PALS Things to Remember

Question 1

Hydrocortisone

Answer 1

Septic Shock, Correction of Adrenal Insufficiency:

1-2 mg/kg IV bolus

Question 2

Dextrose

Answer 2

Hypoglycemia:
0.5 to 1 g/kg IV

(2-4 mL/kg D25 or 5-10 mL/kg D10)

Question 3

Atropine

Answer 3

Bradycardia:

0.02mg/kg IV/IO, may repeat once (minimum dose 0.1mg, max dose 0.5mg); 0.04-0.06mg/kg ET (may need 2-3x IV dose)

Question 4

IV Fluids

Answer 4

Hypovolemic or Distributive Shock:
20 mL/kg bolus (repeat as needed) over 5-20 minutes; given over 5-10 minutes if severe and/or hypotensive

Cardiogenic Shock or Poisoning:
5-10 mL/kg (repeat as needed), over 10-20 minutes

DKA with Shock:
10-20 mL/kg, per local protocol; if used, give over at least 1-2 hours

Septic Shock:
10-20 mL/kg (repeat as needed), over 5-20 minutes

Maintenance: 
4-2-1 Method
4ml/kg for each kg <10
2ml/kg for each kg 10-20
1ml/kg for each kg >20

Question 5

Magnesium Sulfate

Answer 5

Cardiac Arrest, Torsades:

25-50mg/kg IV/IO bolus (max 2g)

Question 6

Milrinone

Answer 6

ROSC, Normotensive Shock:

50mcg/kg over 10-60min, then 0.25-0.75mcg/kg/min

Question 7

Norepinephrine

Answer 7

ROSC, Hypotensive Shock:

0.03-0.5mcg/kg/min

Question 8

Defibrillation

Answer 8

Initial dose: 2 J/kg (acceptable range 2-4 J/kg)

Subsequent doses: 4 J/kg or higher (not to exceed 10 J/kg or standard adult dose)

Question 9

Epinephrine

Answer 9

Cardiac Arrest or Bradycardia:
q3-5min, dose based on route
IV/IO: 0.01mg/kg (0.1ml/kg of 0.1mg/ml concentration), max dose 1mg
ET: 0.1mg/kg (0.1ml/kg of 1mg/ml concentration)

Persistent Bradycardia:
consider a continuous infusion, 0.1-0.3 mcg/kg/min

ROSC, Hypotensive Shock:
0.03-0.2mcg/kg/min

ROSC, Normotensive Shock:
0.03-0.05mcg/kg/min

Anaphylactic Shock:
frequently a low-dose infusion (<0.05 mcg/kg per minute) is effective

Question 10

Procainamide

Answer 10

Tachycardia:

15mg/kg over 30-60min

Question 11

Cardioversion

Answer 11

Initial: 0.5-1J/kg
Subsequent: 2J/kg

Question 12

Lidocaine

Answer 12

Arrest with Shockable Rhythm:

1mg/kg IV/IO (may repeat if >15min to initiation of maintenance), then 20-50mcg/kg/min with conversion

Question 13

Amiodarone

Answer 13

Arrest with Shockable Rhythm:
5mg/kg IV/IO (max 300mg), may repeat x2 (max total dose 15mg/kg or 2.2g)

Tachycardia:
5mg/kg over 20-60min (max 300mg), may repeat (up to max 15mg/kg or 2.2g)

Question 14

Adenosine

Answer 14

Tachycardia:
0.1mg/kg IV (max 6mg), then 0.2mg/kg (max 12mg)

*consider 1/4 doses with heart transplant; also with use of carbamazepine or dipyridamole