Pharmacological Tools

Use of any of the medications listed in Table 9 should be done within your scope of practice and after a thorough study of the actions and side effects. This table provides only a brief reminder for those who are already knowledgeable in the use of these medications. Moreover, Table 9 contains only pediatric doses, indications, and routes of administration (intravenous/intraosseous) for the most common PALS drugs. Although cited for reference, routine administration of drugs via an ET tube is discouraged. Rapid access and drug delivery through an IO are preferred to ET administration as drug absorption from the ET tube route is unpredictable.

DRUG	MAIN PALS USE	PEDIATRIC DOSE (IV/IO)	NOTES
Adenosine	Supraventricular Tachycardia	First dose: 0.1 mg/kg (MAX DOSE 6 mg) Second dose: 0.2 mg/kg (MAX DOSE 12 mg)	Rapid IV/IO bolus (no ET) Flush with saline Monitor ECG
Amiodarone	Tachyarrhythmia	5 mg/kg over 20 to 60 minutes Repeat up to 15 mg/kg (MAX DOSE 300 mg)	Very long half-life Monitor ECG & BP
Atropine	Bradycardia	0.02 mg/kg ET: 0.03 mg/kg Repeat once if needed (MAX single dose 0.5 mg)	Also used to treat specific toxins (e.g. organophosphate poisoning)
Epinephrine	Cardiac Arrest/Shock	IV/IO: 0.01 mg/kg [1:10,000] (MAX DOSE 1 mg) ET: 0.1 mg/kg [1:1,000] (MAX DOSE 2.5 mg)	Multiple uses, multiple routes Repeat every 3 to 5 min if needed
Glucose	Hypoglycemia	0.5 to 1 g/kg	Newborn: 5 to 10 mL/kg D₁₀W Infants/Children: 2 to 4 mL/kg D₂₅W Adolescents: 1 to 2 mL/kg D₅₀W
Lidocaine	Tachyarrhythmia	Initial: 1 mg/kg Infusion: 20 to 50 mcg/kg/min (MAX DOSE 100 mg) ET: 2 to 3 mg
Magnesium Sulfate	Torsades de Pointes Refractory Asthma	20 to 50 mg/kg over 10 to 20 min (MAX DOSE 2 grams)	May run faster for Torsades
Milrinone	Cardiogenic Shock	Initial: 50 mcg/kg over 10 to 60 min Maintain: 0.5 to 0.75 mcg/kg/min	Longer infusion times and euvolemia will reduce risk of hypotension
Naloxone	Opioid Reversal	Less than 5 y/o OR under 20 kg: 0.1 mg/kg Over 5 y/o OR over 20 kg: 2 mg IV q 2 to 3 min prn	Decrease dose to reverse respiratory depression due to therapeutic opioid use (1 to 5 mcg/kg, titrate to effect)
Procainamide	Tachyarrhythmia	15 mg/kg over 30 to 60 minutes	Do NOT give with amiodarone Monitor ECG & BP
Sodium Bicarbonate	Metabolic Acidosis Hyperkalemia	1 mEq/kg slow bolus (MAX DOSE 50 mEq)	Monitor ABG & ECG After adequate ventilation

Table 9

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