A quick-reference guide for evidence-based medication dosing and resuscitation protocols across adult, pediatric, and neonatal emergency and critical care settings.
Adult Emergency Department Dosing
Pharmacist reference • Aligned to 2025 AHA ACLS & 2026 Surviving Sepsis Campaign • Rev. Jul 2026
⚠ Verify Before Use
Concentrations, standard-bag mixes, and titration limits vary by institution. Always confirm against your local formulary, smart-pump library, and current order sets. This sheet is a memory aid, not a substitute for order verification.
1 · Cardiac Arrest — ACLS (2025 AHA)
IV route preferred over IO; IO reasonable if IV delayed
| Drug |
Indication |
Dose |
Notes |
| Epinephrine |
All arrest rhythms |
1 mg IV/IO q3–5 min |
Give ASAP in asystole/PEA; after 2nd shock in VF/pVT. No high-dose epi. |
| Amiodarone |
Refractory VF/pVT |
300 mg IV/IO bolus → 150 mg once |
After epi + defibrillation attempts |
| Lidocaine |
Refractory VF/pVT (alt to amio) |
1–1.5 mg/kg → 0.5–0.75 mg/kg q5–10 min (max 3 mg/kg) |
Reasonable alternative if amio unavailable |
| Magnesium sulfate |
Torsades / known hypoMg only |
1–2 g IV/IO over 1–2 min |
NOT routine in undifferentiated arrest |
| Calcium chloride |
HyperK, hypoCa, CCB/Mg toxicity |
1 g (10 mL of 10%) IV/IO |
Not routine — specific indication only |
| Sodium bicarbonate |
TCA OD, hyperK, known acidosis |
1 mEq/kg IV/IO |
Not routine — specific indication only |
2 · Peri-Arrest — Bradycardia & Tachycardia
| Drug |
Indication |
Bolus / Load |
Infusion |
| Atropine |
Symptomatic bradycardia |
1 mg IV q3–5 min (max 3 mg) |
— |
| Epinephrine |
Bradycardia (refractory) |
— |
2–10 mcg/min, titrate |
| Dopamine |
Bradycardia (refractory) |
— |
5–20 mcg/kg/min |
| Adenosine |
Stable SVT (regular, narrow) |
6 mg rapid IVP → 12 mg → 12 mg |
— (fast flush + arm elevation) |
| Diltiazem |
A-fib/flutter rate control |
0.25 mg/kg (~20 mg) over 2 min; may repeat 0.35 mg/kg (~25 mg) |
5–15 mg/h |
| Metoprolol |
A-fib/flutter, SVT rate control |
2.5–5 mg IV over 2 min, q5 min up to 15 mg |
— |
| Amiodarone |
Stable VT / A-fib |
150 mg IV over 10 min |
1 mg/min ×6 h → 0.5 mg/min ×18 h |
| Procainamide |
Stable wide-complex/VT, WPW A-fib |
20–50 mg/min until suppressed, hypotension, QRS ↑>50%, or 17 mg/kg |
1–4 mg/min |
3 · Vasopressors & Inotropes
Continuous Infusions • Titrate to MAP ≥ 65 unless otherwise ordered
| Agent |
Typical Range |
Usual Start |
Common Concentration |
Role / Notes |
| Norepinephrine |
0.01–3 mcg/kg/min |
5–15 mcg/min |
4 mg / 250 mL (16 mcg/mL) |
1st-line septic & most shock; start early |
| Epinephrine |
0.01–0.5 mcg/kg/min |
2–10 mcg/min |
4 mg / 250 mL (16 mcg/mL) |
2nd-line sepsis; anaphylaxis; ↑ lactate/HR |
| Phenylephrine |
0.5–6 mcg/kg/min |
40–60 mcg/min |
20 mg / 250 mL (80 mcg/mL) |
Pure α; useful when tachyarrhythmic |
| Vasopressin |
0.03 units/min FIXED |
0.03 units/min |
20 units / 100 mL |
Do NOT titrate. Add when NE 0.25–0.5 mcg/kg/min |
| Dopamine |
5–20 mcg/kg/min |
5 mcg/kg/min |
400 mg / 250 mL (1600 mcg/mL) |
Rarely 1st-line; ↑ arrhythmia risk |
| Dobutamine |
2–20 mcg/kg/min |
2.5–5 mcg/kg/min |
500 mg / 250 mL (2000 mcg/mL) |
Inotrope; may drop SVR/BP |
| Milrinone |
0.125–0.75 mcg/kg/min |
0.125 mcg/kg/min |
20 mg / 100 mL (200 mcg/mL) |
Inodilator; renally cleared, causes hypotension |
| Angiotensin II |
20–80 ng/kg/min |
20 ng/kg/min |
Per product labeling |
Refractory vasodilatory shock adjunct |
4 · Push-Dose (Bolus) Pressors
Bridge to infusion / transient hypotension — short-term use
| Agent |
Concentration |
Dose |
Onset / Duration |
| Phenylephrine |
100 mcg/mL |
50–200 mcg (0.5–2 mL) q2–5 min |
~1 min / 10–20 min · pure α, watch reflex bradycardia |
| Epinephrine |
10 mcg/mL |
5–20 mcg (0.5–2 mL) q2–5 min |
~1 min / 5–10 min · α+β, for hypotension + bradycardia |
Critical: Never mix concentrations
Never give cardiac-arrest epinephrine (1 mg / 1 mg/mL) to a patient with a pulse. Bolus pressors are a bridge — if repeated dosing is needed, start an infusion.
5 · RSI, Sedation & Post-Intubation Infusions
| Category / Drug |
Dose |
Onset/Duration |
Notes |
| INDUCTION |
| Etomidate |
0.3 mg/kg IV |
30 sec / 3–5 min |
Hemodynamically neutral; transient adrenal suppression |
| Ketamine |
1–2 mg/kg IV (≈1.5 mg/kg) |
60 sec / 10–20 min |
Preserves BP/drive; good for reactive airway, shock |
| Propofol |
1.5–2.5 mg/kg IV |
30 sec / 3–10 min |
Can cause hypotension — caution in shock |
| Midazolam |
0.2–0.3 mg/kg IV |
1–3 min / 15–30 min |
Slower onset; hypotension possible |
| PARALYTICS |
| Succinylcholine |
1–1.5 mg/kg IV |
60 sec / 6–10 mins |
Avoid: hyperK, ↑ risk of malignant hyperthermia, major burns >48–72 h |
| Rocuronium |
1–1.2 mg/kg IV (RSI dose) |
60 sec / 60 mins |
Longer duration (~45–70 min); reversible w/ sugammadex |
| MAINTENANCE INFUSIONS |
| Propofol |
5–50 mcg/kg/min |
Monitor BP, triglycerides; ensure analgesia paired |
| Dexmedetomidine |
0.2–1.5 mcg/kg/h (no bolus) |
Bradycardia/hypotension; light sedation, no resp depression |
| Ketamine (sedation) |
0.5–2 mg/kg/h |
Analgosedation; maintains hemodynamics |
| Midazolam |
0.02–0.1 mg/kg/h |
Accumulates; delirium risk |
| Fentanyl |
25–200 mcg/h |
Pair with sedative; analgesia-first strategy |
6 · Analgesia (Acute)
| Drug |
Dose |
Notes |
| Fentanyl |
0.5–1 mcg/kg (≈25–50 mcg) IV q30–60 min |
Fast on/off; least histamine/hypotension |
| Morphine |
0.05–0.1 mg/kg (2–4 mg) IV q5–30 min |
Histamine release; caution renal impairment |
| Hydromorphone |
0.2–0.5 mg IV q2–3 h prn |
Potent — start low, titrate |
| Ketamine (sub-dissociative) |
0.1–0.3 mg/kg IV over 10–15 min |
Opioid-sparing; avoid rapid push (dysphoria) |
| Acetaminophen IV |
1 g IV (15 mg/kg if <50 kg) |
Adjunct; max 4 g/day |
| Ketorolac |
15–30 mg IV |
Ceiling effect at 10 mg; caution renal/bleeding/elderly |
7 · Toxicology & Antidotes
| Toxin / Scenario |
Antidote |
Dose |
| Opioid |
Naloxone |
0.04–0.4 mg IV, titrate q2–3 min; 2–4 mg IN. Infusion: ⅔ of arousal dose per hour |
| Benzodiazepine |
Flumazenil |
0.2 mg IV q1 min (max 1 mg). Avoid if chronic use/coingestion — seizure risk |
| Acetaminophen |
N-acetylcysteine |
IV: 150 mg/kg over 1 h → 50 mg/kg over 4 h → 100 mg/kg over 16 h |
| Toxic alcohols (EG/methanol) |
Fomepizole |
15 mg/kg load → 10 mg/kg q12h ×4 → 15 mg/kg q12h |
| TCA (wide QRS) |
Sodium bicarbonate |
1–2 mEq/kg IV bolus; repeat to QRS narrowing / pH 7.45–7.55 |
| β-blocker OD |
Glucagon |
3–10 mg IV over 1–2 min → 3–5 mg/h infusion |
| CCB / β-blocker OD |
High-dose insulin |
1 unit/kg regular insulin bolus + 1 unit/kg/h (titrate to 10); co-infuse dextrose, monitor glucose/K |
| Calcium channel blocker |
Calcium |
CaCl₂ 10% 1 g (central) or Ca-gluconate 10% 2–3 g, repeat prn |
| Digoxin |
Digoxin immune Fab |
Acute empiric 10–20 vials; chronic 3–6 vials; or per level/ingested dose |
| Cyanide |
Hydroxocobalamin |
5 g IV over 15 min (may repeat ×1) |
| Anticholinergic (pure) |
Physostigmine |
1–2 mg slow IV over ≥5 min; have atropine ready |
| Local anesthetic systemic tox (LAST) |
Lipid emulsion 20% |
1.5 mL/kg bolus → 0.25 mL/kg/min; repeat bolus for persistent collapse |
| Sulfonylurea hypoglycemia |
Octreotide |
50 mcg SC/IV q6–8 h (with dextrose) |
| Isoniazid seizures |
Pyridoxine (B6) |
5 g IV (or gram-for-gram of ingested INH) |
8 · Anticoagulation Reversal
| Agent to Reverse |
Reversal |
Dose |
| Warfarin (major bleed) |
4F-PCC + Vit K |
4F-PCC 25–50 units/kg (INR-based) + Vitamin K 10 mg IV slow |
| Warfarin (non-urgent) |
Vitamin K |
Vitamin K 10 mg IV or PO; hold warfarin |
| Dabigatran |
Idarucizumab |
5 g IV (two 2.5 g vials) |
| Apixaban / Rivaroxaban |
Andexanet alfa |
Low-dose or high-dose regimen per last dose & timing; 4F-PCC 50 units/kg (2000 u) if unavailable |
| Unfractionated heparin |
Protamine |
1 mg per 100 units heparin in prior 2–3 h (max 50 mg) |
| Enoxaparin (LMWH) |
Protamine |
1 mg per 1 mg enoxaparin if <8 h (partial reversal) |
| tPA-associated ICH |
Cryoprecipitate ± TXA |
Cryoprecipitate 10 units; consider TXA 1 g IV |
9 · Neurologic Emergencies
Status Epilepticus (1st line)
| Drug |
Dose |
Notes |
| Lorazepam |
0.1 mg/kg IV (max 4 mg/dose), may repeat ×1 |
Preferred if IV access |
| Midazolam |
10 mg IM (or IN/buccal) if no IV |
Weight-based: 0.2 mg/kg IM |
| Diazepam |
0.15–0.2 mg/kg IV (max 10 mg/dose) |
Alternative to lorazepam |
Second Line (choose one)
| Drug |
Dose |
Notes |
| Levetiracetam |
60 mg/kg IV (max 4500 mg) |
Fewest interactions; well tolerated |
| Fosphenytoin |
20 mg PE/kg IV (max 1500 mg PE) |
Monitor BP/ECG; infusion rate limits |
| Valproate |
40 mg/kg IV (max 3000 mg) |
Avoid in hepatic disease, pregnancy |
Ischemic Stroke (thrombolysis)
| Drug |
Dose |
Notes |
| Alteplase (tPA) |
0.9 mg/kg (max 90 mg): 10% bolus over 1 min, remainder over 60 min |
BP must be <185/110 before/after |
| Tenecteplase (TNK) |
0.25 mg/kg (max 25 mg) single IV bolus |
Increasingly preferred; single bolus |
Stroke BP Control
| Drug |
Dose |
Notes |
| Nicardipine |
5 mg/h, titrate by 2.5 mg/h q5–15 min (max 15 mg/h) |
Smooth titratable control |
| Labetalol |
10–20 mg IV, may repeat/double q10 min (max 300 mg) |
Avoid in bradycardia/severe reactive airway |
| Clevidipine |
1–2 mg/h, double q90 sec (max 32 mg/h) |
Lipid emulsion; rapid on/off |
10 · Hyperkalemia, HTN Emergency & Other Common Infusions
Hyperkalemia
| Drug |
Dose / Rate |
Notes |
| Calcium gluconate |
1–3 g IV (10% = 10–30 mL) |
Membrane stabilization; onset 1–3 min |
| Insulin + dextrose |
10 units regular IV + 25 g dextrose (D50 50 mL) |
Recheck glucose; consider 5 units if renal failure |
| Albuterol |
10–20 mg nebulized |
Adjunct; additive to insulin |
| Sodium bicarbonate |
1 mEq/kg IV (if acidotic) |
Adjunct only when metabolic acidosis present |
Hypertensive Emergency
| Drug |
Dose |
Notes |
| Nicardipine |
5–15 mg/h |
First-line titratable; avoid in advanced HF |
| Clevidipine |
1–2 mg/h up to 32 mg/h |
Rapid; lipid vehicle |
| Labetalol |
Bolus 10–20 mg; infusion 0.5–2 mg/min |
Combined α/β |
| Esmolol |
500 mcg/kg load → 50–200 mcg/kg/min |
Aortic dissection (with vasodilator), rate control |
| Nitroglycerin |
5–200 mcg/min |
ACS/flash pulmonary edema |
| Nitroprusside |
0.3–10 mcg/kg/min |
Cyanide/thiocyanate risk; light-protect; short duration |
Other
| Drug |
Dose |
Notes |
| Magnesium sulfate |
2 g IV over 15–60 min (2 g/hr preeclampsia after 4–6 g load) |
Torsades, severe asthma, eclampsia |
| Dextrose (hypoglycemia) |
D50 25 g (50 mL) IV, or D10 100–250 mL |
Recheck glucose in 15 min |
| Insulin (DKA) |
0.1 unit/kg/h (± 0.1 unit/kg bolus) |
Hold if K <3.3; add dextrose when glucose <200–250 |
| Tranexamic acid (TXA) |
1 g IV over 10 min (trauma: within 3 h) → 1 g over 8 h |
Trauma/hemorrhage per protocol |
Compiled from: 2025 AHA Guidelines for CPR & ECC (Part 9: Adult ALS), 2026 Surviving Sepsis Campaign, and standard emergency-medicine references. Doses are for typical adults; adjust for renal/hepatic function, weight, and pregnancy. Confirm every value against institutional protocols before dispensing or verifying an order.
Pediatric Emergency Department Dosing
Pharmacist reference • Weight-based (per kg), doses capped at adult max • Aligned to 2025 AHA/AAP PALS • Rev. Jul 2026
⚠ Verify Before Use
All doses are weight-based; confirm actual weight (kg) and never exceed the listed adult maximum. Use a length-based tape (Broselow) or a pre-calculated, weight-specific code sheet at the bedside for arrest dosing.
⚠ Epinephrine Concentration Alert
Arrest/bradycardia = 0.1 mg/mL (1:10,000), 0.1 mL/kg IV/IO. Anaphylaxis = 1 mg/mL (1:1,000), 0.01 mL/kg IM. Confirm concentration and route every time.
1 · Cardiac Arrest — PALS (2025 AHA/AAP)
Defib 2 J/kg → 4 J/kg → ≥4 (max 10 J/kg or adult dose)
| Drug |
Dose (per kg) |
Max single dose |
Notes |
| Epinephrine |
0.01 mg/kg (0.1 mL/kg of 0.1 mg/mL) IV/IO q3–5 min |
1 mg |
Give EARLY in non-shockable; AFTER defib fails in shockable |
| Amiodarone |
5 mg/kg IV/IO bolus (refractory VF/pVT) |
300 mg |
May repeat up to 2× (max 15 mg/kg/day) |
| Lidocaine |
1 mg/kg IV/IO bolus (alt to amio) |
100 mg |
Infusion 20–50 mcg/kg/min if used |
| Magnesium sulfate |
25–50 mg/kg IV/IO over 10–20 min |
2 g |
Torsades / known hypoMg only — not routine |
| Glucose (hypoglycemia) |
D10 5 mL/kg or D25 2 mL/kg IV/IO |
— |
Check glucose in all arrests; treat if low |
| Sodium bicarb / Calcium |
Not routine |
— |
Only for hyperK, TCA, CCB, hypoCa, hyperMg |
2 · Peri-Arrest — Bradycardia & Tachycardia
Bradycardia (HR <60 with poor perfusion)
| Drug |
Dose (per kg) |
Max |
Notes |
| Epinephrine |
0.01 mg/kg (0.1 mL/kg of 0.1 mg/mL) IV/IO q3–5 min |
1 mg |
First-line; treat hypoxia/ventilation FIRST |
| Atropine |
0.02 mg/kg IV/IO, may repeat ×1 |
0.5 mg/dose |
For vagal/AV block; min effective dose ~0.1 mg |
SVT (regular, narrow)
| Drug |
Dose (per kg) |
Max |
Notes |
| Adenosine |
1st: 0.1 mg/kg rapid IVP → 2nd: 0.2 mg/kg |
6 / 12 mg |
Rapid push + flush; largest, most proximal vein |
| Synchronized cardioversion |
0.5–1 J/kg → 2 J/kg if needed |
— |
For unstable SVT/VT with pulse |
VT (with pulse) / other
| Drug |
Dose (per kg) |
Max |
Notes |
| Amiodarone |
5 mg/kg IV/IO over 20–60 min |
300 mg |
Do not give with procainamide |
| Procainamide |
15 mg/kg IV/IO over 30–60 min |
— |
Monitor QRS/QT and BP |
3 · Anaphylaxis
Epinephrine is first-line — give IM without delay
| Drug |
Dose (per kg) |
Max / Notes |
| Epinephrine (IM) |
0.01 mg/kg (0.01 mL/kg of 1 mg/mL) IM, mid-outer thigh, q5–15 min |
Max 0.3–0.5 mg. Autoinjector: 0.15 mg if <25–30 kg, else 0.3 mg |
| Epinephrine (infusion) |
0.05–1 mcg/kg/min, titrate |
For refractory shock after ≥2 IM doses + fluids |
| IV fluid bolus |
20 mL/kg isotonic crystalloid, repeat prn |
For hypotension; reassess between boluses |
| Diphenhydramine |
1 mg/kg IV/IM/PO |
Max 50 mg. Adjunct only — not a substitute for epi |
| Methylprednisolone |
1–2 mg/kg IV |
Max 125 mg. Adjunct; does not treat acute obstruction |
| Albuterol |
2.5 mg (<20 kg) or 5 mg neb |
For bronchospasm/wheeze |
4 · Rapid Sequence Intubation
Pretreatment (optional)
| Drug |
Dose (per kg) |
Notes |
| Atropine |
0.02 mg/kg IV (min ~0.1 mg) |
Consider in infants <1 yr or with succinylcholine (bradycardia) |
| Fentanyl |
1–2 mcg/kg IV |
Blunts sympathetic response; push slowly (chest-wall rigidity) |
Induction
| Drug |
Dose (per kg) |
Notes |
| Etomidate |
0.3 mg/kg IV |
Hemodynamically stable; transient adrenal suppression |
| Ketamine |
1–2 mg/kg IV |
Preferred in shock/reactive airway; maintains BP |
| Propofol |
1–2 mg/kg IV |
Risk of hypotension — caution if unstable |
Paralysis
| Drug |
Dose (per kg) |
Notes |
| Rocuronium |
1–1.2 mg/kg IV |
Longer duration (~30–45 min); reversible with sugammadex |
| Succinylcholine |
1–2 mg/kg IV (2 mg/kg if <2 yr) |
Avoid: hyperK, myopathy/dystrophy, malignant hyperthermia risk, burns/crush >48 h |
5 · Status Epilepticus
Benzodiazepine first; second agent if seizing after 2 benzo doses
First Line (benzodiazepine)
| Drug |
Dose (per kg) |
Max |
Notes |
| Lorazepam |
0.1 mg/kg IV, may repeat ×1 |
4 mg/dose |
Preferred if IV access |
| Midazolam |
0.2 mg/kg IM (or 0.2 mg/kg IN / buccal) |
10 mg |
Preferred if no IV |
| Diazepam |
0.15 mg/kg IV, or 0.5 mg/kg PR |
10 mg IV |
Rectal option for no IV |
Second Line (choose one)
| Drug |
Dose (per kg) |
Max |
Notes |
| Levetiracetam |
40–60 mg/kg IV over 10 min |
4500 mg |
Fewest interactions; well tolerated |
| Fosphenytoin |
20 mg PE/kg IV |
1500 mg PE |
Monitor BP/ECG; order as PE |
| Valproate |
40 mg/kg IV |
3000 mg |
Avoid <2 yr, hepatic/metabolic disease |
Adjunct
| Drug |
Dose (per kg) |
Notes |
| Pyridoxine (B6) |
50–100 mg IV (infants); INH tox: g-for-g |
Consider in refractory neonatal/infant seizures |
6 · Analgesia & Procedural Sedation
| Drug |
Dose (per kg) |
Max / Notes |
| Fentanyl |
IV 1–2 mcg/kg; intranasal 1.5–2 mcg/kg |
Fast on/off; least hypotension |
| Morphine |
0.05–0.1 mg/kg IV q2–4 h |
Max ~4 mg/dose initial; histamine release |
| Hydromorphone |
0.015 mg/kg IV q3–4 h |
Potent — start low |
| Ketamine (procedural) |
IV 1–2 mg/kg; IM 4–5 mg/kg |
Dissociative; laryngospasm rare, emergence phenomena |
| Acetaminophen |
15 mg/kg PO/IV q6 h |
Max 75 mg/kg/day, ≤4 g/day |
| Ibuprofen |
10 mg/kg PO q6–8 h |
Max 40 mg/kg/day; avoid <6 mo, dehydration |
| Ketorolac |
0.5 mg/kg IV q6 h |
Max 30 mg/dose; caution renal/bleeding |
7 · Respiratory — Asthma, Croup, Bronchiolitis
Asthma
| Drug |
Dose (per kg) |
Max / Notes |
| Albuterol |
Neb 2.5 mg (<20 kg) / 5 mg; continuous 0.5 mg/kg/h |
Continuous max ~20 mg/h; monitor for tachycardia/K |
| Ipratropium |
250 mcg (<20 kg) / 500 mcg neb ×3 with albuterol |
Early severe exacerbation |
| Dexamethasone |
0.6 mg/kg PO/IV/IM |
Max 16 mg; often ×1–2 doses |
| Methylprednisolone |
1–2 mg/kg IV |
Max 60–125 mg |
| Magnesium sulfate |
25–50 mg/kg IV over 20 min |
Max 2 g; severe/refractory; watch BP |
| Terbutaline |
Load 10 mcg/kg → 0.1–4 mcg/kg/min |
Refractory status asthmaticus; cardiac monitoring |
Croup
| Drug |
Dose (per kg) |
Notes |
| Dexamethasone |
0.6 mg/kg PO/IV/IM ×1 |
Max 16 mg |
| Nebulized epinephrine |
Racemic 2.25% 0.5 mL in 3 mL NS (or L-epi 0.5 mL/kg of 1 mg/mL, max 5 mL) |
Observe ≥2–3 h for rebound stridor |
8 · Vasoactive & Inotrope Infusions
Titrate to age-appropriate MAP / perfusion
| Agent |
Range |
Usual Start |
Role / Notes |
| Epinephrine |
0.05–1 mcg/kg/min |
0.05 mcg/kg/min |
Cold shock; first-line inopressor in kids |
| Norepinephrine |
0.05–2 mcg/kg/min |
0.05 mcg/kg/min |
Warm/vasodilated (septic) shock |
| Dopamine |
5–20 mcg/kg/min |
5 mcg/kg/min |
Alternative when epi/NE not immediately available |
| Dobutamine |
2–20 mcg/kg/min |
5 mcg/kg/min |
Myocardial dysfunction / normal BP |
| Milrinone |
0.25–0.75 mcg/kg/min |
0.25 mcg/kg/min |
Inodilator; low-CO states; renally cleared |
| Vasopressin |
0.17–8 milliunits/kg/min |
0.5 milliunits/kg/min |
Catecholamine-resistant vasodilatory shock |
| Prostaglandin E1 |
0.01–0.05 mcg/kg/min |
0.01 mcg/kg/min |
Ductal-dependent CHD; watch for apnea |
9 · Fluids, Glucose & Electrolytes
| Scenario / Drug |
Dose (per kg) |
Notes |
| Fluid bolus (shock) |
10–20 mL/kg isotonic crystalloid |
Reassess after each; 10 mL/kg in DKA/cardiac/malnutrition |
| Hypoglycemia |
D10 5 mL/kg (or D25 2–4 mL/kg) IV |
Recheck glucose in 15 min; D10 preferred in infants |
| DKA insulin |
0.05–0.1 units/kg/h infusion |
NO initial bolus in children; correct slowly (cerebral edema risk) |
| Symptomatic hyponatremia / ↑ICP |
3% saline 3–5 mL/kg IV over 10–30 min |
May repeat; target Na rise ~5 mmol/L acutely |
| HYPERKALEMIA |
| Calcium gluconate 10% |
60 mg/kg (0.6 mL/kg) IV |
Max 3 g; membrane stabilization; onset 1–3 min |
| Insulin + dextrose |
0.1 units/kg regular + 0.5 g/kg dextrose (D25 2 mL/kg) |
Recheck glucose; shifts K intracellularly |
| Albuterol / Sodium bicarb |
Albuterol neb; bicarb 1 mEq/kg (if acidotic) |
Adjuncts; then definitive K removal |
10 · Toxicology & Antidotes
| Toxin / Scenario |
Antidote |
Dose (per kg) |
| Opioid |
Naloxone |
0.01–0.1 mg/kg IV/IM/IN (max 2 mg), titrate & repeat q2–3 min |
| Acetaminophen |
N-acetylcysteine |
IV: 150 mg/kg over 1 h → 50 mg/kg over 4 h → 100 mg/kg over 16 h |
| TCA (wide QRS) |
Sodium bicarbonate |
1–2 mEq/kg IV bolus; repeat to QRS narrowing |
| Calcium channel blocker |
Calcium / HDI |
Ca-gluconate 60 mg/kg; high-dose insulin 1 unit/kg bolus → 0.5–1 unit/kg/h + dextrose |
| β-blocker OD |
Glucagon |
0.05 mg/kg IV (max 5 mg) → infusion 0.07 mg/kg/h |
| Benzodiazepine |
Flumazenil |
0.01 mg/kg IV (max 0.2 mg); avoid if chronic use / coingestion — seizure risk |
| Toxic alcohols |
Fomepizole |
15 mg/kg load → 10 mg/kg q12h ×4 |
| Iron |
Deferoxamine |
15 mg/kg/h IV infusion (max ~6 g/day up to 24 hours only) |
| Sulfonylurea hypoglycemia |
Octreotide |
1–1.25 mcg/kg SC/IV q6 h (with dextrose) |
| Local anesthetic tox (LAST) |
Lipid emulsion 20% |
1.5 mL/kg bolus → 0.25 mL/kg/min |
| Methemoglobinemia |
Methylene blue |
1–2 mg/kg IV over 5 min |
Compiled from: 2025 AHA/AAP Guidelines for CPR & ECC (Part 9: Pediatric Advanced Life Support) and standard pediatric emergency references. Doses are weight-based and capped at adult maximums; adjust for renal/hepatic function, and comorbidities. Confirm every value against institutional protocols and a pediatric formulary before dispensing or verifying an order.
Neonatal Emergency & Delivery Room Dosing
Pharmacist reference • Newborn / NICU, weight-based (per kg) • Aligned to 2025 AHA/AAP NRP 9th Edition • Rev. Jul 2026
⚠ Verify Before Use
Neonatal dosing is weight-based and frequently gestational-age (GA/PMA) and postnatal-age dependent. Antibiotic, anticonvulsant, and vasoactive dosing intervals in particular vary with maturity — confirm against a neonatal reference (e.g., NeoFax/Lexicomp) and local NICU protocol.
⚠ Epinephrine Concentration Alert
Resuscitation uses 0.1 mg/mL (1:10,000) ONLY. IV/IO is strongly preferred over ET. Confirm concentration, route, and that a normal-saline flush follows every dose.
1 · NRP Algorithm Essentials (2025 / 9th Ed.)
Newborn transition & resuscitation
| Parameter |
Target / Value |
| First step after birth |
Initiate cord management plan (NEW). Deferred cord clamping ≥60 sec for most vigorous newborns |
| Initial steps |
Warm/maintain temp (36.5–37.5 °C), position airway, clear secretions if needed, dry, stimulate |
| PPV — indication & rate |
Apnea/gasping or HR <100. Rate 40–60 breaths/min. PPV is the single most important step |
| Chest compressions |
Start if HR <60 despite 30 sec of effective PPV (after intubation/airway). 3:1 ratio = 90 compressions + 30 breaths (120 events/min) |
| Oxygen |
Start term ≥35 wk at 21%; preterm <35 wk at 21–30%. Titrate to preductal SpO₂ targets. Use 100% O₂ once compressions begin |
| Alternative airway |
ETT or laryngeal mask (LMA now allowed as PRIMARY device, 9th ed.). Cardiac monitor preferred for HR during compressions |
| Vascular access |
Low-lying UVC preferred; IO acceptable if UVC not feasible |
2 · Delivery-Room Resuscitation Medications
| Drug |
Dose (per kg) |
Route / Conc. |
Notes |
| Epinephrine |
0.01–0.03 mg/kg (0.1–0.3 mL/kg of 0.1 mg/mL) q3–5 min |
IV/IO preferred; 0.1 mg/mL |
Indicated if HR <60 despite effective PPV + compressions |
| Epinephrine (ET) |
0.05–0.1 mg/kg (0.5–1 mL/kg of 0.1 mg/mL) |
ET only if no access |
Less effective — place UVC/IO ASAP; give IV dose when access ready |
| NS flush (after epi) |
Follow IV/IO epi with NS flush |
IV/IO |
NRP 9th ed. increased flush volume — verify local protocol (commonly ~3 mL) |
| Volume expander |
10 mL/kg over 5–10 min, may repeat |
IV/IO |
NS or O-neg blood; for hypovolemia/blood loss/shock |
| Dextrose (D10W) |
2 mL/kg (200 mg/kg) IV |
IV; D10W |
For documented hypoglycemia; then start infusion |
| Naloxone |
NOT recommended in delivery-room resuscitation |
— |
Focus on ventilation; supportive care for maternal-opioid respiratory depression |
| Sodium bicarbonate |
Not recommended during brief resuscitation |
— |
No routine role; ventilation is the priority |
3 · Neonatal Hypoglycemia
Thresholds and protocols vary by institution — verify local pathway
| Intervention |
Dose (per kg) |
Notes |
| Dextrose gel 40% |
0.5 mL/kg (200 mg/kg) buccal |
Asymptomatic at-risk newborn; pair with feeding; may repeat |
| IV mini-bolus (D10W) |
2 mL/kg (200 mg/kg) IV |
Symptomatic or persistent/severe low glucose; recheck in 15–30 min |
| Continuous infusion |
GIR 5–8 mg/kg/min (≈80–120 mL/kg/day D10W) |
Titrate to euglycemia; escalate GIR and concentration if refractory |
| Glucagon |
0.2 mg/kg IM/IV (max 1 mg) |
If no IV access or refractory; temporary measure |
4 · Neonatal Seizures
Phenobarbital remains first-line in neonates
First Line
| Drug |
Dose (per kg) |
Max |
Notes |
| Phenobarbital |
20 mg/kg IV load; may add 10 mg/kg |
40 mg/kg total |
First-line for neonatal seizures |
Second Line
| Drug |
Dose (per kg) |
Notes |
| Levetiracetam |
20–40 mg/kg IV (up to 60) |
Increasingly used; favorable safety |
| Fosphenytoin |
20 mg PE/kg IV |
Monitor BP/ECG; order as PE |
| Midazolam |
0.05–0.15 mg/kg IV → 0.05–0.4 mg/kg/h infusion |
For refractory seizures |
Special
| Drug |
Dose |
Notes |
| Pyridoxine (B6) |
100 mg IV |
Trial for pyridoxine-dependent seizures (refractory, unexplained) |
| Correct reversibles |
Glucose, Ca, Mg, Na |
Always check/treat hypoglycemia, hypoCa, hypoMg, hypoNa |
5 · Vasoactive Infusions & Hypotension
| Agent |
Range |
Usual Start |
Role / Notes |
| Dopamine |
5–20 mcg/kg/min |
5 mcg/kg/min |
Common first-line for neonatal hypotension |
| Dobutamine |
2–20 mcg/kg/min |
5 mcg/kg/min |
Myocardial dysfunction / low CO |
| Epinephrine |
0.05–1 mcg/kg/min |
0.05 mcg/kg/min |
Refractory hypotension; inopressor |
| Norepinephrine |
0.05–1 mcg/kg/min |
0.05 mcg/kg/min |
Vasodilated / septic shock |
| Milrinone |
0.25–0.75 mcg/kg/min |
0.25 mcg/kg/min |
PPHN / low CO; renally cleared |
| Hydrocortisone |
1 mg/kg IV q8–12 h |
— |
Catecholamine-refractory hypotension |
| Prostaglandin E1 |
0.01–0.05 mcg/kg/min |
0.01 mcg/kg/min |
Ductal-dependent CHD — watch for apnea, be ready to ventilate |
6 · Early-Onset Sepsis — Empiric Antibiotics
Ampicillin + gentamicin; PMA = gestational + postnatal age
Gentamicin — extended-interval (NeoFax/Lexicomp standard)
| PMA |
Postnatal age |
Dose |
Interval |
| ≤29 wk |
0–7 days |
5 mg/kg |
q48h |
|
8–28 days |
4 mg/kg |
q36h |
|
≥29 days |
4 mg/kg |
q24h |
| 30–34 wk |
0–7 days |
4.5 mg/kg |
q36h |
|
≥8 days |
4 mg/kg |
q24h |
| ≥35 wk |
All |
4 mg/kg |
q24h |
Ampicillin — dose 50 mg/kg (non-meningitis); interval by PMA + postnatal age
| PMA |
Postnatal age |
Interval |
| ≤29 wk |
0–28 days |
q12h |
|
>28 days |
q8h |
| 30–36 wk |
0–14 days |
q12h |
|
>14 days |
q8h |
| 37–44 wk |
0–7 days |
q12h |
|
>7 days |
q8h |
| ≥45 wk |
— |
q6h |
| GBS / meningitis |
any GA |
100 mg/kg/dose: q8h (≤7 d) or q6h (>7 d) |
Other agents (interval PMA-dependent — confirm per NeoFax)
| Drug |
Dose (per kg) |
Interval by PMA |
Notes |
| Cefotaxime |
50 mg/kg/dose |
Same PMA grid as ampicillin (q12h→q8h→q6h) |
Gram-neg meningitis; preferred where stocked |
| Cefepime |
50 mg/kg/dose |
q12h (term q8h for higher-MIC GNR) |
If cefotaxime unavailable / per pathway |
| Acyclovir |
20 mg/kg/dose IV |
<30 wk q12h; ≥30 wk q8h |
Neonatal HSV; hydrate, monitor renal/CBC |
| Vancomycin |
15 mg/kg/dose (±20 mg/kg load) |
q24h ≤29 wk / q12h 30–44 wk / q8h ≥45 wk |
Late-onset / MRSA; target AUC or trough |
7 · Common Neonatal / NICU Medications
| Drug |
Dose |
Indication / Notes |
| Surfactant (poractant) |
2.5 mL/kg (200 mg/kg) initial; 1.25 mL/kg repeat |
RDS; via ETT (or LISA/MIST). Beractant 4 mL/kg (100 mg/kg) |
| Caffeine citrate |
20 mg/kg IV load → 5–10 mg/kg/day maintenance |
Apnea of prematurity |
| Vitamin K1 (phytonadione) |
1 mg IM ×1 (0.5 mg if <1500 g) |
Routine prophylaxis for hemorrhagic disease at birth |
| Erythromycin eye ointment |
0.5% ribbon to each eye ×1 |
Ophthalmia neonatorum prophylaxis |
| Hepatitis B vaccine |
Per schedule at birth (± HBIG) |
HBIG if mother HBsAg+ |
| Calcium gluconate 10% |
100–200 mg/kg IV slow (1–2 mL/kg) |
Symptomatic hypocalcemia; cardiac monitor, watch extravasation |
| Indomethacin / Ibuprofen |
Per PDA protocol |
PDA closure; monitor renal function/platelets |
| Naloxone |
Not for delivery-room resuscitation |
May precipitate withdrawal/seizures in opioid-exposed infants |
8 · Rate ↔ Dose Quick Math
| Conversion |
Formula |
| Glucose infusion rate (GIR, mg/kg/min) |
GIR = (rate mL/h × dextrose %) ÷ (wt kg × 6) |
| mcg/kg/min → mL/h |
rate = (dose × wt_kg × 60) ÷ concentration(mcg/mL) |
| Example: 3.2 kg, D10W at 12 mL/h |
GIR = (12 × 10) ÷ (3.2 × 6) = 6.25 mg/kg/min |
| Example: Dopamine 800 mcg/mL, 3 kg, 5 mcg/kg/min |
= (5 × 3 × 60) ÷ 800 = 1.1 mL/h |
Compiled from: 2025 AHA/AAP Guidelines for CPR & ECC (Part 5: Neonatal Resuscitation) and the NRP 9th Edition, plus standard neonatal references. Dosing intervals for antibiotics and many infusions depend on gestational and postnatal age — always confirm against a neonatal formulary (NeoFax/Lexicomp) and local NICU protocol before dispensing or verifying an order.
