Pharmacological Tools in PALS

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.

AdenosineSupraventricular TachycardiaFirst 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
AmiodaroneTachyarrhythmia5 mg/kg over 20 to 60 minutes
Repeat up to 15 mg/kg
(MAX DOSE 300 mg)
Very long half-life
Monitor ECG & BP
AtropineBradycardia0.02 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
EpinephrineCardiac Arrest/ShockIV/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
GlucoseHypoglycemia0.5 to 1 g/kgNewborn: 5 to 10 mL/kg D10W
Infants/Children: 2 to 4 mL/kg D25W
Adolescents: 1 to 2 mL/kg D50W
LidocaineTachyarrhythmiaInitial: 1 mg/kg
Infusion: 20 to 50 mcg/kg/min
(MAX DOSE 100 mg)
ET: 2 to 3 mg
Magnesium SulfateTorsades de Pointes
Refractory Asthma
20 to 50 mg/kg over 10 to 20 min
(MAX DOSE 2 grams)
May run faster for Torsades
MilrinoneCardiogenic ShockInitial: 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
NaloxoneOpioid ReversalLess 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)
ProcainamideTachyarrhythmia15 mg/kg over 30 to 60 minutesDo NOT give with amiodarone
Monitor ECG & BP
Sodium BicarbonateMetabolic Acidosis Hyperkalemia1 mEq/kg slow bolus
(MAX DOSE 50 mEq)
Monitor ABG & ECG
After adequate ventilation
Table 9