | 2mL/kg | | | amiodarone | 5mg/kg | | | hydrocortisone | 4 mg/kg IV | | | **Blood transfusion** | | | | pRBC <br>FFP<br>plt | 10 mL/kg each | | | cryoprecipitate | 5-10 mL/kg | | | TXA | 15 mL/kg | | | **Oxygen** | | | | HFNC | 2L/kg/min | | | **Seizures** | | | | midazolam | 0.15 mg/kg IV/IM | | | keppra | 40 mg/kg | | | phenytoin | 20mg/kg | | --- **Common RSI medications in children** | medication | dose | comment | | --------------- | --------------------------------------------------- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | atropine | 0.02mg/kg | - not routine for RSI<br>- consider in infants < 1 year<br>- give for pre-existing or periprocedure bradycardia not responsive to O2 and ventilation | | ketamine | 1-2mg/kg IV | - adrenergic<br>- may help with bronchodilation<br>- preserves airway reflexes<br>- can be used with neuromuscular blocker or "awake sedated look" if suspected difficult airway | | propofol | 3mg/kg | - rapid onset, short acting<br>- may cause hypotension<br>- higher dose in infants<br>- no analgesia | | midazolam | 0.3mg/kg | ↑ dose required than as AED or anxiolysis<br>- may cause hypotension at this dose<br>- often use w/ opioids | | fentanyl | 1-5mcg/kg | often with midaz<br>lower dose for shock or haemodynamic concerns (1-2mcg/kg) | | rocuronium | 1-1.2mg/kg | non-depolarising agent<br>- no specific contraindications<br>- equivalent onset as sux but longer duration of action | | succinylcholine | 0-11 y: 2mg/kg<br>> 11 y 1.5 mg/kg<br>2x dose if IM | fasiculations irrelevant in children<br>very low risk of bradycardia<br>risk of ↑ K and arrest in patients with known and undiagnosed myopathies and neuromuscular disease | | sugammadex | 16mg/kg (full reversal dose) | rapid reversal agent for rocuronium or vecuronium within 3 minutes |