Broselow Cart Manual

Tab 1 – Tele-PICU Resources Tab 8 – Blood Draw References

Tab 2 – PALS Algorithm Tab 9 – Tray Photos
Tab 3 – ACLS Algorithm Tab 10 – Code Blue & Rapid
Response Forms
Tab 4 – Emergency Pediatric Dosing
Sheets Tab 11 – Debriefing Forms
Tab 5 – Pediatric Anaphylaxis Sheets Tab 12 – Code Cart Daily &
Weekly Checklists
Tab 6 – Medication Tray Contents
Tab 13 – Stocking Checklists
Tab 7 – Endotracheal Tube
Guideline

(5/6/22)
1 – Tele-PICU Resources
 PICU and Tele-PICU ED Consults:
Applies to all 8 Providence Oregon Ministries
ED physician determines need for PICU
consult.

TH- Telehealth
TC- Transfer Center
Sending site calls TC 503-216-7768
and requests consult/TH consult with PICU provider

TC Obtains Information:
TC will page On-Call PICU 1. Pt. name/DOB
provider via AMCOM 2. Pt. Location
including TelePICU and 3. Requesting physician
referring hospital 4. Urgent or consult (non-urgent)
5. Diagnosis

TC to connect PICU
Is TH consult Phone consult
provider with Sending
needed?
NO sufficient
ED MD

YES

On-Call PICU provider will

call ED physician via the
TC to discuss
recommendations

TC provides TC submits
RN Report bed request Transfer to Patient to stay at
Number to to accepting
YES Portland needed?
NO sending site
sending site unit

Transport team
needed?
YES

NO
On-Call PICU
provider will
dispatch Transport
Team

PICU provider calls

Sending site to
TC back to
coordinate
reconnect with ED
transport via
physician on ETA of
normal protocol
Transport Team

Version 2.0 created 11/20/2020 RRB

 PREPARATION FOR & DURING TELE-CONSULTATIONS:

• Prior to moving telehealth cart, ensure:

o It’s set at lowest position
o Telehealth stethoscope is present
o Power cord, including any auxiliary devices attached to cart, are unplugged
o Wheels are unlocked
• Move cart to desired location (pushing with handle):
o Exercise caution when encountering thresholds
o Place at foot of bed with clear view of patient
o Lock wheels
o Plug in power cord
• Power on telehealth cart should always remain on:
o If unit is accidentally off, press power button once to turn unit on
o Wait for self-testing to be performed (1-2 minutes)
o Watch for Screensaver on Lite Display
o Adjust height of head display as needed
• Follow appropriate Tele-Consult Algorithm:
o Call Transfer Center (TC) 503-216-7768 to request Tele-Consult
o Provides (TC) with required information:
▪ Patient name and date of birth
▪ Patient location
▪ Requesting physician
▪ Urgent or consult (non-urgent)
▪ Chief Complaint/Diagnosis
o Remain on the line until Tele-Provider has established connection via telehealth device with referring provider, adjusting volume as
needed so all can hear clearly
o Introduce self/patient/family to Tele-Provider
• Operate stethoscope appropriately:
o Position self between stethoscope and telehealth cart (< 20 feet, no obstructions between both devices)
o Turn stethoscope on by pressing and holding power button (code 911 to unlock)
o Ask Tele-Provider to press “Start” once Bluetooth icon on stethoscope starts blinking
o Watch for solid Bluetooth icon for auscultation to begin
o Place stethoscope directly on patient skin for optimal audio quality and minimal artifact
o Watch for “cursor mode” to see where Tele-Provider wants to listen with stethoscope

TROUBLESHOOTING & AFTER CONSULTATIONS:

• Troubleshoot stethoscope issues:

o Device not connecting: Restart device and try to connect again.
o Battery low: Install or change battery
o Call Live Technical Support (877) 484-9119
• After telehealth consultation:
o Do NOT power off Telehealth cart unless instructed by Technical Support (turning off device will disable 24/7 patient care)
o Ensure patient and family’s questions are answered
• Use appropriate infection control techniques with stethoscope after usage:
o Make sure light is unplugged and main power is off prior to cleaning
o Clean when visibly soiled and/or after contact with any contaminated surfaces
o Use hospital disinfectant solution to wipe down contaminated surfaces
o Clean monitor with LCD computer screen cleaner (to prevent craze, staining or discoloration)
o Clean camera lens with optical lens cleaner
2 – PALS Algorithm
Pediatric Cardiac Arrest Algorithm

1
CPR Quality
Start CPR
• Begin bag-mask ventilation and give oxygen • Push hard (≥⅓ of anteroposterior
• Attach monitor/defibrillator diameter of chest) and fast
(100-120/min) and allow complete
chest recoil
• Minimize interruptions in
Yes No compressions
Rhythm • Change compressor every
shockable? 2 minutes, or sooner if fatigued
• If no advanced airway, 15:2
2 9 compression-ventilation ratio
VF/pVT Asystole/PEA • If advanced airway, provide
continuous compressions and
give a breath every 2-3 seconds
Shock Energy for Defibrillation
3
Shock Epinephrine • First shock 2 J/kg
ASAP • Second shock 4 J/kg
4 10 • Subsequent shocks ≥4 J/kg,
maximum 10 J/kg or adult dose
CPR 2 min CPR 2 min
IV/IO access • IV/IO access Drug Therapy
• Epinephrine every 3-5 min
• Consider advanced • Epinephrine IV/IO dose:
0.01 mg/kg (0.1 mL/kg of the
airway and capnography 0.1 mg/mL concentration).
No Max dose 1 mg.
Rhythm Repeat every 3-5 minutes.
shockable? If no IV/IO access, may give
Yes endotracheal dose: 0.1 mg/kg
Yes Rhythm (0.1 mL/kg of the 1 mg/mL
shockable? concentration).
5 Shock • Amiodarone IV/IO dose:
5 mg/kg bolus during cardiac
arrest. May repeat up to
No
6 3 total doses for refractory
CPR 2 min VF/pulseless VT
or
• Epinephrine every 3-5 min
11 LidocaineIV/IOdose:
• Consider advanced airway Initial: 1 mg/kg loading dose
CPR 2 min
Treat reversible causes Advanced Airway

No • Endotracheal intubation or
Rhythm
supraglottic advanced airway
shockable? • Waveform capnography or
No Yes capnometry to confirm and
Rhythm
Yes monitor ET tube placement
shockable?
Shock Reversible Causes
7
• Hypovolemia
8 • Hypoxia
• Hydrogen ion (acidosis)
CPR 2 min • Hypoglycemia
• Amiodarone or lidocaine
• Hypo-/hyperkalemia
• Treat reversible causes • Hypothermia
• Tension pneumothorax
• Tamponade, cardiac
• Toxins
12 • Thrombosis, pulmonary
• If no signs of return of spontaneous Go to 7. • Thrombosis, coronary
circulation (ROSC), go to 10
• If ROSC, go to Post–Cardiac Arrest
Care checklist
© 2020 American Heart Association
Pediatric Bradycardia With a Pulse Algorithm

Patient with bradycardia

Cardiopulmonary
compromise?
No
• Acutely altered
mental status
• Signs of shock
• Hypotension

Yes

Assessment and support • Support ABCs

• Maintain patent airway • Consider oxygen
• Assist breathing with positive • Observe
pressure ventilation and oxygen • 12-Lead ECG
as necessary • Identify and treat
• Cardiac monitor to identify rhythm; underlying causes
monitor pulse, BP, and oximetry

Start CPR if HR <60/min

despite oxygenation and
ventilation.

No
Bradycardia
persists?

Yes

• Continue CPR if HR <60/min

• IV/IO access
• Epinephrine Doses/Details
• Atropine for increased vagal
tone or primary AV block Epinephrine IV/IO dose:
0.01 mg/kg (0.1 mL/kg of the
• Consider transthoracic/ 0.1 mg/mL concentration).
transvenous pacing Repeat every 3-5 minutes.
• Identify and treat underlying If IV/IO access not available
causes but endotracheal (ET) tube
in place, may give ET dose:
0.1 mg/kg (0.1 mL/kg of the
1 mg/mL concentration).
Atropine IV/IO dose:
0.02 mg/kg. May repeat once.
Yes Check pulse Minimum dose 0.1 mg and
every 2 minutes. maximum single dose 0.5 mg.
Pulse present?
Possible Causes

No • Hypothermia
• Hypoxia
Go to Pediatric • Medications
Cardiac Arrest Algorithm.
© 2020 American Heart Association
Pediatric Tachycardia With a Pulse Algorithm

Initial assessment and support Doses/Details

• Maintain patent airway; assist breathing as necessary Synchronized
• Administer oxygen cardioversion
• Cardiac monitor to identify rhythm; monitor pulse, Begin with 0.5-1 J/kg;
blood pressure, and oximetry if not effective, increase
• IV/IO access to 2 J/kg. Sedate if
• 12-Lead ECG if available needed, but don’t delay
cardioversion.

Drug Therapy
Probable sinus
tachycardia if Adenosine IV/IO dose
Evaluate rhythm
• P waves present/normal • First dose: 0.1 mg/kg
with 12-lead ECG
• Variable RR interval rapid bolus (maximum:
or monitor. 6 mg)
• Infant rate usually <220/min
• Child rate usually <180/min • Second dose:
0.2 mg/kg rapid bolus
(maximum second
dose: 12 mg)

Cardiopulmonary
Search for
compromise?
and treat cause. Yes No
• Acutely altered
mental status
• Signs of shock
• Hypotension

Narrow Wide Narrow Wide

(≤0.09 sec) (>0.09 sec) (≤0.09 sec) (>0.09 sec)
Evaluate Evaluate
QRS duration. QRS duration.

Probable supraventricular Possible ventricular Probable supraventricular Possible ventricular

tachycardia tachycardia tachycardia tachycardia
• P waves absent/abnormal • P waves absent/abnormal
• RR interval not variable • RR interval not variable
• Infant rate usually ≥220/min • Infant rate usually ≥220/min
• Child rate usually ≥180/min • Child rate usually ≥180/min
• History of abrupt rate change Synchronized • History of abrupt rate change If rhythm is regular and
cardioversion QRS monomorphic,
Expert consultation consider adenosine.
is advised before
additional drug
• If IV/IO access is present, therapies. Consider
give adenosine vagal maneuvers.
or Expert consultation
• If IV/IO access is not is recommended.
available, or if adenosine
is ineffective, perform
synchronized cardioversion If IV/IO access
is present, give
adenosine.
© 2020 American Heart Association
Pediatric Basic Life Support Algorithm for Healthcare Providers—2 or More Rescuers

Verify scene safety.

• Check for responsiveness.

• Shout for nearby help.
• First rescuer remains with the child.
Second rescuer activates emergency
response system and retrieves the
AED and emergency equipment.

Normal No normal
breathing, Look for no breathing breathing, • Provide rescue breathing,
Monitor until pulse felt or only gasping and check pulse felt 1 breath every 2-3 seconds,
emergency pulse (simultaneously). or about 20-30 breaths/min.
responders arrive. Is pulse definitely felt • Assess pulse rate for no
within 10 seconds? more than 10 seconds.

Yes HR <60/min No
with signs of poor
perfusion?
No breathing
or only gasping,
pulse not felt
Start CPR. • Continue rescue
breathing; check
pulse about
every 2 minutes.
• If no pulse, start
CPR.
Start CPR
• First rescuer performs cycles of
30 compressions and 2 breaths.
• When second rescuer returns,
perform cycles of 15 compressions
and 2 breaths.
• Use AED as soon as it is available.

Check rhythm.
Shockable rhythm?
Yes, No,
shockable nonshockable

• Give 1 shock. Resume CPR • Resume CPR immediately for

immediately for 2 minutes 2 minutes (until prompted by AED
(until prompted by AED to allow to allow rhythm check).
rhythm check). • Continue until ALS providers take
• Continue until ALS providers take over or the child starts to move.
over or the child starts to move.

© 2020 American Heart Association

Pediatric Basic Life Support Algorithm for Healthcare Providers—Single Rescuer

Verify scene safety.

• Check for responsiveness.

• Shout for nearby help.
• Activate the emergency response system
via mobile device (if appropriate).

Normal No normal • Provide rescue breathing,

breathing, breathing, 1 breath every 2-3 seconds,
Look for no breathing or about 20-30 breaths/min.
Monitor until pulse felt or only gasping and check pulse felt
• Assess pulse rate for no
emergency pulse (simultaneously). more than 10 seconds.
responders arrive. Is pulse definitely felt
within 10 seconds?
Yes HR <60/min No
with signs of poor
perfusion?

No breathing
or only gasping, Start CPR. • Continue rescue
pulse not felt breathing; check
pulse every 2
minutes.
• If no pulse, start
CPR.

Yes Activate emergency response

Witnessed system (if not already done),
sudden collapse? and retrieve AED/defibrillator.

No

Start CPR
• 1 rescuer: Perform cycles of
30 compressions and 2 breaths.
• When second rescuer arrives,
perform cycles of 15 compressions
and 2 breaths.
• Use AED as soon as it is available.

After about 2 minutes, if still alone, activate

emergency response system and retrieve AED
(if not already done).

Check rhythm.
Shockable rhythm?
Yes, No,
shockable nonshockable

• Give 1 shock. Resume CPR • Resume CPR immediately for

immediately for 2 minutes 2 minutes (until prompted by AED
(until prompted by AED to allow to allow rhythm check).
rhythm check). • Continue until ALS providers take
• Continue until ALS providers take over or the child starts to move.
over or the child starts to move.

© 2020 American Heart Association

PALS Systematic Approach Algorithm
3 – ACLS Algorithm
ACLS Cardiac Arrest Algorithm
CPR Quality
for Suspected or Confirmed COVID-19 Patients • Push hard (at least 2 inches
Updated April 2020 A [5 cm]) and fast (100-120/min)
and allow complete chest recoil.
Don PPE • Minimize interruptions in
• Limit personnel compressions.
• Consider resuscitation appropriateness • Avoid excessive ventilation.
• Change compressor every
1 2 minutes, or sooner if fatigued.
• If no advanced airway, 30:2
Start CPR compression-ventilation ratio.
• Give oxygen (limit aerosolization) • Quantitative waveform
• Attach monitor/defibrillator capnography
• Prepare to intubate – If Petco2 <10 mm Hg, attempt
to improve CPR quality.
• Intra-arterial pressure
– If relaxation phase (diastolic)
Yes Rhythm No pressure <20 mm Hg, attempt
2 shockable? to improve CPR quality.
9 Shock Energy for Defibrillation
VF/pVT Asystole/PEA
• Biphasic: Manufacturer
recommendation (eg, initial
3 dose of 120-200 J); if unknown,
Shock use maximum available.
Second and subsequent doses
B should be equivalent, and higher
doses may be considered.
Prioritize Intubation / Resume CPR • Monophasic: 360 J
• Pause chest compressions for intubation
Advanced Airway
• If intubation delayed, consider supraglottic airway or bag-mask device with filter and tight seal
• Connect to ventilator with filter when possible • Minimize closed-circuit
disconnection
4 10 • Use intubator with highest
likelihood of first pass
CPR 2 min CPR 2 min success
IV/IO access • IV/IO access • Consider video laryngoscopy
• Epinephrine every 3-5 min • Endotracheal intubation or
• Consider mechanical supraglottic advanced airway
compression device • Waveform capnography or
capnometry to confirm and
monitor ET tube placement
• Once advanced airway in place,
Rhythm No Rhythm Yes give 1 breath every 6 seconds
shockable? shockable? (10 breaths/min) with continuous
chest compressions
Yes Drug Therapy
5
Shock No • Epinephrine IV/IO dose:
1 mg every 3-5 minutes
6 11 • Amiodarone IV/IO dose: First
dose: 300 mg bolus. Second
CPR 2 min CPR 2 min dose: 150 mg.
• Epinephrine every 3-5 min Treat reversible causes or
• Consider mechanical Lidocaine IV/IO dose:
compression device First dose: 1-1.5 mg/kg. Second
dose: 0.5-0.75 mg/kg.
Return of Spontaneous
No No Yes Circulation (ROSC)
Rhythm Rhythm
shockable? shockable? • Pulse and blood pressure
• Abrupt sustained increase in
Yes Petco2 (typically ≥40 mm Hg)
• Spontaneous arterial pressure
7
Shock waves with intra-arterial
monitoring
8 Reversible Causes

CPR 2 min • Hypovolemia

• Amiodarone or lidocaine • Hypoxia
• Treat reversible causes • Hydrogen ion (acidosis)
• Hypo-/hyperkalemia
12 • Hypothermia
• Tension pneumothorax
• If no signs of return of spontaneous Go to 5 or 7 • Tamponade, cardiac
circulation (ROSC), go to 10 or 11 • Toxins
• If ROSC, go to Post–Cardiac Arrest Care • Thrombosis, pulmonary
• Thrombosis, coronary
© 2020 American Heart Association
Adult Bradycardia Algorithm

Assess appropriateness for clinical condition.

Heart rate typically <50/min if bradyarrhythmia.

Identify and treat underlying cause

• Maintain patent airway; assist breathing as necessary
• Oxygen (if hypoxemic)
• Cardiac monitor to identify rhythm; monitor blood pressure and oximetry
• IV access
• 12-Lead ECG if available; don’t delay therapy
• Consider possible hypoxic and toxicologic causes

Persistent
bradyarrhythmia causing:
No • Hypotension?
Monitor and observe • Acutely altered mental status?
• Signs of shock? Doses/Details
• Ischemic chest discomfort? Atropine IV dose:
• Acute heart failure? First dose: 1 mg bolus.
Repeat every 3-5 minutes.
Yes Maximum: 3 mg.
Dopamine IV infusion:
Usual infusion rate is
Atropine
5-20 mcg/kg per minute.
If atropine ineffective: Titrate to patient response;
• Transcutaneous pacing taper slowly.
and/or Epinephrine IV infusion:
• Dopamine infusion
2-10 mcg per minute infusion.
or Titrate to patient response.
• Epinephrine infusion
Causes:
• Myocardial ischemia/
infarction
• Drugs/toxicologic (eg,
calcium-channel blockers,
Consider: beta blockers, digoxin)
• Hypoxia
• Expert consultation
• Electrolyte abnormality
• Transvenous pacing (eg, hyperkalemia)
© 2020 American Heart Association
Adult Cardiac Arrest Algorithm

1
CPR Quality
Start CPR
• Give oxygen • Push hard (at least 2 inches
• Attach monitor/defibrillator [5 cm]) and fast (100-120/min)
and allow complete chest recoil.
• Minimize interruptions in
compressions.
Yes No • Avoid excessive ventilation.
Rhythm • Change compressor every
shockable? 2 minutes, or sooner if fatigued.
• If no advanced airway, 30:2
2 9 compression-ventilation ratio,
VF/pVT Asystole/PEA or 1 breath every 6 seconds.
• Quantitative waveform
capnography
– If Petco2 is low or decreasing,
reassess CPR quality.
3 Shock Epinephrine
ASAP Shock Energy for Defibrillation

4 10 • Biphasic: Manufacturer
recommendation (eg, initial
CPR 2 min CPR 2 min dose of 120-200 J); if unknown,
• IV/IO access use maximum available.
• IV/IO access
• Epinephrine every 3-5 min Second and subsequent doses
• Consider advanced airway, should be equivalent, and higher
capnography doses may be considered.
• Monophasic: 360 J
Rhythm No
shockable? Drug Therapy

Rhythm Yes • Epinephrine IV/IO dose:

Yes 1 mg every 3-5 minutes
shockable?
• Amiodarone IV/IO dose:
5 Shock First dose: 300 mg bolus.
Second dose: 150 mg.
No or
6 Lidocaine IV/IO dose:
CPR 2 min First dose: 1-1.5 mg/kg.
• Epinephrine every 3-5 min Second dose: 0.5-0.75 mg/kg.
• Consider advanced airway, Advanced Airway
capnography
• Endotracheal intubation or su-
praglottic advanced airway
• Waveform capnography or cap-
Rhythm No nometry to confirm and monitor
ET tube placement
shockable? • Once advanced airway in place,
give 1 breath every 6 seconds
Yes (10 breaths/min) with continu-
ous chest compressions
7 Shock
Return of Spontaneous
Circulation (ROSC)
8 11
• Pulse and blood pressure
CPR 2 min CPR 2 min • Abrupt sustained increase in
• Amiodarone or lidocaine Petco2 (typically ≥40 mm Hg)
• Treat reversible causes
• Treat reversible causes • Spontaneous arterial pressure
waves with intra-arterial
monitoring

No Rhythm Yes Reversible Causes

shockable? • Hypovolemia
• Hypoxia
12 • Hydrogen ion (acidosis)
• Hypo-/hyperkalemia
• If no signs of return of Go to 5 or 7 • Hypothermia
spontaneous circulation • Tension pneumothorax
(ROSC), go to 10 or 11 • Tamponade, cardiac
• If ROSC, go to • Toxins
• Thrombosis, pulmonary
Post–Cardiac Arrest Care
• Thrombosis, coronary
• Consider appropriateness
of continued resuscitation
© 2020 American Heart Association
ACLS Healthcare Provider
Post–Cardiac Arrest Care Algorithm

ROSC obtained Initial Stabilization Phase

Resuscitation is ongoing during the

post-ROSC phase, and many of these
Manage airway activities can occur concurrently.
Early placement of endotracheal tube However, if prioritization is
necessary, follow these steps:
• Airway management:
Manage respiratory parameters
Waveform capnography or
Initial Start 10 breaths/min
capnometry to confirm and monitor
Stabilization Spo2 92%-98%
endotracheal tube placement
Phase Paco2 35-45 mm Hg
• Manage respiratory parameters:
Titrate Fio2 for Spo2 92%-98%; start
Manage hemodynamic parameters at 10 breaths/min; titrate to Paco2 of
Systolic blood pressure >90 mm Hg 35-45 mm Hg
Mean arterial pressure >65 mm Hg • Manage hemodynamic parameters:
Administer crystalloid and/or
vasopressor or inotrope for goal
Obtain 12-lead ECG systolic blood pressure >90 mm Hg
or mean arterial pressure >65 mm Hg

Continued Management and

Consider for emergent cardiac intervention if Additional Emergent Activities
• STEMI present
These evaluations should be done
• Unstable cardiogenic shock
concurrently so that decisions on
• Mechanical circulatory support required
targeted temperature management
(TTM) receive high priority as
cardiac interventions.
• Emergent cardiac intervention:
Follows commands?
Early evaluation of 12-lead
No Yes
Continued electrocardiogram (ECG); consider
Management hemodynamics for decision on
and Additional Comatose Awake cardiac intervention
Emergent • TTM Other critical care • TTM: If patient is not following
Activities • Obtain brain CT management commands, start TTM as soon as
• EEG monitoring possible; begin at 32-36°C for 24
• Other critical care hours by using a cooling device with
management feedback loop
• Other critical care management
– Continuously monitor core
temperature (esophageal,
rectal, bladder)
Evaluate and treat rapidly reversible etiologies
– Maintain normoxia, normocapnia,
Involve expert consultation for continued management euglycemia
– Provide continuous or intermittent
electroencephalogram (EEG)
monitoring
– Provide lung-protective ventilation

H’s and T’s

Hypovolemia
Hypoxia
Hydrogen ion (acidosis)
Hypokalemia/hyperkalemia
Hypothermia
Tension pneumothorax
Tamponade, cardiac
Toxins
Thrombosis, pulmonary
Thrombosis, coronary
© 2020 American Heart Association
Adult Tachycardia With a Pulse Algorithm

Assess appropriateness for clinical condition. Doses/Details

Heart rate typically ≥150/min if tachyarrhythmia. Synchronized cardioversion:
Refer to your specific device’s recommended energy level to
maximize first shock success.
Adenosine IV dose:
First dose: 6 mg rapid IV push; follow with NS flush.
Second dose: 12 mg if required.
Identify and treat underlying cause Antiarrhythmic Infusions for Stable Wide-QRS Tachycardia
• Maintain patent airway; assist breathing as necessary Procainamide IV dose:
• Oxygen (if hypoxemic) 20-50 mg/min until arrhythmia suppressed, hypotension ensues,
• Cardiac monitor to identify rhythm; monitor blood QRS duration increases >50%, or maximum dose 17 mg/kg given.
pressure and oximetry Maintenance infusion: 1-4 mg/min. Avoid if prolonged QT or CHF.
• IV access
Amiodarone IV dose:
• 12-lead ECG, if available
First dose: 150 mg over 10 minutes. Repeat as needed if VT recurs.
Follow by maintenance infusion of 1 mg/min for first 6 hours.
Sotalol IV dose:
100 mg (1.5 mg/kg) over 5 minutes. Avoid if prolonged QT.

Persistent
tachyarrhythmia causing:
Synchronized cardioversion
• Hypotension? Yes
• Acutely altered mental status? • Consider sedation
• Signs of shock? • If regular narrow complex, If refractory, consider
• Ischemic chest discomfort? consider adenosine
• Underlying cause
• Acute heart failure?
• Need to increase
energy level for next
No cardioversion
• Addition of anti-
Yes Consider arrhythmic drug
Wide QRS?
• Adenosine only if • Expert consultation
≥0.12 second
regular and monomorphic
• Antiarrhythmic infusion
No • Expert consultation

• Vagal maneuvers (if regular)

• Adenosine (if regular)
• β-Blocker or calcium channel blocker
• Consider expert consultation
© 2020 American Heart Association
4 – Emergency Pediatric
Dosing Sheets
 Patient Name test
Date
Weight kg 3.00

For Patients 2.5 kg to 3 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.03 mg 0.3 mL
Epinephrine 1. mg/mL 0.1 mg/kg 0.3 mg 0.3 mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.06 mg 0.6 mL

Calcium Chloride 100. mg/mL 20. mg/kg 60. mg 0.6 mL
Dextrose 10% 0.1 g/mL 0.5 g/kg 1.5 g 15. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 75 - 150 mg 1.875 - 3.75 mL
NaBicarb 4.2% 0.5 mEq/ml 1. mEq/kg 3. mEq 6. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 0.3 - 0.6 mg 0.1 - 0.2 mL
Amiodarone 50. mg/mL 5. mg/kg 15. mg 0.3 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 3. mg 0.15 mL

1st Shock 0.5 J/kg 0.5 J/kg 1.5 Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 3. Joules
1st Shock 2. J/kg 2. J/kg 6. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 12. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.06 mg 0.6 mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 0.9 mg 0.45 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 9. - 15. mcg 0.18 - 0.3 mL
Ketamine 10. mg/mL 1. - 2. mg/kg 3. - 6. mg 0.3 - 0.6 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 6 -9 mg 0.6 - 0.9 mL
Midazolam 1. mg/mL 0.2 mg/kg 0.6 mg 0.6 mL
Rocuronium 10. mg/mL 1. mg/kg 3. mg 0.3 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 3 - 6. mg 0.15 - 0.3 mL
Vecuronium 1. mg/mL 0.1 mg/kg 0.3 mg 0.3 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.03 mg 0.3 mL

Naloxone 0.4 mg/mL 0.1 mg/kg 0.3 mg 0.75 mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 0.5

Dopamine * 1600 5 - 20 5. 0.6
Drips

Dobutamine * 4000 5 - 20 5. 0.2

Epinephrine 10 0.1 - 1 0.1 1.8
Lidocaine * 8000 20 - 50 20. 0.5
Norepinephrine 16 0.1 - 2 0.1 1.1
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.03 mg 0.03 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 3. 300. 13
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN GRAY DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 4.00

For Patients 3.1 kg to 4 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.04 mg 0.4 mL
Epinephrine 1. mg/mL 0.1 mg/kg 0.4 mg 0.4 mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.08 mg 0.8 mL

Calcium Chloride 100. mg/mL 20. mg/kg 80. mg 0.8 mL
Dextrose 10% 0.1 g/mL 0.5 g/kg 2. g 20. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 100 - 200 mg 2.5 - 5 mL
NaBicarb 4.2% 0.5 mEq/ml 1. mEq/kg 4. mEq 8. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 0.4 - 0.8 mg 0.13 - 0.27 mL
Amiodarone 50. mg/mL 5. mg/kg 20. mg 0.4 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 4. mg 0.2 mL

1st Shock 0.5 J/kg 0.5 J/kg 2. Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 4. Joules
1st Shock 2. J/kg 2. J/kg 8. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 16. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.08 mg 0.8 mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 1.2 mg 0.6 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 12. - 20. mcg 0.24 - 0.4 mL
Ketamine 10. mg/mL 1. - 2. mg/kg 4. - 8. mg 0.4 - 0.8 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 8 - 12 mg 0.8 - 1.2 mL
Midazolam 1. mg/mL 0.2 mg/kg 0.8 mg 0.8 mL
Rocuronium 10. mg/mL 1. mg/kg 4. mg 0.4 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 4 - 8. mg 0.2 - 0.4 mL
Vecuronium 1. mg/mL 0.1 mg/kg 0.4 mg 0.4 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.04 mg 0.4 mL

Naloxone 0.4 mg/mL 0.1 mg/kg 0.4 mg 1. mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 0.7

Dopamine * 1600 5 - 20 5. 0.8
Drips

Dobutamine * 4000 5 - 20 5. 0.3

Epinephrine 10 0.1 - 1 0.1 2.4
Lidocaine * 8000 20 - 50 20. 0.6
Norepinephrine 16 0.1 - 2 0.1 1.5
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.04 mg 0.04 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 4. 400. 17
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN GRAY DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 5.00

For Patients 4.1 kg to 5 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.05 mg 0.5 mL
Epinephrine 1. mg/mL 0.1 mg/kg 0.5 mg 0.5 mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.1 mg 1. mL

Calcium Chloride 100. mg/mL 20. mg/kg 100. mg 1. mL
Dextrose 10% 0.1 g/mL 0.5 g/kg 2.5 g 25. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 125 - 250 mg 3.125 - 6.25 mL
NaBicarb 4.2% 0.5 mEq/ml 1. mEq/kg 5. mEq 10. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 0.5 - 1. mg 0.17 - 0.33 mL
Amiodarone 50. mg/mL 5. mg/kg 25. mg 0.5 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 5. mg 0.25 mL

1st Shock 0.5 J/kg 0.5 J/kg 2.5 Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 5. Joules
1st Shock 2. J/kg 2. J/kg 10. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 20. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.1 mg 1. mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 1.5 mg 0.75 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 15. - 25. mcg 0.3 - 0.5 mL
Ketamine 10. mg/mL 1. - 2. mg/kg 5. - 10. mg 0.5 - 1. mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 10 - 15 mg 1. - 1.5 mL
Midazolam 1. mg/mL 0.2 mg/kg 1. mg 1. mL
Rocuronium 10. mg/mL 1. mg/kg 5. mg 0.5 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 5 - 10. mg 0.25 - 0.5 mL
Vecuronium 1. mg/mL 0.1 mg/kg 0.5 mg 0.5 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.05 mg 0.5 mL

Naloxone 0.4 mg/mL 0.1 mg/kg 0.5 mg 1.25 mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 0.8

Dopamine * 1600 5 - 20 5. 0.9
Drips

Dobutamine * 4000 5 - 20 5. 0.4

Epinephrine 10 0.1 - 1 0.1 3.0
Lidocaine * 8000 20 - 50 20. 0.8
Norepinephrine 16 0.1 - 2 0.1 1.9
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.05 mg 0.05 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 5. 500. 21
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN GRAY DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 6.00

For Patients 5.1 kg to 6 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.06 mg 0.6 mL
Epinephrine 1. mg/mL 0.1 mg/kg 0.6 mg 0.6 mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.12 mg 1.2 mL

Calcium Chloride 100. mg/mL 20. mg/kg 120. mg 1.2 mL
Dextrose 10% 0.1 g/mL 0.5 g/kg 3. g 30. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 150 - 300 mg 3.75 - 7.5 mL
NaBicarb 4.2% 0.5 mEq/ml 1. mEq/kg 6. mEq 12. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 0.6 - 1.2 mg 0.2 - 0.4 mL
Amiodarone 50. mg/mL 5. mg/kg 30. mg 0.6 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 6. mg 0.3 mL

1st Shock 0.5 J/kg 0.5 J/kg 3. Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 6. Joules
1st Shock 2. J/kg 2. J/kg 12. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 24. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.12 mg 1.2 mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 1.8 mg 0.9 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 18. - 30. mcg 0.36 - 0.6 mL
Ketamine 10. mg/mL 1. - 2. mg/kg 6. - 12. mg 0.6 - 1.2 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 12 - 18 mg 1.2 - 1.8 mL
Midazolam 1. mg/mL 0.2 mg/kg 1.2 mg 1.2 mL
Rocuronium 10. mg/mL 1. mg/kg 6. mg 0.6 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 6 - 12. mg 0.3 - 0.6 mL
Vecuronium 1. mg/mL 0.1 mg/kg 0.6 mg 0.6 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.06 mg 0.6 mL

Naloxone 0.4 mg/mL 0.1 mg/kg 0.6 mg 1.5 mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 1.0

Dopamine * 1600 5 - 20 5. 1.1
Drips

Dobutamine * 4000 5 - 20 5. 0.5

Epinephrine 10 0.1 - 1 0.1 3.6
Lidocaine * 8000 20 - 50 20. 0.9
Norepinephrine 16 0.1 - 2 0.1 2.3
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.06 mg 0.06 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 6. 600. 25
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN PINK DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 7.00

For Patients 6.1 kg to 7 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.07 mg 0.7 mL
Epinephrine 1. mg/mL 0.1 mg/kg 0.7 mg 0.7 mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.14 mg 1.4 mL

Calcium Chloride 100. mg/mL 20. mg/kg 140. mg 1.4 mL
Dextrose 10% 0.1 g/mL 0.5 g/kg 3.5 g 35. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 175 - 350 mg 4.375 - 8.75 mL
NaBicarb 4.2% 0.5 mEq/ml 1. mEq/kg 7. mEq 14. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 0.7 - 1.4 mg 0.23 - 0.47 mL
Amiodarone 50. mg/mL 5. mg/kg 35. mg 0.7 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 7. mg 0.35 mL

1st Shock 0.5 J/kg 0.5 J/kg 3.5 Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 7. Joules
1st Shock 2. J/kg 2. J/kg 14. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 28. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.14 mg 1.4 mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 2.1 mg 1.05 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 21. - 35. mcg 0.42 - 0.7 mL
Ketamine 10. mg/mL 1. - 2. mg/kg 7. - 14. mg 0.7 - 1.4 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 14 - 21 mg 1.4 - 2.1 mL
Midazolam 1. mg/mL 0.2 mg/kg 1.4 mg 1.4 mL
Rocuronium 10. mg/mL 1. mg/kg 7. mg 0.7 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 7 - 14. mg 0.35 - 0.7 mL
Vecuronium 1. mg/mL 0.1 mg/kg 0.7 mg 0.7 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.07 mg 0.7 mL

Naloxone 0.4 mg/mL 0.1 mg/kg 0.7 mg 1.75 mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 1.2

Dopamine * 1600 5 - 20 5. 1.3
Drips

Dobutamine * 4000 5 - 20 5. 0.5

Epinephrine 10 0.1 - 1 0.1 4.2
Lidocaine * 8000 20 - 50 20. 1.1
Norepinephrine 16 0.1 - 2 0.1 2.6
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.07 mg 0.07 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 7. 700. 29
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN PINK DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 8.00

For Patients 7.1 kg to 8 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.08 mg 0.8 mL
Epinephrine 1. mg/mL 0.1 mg/kg 0.8 mg 0.8 mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.16 mg 1.6 mL

Calcium Chloride 100. mg/mL 20. mg/kg 160. mg 1.6 mL
Dextrose 25% 0.25 g/mL 0.5 g/kg 4. g 16. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 200 - 400 mg 5 - 10 mL
NaBicarb 4.2% 0.5 mEq/ml 1. mEq/kg 8. mEq 16. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 0.8 - 1.6 mg 0.27 - 0.53 mL
Amiodarone 50. mg/mL 5. mg/kg 40. mg 0.8 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 8. mg 0.4 mL

1st Shock 0.5 J/kg 0.5 J/kg 4. Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 8. Joules
1st Shock 2. J/kg 2. J/kg 16. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 32. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.16 mg 1.6 mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 2.4 mg 1.2 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 24. - 40. mcg 0.48 - 0.8 mL
Ketamine 10. mg/mL 1. - 2. mg/kg 8. - 16. mg 0.8 - 1.6 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 16 - 24 mg 1.6 - 2.4 mL
Midazolam 1. mg/mL 0.2 mg/kg 1.6 mg 1.6 mL
Rocuronium 10. mg/mL 1. mg/kg 8. mg 0.8 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 8 - 16. mg 0.4 - 0.8 mL
Vecuronium 1. mg/mL 0.1 mg/kg 0.8 mg 0.8 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.08 mg 0.8 mL

Naloxone 0.4 mg/mL 0.1 mg/kg 0.8 mg 2. mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 1.3

Dopamine * 1600 5 - 20 5. 1.5
Drips

Dobutamine * 4000 5 - 20 5. 0.6

Epinephrine 10 0.1 - 1 0.1 4.8
Lidocaine * 8000 20 - 50 20. 1.2
Norepinephrine 16 0.1 - 2 0.1 3.0
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.08 mg 0.08 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 8. 800. 33
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN RED DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 9.00
For Patients 8.1 kg to 9 kg
Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.09 mg 0.9 mL
Epinephrine 1. mg/mL 0.1 mg/kg 0.9 mg 0.9 mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.18 mg 1.8 mL

Calcium Chloride 100. mg/mL 20. mg/kg 180. mg 1.8 mL
Dextrose 25% 0.25 g/mL 0.5 g/kg 4.5 g 18. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 225 - 450 mg 5.625 - 11.25 mL
NaBicarb 4.2% 0.5 mEq/ml 1. mEq/kg 9. mEq 18. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 0.9 - 1.8 mg 0.3 - 0.6 mL
Amiodarone 50. mg/mL 5. mg/kg 45. mg 0.9 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 9. mg 0.45 mL

1st Shock 0.5 J/kg 0.5 J/kg 4.5 Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 9. Joules
1st Shock 2. J/kg 2. J/kg 18. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 36. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.18 mg 1.8 mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 2.7 mg 1.35 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 27. - 45. mcg 0.54 - 0.9 mL
Ketamine 10. mg/mL 1. - 2. mg/kg 9. - 18. mg 0.9 - 1.8 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 18 - 27 mg 1.8 - 2.7 mL
Midazolam 1. mg/mL 0.2 mg/kg 1.8 mg 1.8 mL
Rocuronium 10. mg/mL 1. mg/kg 9. mg 0.9 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 9 - 18. mg 0.45 - 0.9 mL
Vecuronium 1. mg/mL 0.1 mg/kg 0.9 mg 0.9 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.09 mg 0.9 mL

Naloxone 0.4 mg/mL 0.1 mg/kg 0.9 mg 2.25 mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 1.5

Dopamine * 1600 5 - 20 5. 1.7
Drips

Dobutamine * 4000 5 - 20 5. 0.7

Epinephrine 10 0.1 - 1 0.1 5.4
Lidocaine * 8000 20 - 50 20. 1.4
Norepinephrine 16 0.1 - 2 0.1 3.4
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.09 mg 0.09 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 9. 900. 38
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN RED DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 10.00

For Patients 9.1 kg to 10 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.1 mg 1. mL
Epinephrine 1. mg/mL 0.1 mg/kg 1. mg 1. mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.2 mg 2. mL

Calcium Chloride 100. mg/mL 20. mg/kg 200. mg 2. mL
Dextrose 25% 0.25 g/mL 0.5 g/kg 5. g 20. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 250 - 500 mg 6.25 - 12.5 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 10. mEq 10. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 1. - 2. mg 0.33 - 0.67 mL
Amiodarone 50. mg/mL 5. mg/kg 50. mg 1. mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 10. mg 0.5 mL

1st Shock 0.5 J/kg 0.5 J/kg 5. Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 10. Joules
1st Shock 2. J/kg 2. J/kg 20. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 40. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.2 mg 2. mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 3. mg 1.5 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 30. - 50. mcg 0.6 - 1. mL
Ketamine 10. mg/mL 1. - 2. mg/kg 10. - 20. mg 1. - 2. mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 20 - 30 mg 2. - 3. mL
Midazolam 1. mg/mL 0.2 mg/kg 2. mg 2. mL
Rocuronium 10. mg/mL 1. mg/kg 10. mg 1. mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 10 - 20. mg 0.5 - 1. mL
Vecuronium 1. mg/mL 0.1 mg/kg 1. mg 1. mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.1 mg 1. mL

Naloxone 0.4 mg/mL 0.1 mg/kg 1. mg 2.5 mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 1.7

Dopamine * 1600 5 - 20 5. 1.9
Drips

Dobutamine * 4000 5 - 20 5. 0.8

Epinephrine 10 0.1 - 1 0.1 6.0
Lidocaine * 8000 20 - 50 20. 1.5
Norepinephrine 16 0.1 - 2 0.1 3.8
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.1 mg 0.1 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 10. 1000. 42
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN PURPLE DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 11.00

For Patients 10.1 kg to 11 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.11 mg 1.1 mL
Epinephrine 1. mg/mL 0.1 mg/kg 1.1 mg 1.1 mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.22 mg 2.2 mL

Calcium Chloride 100. mg/mL 20. mg/kg 220. mg 2.2 mL
Dextrose 25% 0.25 g/mL 0.5 g/kg 5.5 g 22. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 275 - 550 mg 6.875 - 13.75 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 11. mEq 11. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 1.1 - 2.2 mg 0.37 - 0.73 mL
Amiodarone 50. mg/mL 5. mg/kg 55. mg 1.1 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 11. mg 0.55 mL

1st Shock 0.5 J/kg 0.5 J/kg 5.5 Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 11. Joules
1st Shock 2. J/kg 2. J/kg 22. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 44. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.22 mg 2.2 mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 3.3 mg 1.65 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 33. - 55. mcg 0.66 - 1.1 mL
Ketamine 10. mg/mL 1. - 2. mg/kg 11. - 22. mg 1.1 - 2.2 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 22 - 33 mg 2.2 - 3.3 mL
Midazolam 1. mg/mL 0.2 mg/kg 2.2 mg 2.2 mL
Rocuronium 10. mg/mL 1. mg/kg 11. mg 1.1 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 11 - 22. mg 0.55 - 1.1 mL
Vecuronium 1. mg/mL 0.1 mg/kg 1.1 mg 1.1 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.11 mg 1.1 mL

Naloxone 0.4 mg/mL 0.1 mg/kg 1.1 mg 2.75 mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 1.8

Dopamine * 1600 5 - 20 5. 2.1
Drips

Dobutamine * 4000 5 - 20 5. 0.8

Epinephrine 10 0.1 - 1 0.1 6.6
Lidocaine * 8000 20 - 50 20. 1.7
Norepinephrine 16 0.1 - 2 0.1 4.1
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.11 mg 0.11 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 11. 1050. 44
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN PURPLE DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 12.00

For Patients 11.1 kg to 12 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.12 mg 1.2 mL
Epinephrine 1. mg/mL 0.1 mg/kg 1.2 mg 1.2 mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.24 mg 2.4 mL

Calcium Chloride 100. mg/mL 20. mg/kg 240. mg 2.4 mL
Dextrose 50`% 0.5 g/mL 0.5 g/kg 6. g 12. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 300 - 600 mg 7.5 - 15 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 12. mEq 12. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 1.2 - 2.4 mg 0.4 - 0.8 mL
Amiodarone 50. mg/mL 5. mg/kg 60. mg 1.2 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 12. mg 0.6 mL

1st Shock 0.5 J/kg 0.5 J/kg 6. Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 12. Joules
1st Shock 2. J/kg 2. J/kg 24. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 48. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.24 mg 2.4 mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 3.6 mg 1.8 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 36. - 60. mcg 0.72 - 1.2 mL
Ketamine 10. mg/mL 1. - 2. mg/kg 12. - 24. mg 1.2 - 2.4 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 24 - 36 mg 2.4 - 3.6 mL
Midazolam 1. mg/mL 0.2 mg/kg 2.4 mg 2.4 mL
Rocuronium 10. mg/mL 1. mg/kg 12. mg 1.2 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 12 - 24. mg 0.6 - 1.2 mL
Vecuronium 1. mg/mL 0.1 mg/kg 1.2 mg 1.2 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.12 mg 1.2 mL

Naloxone 0.4 mg/mL 0.1 mg/kg 1.2 mg 3. mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 2.0

Dopamine * 1600 5 - 20 5. 2.3
Drips

Dobutamine * 4000 5 - 20 5. 0.9

Epinephrine 10 0.1 - 1 0.1 7.2
Lidocaine * 8000 20 - 50 20. 1.8
Norepinephrine 16 0.1 - 2 0.1 4.5
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.12 mg 0.12 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 12. 1100. 46
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN YELLOW DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 13.00

For Patients 12.1 kg to 13 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.13 mg 1.3 mL
Epinephrine 1. mg/mL 0.1 mg/kg 1.3 mg 1.3 mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.26 mg 2.6 mL

Calcium Chloride 100. mg/mL 20. mg/kg 260. mg 2.6 mL
Dextrose 50% 0.5 g/mL 0.5 g/kg 6.5 g 13. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 325 - 650 mg 8.125 - 16.25 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 13. mEq 13. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 1.3 - 2.6 mg 0.43 - 0.87 mL
Amiodarone 50. mg/mL 5. mg/kg 65. mg 1.3 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 13. mg 0.65 mL

1st Shock 0.5 J/kg 0.5 J/kg 6.5 Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 13. Joules
1st Shock 2. J/kg 2. J/kg 26. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 52. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.26 mg 2.6 mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 3.9 mg 1.95 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 39. - 65. mcg 0.78 - 1.3 mL
Ketamine 10. mg/mL 1. - 2. mg/kg 13. - 26. mg 1.3 - 2.6 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 26 - 39 mg 2.6 - 3.9 mL
Midazolam 1. mg/mL 0.2 mg/kg 2.6 mg 2.6 mL
Rocuronium 10. mg/mL 1. mg/kg 13. mg 1.3 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 13 - 26. mg 0.65 - 1.3 mL
Vecuronium 1. mg/mL 0.1 mg/kg 1.3 mg 1.3 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.13 mg 1.3 mL

Naloxone 0.4 mg/mL 0.1 mg/kg 1.3 mg 3.25 mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 2.2

Dopamine * 1600 5 - 20 5. 2.4
Drips

Dobutamine * 4000 5 - 20 5. 1.0

Epinephrine 10 0.1 - 1 0.1 7.8
Lidocaine * 8000 20 - 50 20. 2.0
Norepinephrine 16 0.1 - 2 0.1 4.9
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.13 mg 0.13 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 13. 1150. 48
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN YELLOW DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 14.00

For Patients 13.1 kg to 14 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.14 mg 1.4 mL
Epinephrine 1. mg/mL 0.1 mg/kg 1.4 mg 1.4 mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.28 mg 2.8 mL

Calcium Chloride 100. mg/mL 20. mg/kg 280. mg 2.8 mL
Dextrose 50% 0.5 g/mL 0.5 g/kg 7. g 14. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 350 - 700 mg 8.75 - 17.5 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 14. mEq 14. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 1.4 - 2.8 mg 0.47 - 0.93 mL
Amiodarone 50. mg/mL 5. mg/kg 70. mg 1.4 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 14. mg 0.7 mL

1st Shock 0.5 J/kg 0.5 J/kg 7. Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 14. Joules
1st Shock 2. J/kg 2. J/kg 28. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 56. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.28 mg 2.8 mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 4.2 mg 2.1 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 42. - 70. mcg 0.84 - 1.4 mL
Ketamine 10. mg/mL 1. - 2. mg/kg 14. - 28. mg 1.4 - 2.8 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 28 - 42 mg 2.8 - 4.2 mL
Midazolam 1. mg/mL 0.2 mg/kg 2.8 mg 2.8 mL
Rocuronium 10. mg/mL 1. mg/kg 14. mg 1.4 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 14 - 28. mg 0.7 - 1.4 mL
Vecuronium 1. mg/mL 0.1 mg/kg 1.4 mg 1.4 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.14 mg 1.4 mL

Naloxone 0.4 mg/mL 0.1 mg/kg 1.4 mg 3.5 mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 2.3

Dopamine * 1600 5 - 20 5. 2.6
Drips

Dobutamine * 4000 5 - 20 5. 1.1

Epinephrine 10 0.1 - 1 0.1 8.4
Lidocaine * 8000 20 - 50 20. 2.1
Norepinephrine 16 0.1 - 2 0.1 5.3
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.14 mg 0.14 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 14. 1200. 50
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN YELLOW DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 15.00

For Patients 14.1 kg to 15 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.15 mg 1.5 mL

Epinephrine 1. mg/mL 0.1 mg/kg 1.5 mg 1.5 mL

(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.3 mg 3. mL

Calcium Chloride 100. mg/mL 20. mg/kg 300. mg 3. mL
Dextrose 50% 0.5 g/mL 0.5 g/kg 7.5 g 15. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 375 - 750 mg 9.375 - 18.75 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 15. mEq 15. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 1.5 - 3. mg 0.5 - 1. mL
Amiodarone 50. mg/mL 5. mg/kg 75. mg 1.5 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 15. mg 0.75 mL

1st Shock 0.5 J/kg 0.5 J/kg 7.5 Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 15. Joules
1st Shock 2. J/kg 2. J/kg 30. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 60. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.3 mg 3. mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 4.5 mg 2.25 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 45. - 75. mcg 0.9 - 1.5 mL
Ketamine 10. mg/mL 1. - 2. mg/kg 15. - 30. mg 1.5 - 3. mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 30 - 45 mg 3. - 4.5 mL
Midazolam 1. mg/mL 0.2 mg/kg 3. mg 3. mL
Rocuronium 10. mg/mL 1. mg/kg 15. mg 1.5 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 15 - 30. mg 0.75 - 1.5 mL
Vecuronium 1. mg/mL 0.1 mg/kg 1.5 mg 1.5 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.15 mg 1.5 mL

Naloxone 0.4 mg/mL 0.1 mg/kg 1.5 mg 3.75 mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 2.5

Dopamine * 1600 5 - 20 5. 2.8
Drips

Dobutamine * 4000 5 - 20 5. 1.1

Epinephrine 10 0.1 - 1 0.1 9.0
Lidocaine * 8000 20 - 50 20. 2.3
Norepinephrine 16 0.1 - 2 0.1 5.6
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.15 mg 0.15 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 15. 1250. 52
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN WHITE DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 16.00

For Patients 15.1 kg to 16 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.16 mg 1.6 mL

Epinephrine 1. mg/mL 0.1 mg/kg 1.6 mg 1.6 mL

(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.32 mg 3.2 mL

Calcium Chloride 100. mg/mL 20. mg/kg 320. mg 3.2 mL
Dextrose 50% 0.5 g/mL 0.5 g/kg 8. g 16. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 400 - 800 mg 10 - 20 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 16. mEq 16. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 1.6 - 3.2 mg 0.53 - 1.07 mL
Amiodarone 50. mg/mL 5. mg/kg 80. mg 1.6 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 16. mg 0.8 mL

1st Shock 0.5 J/kg 0.5 J/kg 8. Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 16. Joules
1st Shock 2. J/kg 2. J/kg 32. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 64. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.32 mg 3.2 mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 4.8 mg 2.4 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 48. - 80. mcg 0.96 - 1.6 mL
Ketamine 10. mg/mL 1. - 2. mg/kg 16. - 32. mg 1.6 - 3.2 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 32 - 48 mg 3.2 - 4.8 mL
Midazolam 1. mg/mL 0.2 mg/kg 3.2 mg 3.2 mL
Rocuronium 10. mg/mL 1. mg/kg 16. mg 1.6 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 16 - 32. mg 0.8 - 1.6 mL
Vecuronium 1. mg/mL 0.1 mg/kg 1.6 mg 1.6 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.16 mg 1.6 mL

Naloxone 0.4 mg/mL 0.1 mg/kg 1.6 mg 4. mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 2.7

Dopamine * 1600 5 - 20 5. 3.0
Drips

Dobutamine * 4000 5 - 20 5. 1.2

Epinephrine 10 0.1 - 1 0.1 9.6
Lidocaine * 8000 20 - 50 20. 2.4
Norepinephrine 16 0.1 - 2 0.1 6.0
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.16 mg 0.16 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 16. 1300. 54
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN WHITE DRAWER v.12.15.21
 Patient Name test
Date
Weight kg 17.00

For Patients 16.1 kg to 17 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.17 mg 1.7 mL

Epinephrine 1. mg/mL 0.1 mg/kg 1.7 mg 1.7 mL

(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.34 mg 3.4 mL

Calcium Chloride 100. mg/mL 20. mg/kg 340. mg 3.4 mL
Dextrose 50% 0.5 g/mL 0.5 g/kg 8.5 g 17. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 425 - 850 mg 10.63 - 21.25 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 17. mEq 17. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 1.7 - 3.4 mg 0.57 - 1.13 mL
Amiodarone 50. mg/mL 5. mg/kg 85. mg 1.7 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 17. mg 0.85 mL

1st Shock 0.5 J/kg 0.5 J/kg 8.5 Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 17. Joules
1st Shock 2. J/kg 2. J/kg 34. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 68. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.34 mg 3.4 mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 5.1 mg 2.55 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 51. - 85. mcg 1.02 - 1.7 mL
Ketamine 10. mg/mL 1. - 2. mg/kg 17. - 34. mg 1.7 - 3.4 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 34 - 51 mg 3.4 - 5.1 mL
Midazolam 1. mg/mL 0.2 mg/kg 3.4 mg 3.4 mL
Rocuronium 10. mg/mL 1. mg/kg 17. mg 1.7 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 17 - 34. mg 0.85 - 1.7 mL
Vecuronium 1. mg/mL 0.1 mg/kg 1.7 mg 1.7 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.17 mg 1.7 mL

Naloxone 0.4 mg/mL 0.1 mg/kg 1.7 mg 4.25 mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 2.8

Dopamine * 1600 5 - 20 5. 3.2
Drips

Dobutamine * 4000 5 - 20 5. 1.3

Epinephrine 10 0.1 - 1 0.1 10.2
Lidocaine * 8000 20 - 50 20. 2.6
Norepinephrine 16 0.1 - 2 0.1 6.4
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.17 mg 0.17 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 17. 1350. 56
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN WHITE DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 18.00

For Patients 17.1 kg to 18 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.18 mg 1.8 mL

Epinephrine 1. mg/mL 0.1 mg/kg 1.8 mg 1.8 mL

(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.36 mg 3.6 mL

Calcium Chloride 100. mg/mL 20. mg/kg 360. mg 3.6 mL
Dextrose 50% 0.5 g/mL 0.5 g/kg 9. g 18. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 450 - 900 mg 11.25 - 22.5 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 18. mEq 18. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 1.8 - 3.6 mg 0.6 - 1.2 mL
Amiodarone 50. mg/mL 5. mg/kg 90. mg 1.8 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 18. mg 0.9 mL

1st Shock 0.5 J/kg 0.5 J/kg 9. Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 18. Joules
1st Shock 2. J/kg 2. J/kg 36. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 72. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.36 mg 3.6 mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 5.4 mg 2.7 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 54. - 90. mcg 1.08 - 1.8 mL
Ketamine 10. mg/mL 1. - 2. mg/kg 18. - 36. mg 1.8 - 3.6 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 36 - 54 mg 3.6 - 5.4 mL
Midazolam 1. mg/mL 0.2 mg/kg 3.6 mg 3.6 mL
Rocuronium 10. mg/mL 1. mg/kg 18. mg 1.8 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 18 - 36. mg 0.9 - 1.8 mL
Vecuronium 1. mg/mL 0.1 mg/kg 1.8 mg 1.8 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.18 mg 1.8 mL

Naloxone 0.4 mg/mL 0.1 mg/kg 1.8 mg 4.5 mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 3.0

Dopamine * 1600 5 - 20 5. 3.4
Drips

Dobutamine * 4000 5 - 20 5. 1.4

Epinephrine 10 0.1 - 1 0.1 10.8
Lidocaine * 8000 20 - 50 20. 2.7
Norepinephrine 16 0.1 - 2 0.1 6.8
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.18 mg 0.18 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 18. 1400. 58
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN WHITE DRAWER v.12.22.22
 Patient Name test
Date
Weight kg 19.00
For Patients 18.1 kg to 19 kg
Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.19 mg 1.9 mL
Epinephrine 1. mg/mL 0.1 mg/kg 1.9 mg 1.9 mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.38 mg 3.8 mL

Calcium Chloride 100. mg/mL 20. mg/kg 380. mg 3.8 mL
Dextrose 50% 0.5 g/mL 0.5 g/kg 9.5 g 19. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 475 - 950 mg 11.88 - 23.75 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 19. mEq 19. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 1.9 - 3.8 mg 0.63 - 1.27 mL
Amiodarone 50. mg/mL 5. mg/kg 95. mg 1.9 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 19. mg 0.95 mL

1st Shock 0.5 J/kg 0.5 J/kg 9.5 Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 19. Joules
1st Shock 2. J/kg 2. J/kg 38. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 76. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.38 mg 3.8 mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 5.7 mg 2.85 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 57. - 95. mcg 1.14 - 1.9 mL
Ketamine 10. mg/mL 1. - 2. mg/kg 19. - 38. mg 1.9 - 3.8 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 38 - 57 mg 3.8 - 5.7 mL
Midazolam 1. mg/mL 0.2 mg/kg 3.8 mg 3.8 mL
Rocuronium 10. mg/mL 1. mg/kg 19. mg 1.9 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 19 - 38. mg 0.95 - 1.9 mL
Vecuronium 1. mg/mL 0.1 mg/kg 1.9 mg 1.9 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.19 mg 1.9 mL

Naloxone 0.4 mg/mL 0.1 mg/kg 1.9 mg 4.75 mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 3.2

Dopamine * 1600 5 - 20 5. 3.6
Drips

Dobutamine * 4000 5 - 20 5. 1.4

Epinephrine 10 0.1 - 1 0.1 11.4
Lidocaine * 8000 20 - 50 20. 2.9
Norepinephrine 16 0.1 - 2 0.1 7.1
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.19 mg 0.19 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 19. 1450. 60
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN BLUE DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 20.00
For Patients 19.1 kg to 20 kg
Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.2 mg 2. mL
Epinephrine 1. mg/mL 0.1 mg/kg 2. mg 2. mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.4 mg 4. mL

Calcium Chloride 100. mg/mL 20. mg/kg 400. mg 4. mL
Dextrose 50% 0.5 g/mL 0.5 g/kg 10. g 20. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 500 - 1000 mg 12.5 - 25 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 20. mEq 20. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 2. - 4. mg 0.67 - 1.33 mL
Amiodarone 50. mg/mL 5. mg/kg 100. mg 2. mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 20. mg 1. mL

1st Shock 0.5 J/kg 0.5 J/kg 10. Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 20. Joules
1st Shock 2. J/kg 2. J/kg 40. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 80. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.4 mg 4. mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 6. mg 3. mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 60. - 100. mcg 1.2 - 2. mL
Ketamine 10. mg/mL 1. - 2. mg/kg 20. - 40. mg 2. - 4. mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 40 - 60 mg 4. - 6. mL
Midazolam 1. mg/mL 0.2 mg/kg 4. mg 4. mL
Rocuronium 10. mg/mL 1. mg/kg 20. mg 2. mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 20 - 40. mg 1. - 2. mL
Vecuronium 1. mg/mL 0.1 mg/kg 2. mg 2. mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.2 mg 2. mL

Naloxone 0.4 mg/mL 0.1 mg/kg 2. mg 5. mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 3.3

Dopamine * 1600 5 - 20 5. 3.8
Drips

Dobutamine * 4000 5 - 20 5. 1.5

Epinephrine 10 0.1 - 1 0.1 12.0
Lidocaine * 8000 20 - 50 20. 3.0
Norepinephrine 16 0.1 - 2 0.1 7.5
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.2 mg 0.2 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 20. 1500. 63
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN BLUE DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 21.00

For Patients 20.1 kg to 21 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.21 mg 2.1 mL
Epinephrine 1. mg/mL 0.1 mg/kg 2.1 mg 2.1 mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.42 mg 4.2 mL

Calcium Chloride 100. mg/mL 20. mg/kg 420. mg 4.2 mL
Dextrose 50% 0.5 g/mL 0.5 g/kg 10.5 g 21. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 525 - 1050 mg 13.13 - 26.25 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 21. mEq 21. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 2.1 - 4.2 mg 0.7 - 1.4 mL
Amiodarone 50. mg/mL 5. mg/kg 105. mg 2.1 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 21. mg 1.05 mL

1st Shock 0.5 J/kg 0.5 J/kg 10.5 Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 21. Joules
1st Shock 2. J/kg 2. J/kg 42. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 84. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.42 mg 4.2 mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 6.3 mg 3.15 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 63. - 100. mcg 1.26 - 2. mL
Ketamine 10. mg/mL 1. - 2. mg/kg 21. - 42. mg 2.1 - 4.2 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 42 - 63 mg 4.2 - 6.3 mL
Midazolam 1. mg/mL 0.2 mg/kg 4.2 mg 4.2 mL
Rocuronium 10. mg/mL 1. mg/kg 21. mg 2.1 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 21 - 42. mg 1.05 - 2.1 mL
Vecuronium 1. mg/mL 0.1 mg/kg 2.1 mg 2.1 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.2 mg 2. mL

Naloxone 0.4 mg/mL 0.1 mg/kg 2. mg 5. mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 3.5

Dopamine * 1600 5 - 20 5. 3.9
Drips

Dobutamine * 4000 5 - 20 5. 1.6

Epinephrine 10 0.1 - 1 0.1 12.6
Lidocaine * 8000 20 - 50 20. 3.2
Norepinephrine 16 0.1 - 2 0.1 7.9
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.21 mg 0.21 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 21. 1520. 63
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN BLUE DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 22.00

For Patients 21.1 kg to 22 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.22 mg 2.2 mL
Epinephrine 1. mg/mL 0.1 mg/kg 2.2 mg 2.2 mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.44 mg 4.4 mL

Calcium Chloride 100. mg/mL 20. mg/kg 440. mg 4.4 mL
Dextrose 50% 0.5 g/mL 0.5 g/kg 11. g 22. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 550 - 1100 mg 13.75 - 27.5 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 22. mEq 22. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 2.2 - 4.4 mg 0.73 - 1.47 mL
Amiodarone 50. mg/mL 5. mg/kg 110. mg 2.2 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 22. mg 1.1 mL

1st Shock 0.5 J/kg 0.5 J/kg 11. Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 22. Joules
1st Shock 2. J/kg 2. J/kg 44. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 88. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.44 mg 4.4 mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 6.6 mg 3.3 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 66. - 100. mcg 1.32 - 2. mL
Ketamine 10. mg/mL 1. - 2. mg/kg 22. - 44. mg 2.2 - 4.4 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 44 - 66 mg 4.4 - 6.6 mL
Midazolam 1. mg/mL 0.2 mg/kg 4.4 mg 4.4 mL
Rocuronium 10. mg/mL 1. mg/kg 22. mg 2.2 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 22 - 44. mg 1.1 - 2.2 mL
Vecuronium 1. mg/mL 0.1 mg/kg 2.2 mg 2.2 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.2 mg 2. mL

Naloxone 0.4 mg/mL 0.1 mg/kg 2. mg 5. mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 3.7

Dopamine * 1600 5 - 20 5. 4.1
Drips

Dobutamine * 4000 5 - 20 5. 1.7

Epinephrine 10 0.1 - 1 0.1 13.2
Lidocaine * 8000 20 - 50 20. 3.3
Norepinephrine 16 0.1 - 2 0.1 8.3
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.22 mg 0.22 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 22. 1540. 64
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN BLUE DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 23.00

For Patients 22.1 kg to 23 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.23 mg 2.3 mL
Epinephrine 1. mg/mL 0.1 mg/kg 2.3 mg 2.3 mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.46 mg 4.6 mL

Calcium Chloride 100. mg/mL 20. mg/kg 460. mg 4.6 mL
Dextrose 50% 0.5 g/mL 0.5 g/kg 11.5 g 23. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 575 - 1150 mg 14.38 - 28.75 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 23. mEq 23. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 2.3 - 4.6 mg 0.77 - 1.53 mL
Amiodarone 50. mg/mL 5. mg/kg 115. mg 2.3 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 23. mg 1.15 mL

1st Shock 0.5 J/kg 0.5 J/kg 11.5 Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 23. Joules
1st Shock 2. J/kg 2. J/kg 46. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 92. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.46 mg 4.6 mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 6.9 mg 3.45 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 69. - 100. mcg 1.38 - 2. mL
Ketamine 10. mg/mL 1. - 2. mg/kg 23. - 46. mg 2.3 - 4.6 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 46 - 69 mg 4.6 - 6.9 mL
Midazolam 1. mg/mL 0.2 mg/kg 4.6 mg 4.6 mL
Rocuronium 10. mg/mL 1. mg/kg 23. mg 2.3 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 23 - 46. mg 1.15 - 2.3 mL
Vecuronium 1. mg/mL 0.1 mg/kg 2.3 mg 2.3 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.2 mg 2. mL

Naloxone 0.4 mg/mL 0.1 mg/kg 2. mg 5. mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 3.8

Dopamine * 1600 5 - 20 5. 4.3
Drips

Dobutamine * 4000 5 - 20 5. 1.7

Epinephrine 10 0.1 - 1 0.1 13.8
Lidocaine * 8000 20 - 50 20. 3.5
Norepinephrine 16 0.1 - 2 0.1 8.6
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.23 mg 0.23 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 23. 1560. 65
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN BLUE DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 24.00

For Patients 23.1 kg to 24 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.24 mg 2.4 mL
Epinephrine 1. mg/mL 0.1 mg/kg 2.4 mg 2.4 mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.48 mg 4.8 mL

Calcium Chloride 100. mg/mL 20. mg/kg 480. mg 4.8 mL
Dextrose 50% 0.5 g/mL 0.5 g/kg 12. g 24. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 600 - 1200 mg 15 - 30 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 24. mEq 24. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 2.4 - 4.8 mg 0.8 - 1.6 mL
Amiodarone 50. mg/mL 5. mg/kg 120. mg 2.4 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 24. mg 1.2 mL

1st Shock 0.5 J/kg 0.5 J/kg 12. Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 24. Joules
1st Shock 2. J/kg 2. J/kg 48. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 96. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.48 mg 4.8 mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 7.2 mg 3.6 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 72. - 100. mcg 1.44 - 2. mL
Ketamine 10. mg/mL 1. - 2. mg/kg 24. - 48. mg 2.4 - 4.8 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 48 - 72 mg 4.8 - 7.2 mL
Midazolam 1. mg/mL 0.2 mg/kg 4.8 mg 4.8 mL
Rocuronium 10. mg/mL 1. mg/kg 24. mg 2.4 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 24 - 48. mg 1.2 - 2.4 mL
Vecuronium 1. mg/mL 0.1 mg/kg 2.4 mg 2.4 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.2 mg 2. mL

Naloxone 0.4 mg/mL 0.1 mg/kg 2. mg 5. mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 4.0

Dopamine * 1600 5 - 20 5. 4.5
Drips

Dobutamine * 4000 5 - 20 5. 1.8

Epinephrine 10 0.1 - 1 0.1 14.4
Lidocaine * 8000 20 - 50 20. 3.6
Norepinephrine 16 0.1 - 2 0.1 9.0
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.24 mg 0.24 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 24. 1580. 66
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN ORANGE DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 25.00

For Patients 24.1 kg to 25 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.25 mg 2.5 mL
Epinephrine 1. mg/mL 0.1 mg/kg 2.5 mg 2.5 mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL

Calcium Chloride 100. mg/mL 20. mg/kg 500. mg 5. mL
Dextrose 50% 0.5 g/mL 0.5 g/kg 12.5 g 25. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 625 - 1250 mg 15.63 - 31.25 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 25. mEq 25. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 2.5 - 5. mg 0.83 - 1.67 mL
Amiodarone 50. mg/mL 5. mg/kg 125. mg 2.5 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 25. mg 1.25 mL

1st Shock 0.5 J/kg 0.5 J/kg 12.5 Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 25. Joules
1st Shock 2. J/kg 2. J/kg 50. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 100. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 7.5 mg 3.75 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 75. - 100. mcg 1.5 - 2. mL
Ketamine 10. mg/mL 1. - 2. mg/kg 25. - 50. mg 2.5 - 5. mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 50 - 75 mg 5. - 7.5 mL
Midazolam 1. mg/mL 0.2 mg/kg 5. mg 5. mL
Rocuronium 10. mg/mL 1. mg/kg 25. mg 2.5 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 25 - 50. mg 1.25 - 2.5 mL
Vecuronium 1. mg/mL 0.1 mg/kg 2.5 mg 2.5 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.2 mg 2. mL

Naloxone 0.4 mg/mL 0.1 mg/kg 2. mg 5. mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 4.2

Dopamine * 1600 5 - 20 5. 4.7
Drips

Dobutamine * 4000 5 - 20 5. 1.9

Epinephrine 10 0.1 - 1 0.1 15.0
Lidocaine * 8000 20 - 50 20. 3.8
Norepinephrine 16 0.1 - 2 0.1 9.4
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.25 mg 0.25 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 25. 1600. 67
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN ORANGE DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 26.00

For Patients 25.1 kg to 26 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.26 mg 2.6 mL
Epinephrine 1. mg/mL 0.1 mg/kg 2.6 mg 2.6 mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL

Calcium Chloride 100. mg/mL 20. mg/kg 520. mg 5.2 mL
Dextrose 50% 0.5 g/mL 0.5 g/kg 13. g 26. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 650 - 1300 mg 16.25 - 32.5 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 26. mEq 26. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 2.6 - 5.2 mg 0.87 - 1.73 mL
Amiodarone 50. mg/mL 5. mg/kg 130. mg 2.6 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 26. mg 1.3 mL

1st Shock 0.5 J/kg 0.5 J/kg 13. Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 26. Joules
1st Shock 2. J/kg 2. J/kg 52. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 104. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 7.8 mg 3.9 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 78. - 100. mcg 1.56 - 2. mL
Ketamine 10. mg/mL 1. - 2. mg/kg 26. - 52. mg 2.6 - 5.2 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 52 - 78 mg 5.2 - 7.8 mL
Midazolam 1. mg/mL 0.2 mg/kg 5. mg 5. mL
Rocuronium 10. mg/mL 1. mg/kg 26. mg 2.6 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 26 - 52. mg 1.3 - 2.6 mL
Vecuronium 1. mg/mL 0.1 mg/kg 2.6 mg 2.6 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.2 mg 2. mL

Naloxone 0.4 mg/mL 0.1 mg/kg 2. mg 5. mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 4.3

Dopamine * 1600 5 - 20 5. 4.9
Drips

Dobutamine * 4000 5 - 20 5. 2.0

Epinephrine 10 0.1 - 1 0.1 15.6
Lidocaine * 8000 20 - 50 20. 3.9
Norepinephrine 16 0.1 - 2 0.1 9.8
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.26 mg 0.26 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 26. 1620. 68
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN ORANGE DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 27.00

For Patients 26.1 kg to 27 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.27 mg 2.7 mL
Epinephrine 1. mg/mL 0.1 mg/kg 2.7 mg 2.7 mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL

Calcium Chloride 100. mg/mL 20. mg/kg 540. mg 5.4 mL
Dextrose 50% 0.5 g/mL 0.5 g/kg 13.5 g 27. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 675 - 1350 mg 16.88 - 33.75 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 27. mEq 27. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 2.7 - 5.4 mg 0.9 - 1.8 mL
Amiodarone 50. mg/mL 5. mg/kg 135. mg 2.7 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 27. mg 1.35 mL

1st Shock 0.5 J/kg 0.5 J/kg 13.5 Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 27. Joules
1st Shock 2. J/kg 2. J/kg 54. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 108. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 8.1 mg 4.05 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 81. - 100. mcg 1.62 - 2. mL
Ketamine 10. mg/mL 1. - 2. mg/kg 27. - 54. mg 2.7 - 5.4 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 54 - 81 mg 5.4 - 8.1 mL
Midazolam 1. mg/mL 0.2 mg/kg 5. mg 5. mL
Rocuronium 10. mg/mL 1. mg/kg 27. mg 2.7 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 27 - 54. mg 1.35 - 2.7 mL
Vecuronium 1. mg/mL 0.1 mg/kg 2.7 mg 2.7 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.2 mg 2. mL

Naloxone 0.4 mg/mL 0.1 mg/kg 2. mg 5. mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 4.5

Dopamine * 1600 5 - 20 5. 5.1
Drips

Dobutamine * 4000 5 - 20 5. 2.0

Epinephrine 10 0.1 - 1 0.1 16.2
Lidocaine * 8000 20 - 50 20. 4.1
Norepinephrine 16 0.1 - 2 0.1 10.1
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.27 mg 0.27 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 27. 1640. 68
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN ORANGE DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 28.00

For Patients 27.1 kg to 28 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.28 mg 2.8 mL
Epinephrine 1. mg/mL 0.1 mg/kg 2.8 mg 2.8 mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL

Calcium Chloride 100. mg/mL 20. mg/kg 560. mg 5.6 mL
Dextrose 50% 0.5 g/mL 0.5 g/kg 14. g 28. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 700 - 1400 mg 17.5 - 35 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 28. mEq 28. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 2.8 - 5.6 mg 0.93 - 1.87 mL
Amiodarone 50. mg/mL 5. mg/kg 140. mg 2.8 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 28. mg 1.4 mL

1st Shock 0.5 J/kg 0.5 J/kg 14. Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 28. Joules
1st Shock 2. J/kg 2. J/kg 56. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 112. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 8.4 mg 4.2 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 84. - 100. mcg 1.68 - 2. mL
Ketamine 10. mg/mL 1. - 2. mg/kg 28. - 56. mg 2.8 - 5.6 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 56 - 84 mg 5.6 - 8.4 mL
Midazolam 1. mg/mL 0.2 mg/kg 5. mg 5. mL
Rocuronium 10. mg/mL 1. mg/kg 28. mg 2.8 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 28 - 56. mg 1.4 - 2.8 mL
Vecuronium 1. mg/mL 0.1 mg/kg 2.8 mg 2.8 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.2 mg 2. mL

Naloxone 0.4 mg/mL 0.1 mg/kg 2. mg 5. mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 4.7

Dopamine * 1600 5 - 20 5. 5.3
Drips

Dobutamine * 4000 5 - 20 5. 2.1

Epinephrine 10 0.1 - 1 0.1 16.8
Lidocaine * 8000 20 - 50 20. 4.2
Norepinephrine 16 0.1 - 2 0.1 10.5
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.28 mg 0.28 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 28. 1660. 69
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN ORANGE DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 29.00

For Patients 28.1 kg to 29 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.29 mg 2.9 mL
Epinephrine 1. mg/mL 0.1 mg/kg 2.9 mg 2.9 mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL

Calcium Chloride 100. mg/mL 20. mg/kg 580. mg 5.8 mL
Dextrose 50% 0.5 g/mL 0.5 g/kg 14.5 g 29. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 725 - 1450 mg 18.13 - 36.25 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 29. mEq 29. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 2.9 - 5.8 mg 0.97 - 1.93 mL
Amiodarone 50. mg/mL 5. mg/kg 145. mg 2.9 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 29. mg 1.45 mL

1st Shock 0.5 J/kg 0.5 J/kg 14.5 Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 29. Joules
1st Shock 2. J/kg 2. J/kg 58. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 116. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 8.7 mg 4.35 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 87. - 100. mcg 1.74 - 2. mL
Ketamine 10. mg/mL 1. - 2. mg/kg 29. - 58. mg 2.9 - 5.8 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 58 - 87 mg 5.8 - 8.7 mL
Midazolam 1. mg/mL 0.2 mg/kg 5. mg 5. mL
Rocuronium 10. mg/mL 1. mg/kg 29. mg 2.9 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 29 - 58. mg 1.45 - 2.9 mL
Vecuronium 1. mg/mL 0.1 mg/kg 2.9 mg 2.9 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.2 mg 2. mL

Naloxone 0.4 mg/mL 0.1 mg/kg 2. mg 5. mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 4.8

Dopamine * 1600 5 - 20 5. 5.4
Drips

Dobutamine * 4000 5 - 20 5. 2.2

Epinephrine 10 0.1 - 1 0.1 17.4
Lidocaine * 8000 20 - 50 20. 4.4
Norepinephrine 16 0.1 - 2 0.1 10.9
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.29 mg 0.29 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 29. 1680. 70
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN ORANGE DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 30.00

For Patients 29.1 kg to 30 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.3 mg 3. mL
Epinephrine 1. mg/mL 0.1 mg/kg 3. mg 3. mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL

Calcium Chloride 100. mg/mL 20. mg/kg 600. mg 6. mL
Dextrose 50% 0.5 g/mL 0.5 g/kg 15. g 30. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 750 - 1500 mg 18.75 - 37.5 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 30. mEq 30. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 3. - 6. mg 1. - 2. mL
Amiodarone 50. mg/mL 5. mg/kg 150. mg 3. mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 30. mg 1.5 mL

1st Shock 0.5 J/kg 0.5 J/kg 15. Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 30. Joules
1st Shock 2. J/kg 2. J/kg 60. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 120. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 9. mg 4.5 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 90. - 100. mcg 1.8 - 2. mL
Ketamine 10. mg/mL 1. - 2. mg/kg 30. - 60. mg 3. - 6. mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 60 - 90 mg 6. - 9. mL
Midazolam 1. mg/mL 0.2 mg/kg 5. mg 5. mL
Rocuronium 10. mg/mL 1. mg/kg 30. mg 3. mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 30 - 60. mg 1.5 - 3. mL
Vecuronium 1. mg/mL 0.1 mg/kg 3. mg 3. mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.2 mg 2. mL

Naloxone 0.4 mg/mL 0.1 mg/kg 2. mg 5. mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 5.0

Dopamine * 1600 5 - 20 5. 5.6
Drips

Dobutamine * 4000 5 - 20 5. 2.3

Epinephrine 10 0.1 - 1 0.1 18.0
Lidocaine * 8000 20 - 50 20. 4.5
Norepinephrine 16 0.1 - 2 0.1 11.3
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.3 mg 0.3 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 30. 1700. 71
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN GREEN DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 32.00

For Patients 30.1 kg to 32 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.32 mg 3.2 mL
Epinephrine 1. mg/mL 0.1 mg/kg 3.2 mg 3.2 mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL

Calcium Chloride 100. mg/mL 20. mg/kg 640. mg 6.4 mL
Dextrose 50% 0.5 g/mL 0.5 g/kg 16. g 32. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 800 - 1600 mg 20 - 40 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 32. mEq 32. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 3.2 - 6.4 mg 1.07 - 2.13 mL
Amiodarone 50. mg/mL 5. mg/kg 160. mg 3.2 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 32. mg 1.6 mL

1st Shock 0.5 J/kg 0.5 J/kg 16. Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 32. Joules
1st Shock 2. J/kg 2. J/kg 64. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 128. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 9.6 mg 4.8 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 96. - 100. mcg 1.92 - 2. mL
Ketamine 10. mg/mL 1. - 2. mg/kg 32. - 64. mg 3.2 - 6.4 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 64 - 100 mg 6.4 - 10. mL
Midazolam 1. mg/mL 0.2 mg/kg 5. mg 5. mL
Rocuronium 10. mg/mL 1. mg/kg 32. mg 3.2 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 32 - 64. mg 1.6 - 3.2 mL
Vecuronium 1. mg/mL 0.1 mg/kg 3.2 mg 3.2 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.2 mg 2. mL

Naloxone 0.4 mg/mL 0.1 mg/kg 2. mg 5. mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 5.3

Dopamine * 1600 5 - 20 5. 6.0
Drips

Dobutamine * 4000 5 - 20 5. 2.4

Epinephrine 10 0.1 - 1 0.1 19.2
Lidocaine * 8000 20 - 50 20. 4.8
Norepinephrine 16 0.1 - 2 0.1 12.0
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.3 mg 0.3 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 32. 1740. 73
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN GREEN DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 34.00

For Patients 32.1 kg to 34 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.34 mg 3.4 mL
Epinephrine 1. mg/mL 0.1 mg/kg 3.4 mg 3.4 mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL

Calcium Chloride 100. mg/mL 20. mg/kg 680. mg 6.8 mL
Dextrose 50% 0.5 g/mL 0.5 g/kg 17. g 34. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 850 - 1700 mg 21.25 - 42.5 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 34. mEq 34. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 3.4 - 6.8 mg 1.13 - 2.27 mL
Amiodarone 50. mg/mL 5. mg/kg 170. mg 3.4 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 34. mg 1.7 mL

1st Shock 0.5 J/kg 0.5 J/kg 17. Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 34. Joules
1st Shock 2. J/kg 2. J/kg 68. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 136. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 10.2 mg 5.1 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 100. - 100. mcg - 2.
2. mL
Ketamine 10. mg/mL 1. - 2. mg/kg 34. - 68. mg 3.4 - 6.8 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 68 - 100 mg 6.8 - 10. mL
Midazolam 1. mg/mL 0.2 mg/kg 5. mg 5. mL
Rocuronium 10. mg/mL 1. mg/kg 34. mg 3.4 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 34 - 68. mg 1.7 - 3.4 mL
Vecuronium 1. mg/mL 0.1 mg/kg 3.4 mg 3.4 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.2 mg 2. mL

Naloxone 0.4 mg/mL 0.1 mg/kg 2. mg 5. mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 5.7

Dopamine * 1600 5 - 20 5. 6.4
Drips

Dobutamine * 4000 5 - 20 5. 2.6

Epinephrine 10 0.1 - 1 0.1 20.4
Lidocaine * 8000 20 - 50 20. 5.1
Norepinephrine 16 0.1 - 2 0.1 12.8
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.3 mg 0.3 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 34. 1780. 74
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN GREEN DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 36.00

For Patients 34.1 kg to 36 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.36 mg 3.6 mL
Epinephrine 1. mg/mL 0.1 mg/kg 3.6 mg 3.6 mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL

Calcium Chloride 100. mg/mL 20. mg/kg 720. mg 7.2 mL
Dextrose 50% 0.5 g/mL 0.5 g/kg 18. g 36. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 900 - 1800 mg 22.5 - 45 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 36. mEq 36. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 3.6 - 7.2 mg 1.2 - 2.4 mL
Amiodarone 50. mg/mL 5. mg/kg 180. mg 3.6 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 36. mg 1.8 mL

1st Shock 0.5 J/kg 0.5 J/kg 18. Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 36. Joules
1st Shock 2. J/kg 2. J/kg 72. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 144. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 10.8 mg 5.4 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 100. - 100. mcg 2. - 2. mL
Ketamine 10. mg/mL 1. - 2. mg/kg 36. - 72. mg 3.6 - 7.2 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 72 - 100 mg 7.2 - 10. mL
Midazolam 1. mg/mL 0.2 mg/kg 5. mg 5. mL
Rocuronium 10. mg/mL 1. mg/kg 36. mg 3.6 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 36 - 72. mg 1.8 - 3.6 mL
Vecuronium 1. mg/mL 0.1 mg/kg 3.6 mg 3.6 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.2 mg 2. mL

Naloxone 0.4 mg/mL 0.1 mg/kg 2. mg 5. mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 6.0

Dopamine * 1600 5 - 20 5. 6.8
Drips

Dobutamine * 4000 5 - 20 5. 2.7

Epinephrine 10 0.1 - 1 0.1 21.6
Lidocaine * 8000 20 - 50 20. 5.4
Norepinephrine 16 0.1 - 2 0.1 13.5
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.3 mg 0.3 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 36. 1820. 76
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN GREEN DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 38.00

For Patients 36.1 kg to 38 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.38 mg 3.8 mL
Epinephrine 1. mg/mL 0.1 mg/kg 3.8 mg 3.8 mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL

Calcium Chloride 100. mg/mL 20. mg/kg 760. mg 7.6 mL
Dextrose 50% 0.5 g/mL 0.5 g/kg 19. g 38. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 950 - 1900 mg 23.75 - 47.5 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 38. mEq 38. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 3.8 - 7.6 mg 1.27 - 2.53 mL
Amiodarone 50. mg/mL 5. mg/kg 190. mg 3.8 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 38. mg 1.9 mL

1st Shock 0.5 J/kg 0.5 J/kg 19. Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 38. Joules
1st Shock 2. J/kg 2. J/kg 76. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 150. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 11.4 mg 5.7 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 100. - 100. mcg - 2.
2. mL
Ketamine 10. mg/mL 1. - 2. mg/kg 38. - 76. mg 3.8 - 7.6 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 76 - 100 mg 7.6 - 10. mL
Midazolam 1. mg/mL 0.2 mg/kg 5. mg 5. mL
Rocuronium 10. mg/mL 1. mg/kg 38. mg 3.8 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 38 - 76. mg 1.9 - 3.8 mL
Vecuronium 1. mg/mL 0.1 mg/kg 3.8 mg 3.8 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.2 mg 2. mL

Naloxone 0.4 mg/mL 0.1 mg/kg 2. mg 5. mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 6.3

Dopamine * 1600 5 - 20 5. 7.1
Drips

Dobutamine * 4000 5 - 20 5. 2.9

Epinephrine 10 0.1 - 1 0.1 22.8
Lidocaine * 8000 20 - 50 20. 5.7
Norepinephrine 16 0.1 - 2 0.1 14.3
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.3 mg 0.3 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 38. 1860. 78
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN GREEN DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 40.00

For Patients 38.1 kg to 40 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.4 mg 4. mL
Epinephrine 1. mg/mL 0.1 mg/kg 4. mg 4. mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL

Calcium Chloride 100. mg/mL 20. mg/kg 800. mg 8. mL
Dextrose 50% 0.5 g/mL 0.5 g/kg 20. g 40. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 1000 - 2000 mg 25 - 50 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 40. mEq 40. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 4. - 8. mg 1.33 - 2.67 mL
Amiodarone 50. mg/mL 5. mg/kg 200. mg 4. mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 40. mg 2. mL

1st Shock 0.5 J/kg 0.5 J/kg 20. Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 40. Joules
1st Shock 2. J/kg 2. J/kg 80. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 150. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 12. mg 6. mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 100. - 100. mcg 2. - 2. mL
Ketamine 10. mg/mL 1. - 2. mg/kg 40. - 80. mg 4. - 8. mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 80 - 100 mg 8. - 10. mL
Midazolam 1. mg/mL 0.2 mg/kg 5. mg 5. mL
Rocuronium 10. mg/mL 1. mg/kg 40. mg 4. mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 40 - 80. mg 2. - 4. mL
Vecuronium 1. mg/mL 0.1 mg/kg 4. mg 4. mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.2 mg 2. mL

Naloxone 0.4 mg/mL 0.1 mg/kg 2. mg 5. mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 6.7

Dopamine * 1600 5 - 20 5. 7.5
Drips

Dobutamine * 4000 5 - 20 5. 3.0

Epinephrine 10 0.1 - 1 0.1 24.0
Lidocaine * 8000 20 - 50 20. 6.0
Norepinephrine 16 0.1 - 2 0.1 15.0
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.3 mg 0.3 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 40. 1900. 79
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN GREEN DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 42.00

For Patients 40.1 kg to 42 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.42 mg 4.2 mL
Epinephrine 1. mg/mL 0.1 mg/kg 4.2 mg 4.2 mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL

Calcium Chloride 100. mg/mL 20. mg/kg 840. mg 8.4 mL
Dextrose 50% 0.5 g/mL 0.5 g/kg 21. g 42. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 1050 - 2000 mg 26.25 - 50 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 42. mEq 42. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 4.2 - 8.4 mg 1.4 - 2.8 mL
Amiodarone 50. mg/mL 5. mg/kg 210. mg 4.2 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 42. mg 2.1 mL

1st Shock 0.5 J/kg 0.5 J/kg 21. Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 42. Joules
1st Shock 2. J/kg 2. J/kg 84. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 150. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 12.6 mg 6.3 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 100. - 100. mcg 2. - 2. mL
Ketamine 10. mg/mL 1. - 2. mg/kg 42. - 84. mg 4.2 - 8.4 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 84 - 100 mg 8.4 - 10. mL
Midazolam 1. mg/mL 0.2 mg/kg 5. mg 5. mL
Rocuronium 10. mg/mL 1. mg/kg 42. mg 4.2 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 42 - 84. mg 2.1 - 4.2 mL
Vecuronium 1. mg/mL 0.1 mg/kg 4.2 mg 4.2 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.2 mg 2. mL

Naloxone 0.4 mg/mL 0.1 mg/kg 2. mg 5. mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 7.0

Dopamine * 1600 5 - 20 5. 7.9
Drips

Dobutamine * 4000 5 - 20 5. 3.2

Epinephrine 10 0.1 - 1 0.1 25.2
Lidocaine * 8000 20 - 50 20. 6.3
Norepinephrine 16 0.1 - 2 0.1 15.8
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.3 mg 0.3 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 42. 1940. 81
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN GREEN DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 44.00

For Patients 42.1 kg to 44 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.44 mg 4.4 mL
Epinephrine 1. mg/mL 0.1 mg/kg 4.4 mg 4.4 mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL

Calcium Chloride 100. mg/mL 20. mg/kg 880. mg 8.8 mL
Dextrose 50% 0.5 g/mL 0.5 g/kg 22. g 44. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 1100 - 2000 mg 27.5 - 50 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 44. mEq 44. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 4.4 - 8.8 mg 1.47 - 2.93 mL
Amiodarone 50. mg/mL 5. mg/kg 220. mg 4.4 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 44. mg 2.2 mL

1st Shock 0.5 J/kg 0.5 J/kg 22. Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 44. Joules
1st Shock 2. J/kg 2. J/kg 88. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 150. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 13.2 mg 6.6 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 100. - 100. mcg - 2.
2. mL
Ketamine 10. mg/mL 1. - 2. mg/kg 44. - 88. mg 4.4 - 8.8 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 88 - 100 mg 8.8 - 10. mL
Midazolam 1. mg/mL 0.2 mg/kg 5. mg 5. mL
Rocuronium 10. mg/mL 1. mg/kg 44. mg 4.4 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 44 - 88. mg 2.2 - 4.4 mL
Vecuronium 1. mg/mL 0.1 mg/kg 4.4 mg 4.4 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.2 mg 2. mL

Naloxone 0.4 mg/mL 0.1 mg/kg 2. mg 5. mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 7.3

Dopamine * 1600 5 - 20 5. 8.3
Drips

Dobutamine * 4000 5 - 20 5. 3.3

Epinephrine 10 0.1 - 1 0.1 26.4
Lidocaine * 8000 20 - 50 20. 6.6
Norepinephrine 16 0.1 - 2 0.1 16.5
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.3 mg 0.3 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 44. 1980. 83
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN GREEN DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 46.00

For Patients 44.1 kg to 46 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.46 mg 4.6 mL
Epinephrine 1. mg/mL 0.1 mg/kg 4.6 mg 4.6 mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL

Calcium Chloride 100. mg/mL 20. mg/kg 920. mg 9.2 mL
Dextrose 50% 0.5 g/mL 0.5 g/kg 23. g 46. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 1150 - 2000 mg 28.75 - 50 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 46. mEq 46. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 4.6 - 9.2 mg 1.53 - 3.07 mL
Amiodarone 50. mg/mL 5. mg/kg 230. mg 4.6 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 46. mg 2.3 mL

1st Shock 0.5 J/kg 0.5 J/kg 23. Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 46. Joules
1st Shock 2. J/kg 2. J/kg 92. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 150. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 13.8 mg 6.9 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 100. - 100. mcg - 2.
2. mL
Ketamine 10. mg/mL 1. - 2. mg/kg 46. - 92. mg 4.6 - 9.2 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 92 - 100 mg 9.2 - 10. mL
Midazolam 1. mg/mL 0.2 mg/kg 5. mg 5. mL
Rocuronium 10. mg/mL 1. mg/kg 46. mg 4.6 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 46 - 92. mg 2.3 - 4.6 mL
Vecuronium 1. mg/mL 0.1 mg/kg 4.6 mg 4.6 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.2 mg 2. mL

Naloxone 0.4 mg/mL 0.1 mg/kg 2. mg 5. mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 7.7

Dopamine * 1600 5 - 20 5. 8.6
Drips

Dobutamine * 4000 5 - 20 5. 3.5

Epinephrine 10 0.1 - 1 0.1 27.6
Lidocaine * 8000 20 - 50 20. 6.9
Norepinephrine 16 0.1 - 2 0.1 17.3
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.3 mg 0.3 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 46. 2020. 84
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN GREEN DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 48.00

For Patients 46.1 kg to 48 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.48 mg 4.8 mL
Epinephrine 1. mg/mL 0.1 mg/kg 4.8 mg 4.8 mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL

Calcium Chloride 100. mg/mL 20. mg/kg 960. mg 9.6 mL
Dextrose 50% 0.5 g/mL 0.5 g/kg 24. g 48. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 1200 - 2000 mg 30 - 50 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 48. mEq 48. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 4.8 - 9.6 mg 1.6 - 3.2 mL
Amiodarone 50. mg/mL 5. mg/kg 240. mg 4.8 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 48. mg 2.4 mL

1st Shock 0.5 J/kg 0.5 J/kg 24. Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 48. Joules
1st Shock 2. J/kg 2. J/kg 96. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 150. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 14.4 mg 7.2 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 100. - 100. mcg 2. - 2. mL
Ketamine 10. mg/mL 1. - 2. mg/kg 48. - 96. mg 4.8 - 9.6 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 96 - 100 mg 9.6 - 10. mL
Midazolam 1. mg/mL 0.2 mg/kg 5. mg 5. mL
Rocuronium 10. mg/mL 1. mg/kg 48. mg 4.8 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 48 - 96. mg 2.4 - 4.8 mL
Vecuronium 1. mg/mL 0.1 mg/kg 4.8 mg 4.8 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.2 mg 2. mL

Naloxone 0.4 mg/mL 0.1 mg/kg 2. mg 5. mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 8.0

Dopamine * 1600 5 - 20 5. 9.0
Drips

Dobutamine * 4000 5 - 20 5. 3.6

Epinephrine 10 0.1 - 1 0.1 28.8
Lidocaine * 8000 20 - 50 20. 7.2
Norepinephrine 16 0.1 - 2 0.1 18.0
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.3 mg 0.3 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 48. 2060. 86
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN GREEN DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 50.00

For Patients 48.1 kg to 50 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 0.5 mg 5. mL
Epinephrine 1. mg/mL 0.1 mg/kg 5. mg 5. mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL

Calcium Chloride 100. mg/mL 20. mg/kg 1000. mg 10. mL
Dextrose 50% 0.5 g/mL 0.5 g/kg 25. g 50. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 1250 - 2000 mg 31.25 - 50 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 50. mEq 50. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 5. - 10. mg 1.67 - 3.33 mL
Amiodarone 50. mg/mL 5. mg/kg 250. mg 5. mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 50. mg 2.5 mL

1st Shock 0.5 J/kg 0.5 J/kg 25. Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 50. Joules
1st Shock 2. J/kg 2. J/kg 100. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 150. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 15. mg 7.5 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 100. - 100. mcg 2. - 2. mL
Ketamine 10. mg/mL 1. - 2. mg/kg 50. - 100. mg 5. - 10. mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 100 - 100 mg 10. - 10. mL
Midazolam 1. mg/mL 0.2 mg/kg 5. mg 5. mL
Rocuronium 10. mg/mL 1. mg/kg 50. mg 5. mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 50 - 100. mg 2.5 - 5. mL
Vecuronium 1. mg/mL 0.1 mg/kg 5. mg 5. mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.2 mg 2. mL

Naloxone 0.4 mg/mL 0.1 mg/kg 2. mg 5. mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 8.3

Dopamine * 1600 5 - 20 5. 9.4
Drips

Dobutamine * 4000 5 - 20 5. 3.8

Epinephrine 10 0.1 - 1 0.1 30.0
Lidocaine * 8000 20 - 50 20. 7.5
Norepinephrine 16 0.1 - 2 0.1 18.8
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.3 mg 0.3 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 50. 2100. 88
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN GREEN DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 52.00

For Patients 50.1 kg to 52 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 1. mg 10. mL
Epinephrine 1. mg/mL 0.1 mg/kg 5. mg 5. mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL

Calcium Chloride 100. mg/mL 20. mg/kg 1000. mg 10. mL
Dextrose 50% 0.5 g/mL 0.5 g/kg 25. g 50. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 1300 - 2000 mg 32.5 - 50 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 50. mEq 50. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 5.2 - 10.4 mg 1.73 - 3.47 mL
Amiodarone 50. mg/mL 5. mg/kg 260. mg 5.2 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 52. mg 2.6 mL

1st Shock 0.5 J/kg 0.5 J/kg 26. Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 52. Joules
1st Shock 2. J/kg 2. J/kg 104. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 150. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 15.6 mg 7.8 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 100. - 100. mcg - 2.
2. mL
Ketamine 10. mg/mL 1. - 2. mg/kg 52. - 104. mg 5.2 - 10.4 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 100 - 100 mg 10. - 10. mL
Midazolam 1. mg/mL 0.2 mg/kg 5. mg 5. mL
Rocuronium 10. mg/mL 1. mg/kg 52. mg 5.2 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 52 - 104. mg 2.6 - 5.2 mL
Vecuronium 1. mg/mL 0.1 mg/kg 5.2 mg 5.2 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.2 mg 2. mL

Naloxone 0.4 mg/mL 0.1 mg/kg 2. mg 5. mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 8.7

Dopamine * 1600 5 - 20 5. 9.8
Drips

Dobutamine * 4000 5 - 20 5. 3.9

Epinephrine 10 0.1 - 1 0.1 31.2
Lidocaine * 8000 20 - 50 20. 7.8
Norepinephrine 16 0.1 - 2 0.1 19.5
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.3 mg 0.3 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 52. 2140. 89
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN GREEN DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 54.00

For Patients 52.1 kg to 54 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 1. mg 10. mL
Epinephrine 1. mg/mL 0.1 mg/kg 5. mg 5. mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL

Calcium Chloride 100. mg/mL 20. mg/kg 1000. mg 10. mL
Dextrose 50% 0.5 g/mL 0.5 g/kg 25. g 50. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 1350 - 2000 mg 33.75 - 50 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 50. mEq 50. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 5.4 - 10.8 mg 1.8 - 3.6 mL
Amiodarone 50. mg/mL 5. mg/kg 270. mg 5.4 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 54. mg 2.7 mL

1st Shock 0.5 J/kg 0.5 J/kg 27. Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 54. Joules
1st Shock 2. J/kg 2. J/kg 108. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 150. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 16.2 mg 8.1 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 100. - 100. mcg 2. - 2. mL
Ketamine 10. mg/mL 1. - 2. mg/kg 54. - 108. mg 5.4 - 10.8 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 100 - 100 mg 10. - 10. mL
Midazolam 1. mg/mL 0.2 mg/kg 5. mg 5. mL
Rocuronium 10. mg/mL 1. mg/kg 54. mg 5.4 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 54 - 108. mg 2.7 - 5.4 mL
Vecuronium 1. mg/mL 0.1 mg/kg 5.4 mg 5.4 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.2 mg 2. mL

Naloxone 0.4 mg/mL 0.1 mg/kg 2. mg 5. mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 9.0

Dopamine * 1600 5 - 20 5. 10.1
Drips

Dobutamine * 4000 5 - 20 5. 4.1

Epinephrine 10 0.1 - 1 0.1 32.4
Lidocaine * 8000 20 - 50 20. 8.1
Norepinephrine 16 0.1 - 2 0.1 20.3
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.3 mg 0.3 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 54. 2180. 91
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN GREEN DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 56.00

For Patients 54.1 kg to 56 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 1. mg 10. mL
Epinephrine 1. mg/mL 0.1 mg/kg 5. mg 5. mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL

Calcium Chloride 100. mg/mL 20. mg/kg 1000. mg 10. mL
Dextrose 50% 0.5 g/mL 0.5 g/kg 25. g 50. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 1400 - 2000 mg 35 - 50 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 50. mEq 50. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 5.6 - 11.2 mg 1.87 - 3.73 mL
Amiodarone 50. mg/mL 5. mg/kg 280. mg 5.6 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 56. mg 2.8 mL

1st Shock 0.5 J/kg 0.5 J/kg 28. Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 56. Joules
1st Shock 2. J/kg 2. J/kg 112. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 150. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 16.8 mg 8.4 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 100. - 100. mcg 2.- 2. mL
Ketamine 10. mg/mL 1. - 2. mg/kg 56. - 112. mg 5.6 - 11.2 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 100 - 100 mg 10. - 10. mL
Midazolam 1. mg/mL 0.2 mg/kg 5. mg 5. mL
Rocuronium 10. mg/mL 1. mg/kg 56. mg 5.6 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 56 - 112. mg 2.8 - 5.6 mL
Vecuronium 1. mg/mL 0.1 mg/kg 5.6 mg 5.6 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.2 mg 2. mL

Naloxone 0.4 mg/mL 0.1 mg/kg 2. mg 5. mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 9.3

Dopamine * 1600 5 - 20 5. 10.5
Drips

Dobutamine * 4000 5 - 20 5. 4.2

Epinephrine 10 0.1 - 1 0.1 33.6
Lidocaine * 8000 20 - 50 20. 8.4
Norepinephrine 16 0.1 - 2 0.1 21.0
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.3 mg 0.3 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 56. 2220. 93
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN GREEN DRAWER v.12.22.21
 Patient Name test
Date
Weight kg 58.00

For Patients 56.1 kg to 58 kg

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 1. mg 10. mL
Epinephrine 1. mg/mL 0.1 mg/kg 5. mg 5. mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL

Calcium Chloride 100. mg/mL 20. mg/kg 1000. mg 10. mL
Dextrose 50% 0.5 g/mL 0.5 g/kg 25. g 50. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 1450 - 2000 mg 36.25 - 50 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 50. mEq 50. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 5.8 - 11.6 mg 1.93 - 3.87 mL
Amiodarone 50. mg/mL 5. mg/kg 290. mg 5.8 mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 58. mg 2.9 mL

1st Shock 0.5 J/kg 0.5 J/kg 29. Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 58. Joules
1st Shock 2. J/kg 2. J/kg 116. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 150. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 17.4 mg 8.7 mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 100. - 100. mcg - 2.
2. mL
Ketamine 10. mg/mL 1. - 2. mg/kg 58. - 116. mg 5.8 - 11.6 mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 100 - 100 mg 10. - 10. mL
Midazolam 1. mg/mL 0.2 mg/kg 5. mg 5. mL
Rocuronium 10. mg/mL 1. mg/kg 58. mg 5.8 mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 58 - 116. mg 2.9 - 5.8 mL
Vecuronium 1. mg/mL 0.1 mg/kg 5.8 mg 5.8 mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.2 mg 2. mL

Naloxone 0.4 mg/mL 0.1 mg/kg 2. mg 5. mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 9.7

Dopamine * 1600 5 - 20 5. 10.9
Drips

Dobutamine * 4000 5 - 20 5. 4.4

Epinephrine 10 0.1 - 1 0.1 34.8
Lidocaine * 8000 20 - 50 20. 8.7
Norepinephrine 16 0.1 - 2 0.1 21.8
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.3 mg 0.3 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 58. 2260. 94
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN GREEN DRAWER v.12.22.21
 Patient Name test
Date
Dosing kg 60.00

For Patients 58.1 kg & Above

Emergency Pediatric Dosing Sheet

Chart represents Pediatric dosing by weight up to the usual adult dose

Drug Concentration * Standard Dose Patient Dose Volume

Epinephrine (IV) 0.1 mg/mL 0.01 mg/kg 1. mg 10. mL
Epinephrine 1. mg/mL 0.1 mg/kg 5. mg 5. mL
(ET use ONLY)
Code

Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL

Calcium Chloride 100. mg/mL 20. mg/kg 1000. mg 10. mL
Dextrose 50% 0.5 g/mL 0.5 g/kg 25. g 50. mL
Magnesium 40. mg/ml 25 - 50. mg/kg 1500 - 2000 mg 37.5 - 50 mL
NaBicarb 8.4% 1. mEq/ml 1. mEq/kg 50. mEq 50. mL
Adenosine 3. mg/mL 0.1 - 0.2 mg/kg 6. - 12. mg 2. - 4. mL
Amiodarone 50. mg/mL 5. mg/kg 300. mg 6. mL
Rhythm

Lidocaine 2% 20. mg/mL 1. mg/kg 60. mg 3. mL

1st Shock 0.5 J/kg 0.5 J/kg 30. Joules
Cardioversion
2nd Shock 1. J/kg 1. J/kg 60. Joules
1st Shock 2. J/kg 2. J/kg 120. Joules
Defibrillation
2nd & 3rd Shock 4. J/kg 4. J/kg 150. Joules
Atropine 0.1 mg/mL 0.02 mg/kg 0.5 mg 5. mL
Rapid Sequence Intubation

Do not use in
Etomidate suspected sepsis! 2. mg/mL vial 0.3 mg/kg 18. mg 9. mL
Fentanyl 50. mcg/mL 3. - 5. mcg/kg 100. - 100. mcg 2. - 2. mL
Ketamine 10. mg/mL 1. - 2. mg/kg 60. - 120. mg 6. - 12. mL
Caution: Pts with
sepsis or
Propofol hypovolemia. 10. mg/mL 2. - 3. mg/kg 100 - 100 mg 10. - 10. mL
Midazolam 1. mg/mL 0.2 mg/kg 5. mg 5. mL
Rocuronium 10. mg/mL 1. mg/kg 60. mg 6. mL
Caution: Pts with
Succinylcholine hyperkalemia. 20. mg/mL 1 - 2. mg/kg 60 - 120. mg 3. - 6. mL
Vecuronium 1. mg/mL 0.1 mg/kg 6. mg 6. mL
Antidote

Flumazenil 0.1 mg/mL 0.01 mg/kg 0.2 mg 2. mL

Naloxone 0.4 mg/mL 0.1 mg/kg 2. mg 5. mL

Drug Drip Concentration (mcg/mL) Dose Range (mcg/kg/min.) Patient Dose (mcg/kg/min.) Rate (mL/hr)

Amiodarone * 1800 5 - 15 5. 10.0

Dopamine * 1600 5 - 20 5. 11.3
Drips

Dobutamine * 4000 5 - 20 5. 4.5

Epinephrine 10 0.1 - 1 0.1 36.0
Lidocaine * 8000 20 - 50 20. 9.0
Norepinephrine 16 0.1 - 2 0.1 22.5
* Available in this concentration as a premix solution
Anaphylaxi
s/Asthma

Epinephrine 1:1000
1. mg/mL 0.01 mg/kg 0.3 mg 0.3 mL
(IM/SQ)

Fluid Requirement Fluid Requirement

Weight (kg)
for 24 hrs per hour
Daily: 60. 2300. 96
First 10 kg = 100 mL/kg/24 hrs
Hourly:
Second 10 kg = 1000 mL + 50 mL/kg
Daily fluid requirement ÷ 24
Over 20 kg = 1500 mL + 20 mL/kg >20
* Note Concentration
Weight Verified by: RN GREEN DRAWER v.12.22.21
 5 – Pediatric
Anaphylaxis Sheets
 Pediatric Anaphylaxis Sheets

Pediatric Anaphylaxis Sheets range from:

• 3 kg to 22 kg in 1 kg increment, then
• 22 kg to 40 kg in 2 kg increments

When selecting an appropriate sheet for a patient, round

up to the next whole number in kg and select that sheet
(i.e., patient’s weight is 7.4 kg – use the 8 kg sheet).

For patients who weigh over 40 kg, continue to use the

40kg sheet to avoid exceeding maximum dosing.
Patient Name:
Date:
Actual weight in kg: 3

Pediatric Anaphylaxis Medications

Chart represents pediatric dosing by weight up to the usual adult dose

Drug Concentration Standard Dose Patient Dose Volume

Diphenhydramine: 50 mg/mL 1 mg/kg 3 mg 0.06mL
Epinephrine
(Intramuscular use only) 1 mg/mL 0.01 mg/kg 0.03 mg 0.03mL
Methylprednisolone: 125 mg/2mL 2 mg/kg 6 mg 0.096mL

Weight Verified by:

Date:

Note: For pediatric equipment sizes, refer to Broselow tape to identify correct drawer based on age and weight
Notes:
Patient Name:
Date:
Actual weight in kg: 4

Pediatric Anaphylaxis Medications

Chart represents pediatric dosing by weight up to the usual adult dose

Drug Concentration Standard Dose Patient Dose Volume

Diphenhydramine: 50 mg/mL 1 mg/kg 4 mg 0.08mL
Epinephrine
(Intramuscular use only) 1 mg/mL 0.01 mg/kg 0.04 mg 0.04mL
Methylprednisolone: 125 mg/2mL 2 mg/kg 8 mg 0.128mL

Weight Verified by:

Date:

Note: For pediatric equipment sizes, refer to Broselow tape to identify correct drawer based on age and weight
Notes:
Patient Name:
Date:
Actual weight in kg: 5

Pediatric Anaphylaxis Medications

Chart represents pediatric dosing by weight up to the usual adult dose

Drug Concentration Standard Dose Patient Dose Volume

Diphenhydramine: 50 mg/mL 1 mg/kg 5 mg 0.1mL
Epinephrine
(Intramuscular use only) 1 mg/mL 0.01 mg/kg 0.05 mg 0.05mL
Methylprednisolone: 125 mg/2mL 2 mg/kg 10 mg 0.16mL

Weight Verified by:

Date:

Note: For pediatric equipment sizes, refer to Broselow tape to identify correct drawer based on age and weight
Notes:
Patient Name:
Date:
Actual weight in kg: 6

Pediatric Anaphylaxis Medications

Chart represents pediatric dosing by weight up to the usual adult dose

Drug Concentration Standard Dose Patient Dose Volume

Diphenhydramine: 50 mg/mL 1 mg/kg 6 mg 0.12mL
Epinephrine
(Intramuscular use only) 1 mg/mL 0.01 mg/kg 0.06 mg 0.06mL
Methylprednisolone: 125 mg/2mL 2 mg/kg 12 mg 0.192mL

Weight Verified by:

Date:

Note: For pediatric equipment sizes, refer to Broselow tape to identify correct drawer based on age and weight
Notes:
Patient Name:
Date:
Actual weight in kg: 7

Pediatric Anaphylaxis Medications

Chart represents pediatric dosing by weight up to the usual adult dose

Drug Concentration Standard Dose Patient Dose Volume

Diphenhydramine: 50 mg/mL 1 mg/kg 7 mg 0.14mL
Epinephrine
(Intramuscular use only) 1 mg/mL 0.01 mg/kg 0.07 mg 0.07mL
Methylprednisolone: 125 mg/2mL 2 mg/kg 14 mg 0.224mL

Weight Verified by:

Date:

Note: For pediatric equipment sizes, refer to Broselow tape to identify correct drawer based on age and weight
Notes:
Patient Name:
Date:
Actual weight in kg: 8

Pediatric Anaphylaxis Medications

Chart represents pediatric dosing by weight up to the usual adult dose

Drug Concentration Standard Dose Patient Dose Volume

Diphenhydramine: 50 mg/mL 1 mg/kg 8 mg 0.16mL
Epinephrine
(Intramuscular use only) 1 mg/mL 0.01 mg/kg 0.08 mg 0.08mL
Methylprednisolone: 125 mg/2mL 2 mg/kg 16 mg 0.256mL

Weight Verified by:

Date:

Note: For pediatric equipment sizes, refer to Broselow tape to identify correct drawer based on age and weight
Notes:
Patient Name:
Date:
Actual weight in kg: 9

Pediatric Anaphylaxis Medications

Chart represents pediatric dosing by weight up to the usual adult dose

Drug Concentration Standard Dose Patient Dose Volume

Diphenhydramine: 50 mg/mL 1 mg/kg 9 mg 0.18mL
Epinephrine
(Intramuscular use only) 1 mg/mL 0.01 mg/kg 0.09 mg 0.09mL
Methylprednisolone: 125 mg/2mL 2 mg/kg 18 mg 0.288mL

Weight Verified by:

Date:

Note: For pediatric equipment sizes, refer to Broselow tape to identify correct drawer based on age and weight
Notes:
Patient Name:
Date:
Actual weight in kg: 10

Pediatric Anaphylaxis Medications

Chart represents pediatric dosing by weight up to the usual adult dose

Drug Concentration Standard Dose Patient Dose Volume

Diphenhydramine: 50 mg/mL 1 mg/kg 10 mg 0.2mL
Epinephrine
(Intramuscular use only) 1 mg/mL 0.01 mg/kg 0.1 mg 0.1mL
Methylprednisolone: 125 mg/2mL 2 mg/kg 20 mg 0.32mL

Weight Verified by:

Date:

Note: For pediatric equipment sizes, refer to Broselow tape to identify correct drawer based on age and weight
Notes:
Patient Name:
Date:
Actual weight in kg: 11

Pediatric Anaphylaxis Medications

Chart represents pediatric dosing by weight up to the usual adult dose

Drug Concentration Standard Dose Patient Dose Volume

Diphenhydramine: 50 mg/mL 1 mg/kg 11 mg 0.22mL
Epinephrine
(Intramuscular use only) 1 mg/mL 0.01 mg/kg 0.11 mg 0.11mL
Methylprednisolone: 125 mg/2mL 2 mg/kg 22 mg 0.352mL

Weight Verified by:

Date:

Note: For pediatric equipment sizes, refer to Broselow tape to identify correct drawer based on age and weight
Notes:
Patient Name:
Date:
Actual weight in kg: 12

Pediatric Anaphylaxis Medications

Chart represents pediatric dosing by weight up to the usual adult dose

Drug Concentration Standard Dose Patient Dose Volume

Diphenhydramine: 50 mg/mL 1 mg/kg 12 mg 0.24mL
Epinephrine
(Intramuscular use only) 1 mg/mL 0.01 mg/kg 0.12 mg 0.12mL
Methylprednisolone: 125 mg/2mL 2 mg/kg 24 mg 0.384mL

Weight Verified by:

Date:

Note: For pediatric equipment sizes, refer to Broselow tape to identify correct drawer based on age and weight
Notes:
Patient Name:
Date:
Actual weight in kg: 13

Pediatric Anaphylaxis Medications

Chart represents pediatric dosing by weight up to the usual adult dose

Drug Concentration Standard Dose Patient Dose Volume

Diphenhydramine: 50 mg/mL 1 mg/kg 13 mg 0.26mL
Epinephrine
(Intramuscular use only) 1 mg/mL 0.01 mg/kg 0.13 mg 0.13mL
Methylprednisolone: 125 mg/2mL 2 mg/kg 26 mg 0.416mL

Weight Verified by:

Date:

Note: For pediatric equipment sizes, refer to Broselow tape to identify correct drawer based on age and weight
Notes:
Patient Name:
Date:
Actual weight in kg: 14

Pediatric Anaphylaxis Medications

Chart represents pediatric dosing by weight up to the usual adult dose

Drug Concentration Standard Dose Patient Dose Volume

Diphenhydramine: 50 mg/mL 1 mg/kg 14 mg 0.28mL
Epinephrine
(Intramuscular use only) 1 mg/mL 0.01 mg/kg 0.14 mg 0.14mL
Methylprednisolone: 125 mg/2mL 2 mg/kg 28 mg 0.448mL

Weight Verified by:

Date:

Note: For pediatric equipment sizes, refer to Broselow tape to identify correct drawer based on age and weight
Notes:
Patient Name:
Date:
Actual weight in kg: 15

Pediatric Anaphylaxis Medications

Chart represents pediatric dosing by weight up to the usual adult dose

Drug Concentration Standard Dose Patient Dose Volume

Diphenhydramine: 50 mg/mL 1 mg/kg 15 mg 0.3mL
Epinephrine
(Intramuscular use only) 1 mg/mL 0.01 mg/kg 0.15 mg 0.15mL
Methylprednisolone: 125 mg/2mL 2 mg/kg 30 mg 0.48mL

Weight Verified by:

Date:

Note: For pediatric equipment sizes, refer to Broselow tape to identify correct drawer based on age and weight
Notes:
Patient Name:
Date:
Actual weight in kg: 16

Pediatric Anaphylaxis Medications

Chart represents pediatric dosing by weight up to the usual adult dose

Drug Concentration Standard Dose Patient Dose Volume

Diphenhydramine: 50 mg/mL 1 mg/kg 16 mg 0.32mL
Epinephrine
(Intramuscular use only) 1 mg/mL 0.01 mg/kg 0.16 mg 0.16mL
Methylprednisolone: 125 mg/2mL 2 mg/kg 32 mg 0.512mL

Weight Verified by:

Date:

Note: For pediatric equipment sizes, refer to Broselow tape to identify correct drawer based on age and weight
Notes:
Patient Name:
Date:
Actual weight in kg: 17

Pediatric Anaphylaxis Medications

Chart represents pediatric dosing by weight up to the usual adult dose

Drug Concentration Standard Dose Patient Dose Volume

Diphenhydramine: 50 mg/mL 1 mg/kg 17 mg 0.34mL
Epinephrine
(Intramuscular use only) 1 mg/mL 0.01 mg/kg 0.17 mg 0.17mL
Methylprednisolone: 125 mg/2mL 2 mg/kg 34 mg 0.544mL

Weight Verified by:

Date:

Note: For pediatric equipment sizes, refer to Broselow tape to identify correct drawer based on age and weight
Notes:
Patient Name:
Date:
Actual weight in kg: 18

Pediatric Anaphylaxis Medications

Chart represents pediatric dosing by weight up to the usual adult dose

Drug Concentration Standard Dose Patient Dose Volume

Diphenhydramine: 50 mg/mL 1 mg/kg 18 mg 0.36mL
Epinephrine
(Intramuscular use only) 1 mg/mL 0.01 mg/kg 0.18 mg 0.18mL
Methylprednisolone: 125 mg/2mL 2 mg/kg 36 mg 0.576mL

Weight Verified by:

Date:

Note: For pediatric equipment sizes, refer to Broselow tape to identify correct drawer based on age and weight
Notes:
Patient Name:
Date:
Actual weight in kg: 19

Pediatric Anaphylaxis Medications

Chart represents pediatric dosing by weight up to the usual adult dose

Drug Concentration Standard Dose Patient Dose Volume

Diphenhydramine: 50 mg/mL 1 mg/kg 19 mg 0.38mL
Epinephrine
(Intramuscular use only) 1 mg/mL 0.01 mg/kg 0.19 mg 0.19mL
Methylprednisolone: 125 mg/2mL 2 mg/kg 38 mg 0.608mL

Weight Verified by:

Date:

Note: For pediatric equipment sizes, refer to Broselow tape to identify correct drawer based on age and weight
Notes:
Patient Name:
Date:
Actual weight in kg: 20

Pediatric Anaphylaxis Medications

Chart represents pediatric dosing by weight up to the usual adult dose

Drug Concentration Standard Dose Patient Dose Volume

Diphenhydramine: 50 mg/mL 1 mg/kg 20 mg 0.4mL
Epinephrine
(Intramuscular use only) 1 mg/mL 0.01 mg/kg 0.2 mg 0.2mL
Methylprednisolone: 125 mg/2mL 2 mg/kg 40 mg 0.64mL

Weight Verified by:

Date:

Note: For pediatric equipment sizes, refer to Broselow tape to identify correct drawer based on age and weight
Notes:
Patient Name:
Date:
Actual weight in kg: 21

Pediatric Anaphylaxis Medications

Chart represents pediatric dosing by weight up to the usual adult dose

Drug Concentration Standard Dose Patient Dose Volume

Diphenhydramine: 50 mg/mL 1 mg/kg 21 mg 0.42mL
Epinephrine
(Intramuscular use only) 1 mg/mL 0.01 mg/kg 0.21 mg 0.21mL
Methylprednisolone: 125 mg/2mL 2 mg/kg 42 mg 0.672mL

Weight Verified by:

Date:

Note: For pediatric equipment sizes, refer to Broselow tape to identify correct drawer based on age and weight
Notes:
Patient Name:
Date:
Actual weight in kg: 22

Pediatric Anaphylaxis Medications

Chart represents pediatric dosing by weight up to the usual adult dose

Drug Concentration Standard Dose Patient Dose Volume

Diphenhydramine: 50 mg/mL 1 mg/kg 22 mg 0.44mL
Epinephrine
(Intramuscular use only) 1 mg/mL 0.01 mg/kg 0.22 mg 0.22mL
Methylprednisolone: 125 mg/2mL 2 mg/kg 44 mg 0.704mL

Weight Verified by:

Date:

Note: For pediatric equipment sizes, refer to Broselow tape to identify correct drawer based on age and weight
Notes:
Patient Name:
Date:
Actual weight in kg: 24

Pediatric Anaphylaxis Medications

Chart represents pediatric dosing by weight up to the usual adult dose

Drug Concentration Standard Dose Patient Dose Volume

Diphenhydramine: 50 mg/mL 1 mg/kg 24 mg 0.48mL
Epinephrine
(Intramuscular use only) 1 mg/mL 0.01 mg/kg 0.24 mg 0.24mL
Methylprednisolone: 125 mg/2mL 2 mg/kg 48 mg 0.768mL

Weight Verified by:

Date:

Note: For pediatric equipment sizes, refer to Broselow tape to identify correct drawer based on age and weight
Notes:
Patient Name:
Date:
Actual weight in kg: 26

Pediatric Anaphylaxis Medications

Chart represents pediatric dosing by weight up to the usual adult dose

Drug Concentration Standard Dose Patient Dose Volume

Diphenhydramine: 50 mg/mL 1 mg/kg 26 mg 0.52mL
Epinephrine
(Intramuscular use only) 1 mg/mL 0.01 mg/kg 0.26 mg 0.26mL
Methylprednisolone: 125 mg/2mL 2 mg/kg 52 mg 0.832mL

Weight Verified by:

Date:

Note: For pediatric equipment sizes, refer to Broselow tape to identify correct drawer based on age and weight
Notes:
Patient Name:
Date:
Actual weight in kg: 28

Pediatric Anaphylaxis Medications

Chart represents pediatric dosing by weight up to the usual adult dose

Drug Concentration Standard Dose Patient Dose Volume

Diphenhydramine: 50 mg/mL 1 mg/kg 28 mg 0.56mL
Epinephrine
(Intramuscular use only) 1 mg/mL 0.01 mg/kg 0.28 mg 0.28mL
Methylprednisolone: 125 mg/2mL 2 mg/kg 56 mg 0.896mL

Weight Verified by:

Date:

Note: For pediatric equipment sizes, refer to Broselow tape to identify correct drawer based on age and weight
Notes:
Patient Name:
Date:
Actual weight in kg: 30

Pediatric Anaphylaxis Medications

Chart represents pediatric dosing by weight up to the usual adult dose

Drug Concentration Standard Dose Patient Dose Volume

Diphenhydramine: 50 mg/mL 1 mg/kg 30 mg 0.6mL
Epinephrine
(Intramuscular use only) 1 mg/mL 0.01 mg/kg 0.3 mg 0.3mL
Methylprednisolone: 125 mg/2mL 2 mg/kg 60 mg 0.96mL

Weight Verified by:

Date:

Note: For pediatric equipment sizes, refer to Broselow tape to identify correct drawer based on age and weight
Notes:
Patient Name:
Date:
Actual weight in kg: 32

Pediatric Anaphylaxis Medications

Chart represents pediatric dosing by weight up to the usual adult dose

Drug Concentration Standard Dose Patient Dose Volume

Diphenhydramine: 50 mg/mL 1 mg/kg 32 mg 0.64mL
Epinephrine
(Intramuscular use only) 1 mg/mL 0.01 mg/kg 0.32 mg 0.32mL
Methylprednisolone: 125 mg/2mL 2 mg/kg 64 mg 1.024mL

Weight Verified by:

Date:

Note: For pediatric equipment sizes, refer to Broselow tape to identify correct drawer based on age and weight
Notes:
Patient Name:
Date:
Actual weight in kg: 34

Pediatric Anaphylaxis Medications

Chart represents pediatric dosing by weight up to the usual adult dose

Drug Concentration Standard Dose Patient Dose Volume

Diphenhydramine: 50 mg/mL 1 mg/kg 34 mg 0.68mL
Epinephrine
(Intramuscular use only) 1 mg/mL 0.01 mg/kg 0.34 mg 0.34mL
Methylprednisolone: 125 mg/2mL 2 mg/kg 68 mg 1.088mL

Weight Verified by:

Date:

Note: For pediatric equipment sizes, refer to Broselow tape to identify correct drawer based on age and weight
Notes:
Patient Name:
Date:
Actual weight in kg: 36

Pediatric Anaphylaxis Medications

Chart represents pediatric dosing by weight up to the usual adult dose

Drug Concentration Standard Dose Patient Dose Volume

Diphenhydramine: 50 mg/mL 1 mg/kg 36 mg 0.72mL
Epinephrine
(Intramuscular use only) 1 mg/mL 0.01 mg/kg 0.36 mg 0.36mL
Methylprednisolone: 125 mg/2mL 2 mg/kg 72 mg 1.152mL

Weight Verified by:

Date:

Note: For pediatric equipment sizes, refer to Broselow tape to identify correct drawer based on age and weight
Notes:
Patient Name:
Date:
Actual weight in kg: 38

Pediatric Anaphylaxis Medications

Chart represents pediatric dosing by weight up to the usual adult dose

Drug Concentration Standard Dose Patient Dose Volume

Diphenhydramine: 50 mg/mL 1 mg/kg 38 mg 0.76mL
Epinephrine
(Intramuscular use only) 1 mg/mL 0.01 mg/kg 0.38 mg 0.38mL
Methylprednisolone: 125 mg/2mL 2 mg/kg 76 mg 1.216mL

Weight Verified by:

Date:

Note: For pediatric equipment sizes, refer to Broselow tape to identify correct drawer based on age and weight
Notes:
Patient Name:
Date:
Actual weight in kg: 40

Pediatric Anaphylaxis Medications

Chart represents pediatric dosing by weight up to the usual adult dose

Drug Concentration Standard Dose Patient Dose Volume

Diphenhydramine: 50 mg/mL 1 mg/kg 40 mg 0.8mL
Epinephrine
(Intramuscular use only) 1 mg/mL 0.01 mg/kg 0.4 mg 0.4mL
Methylprednisolone: 125 mg/2mL 2 mg/kg 80 mg 1.28mL

Weight Verified by:

Date:

Note: For pediatric equipment sizes, refer to Broselow tape to identify correct drawer based on age and weight
Notes:
6 – Medication Tray Contents
 Standardized Broselow Cart
Medica�on Drawer
U�lity Drawer- Materials Management to Stock
Top Drawer- Pharmacy to Stock Quan�ty
NS 500mL x 2
Adenosine - 6mg/2ml vial 5 D5W 50mL x1
Amiodarone - 150mg/3ml amp 4 D10W 250mL x 1
Atropine - 1mg/10 ml syringe 3 35mL Luer-Lock Syringe x1
60mL Luer-Lock Syringe x1
Calcium Chloride - 1gm/10ml syringe 2
Dextrose 25% - 2.5gm/10ml syringe 1
Dextrose 50% - 25gm/50ml syringe 1
DOPamine 400mg/250mL infusion 1 bag (on top of med tray)
Epinephrine - 1mg/10ml syringe 6
Epinephrine - 1mg/ml 30ml vial**Label with bright
label "Note Concentra�on" 1
Etomidate - 2mg/ml 20ml vial 1
Flumazenil - 1m/10ml vial 1
Lidocaine 1% - 10mg/ml 30ml vial 1
Lidocaine 2% - 100mg/5ml syringe 4
Magnesium Sulfate 2g/50mL infusion 2
Naloxone - 0.4mg/1ml vial 4
Sodium Bicarbonate 4.2% - 5mEq/10ml syringe 2
Sodium Bicarbonate 8.4% - 50mEq/50ml syringe 2
Sodium Chloride 0.9% Flush - 10ml syringe 6
Sodium Chloride 0.9% PF - 10ml vial 1
Anaphylaxis Kit-Pharmacy to stock
Place in plas�c bag labeled "Anaphylaxis Kit" in
medica�on drawer
Dexamethasone 10mg/1mL vial 1
Diphenhydramine - 50mg/1ml vial 1
Methylprednisolone Sod Succ 125mg/2mL vial 1
Racemic Epinephrine 2.25% 0.5mL neb soln 1
NS 3 ml nebulizer for diluent 1
Materials Management to Stock
Sterile Rapid-fill Connector 2
Clave Mul�dose Vial Access Spike - Latex Free 5
1mL BD Luer-Lock Syringe 6
3mL Luer-Lock Syringe 4
5mL/6mL Luer-Lock Syringe 4
10mL/12mL Luer-Lock Syringe 4
Monoject Syringe Tip Caps 1 pack of 10
NDL MEDIC PLASTIC ANTI STICK 6
WIPE ALCOHOL PREP 2PLY MED 10
Fluid Dispensing Connector #FDC1000 5
Stopcock 3w 3
18G x1" needles 5
27Gx 1mL syringe/needle 1
Filter straw 1
18G Filter needle 1
Sharpie 1
Medica�on labels 1 pack of 6
7 – Endotracheal
Tube Guideline
 Endotracheal Tube (ETT) Guideline
ETT Size: ETT Insertion Length in Located in Broselow
Centimeters (cm): Cart Drawer:
2.5 Uncuffed 9-9.5 cm (3kg); 9.5-10 cm (4kg); Gray/Pink/Red
10-10.5 cm (5 kg)
3.0 Uncuffed 9-10 cm Purple

3.0 Cuffed 10-10.5 (Pink); 10.5-11 (Red) Gray/Pink/Red

3.5 Uncuffed 10-10.5 (Pink); 10.5-11 (Red) Gray/Pink/Red; Yellow

3.5 Cuffed 11-12 Purple

4.0 Uncuffed 11-12 Purple; White

4.0 Cuffed 12.5-13.5 Yellow

4.5 Uncuffed 12.5-13.5 Yellow; Blue

4.5 Cuffed 14-15 White

5.0 Uncuffed 14-15 White

5.0 Cuffed 15.5-16.5 Blue

5.5 Uncuffed 15.5-16.5 Blue

5.5 Cuffed 17-18 Orange

6.0 Cuffed 18.5-19.5 Orange; Green

6.5 Cuffed 19.5-20.5 Green

Insertion Depth: Average starting depth is tube size multiplied by 3

• Follows 2019 Broselow Tape

• Includes additional half size smaller uncuffed ETT in gray/pink/red, purple, yellow, white,
& blue drawers
• Includes a half size larger cuffed ETT in orange and green drawers

1/17/22
8 – Blood Draw Reference
Pediatric Lab Reference Sheets
Content for Pediatric Lab Reference Sheets needs to be
updated frequently to support current practices. To
access a comprehensive list of details for Providence
labs, use the following to verify data:
https://www.testmenu.com/providence or call x56660
 Oregon Region Laboratory Services
Phone: (503) 215-6555
Toll-Free: (866) 674-7990
www.providence.org/lab

Tube Guide & Order of Draw

Tube Type Common Tests
Microbiology: Blood cultures

Blood Culture Bottles

Coagulation: PT/INR, APTT, Factor Assays, Fibrinogen, D-Dimer

Sodium Citrate (Lt Blue)

Special Tests: HLA Typing

ACD (Yellow)
Therapeutic Drug Monitoring / Toxicology: Gabapentin, Keppra, Ethylene Glycol

Special Chemistry: Testosterone

No Additive (Red)
General Chemistry: CMP/ BMP, Bilirubin, Lipids, Renal Panel, Iron, CRP, Vitamin D, B12, PSA,
Thyroid Studies, Lipase, Magnesium, Phosphorous, Potassium, Sodium

SST (Gold) Serology/Immunology: HCG, Hepatitis, HIV, ANA, Syphilis/RPR, Allergens

Trace Metals: Copper, Zinc

Serum Trace Element (Dark Blue)

General Chemistry: CMP/BMP, Lipids, Iron, CRP, B12, Thyroid Studies, Troponin

PST (Lt Green)

Cytogenetic Testing: See Test Catalog

(Dark Green)
Hematology: CBC, Hemoglobin/Hematocrit, Platelet Count, Reticulocyte Count, ESR(Sed Rate)
Hemoglobin A1C, BNP

Molecular Genomics: See Test Catalog

EDTA (Lavender/Pink)
Blood Bank: Type & Screen, Transfusion, OB Panel

Molecular Diagnostics: HCV/HBV/HIV PCR Quant (viral load)

PPT (Pearl)
Trace Metals: Arsenic, Lead, Cadmium, Mercury

EDTA Trace Element (Dark Blue)

Biochemistry: Glucose, Lactate, Methanol

Fluoride Oxalate (Gray)

 This is not a definitive list of currently available tests. See the laboratory Test Catalog for additional
testing information and for details about Providence Oregon Laboratory Services.
9 – Tray Photos
Pink-Red-Gray Drawer:
Purple Drawer:
Yellow Drawer:
White Drawer:
Blue Drawer:
Orange Drawer:
Green Drawer:
Ped IV Access Tray:
Ped Pneumo Tray:
Ped RT Intubation Access Tray:
Ped Defib Tray:
10 – Code Blue & Rapid
Response Forms
Minimum Epic documentation, using Code Blue
Narrator or Rapid Response Flowsheet, must
include:
• Start time
• Stop time
• End outcome
• NOTE: Above elements may be added to Epic
following the event, to avoid disrupting direct
patient care during the event.

If paper-based charting is necessary, the following

resources are available for use and need to be
scanned into patient’s electronic health record:
• Pediatric-Neonatal Code Blue Record
• Pediatric Rapid Response Form
• Neonatal Frequent Observation Flowsheet
o NOTE: Continue with minimum Epic
documentation when using paper-based
charting.
 *2740*
2740

PPMC - Providence Portland Medical Center

NEONATAL FREQUENT PSVMC - Providence St. Vincent Medical Center
PMH - Providence Milwaukie Hospital
OBSERVATION PHRMH - Providence Hood River Memorial Hospital
PNMC - Providence Newberg Medical Center
FLOWSHEET PSH - Providence Seaside Hospital
PMMC - Providence Medford Medical Center
PATIENT IMPRINT

RN APGARS 1 minute 5 minutes 10 minutes

Date / /
RT Heart rate
Birth Time NNP Resp. effort
Weight gms CRNA Muscle tone
Length cm MD/DO/CNM Reflex
Recorder Color
Head cm
Total
VITAL SIGNS OXYGENATION

IVF/Medication
Resp. Mode
Pain Score -

Volume (cc)
Mean BP

Glucose
NPASS

Initials
Temp.

SpO2
Time

FIO 2
HR

RR

BP

Comments

Time pH pCO 2 pO2 HCO 3 BE SpO 2 Source Time pH pCO 2 pO2 HCO 3 BE SpO 2 Source
130276 7/10

Initials Signature/Title Initials Signature/Title Initials Signature/Title

*2740*
2740

PATIENT IMPRINT
VITAL SIGNS OXYGENATION

IVF/Medication
Resp. Mode
Pain Score -

Volume (cc)
Mean BP

Glucose
NPASS

O2 Sat
Temp.

Initials
Time

FIO 2
HR

RR

BP

Comments

Time pH pCO 2 pO2 HCO 3 BE SpO 2 Source Time pH pCO 2 pO2 HCO 3 BE SpO 2 Source

Initials Signature/Title Initials Signature/Title Initials Signature/Title

 *4400*
4400
Newborn Services - Oregon Region

NEONATAL
RESUSCITATION
PATIENT IMPRINT
R-TEAM AND/OR CRNA, NNP, RT OR CARE PROVIDER COMPLETE THIS SECTION
Newborn Name: Newborn Provider Name: Sex:
F / M
Date of Birth: Time of Birth: Weeks of Gestation: EDC:
/ / / /
Birth Weight: Length: Head Circumference:

INDICATION APGARS
Check all that apply: 1 min 5 min 10 min 15 min

 Pertinent Hx: ___________________________________________________ Color

_______________________________________________________________
Heart rate
_______________________________________________________________
Reflex
 Prematurity  Vacuum/Forceps Delivery
 Abnormal FHR Tracing:  Code Light Response Muscle tone
Color ______________________  Multiple Birth Respiratory Effort
 C/S Emergency  Recent Narcotic
Other: ____________________________________________________________ TOTAL
RESUSCITATION
Resuscitation Start: ___________________________  R Team Arrival: ___________________________ Location: ________________________________
Resuscitation End: ___________________________  R Team Dismissal: ________________________ Prebrief:  Yes  No
DOCUMENTATION FOR RESUSCITATION BY R-TEAM
Time Cord  Routine Stabilization:  Additional Stablization:
Clamping/Milking: Warm, dry, stimulate, position
 Duration__________  Pulse oximeter placed on right wrist or hand  PPV: Room Air x ______ minutes
airway, suction if needed,  ECG monitor placed Maximum Oxygen used:
 Contraindication
 <32 weeks use brief assessment, warm  Mask CPAP ______ x ______ minutes ______ % x ______ minutes
polyethylene bag blankets, hat by RN  Orogastric Tube placed
VITAL SIGNS OXYGENATION
Dose / Volume
Medications /
Resp. Mode

Initials
Temp.

Route
SpO2
Time

FIO2
HR

RR

BP

Comments

RESUSCITATION TEAM & ARRIVAL TIMES, NOTE TEAM LEADER(S) WITH ASTERICK
130268 (9/10/21)

RN TIME CRNA/NNP TIME RECORDER SIGNATURE/TITLE

RN TIME
MD/DO/CNM TIME OTHER
RN/RT TIME

NEWBORN CHART
*4400*
4400
Newborn Services - Oregon Region

NEONATAL
RESUSCITATION
PATIENT IMPRINT

Suggested NRP
Documentation of Resuscitation Procedures and Interventions for
Guidelines
CRNA, NNP, RT or MD. Complete Documentation on first page of this form. Below, document
only interventions performed, based on infant’s clinical status and course of treatment.
Before Delivery  Antenatal counseling, team briefing and equipment check
0-60 sec  Routine Stabilization (warm, dry, stimulate, position airway, suction if needed) stimulate,
assess − term?/tone?/breathing?/crying?)
 Place TcSaO2 on right hand or wrist
> 60 sec &  ECG monitor placed
respiratory  PPV – Start in Room Air, blend in FiO2 to meet targeted preductal TcSaO2s
distress  Bag and Mask (maximum PEEP_____________ ; maximum PIP _____________ )
 Neopuff (maximum PEEP_____________ ; maximum PIP _____________ )
 Mask CPAP (PEEP_____________ )
 LMA (laryngeal mask airway)
 Ventilation corrective steps (MR SOPA = adjust mask, reposition airway, suction, open mouth,
Further ↑ pressure, alternative airway)
resuscitation  ETT placed
steps required  Number of attempts: _____________
  Vocal cords visualized
Notes:   ETT size: _____________ depth at the lip: _____________ cm
HR < 100 – take   Confirmation of ETCO2
ventilation   Breath sounds equal, chest movement adequate, & ETT secured
corrective steps   ETT discontinued at (time): _____________
HR < 60 with 30   CXR to document proper placement: ETT at _______________________
sec PPV & ↑ FiO2   Infant placed on ventilator (see orders)
– intubate &   Notes: _____________________________________________________________________________________
initiate chest  Chest compressions, coordinated 3:1 with PPV (preferably after intubation), ensure oxygen at 100%
compressions,  UVC placed emergently
coordinate 3:1   3.5 F  5.0 F  Single lumen  Double lumen
with respirations   Depth: _______________ cm  Positive blood return noted
  UVC discontinued prior to XR documentation
Targeted  PIV Placed:
Preductal   Size: __________ Location: _________________________________________ Attempts: ______________
TcSaO2s:  Intraosseous Line placed. Details: _______________________________________________________________
1 min – 60-65%  Medications Given:
3 min – 70-75%  IV Epinephrine: 0.1-0.3 mg/kg/dose = __________ mg x __________ doses
5 min – 80-85%  ETT Epinephrine: 0.3-1 mg/kg/dose = __________ mg x __________ doses
10 min – 85-95%  IV Normal Saline: 10 ml/kg/dose = __________ ml x __________ doses
 Other: ______________________________________________________________________________________
Post Delivery  Team debriefing
 Infant’s response to resuscitation:
Post-
  Currently active, pink, & alert, with stable respirations.
Resuscitation
  Other: ______________________________________________________________________________________
Response &
 Transitioned to Routine Newborn Care
Disposition
 Transitioned to Routine Post-Resuscitation Care
 Transferred to Newborn Nursery or NICU
 Care of baby transferred to Pediatrician/Transport Team

Additional Notes: ____________________________________________________________________________________________

____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________

Signature: _________________________________________________________________ Date: ______________________

 Pediatric Rapid Response Record Patient Identification
Date: Room/Location: Time Called: Team Arrived: Event Ended:
Code Status:  DNR  DNI  Full Code Individual Initiating Call (print) :
Primary Reason for call: Primary RN (print):
Children’s Hospital
Early Warning System
(CHEWS) Scoring 0 1 2 3 Score

Playing/sleeping - Sleeping, somnolent - Irritable, difficult to - Lethargic/ confused, floppy OR

Behavior/Neuro appropriately OR when not disturbed console OR - Reduced response to pain OR
-Alert, at patient’s - Increase in patient’s - Prolonged or frequent seizures
baseline baseline seizure activity OR
- Pupils asymmetrical or sluggish
- Skin tone - Pale OR -Grey OR - Grey and mottled OR
Cardiovascular appropriate for - Capillary refill 3-4 - Capillary refill 4-5 - Capillary refill › 5 seconds OR
patient seconds OR seconds OR - Severe tachycardia OR
-Capillary refill ≤ - Moderate tachycardia - Moderate tachycardia - New onset bradycardia OR
2 seconds OR - New onset/increase in ectopy,
- Intermittent ectopy or irregular HR or heart block
irregular HR (not new)
- Within normal - Mild tachypnea/increased - Moderate - Severe tachypnea OR
Respiratory parameters WOB (flaring, retracting) tachypnea/increased WOB - RR ‹ normal for age OR
- No retractions OR (i.e. flaring, retracting, - Severe increased WOB (i.e. head
- Up to 40% supplemental
grunting, use of accessory bobbing, paradoxical breathing)
oxygen OR
- Up to 1L NC › patient’s muscles) OR OR
baseline OR - 40-60% oxygen via mask - › 60% oxygen via mask OR
- Intermittent apnea self- OR - › 2 L NC more than patient’s
resolving - 1-2 NC › patient’s baseline need OR
baseline need OR - Nebs Q 30 minutes – 1 hour OR
- Nebs Q 1-2 hours OR - Severe desaturations ‹ patient’s
- Moderate desaturations ‹ baseline OR
patient’s baseline OR - Apnea requiring interventions
- Apnea requiring other than repositioning or
repositioning or stimulation stimulation
Staff Concern -Concerned
Family Concern -Concerned or absent

TOTAL SCORE:

Score 2 extra for ¼ hourly nebulizers or persistent vomiting following surgery

Green = Score 0-2 Yellow = Score 3-4 Red = Score 5-11

-Continue routine assessments - Notify charge nurse or LIP -Activate Rapid Response Team or
-CHEWS Q4 hours - Discuss treatment plan with appropriate personnel per unit standard for
team bedside evaluation
- Consider higher level of care - Notify attending physician
- Increase frequency of vital - Discuss treatment plan with team
signs/CHEWS/assessments to Q2 - Increase frequency of vital
hours signs/CHEWS/assessments to Q30 minutes
- Document interventions and - Document interventions and notifications
notifications
Situation: (The problem is..)

Background: (reason in hospital/clinic; treatment so far, lab values)

Assessment: (what is worrisome)

Temp: B/P: HR: RR: Cap Refill: sec. SpO2 Time:
Capillary Blood Glucose= (time)

Departure VS: Temp: B/P: HR: RR: Cap Refill: SpO2 Time:
Recommendations/ Interventions
Airway/Breathing Circulation Labs Medications: Other: (specify)
 Oral Airway  IV /bolus NS  ABG Weight= _____________ Broselow color
 Suctioned give: ______ml  VBG _________
 Nebulizer Tx  IV Fluids  Electrolytes
 Bag/Mask ________  CBC / diff
 O2 cannula/ NRB mask infuse at ______ml/hr  _________
 Intubated  12 lead EKG  __________
 NG tube  __________  _________
 __________
 __________
RRT RN: (print) ________ Signature ________ _  NA
RRT RT: (print) ______ __ Signature _________  NA
Physician: (print) ______ Signature _________  NA
Other Staff: (print) ______ Signature _________  RN RT  NNP

Outcome:  Stayed in Room  Transferred to: _____________________________________ Family notified / Time: ______________

Follow Up: Time:___________ Date___________ By:

Notes continued:

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
 Comments:

Blood Sugar
Breath Sounds
Ventilation
Heart Rate

(√)Assisted

Blood Sugar
,

(√)Spont.

Saturation
Cap
Rhythm

Pressure

FiO2 %
Time

PEWS
L
Blood

Rate
Refill
Color

RRTRN: (print) ___________________________________ Signature _____________________________________  NA

RRT RT: (print) ___________________________________ Signature_____________________________________  NA
Physician (print) __________________________________ Signature _____________________________________  NA
Other Staff: (print) _________________________________ Signature _________________________ RN CRT NNP
 Patient Label
Pediatric/ Neonatal Code Blue
Today’s date _____________Time Code Started: _____________ Resuscitation Event Ended @__________
Current weight (Kg)________ Broselow Tape Color _________________
Event Outcome:______________________________________________
Was a hospital-wide resuscitation response activated? ‰ Yes ‰ No
Witnessed ‰ Yes ‰ No Disposition of pt:____________________________________________
Area of resuscitation __________________________________
Patient conscious at onset ‰ Yes ‰ No
Airway/Breathing
Respiratory status at onset ‰ Spontaneous ‰ Apnea ‰ Agonal ‰ Assisted Type(s) of Ventilation ‰ Mouth/Mask ‰ ETT ‰ BVM ‰ Trach
Intubation: Time___________ Size___________ Cuffed? Y/N Placed By:_________________________________Verified by X-ray? Y/N
Circulation
Chest Compressions start time:______________ AED applied: Y/N First Documented Pulsesless Rhythm_________________

Vital Signs Interventions Medications

Comments:
Time e.g. Thoracentesis, IV Start/Central Line Placement/IO,

FiO2
Dose

Chest Tube, Response to Interventions, Labs

Blood

Cap Refill
Rhythm
Atropine

Pressure
End Tidal

Saturations

Heart Rate
Dose/Route

Dose/Route
Epinephrine
Dose/Volume

Respirations
Blood Sugar

Defib Joules

Temperature
Normal Saline

Sodium Bicarb

Revised 2/2022 ALP

 Pediatric / Neonatal Code Blue Record (page 2)

Vital Signs Interventions Medications

Comments:
Time

Dose
e.g. Thoracentesis, IV Start/Central Line Placement/IO,

Rhythm

Blood
Chest Tube, Response to Interventions, Labs

Atropine

End Tidal

Pressure

Cap Refill
Dose/Volume

Dose/Route
Normal Saline

Defib Joules
Blood Sugar
Dose/Route

Temperature
Heart Rate
Respirations
Epinephrine

FiO2 Saturations
Sodium Bicarb

Recorder Signature:_______________________________________
Physician Team Code Leader _______________________________
Nursing Team Leader _____________________________________
Primary Nurse __________________________________________
Respiratory therapy ______________________________________
Other participants: _____________________From: _____________
Other participants: _____________________From: _____________
Other participants: _____________________From: _____________
Other participants: _____________________From: _____________
Other participants: _____________________From: _____________
Other participants: _____________________From: _____________
Other participants: _____________________From: ______________

Revised 2/2022 ALP

 RRT & Telephone Encounter Page 1 of 2

Documenting Rapid Response in Telephone Encounters

You’ll need to create a Telephone Encounter to document your Rapid Response activations for non-
inpatients, such as patients receiving lab draws or Diagnostic Imaging exams.

1. In the right upper corner, under the Log Out button, click the magnifying glass to open the
search field. Search for “tele” and click on Telephone Call.

2. Search for the patient using three identifiers.

3. Double click on the correct patient name.

4. Your name and department will auto-fill. Click New and the chart will open.

5. Use the drop-down arrow in the right upper corner of the chart to search for and click on the
Flowsheets activity.

S. Sparks, OSV CIS Last Updated: 2/19/2021

RRT & Telephone Encounter Page 2 of 2

6. Document in the Rapid Response flowsheet per usual, then return to the Call activity.
7. Complete these steps to Sign/close the encounter.
a. Document a Reason for Call
b. Add a brief note in Documentation
c. Use drop down to choose Sign on saving note at the bottom of the note
d. Click Accept
e. Click Sign Encounter – either in the table of contents or in the bottom right corner of
the chart.

S. Sparks, OSV CIS Last Updated: 2/19/2021

11 – Debriefing Forms
 Pediatric Code Blue Debrief Sheets
Examples of generic Pediatric Code Blue Debrief Sheets
are included in this section. Ministry specific debrief
documents may be used in lieu of these resources if
there is a preference to use an alternative resource.
 NOT A PART OF THE MEDICAL RECORD

Code Blue Debriefing Form

Location ____________ Date/Time _______________

Do we know why this patient coded? ________________________ [ ]Yes [ ]No

Are there outstanding orders or medications that require clarification? [ ]Yes [ ]No [ ]N/A

Has the team discussed and reprioritized actions following resuscitation? [ ]Yes [ ]No [ ]N/A

After ROSC: Is additional team support needed to manage this patient’s care? [ ]yes [ ]No [ ]N/A

Any identified concerns with ACLS response and/or equipment: (If yes describe below)

What went well:

Additional Notes:

Does further debriefing need to occur? [ ]Yes [ ]No (If yes, notify unit manager)
Caregivers:

Deliver or email completed form to ED Manager or Code Blue/RRT Committee Chairperson

 Not a part of the Medical Chart Patient Sticker
CODE BLUE QUALITY REVIEW- DEBRIEFING FORM

❖ This form to be completed by Code RN and Direct Care Nurse

Date: Unit: ❑ Changed to RRT

Reason Code Blue Called: ❑ Acute Respiratory Arrest ❑ Acute Cardiac Arrest ❑ Other

Support of Cardiopulmonary Resuscitation Process:

1. Was the patient evaluated by RRT during previous 24 hrs.? ❑ Yes ❑ No
2. Was the patient evaluated by the DCN during previous 1 hr.? ❑ Yes ❑ No
3. Was the patient transferred from Critical Care in previous 24 hrs.? ❑ Yes ❑ No
4. Were ECG leads on & ECG rhythm visible when code team arrived? ❑ Yes ❑ No
5. Was the back board in place? ❑ Yes ❑ No
6. Was BLS in progress when code team arrived? ❑ Yes ❑ No
7. Was same watch/clock used throughout to record times? ❑ Yes ❑ No
8. Was equipment available? If No, provide comment below ❑ Yes ❑ No
9. Did equipment work? If No, provide comment below ❑ Yes ❑ No
10. Were supplies available? If No, provide comment below ❑ Yes ❑ No
11. Was a physician designated as code leader? ❑ Yes ❑ No
12. Was all unnecessary staff asked to leave? ❑ Yes ❑ No
13. Was family present during the code event? ❑ Yes ❑ No
14. Was family support provided? If No, provide comment below ❑ Yes ❑ No
15. Were there difficulties with the family present? If Yes, provide comment below ❑ Yes ❑ No
16. For ED only: Was the chaplain paged? ❑ Yes ❑ No
17. Did code team have difficulty finding the code site? ❑ Yes ❑ No
18. Was patient DNR prior to code call? ❑ Yes ❑ No
19. Event documented in electronic Code Narrator or on paper?

COMMENTS:

Airway: ❑ Multiple Attempts ❑ Misplacement / Displacement ❑ EtCO2 Monitored

Venous Access: ❑ Infiltration / Disconnection ❑ Arterial Cannulation ❑ Other
Chest Compressions: ❑ If intubated, effectiveness measured with EtCO2 waveform and values
❑ EtCO2 values shared out loud with Code Team
Person(s) Completing Form (please print):
Code RN: Direct Care RN

PLEASE SCAN COMPLETED DEBREIFING FORM to

ED Nurse Manager
12 – Code Cart Daily
& Weekly Checklists
CODE CART CHECKLIST Month: Year: Code Cart Name/#:

1 2
A. Supply and Medication lock numbers: Security lock present and intact. Full lock # recorded. For Med lock #, write “N/A” in this field if code cart has only a single supply lock and no med lock.
3
B. Ambu bag: Bag valve mask for population served by cart (INFANT, PEDIATRIC, ADULT). Not expired. NOTE: Check date on bag if stored on top of cart. Check cart expi. sticker if bag locked in cart.
4
C. Defibrillator equipment: Ensure that the unit is clean (with no fluid spills) and free of visible damage; Inspect all cables, cords, and connectors for good condition (no cuts, fraying or bent pins).
5
D. Defibrillator supplies: Verify the presence, proper condition, and quantity of all disposable supplies (such as ECG monitoring electrodes, strip chart paper, supplies to improve pad adherence); Ensure that two sets of
Zoll therapy pads, and/or defibrillator pads appropriate to patient population/unit are available in sealed packages. Check the expiration date on all pad packages.
6
E. Defibrillator batteries/external power supply: Check that a fully charged battery pack is installed in the unit and that the unit is connected to AC power outlet.
7
F. Defibrillator code readiness status (PERFORMED DAILY): Checkmark displayed on Code Readiness Indicator (Confirm daily code readiness test passed).
8
G. Defibrillator manual/pacer/recorder tests (PERFORMED WEEKLY): Note: This must be completed in addition to daily automatic defib code readiness test.
9
H. Defibrillator cleaning (PERFORMED WEEKLY): Clean code cart, cables, and defibrillator weekly with approved cleaning wipes. Discard and replace all opened items.

DAILY CHECKS
Document cart and lock number(s) daily. If cart only has one (1) lock, write "N/A" in the medication lock row. Enter your initials in
each box when check complete. If depaartm
ment is closed, write "CLOSED" on that day. WEEKLY CHECKS
1 2 3 4 5 6 7 8 8 8 9
Supply Lock Medication Lock Earliest Supply/ Earliest Print Your Name
Day

Defib: Batteries/ External power

Number Number: Equipment Medication

Age appropriate bag(s) present

Suction: Equipment present,

Defib: Code readiness status

O2 Tank: Present, functions,
Expiration Date Expiration Date If Failed,

Defib: Equipment present

Defib: Supplies present

Check

Defib: Recorder check

functions, plugged in
This Box

Defib: Manual test

Confirm presence

Defib: Pacer test

to Confirm
Enter full lock # or "N/A" New Defib

Defib: Clean
Backboard:

Ambu Bag:

> 1,000 PSI

if no med lock. Received
Do not enter dashes, from

supply
check marks, or empty Biomed
quotation marks.
Enter full lock # Enter Dates only Enter Dates only Enter caregiver initials only - Do NOT enter check marks. Did you do a weekly check this week?

1
If Defib passes its weekly tests,
2 write your initials or check the
boxes below. If it fails, write "F"
in the boxes:
3

5 Date Weekly Check Was Completed:

8
Write your initials in box below to
9 indicate "Passed". If failed, write "F".

10

11

12 Date Weekly Check Was Completed:

13

14

15

16 Write your initials in box below to

indicate "Passed". If failed, write "F".
17

18

19

20 Date Weekly Check Was Completed:

21

22

23

24
Write your initials in box below to
indicate "Passed". If failed, write "F".
25

26

27

28 Date Weekly Check Was Completed:

29

30

31
1. Medication lock number: Security lock present and intact. Lock number recorded. Document “N/A” in this row if code cart has single supply lock.
2. Supply lock number: Security lock present and intact. Lock number recorded.
3. Ambu bag: Bag valve mask for population served by cart (INFANT, PEDIATRIC, ADULT). Not expired. NOTE: Check date on bag if stored on top of cart. Check cart expiration sticker if bag locked in cart.
4. Defibrillator equipment: Ensure that the unit is clean (with no fluid spills) and free of visible damage; Inspect all cables, cords, and connectors for good condition (no cuts, fraying or bent pins).
5. Defibrillator supplies: Verify the presence, proper condition and quantity of all disposable supplies (such as ECG monitoring electrodes, strip chart paper, supplies to improve pad adherence); Ensure
that two sets of Zoll therapy pads, and/or defibrillator pads appropriate to patient population/unit, are available in sealed packages. Check the expiration date on all pad packages.
6. Defibrillator batteries / external power supply: Check that a fully charged battery pack is installed in the unit and verify that the unit is connected to an AC power outlet.
7. Defibrillator code readiness status (DAILY): Checkmark displayed on Code Readiness Indicator (Confirmation that daily automatic code readiness test passed).
8. Defibrillator manual test (WEEKLY): Pacer test (WEEKLY); Recorder check (WEEKLY): Complete weekly. Note: Must be completed in addition to daily automatic defibrillator code readiness test.
9. Defibrillator cleaning (WEEKLY): Clean code cart, cables, and defibrillator weekly with approved cleaning wipes (Bleach, Super-Sani Cloth, Sani-Cloth plus, Oxivir). Discard and replace all opened items.
ZOLL DEFIBRILLATOR READINESS CHECKS (Refer to Zoll Operator’s Guide for additional details)
DAILY Defibrillator Readiness Check WEEKLY Defibrillator Readiness Check Cont.
 Confirm Green Check Mark (upper right hand corner of device) = Clinically Ready  Recorder check
o Red “X” = Device did not pass automatic self-testing 1. Remain in DEFIB mode.
o If Red “X” remains on after completing daily/weekly testing, consult BioMed 2. Check printer for adequate supply of paper
and replace defibrillator immediately 3. Press and hold SIZE button for at least two seconds - 1 millivolt displays
4. Press RECORDER button to start printing
 Confirm Zoll OneStep CPR pads* are connected to device
5. Inspect printout for legibility of waveform and text
*In departments only using procedural pads, see below for additional details
6. Check print speed by verifying box size is approximately 2.5 mm wide and 10 mm
 Device is plugged-in and battery indicator shows battery is charged – Green circle high (2.5 small boxes wide and 2 big boxes high)
 Ensure that device is clean & free of visible damage 7. Press RECORDER button to stop printing once waveform is seen
 Pacer test*
WEEKLY Defibrillator Readiness Check 1. Turn MODE SELECTOR to “Pacer”
 Battery Check 2. Turn PACER RATE to 150 ppm. Press RECORDER button to start printing
o Press button on battery, check lights: o Review printed strip to verify the pacing stimulus markers -
 Green light – Each bar indicates 25% of charge o Marker should occur every 10 small divisions (squares) or every 2 large
 Yellow light – Can still use but needs to go to BioMed to get divisions (squares)
reconditioned 3. Press RECORDER button to stop printing
 Red light – Battery is no longer functional (replace via BioMed 4. Press and hold the 4:1 button
immediately) o Press RECORDER button to start printing
o Stimulus marker should occur every 40 small divisions or every 8 large
divisions
 Defibrillator (30-20-30 Joule) test*
o Press RECORDER button to stop printing
1. Confirm Zoll OneStep CPR pads* are connected to device
5. Disconnect Zoll OneStep CPR pads*
2. Turn MODE SELECTOR to “Defib” 6. Turn PACER OUTPUT up to 16 mA
3. Press RECORDER button to stop printing o Should receive messages 1) ”Check pads” and 2) “Poor pad contact”
4. Press ENERGY SELECT down to 30 joules o “Pace alarm” sounds and “Clear pace alarm” soft key flashes
5. Press CHARGE – DEFIB 30J READY appears – charge ready 7. Reconnect Zoll OneStep CPR pads* and press CLEAR PACE ALARM soft key
6. Disarm the shock – Press down arrow on ENERGY SELECT (confirm no longer o Messages should now disappear and alarm tone stop
illuminated) *NICU and designated procedural areas ONLY using procedural pads with Zoll defib
7. Press ENERGY SELECT back up to 30 joules 1) Ensure therapy cable remains plugged into side port at all times, expect when in use.
8. Press CHARGE 2) COMPLETE DAILY MANUAL DISCHARGE CHECKS. The machine will not complete
9. Press SHOCK button once illuminated internal auto check unless Zoll pad is plugged in.
o 30J Test OK should appear including print out 3) Weekly pacer test, steps 5 &7: In lieu of Zoll OneStep CPR pads, disconnect and
reconnect therapy cable from side port.

CODE CART LOG Revised 8-25-20

 Zoll Weekly QC Checklists

30 Joule Debrallator Test Pacing Test Recorder Test

 Make sure OneStep pads are  Turn Mode Selector to PACER MODE.  Turn the Mode Selector
connected to the machine.  Turn PACER RATE to 150ppm. Verify increased to MONITOR MODE.

 Turn Mode Selector to DEFIB number of pacer sƟmuli on the monitor. Press  Check the printer for
MODE and release the RECORDER KEY. A strip will adequate supply of pa-
begin to print. per, then press the RE-
 Press energy select key down
 Press and hold the 4:1 key for a few seconds CORDER key.
to 30 joules. Verify DEFIB
PAD SHORT verbiage on the  Press and hold the SIZE
 Verify that only every 4th downward pacer
screen. spike displays. key for at least 2 sec-
onds. A calibraƟon
 Press charge – DEFIB 30J  Turn PACER OUTPUT to 0mA. There should be pulse of 1mV will ap-
READY appears – charge no CHECK PADS or POOR PAD CONTACT mes- pear on the display.
ready. sages. Once displayed on the
 Once fully charged press the  Disconnect from OneStep Pads (or Test Port) printed strip, press the
shock key. and set PACER OUTPUT control to 16 mA. The RECORDER key to stop
 The unit displays the mes- Pacer Alarm will sound and indicate CLEAR prinƟng.
sage 30J TEST OK, prints a PACE ALARM in boƩom leŌ corner of the  Inspect recorder wave-
strip chart indicaƟng 30J TEST screen. form for uniformity,
OK and the energy delivered.  Reconnect OneStep pads and press Clear Pace darkness, annotated
 If the message 30J TEST Alarm key. characters and com-
FAILED appears, call Biomed.  The messages should now disappear and alarm pleteness of words.

 Turn the Mode Selector to tone stop.  Turn the Mode Selector
the “OFF” posiƟon.  Turn the Mode Selector to the “OFF” posiƟon. to the “OFF” posiƟon.
 Zoll Daily QC Check for Units with Multiple Defibrillator Pad Types
BaƩery Check Green light: each bar indicates 25% of charge
 Remove the baƩery. Yellow light: the device may sƟll be used but Biomed needs to be contacted
 Reinstall the baƩer and press the circular buƩon to to recondiƟon the baƩery.
check the baƩery charge. Red light – BaƩery is no longer funcƟonal. Contact Biomed for a new baƩery.

Indicates that the 2am

device self-test was Indicates that the 2am device
Daily QC VericaƟon successfully performed. self-test was not performed.
 Check that the Device is plugged-in and Caregiver must manually
the baƩery indicator shows baƩery is perform the 30 Joule Debril-
charged – green circle.
 Look for Green check upper right hand
corner of machine. The green check
mark indicates that the machine has
performed the 2 am self test.
 Red “X” means unit has not per-
formed self-tesƟng.
 If a Red “X” is present, manually per-
form the 30 Joule Debrillator Test.
(See reverse side for the steps to per-
form the 30 Joule Debrillator Test)
Debrillator Pad VericaƟon
 If Red “X” remains on aŌer compleƟng
the 30 Joule Debrillator Test, consult  Verify that the code cart contains the appropriate debrillator pad tray for your
your BioMed dept. and replace the paƟent populaƟon and any addiƟonal specialty pads required by your unit.
debrillator with a funcƟonal one  If the addiƟonal specialty pads are not found on the code cart, restock them from
immediately. your unit’s par supply.
CODE CART LOG Department: Month: Year:
Initial each box when check complete. If department is CLOSED, document “CLOSED” on that date.
DAILY CHECK
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Code cart
number

Medication
lock number 1
Document
“N/A” in row if
cart only has a
single lock

Supply lock

medication lock row.

number 2

Document cart and lock number(s) daily.

If cart only has one (1) lock, write N/A in the
Earliest supply/equipment
expiration date

Backboard: Confirm
present on code cart
Ambu Bag: Age appropriate
bag(s) on code cart 3
O2 tank: Present,
functioning, > 1,000 PSI
Suction: Equip present,
functions, plugged in
Defib: Equipment 4

Defib: Supplies 5

Defib: Batteries / External

power supply 6
Defib: Code readiness
status 7
WEEKLY CHECK - Must occur weekly on or before the 7th day since last check
Defib: Manual test 8

Defib: Pacer test 8

Defib: Recorder check 8
Defib: Cleaning 9
Initials Print name Initials Print name Initials Print name Initials Print name

CODE CART LOG Revised 8-25-20

1. Medication lock number: Security lock present and intact. Lock number recorded. Document “N/A” in this row if code cart has single supply lock.
2. Supply lock number: Security lock present and intact. Lock number recorded.
3. Ambu bag: Bag valve mask for population served by cart (INFANT, PEDIATRIC, ADULT). Not expired. NOTE: Check date on bag if stored on top of cart. Check cart expiration sticker if bag locked in cart.
4. Defibrillator equipment: Ensure that the unit is clean (with no fluid spills) and free of visible damage; Inspect all cables, cords, and connectors for good condition (no cuts, fraying or bent pins).
5. Defibrillator supplies: Verify the presence, proper condition and quantity of all disposable supplies (such as ECG monitoring electrodes, strip chart paper, supplies to improve pad adherence); Ensure
that two sets of Zoll therapy pads, and/or defibrillator pads appropriate to patient population/unit, are available in sealed packages. Check the expiration date on all pad packages.
6. Defibrillator batteries / external power supply: Check that a fully charged battery pack is installed in the unit and verify that the unit is connected to an AC power outlet.
7. Defibrillator code readiness status (DAILY): Checkmark displayed on Code Readiness Indicator (Confirmation that daily automatic code readiness test passed).
8. Defibrillator manual test (WEEKLY): Pacer test (WEEKLY); Recorder check (WEEKLY): Complete weekly. Note: Must be completed in addition to daily automatic defibrillator code readiness test.
9. Defibrillator cleaning (WEEKLY): Clean code cart, cables, and defibrillator weekly with approved cleaning wipes (Bleach, Super-Sani Cloth, Sani-Cloth plus, Oxivir). Discard and replace all opened items.
ZOLL DEFIBRILLATOR READINESS CHECKS (Refer to Zoll Operator’s Guide for additional details)
DAILY Defibrillator Readiness Check WEEKLY Defibrillator Readiness Check Cont.
 Confirm Green Check Mark (upper right hand corner of device) = Clinically Ready  Recorder check
o Red “X” = Device did not pass automatic self-testing 1. Remain in DEFIB mode.
o If Red “X” remains on after completing daily/weekly testing, consult BioMed 2. Check printer for adequate supply of paper
and replace defibrillator immediately 3. Press and hold SIZE button for at least two seconds - 1 millivolt displays
4. Press RECORDER button to start printing
 Confirm Zoll OneStep CPR pads* are connected to device
5. Inspect printout for legibility of waveform and text
*In departments only using procedural pads, see below for additional details
6. Check print speed by verifying box size is approximately 2.5 mm wide and 10 mm
 Device is plugged-in and battery indicator shows battery is charged – Green circle high (2.5 small boxes wide and 2 big boxes high)
 Ensure that device is clean & free of visible damage 7. Press RECORDER button to stop printing once waveform is seen
 Pacer test*
WEEKLY Defibrillator Readiness Check 1. Turn MODE SELECTOR to “Pacer”
 Battery Check 2. Turn PACER RATE to 150 ppm. Press RECORDER button to start printing
o Press button on battery, check lights: o Review printed strip to verify the pacing stimulus markers -
 Green light – Each bar indicates 25% of charge o Marker should occur every 10 small divisions (squares) or every 2 large
 Yellow light – Can still use but needs to go to BioMed to get divisions (squares)
reconditioned 3. Press RECORDER button to stop printing
 Red light – Battery is no longer functional (replace via BioMed 4. Press and hold the 4:1 button
immediately) o Press RECORDER button to start printing
o Stimulus marker should occur every 40 small divisions or every 8 large
divisions
 Defibrillator (30-20-30 Joule) test*
o Press RECORDER button to stop printing
1. Confirm Zoll OneStep CPR pads* are connected to device
5. Disconnect Zoll OneStep CPR pads*
2. Turn MODE SELECTOR to “Defib” 6. Turn PACER OUTPUT up to 16 mA
3. Press RECORDER button to stop printing o Should receive messages 1) ”Check pads” and 2) “Poor pad contact”
4. Press ENERGY SELECT down to 30 joules o “Pace alarm” sounds and “Clear pace alarm” soft key flashes
5. Press CHARGE – DEFIB 30J READY appears – charge ready 7. Reconnect Zoll OneStep CPR pads* and press CLEAR PACE ALARM soft key
6. Disarm the shock – Press down arrow on ENERGY SELECT (confirm no longer o Messages should now disappear and alarm tone stop
illuminated) *NICU and designated procedural areas ONLY using procedural pads with Zoll defib
7. Press ENERGY SELECT back up to 30 joules 1) Ensure therapy cable remains plugged into side port at all times, expect when in use.
8. Press CHARGE 2) COMPLETE DAILY MANUAL DISCHARGE CHECKS. The machine will not complete
9. Press SHOCK button once illuminated internal auto check unless Zoll pad is plugged in.
o 30J Test OK should appear including print out 3) Weekly pacer test, steps 5 &7: In lieu of Zoll OneStep CPR pads, disconnect and
reconnect therapy cable from side port.

CODE CART LOG Revised 8-25-20

13 – Stocking Checklists
 Broselow Stocking Ckecklist
Item Description Lawson# Manufacture# Par EXP Date
Top of Cart
TRAY CODE CART PED DEFIB 665360 ACC010334B 1
TAPE BROSELOW PED ER 159771 AE4800 1
Side of Cart
BAG RESUS SPUR ADLT PEEP 647929 520611001 1
BAG RESUS SPUR PED MNMTR PEEP 648030 530619031 1
BAG RESUS SPUR INF NEO MTR PEP 648090 544216031 1
Drawer 1 - Medication

Medication Tray Medication trays supplied by RX N/A

Drawers 2-8
DRAWR CODE CART PED PNK RED 665359 ACC010333B 1
DRAWR CODE CART PED PUR 10-11 665358 ACC010332B 1
DRAWR CODE CART PED YEL 12-14 665357 ACC010331A 1
DRAWR CODE CART PED WHT 15-18 665356 ACC010330A 1
DRAWR CODE CART PED BLU 19-23 665355 ACC010329A 1
DRAWR CODE CART PED ORNG 24-29 665354 ACC010328A 1
DRAWR CODE CART PED GRN 30-36 665353 ACC010327B 1
Bottom Drawer
TRAY CODE CART PED PNEUMO 665363 ACC010337B 1
TRAY CODE CART PED IV ACCS 665362 ACC010336B 1
TRAY CODE CART PED RT INTUB 665361 ACC010335B 1

XPZB3 - Assembled by PPMC

BROSELOW RX SUPPLIES Supply Chain 1
XPZB2 - Assembled by local Supply
Broselow IV Fluid supply Kit Chain 1

Built By: Checked By: Lock#:

Closest Outdate:

Updated: April 2022