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Pediatric Advanced Life Support weight-based drug dosing and emergency protocol reference
Weight estimate: Age (years) × 2 + 8 = kg
Infant (0-12 mo): HR 100-160, RR 30-60, BP 70-100 sys
Toddler (1-3 yr): HR 90-150, RR 24-40, BP 80-110 sys
Preschool (3-6 yr): HR 80-140, RR 22-34, BP 80-110 sys
School age (6-12 yr): HR 70-120, RR 18-30, BP 90-120 sys
Adolescent (12+ yr): HR 60-100, RR 12-20, BP 100-130 sys
PALS protocols are for healthcare providers trained in pediatric emergency care. This calculator is for reference only and does not replace clinical judgment or current AHA guidelines.
| Drug | Dose for 20 kg | Standard Dose | Route |
|---|---|---|---|
| Epinephrine (Arrest) | 0.20 mg IV/IO | 0.01 mg/kg (max 1 mg) | IV/IO q3-5min |
| Epinephrine (Anaphylaxis) | 0.20 mg IM | 0.01 mg/kg (max 0.5 mg) | IM (1:1,000) |
| Amiodarone | 100.0 mg IV/IO | 5 mg/kg (max 300 mg) | IV/IO bolus |
| Lidocaine | 20.0 mg IV/IO | 1 mg/kg (max 100 mg) | IV/IO bolus |
| Atropine | 0.40 mg IV/IO | 0.02 mg/kg (min 0.1, max 0.5 mg) | IV/IO |
| Adenosine (1st) | 2.0 mg IV | 0.1 mg/kg (max 6 mg) | Rapid IV push |
| Adenosine (2nd) | 4.0 mg IV | 0.2 mg/kg (max 12 mg) | Rapid IV push |
| Magnesium Sulfate | 500-1000 mg | 25-50 mg/kg (max 2 g) | IV/IO over 10-20 min |
| Calcium Chloride | 400 mg IV | 20 mg/kg (max 2 g) | IV/IO slow push |
| Dextrose (D25W) | 40.0 mL | 2 mL/kg D25W | IV/IO |
| Naloxone | 2.00 mg | 0.1 mg/kg (max 2 mg) | IV/IO/IM/IN |
| Sodium Bicarb | 20.0 mEq | 1 mEq/kg | IV/IO slow push |
400 mL NS or LR bolus (20 mL/kg)
Push rapidly over 5-10 minutes
Reassess after each bolus
May repeat 2-3 times if needed
• Hypovolemic: Fluids, blood
• Distributive (septic): Fluids, antibiotics, pressors
• Cardiogenic: Inotropes, smaller boluses
• Obstructive: Treat cause (pneumo, tamponade)
Initial: 40 J (2 J/kg)
Subsequent: 80 J (4 J/kg)
Max: 10 J/kg or adult dose
Initial: 10-20 J (0.5-1 J/kg)
Subsequent: 40 J (2 J/kg)
Consider sedation if stable
Appearance: Tone, interactiveness, consolability, look/gaze, speech/cry
Work of Breathing: Abnormal sounds, positioning, retractions, nasal flaring
Circulation to Skin: Pallor, mottling, cyanosis
H's: Hypovolemia, Hypoxia, H+ (acidosis), Hypo/Hyperkalemia, Hypoglycemia, Hypothermia
T's: Tension pneumothorax, Tamponade, Toxins, Thrombosis
IO is the preferred alternative to IV in pediatric emergencies. Any medication or fluid that can be given IV can be given IO. Common sites: proximal tibia, distal tibia, distal femur, proximal humerus. Flush after medications to ensure delivery to central circulation.
Only if no IV/IO access: Lidocaine, Epinephrine, Atropine, Naloxone (LEAN). Give 2-3 times the IV dose. Dilute in 3-5 mL NS. Follow with 5 ventilations. However, IV/IO route is strongly preferred as ET absorption is unpredictable.
For children 1-10 years: Weight (kg) = (Age × 2) + 8. For example, a 5-year-old is approximately (5 × 2) + 8 = 18 kg. Alternatively, use length-based systems like the Broselow tape which provides color-coded zones for equipment and drug dosing based on the child's length.
For single rescuer: 30:2 (same as adults). For two healthcare providers: 15:2 (15 compressions, then 2 breaths). Once an advanced airway is placed, give continuous compressions at 100-120/min and 1 breath every 6 seconds (10 breaths/min) - no longer need to synchronize.
Use 1:10,000 (0.1 mg/mL) for cardiac arrest given IV/IO at 0.01 mg/kg. Use 1:1,000 (1 mg/mL) for anaphylaxis given IM at 0.01 mg/kg (max 0.5 mg). The concentration determines the volume - always double-check concentration before drawing up the dose to avoid 10-fold dosing errors.
Give 20 mL/kg boluses of isotonic crystalloid (NS or LR) rapidly. Reassess after each bolus. May give 2-3 boluses (40-60 mL/kg total) if needed. In cardiogenic shock, give smaller boluses (5-10 mL/kg) and reassess frequently for signs of fluid overload. For septic shock, early aggressive fluid resuscitation is critical.
Respiratory distress: Increased work of breathing (tachypnea, retractions, nasal flaring, grunting), but adequate oxygenation/ventilation. Respiratory failure: Inadequate oxygenation or ventilation despite increased work, OR decreased respiratory effort with poor air movement, altered mental status, bradycardia. Failure requires immediate intervention.
Treat bradycardia if it causes cardiopulmonary compromise (poor perfusion, hypotension, respiratory distress, altered mental status). In infants and children, bradycardia is usually caused by hypoxia - ensure adequate oxygenation and ventilation first. If bradycardia persists despite adequate oxygenation, give epinephrine (and atropine for vagal/AV block).
This PALS drug calculator is for educational and reference purposes only. It is designed for use by healthcare professionals trained in Pediatric Advanced Life Support. This tool does not replace clinical judgment, current AHA guidelines, or institutional protocols. Pediatric emergencies require specialized training and immediate action by qualified personnel. Always verify drug concentrations and calculations before administration.