Commonly Used Medications in PALS
Medication recommendations change quickly. It is highly recommended that a pharmacist be included on the resuscitation team to manage all drugs and dosages for pediatric patients.
| Drug | Classification | Indications | Dose/Administration | Possible Side effects | Considerations |
| Adenosine | Antiarrhythmic | SVT | 1st dose = 0.1 mg/kg rapid IV push to max of 6 mg 2nd dose = 0.2 mg/kg rapid IV push to max of 12 mg | Dizziness, headache, metallic taste, shortness of breath, hypotension, slow or fast heart rate, nausea, flushing, sweating | Cardiac monitoring during administration; administer through central line if available; flush with saline following administration |
| Amiodarone | Antiarrhythmic | SVT, VT with pulses, VF, VT without pulse | SVT or VT with pulse: VF or VT without pulse: 5mg/kg rapid bolus to | Headache, dizziness, tremors, syncope, hypotension, bradycardia, CHF, nausea, vomiting, diarrhea, rash, skin discoloration, hair loss, flushing, coagulation problems | Monitor ECG and BP; use with caution in patients with a perfusing rhythm, hepatic failure; contraindicated for 2nd or 3rd degree heart block |
| Atropine | Anticholinergic | Symptomatic bradycardia, toxins and overdoses | Bradycardia: 0.02 mg/kg IV with 0.5 mg max dose may repeat one time Toxins/overdose: | Headache, dizziness, confusion, anxiety, flushing, visual difficulties, pupil dilation, dry mouth, tachycardia, high or low blood pressure, nausea, vomiting, constipation, urinary retention, painful urination, rash, dry skin | Monitor ECG, oxygen, and BP; administer before intubation if bradycardic; contraindicated in glaucoma and tachyarrhythmias |
| Epinephrine | Catecholamine vasopressor, Inotrope | Anaphylaxis, asthma, symptomatic bradycardia, croup, shock, cardiac arrest, toxins or overdose | Anaphylaxis: 0.01 mg/kg every 15 minutes to max of 0.3 mg Asthma: (1:1000) 0.01 mg/kg subcutaneous every 15 minutes to max 0.3 mg Symptomatic bradycardia: 0.01 mg/kg IV every 3-5 minutes to max dose of 1 mg Croup: 0.25 ml Racemic epi solution via nebulizer Cardiac arrest: 0.01 mg/kg (1:10000) IV or 0.1 mg/kg (1:1000) per ET tube every 3-5 minutes Shock: 0.1-1 mcg/kg/ minute IV infusion Toxins/ODs: 0.01 mg/kg (1:10000) IV to max dose of 1 mg | Tremors, anxiety, headaches, dizziness, confusion, hallucinations, dyspnea, SVT, VT, palpitations, hypertension, nausea, vomiting, hyperglycemia, hypokalemia, vasoconstriction | Available in 1:1000 and 1:10000 concentrations so the team must be aware of which concentration is being used; monitor BP, oxygen, and ECG; give via central line if possible; do not give in cocaine induced VT |
| Oxygen | Elemental gas | Hypoxia, respiratory distress or failure, shock, trauma, cardiac arrest | In resuscitation, administer at 100% via high flow system and titrate to response to maintain oxygen saturation >94% | Headache, dry nose/ mouth, airway obstruction if secretions become dry | Monitor oxygen saturation; insufficient flow rates may cause carbon dioxide retention |
| Albumin | Plasma volume expander | Shock, trauma, burns | 0.5-1 g/kg by rapid infusion | Fluid overload, increased respiratory rate, flushing, rash, hypocalcemia | Use within 4 hours of opening vial |
| Albuterol | Bronchodilator | Asthma, bronchospasm, hyperkalemia | 2.5 mg if weight <20 kg 5 mg if weight >20 kg | Tremors, anxiety, headaches, bad taste, dry nose/throat, dyspnea, wheezing, tachycardia, hypotension, nausea, vomiting, flushing | Should not be used with tachyarrhythmias |
| Alprostadil | Prostaglandin vasodilator | Maintain patency of ductus arteriosus in congenital heart disease | Initial: 0.05-0.1 mcg/kg/minute Maintenance: 0.01-0.05 mcg/kg/minute | Apnea, bradycardia, vasodilation, hypotension, cardiac arrest, diarrhea, renal failure, flushing, fever, hypoglycemia, DIC, hypocalcemia, seizures | May cause tissue sloughing, must not be bolused or stopped suddenly, should be refrigerated until administered |
| Calcium chloride/gluconate | Electrolyte | Hypocalcemia, hyperkalemia; consider for calcium channel blocker overdose | In cardiac arrest: 20 mg/kg IV bolus into central line In non-arrest: infuse over 30-60 minutes | Hypotension, cardiac arrhythmias, cardiac arrest, burn or sclerosis of peripheral veins, hypercalcemia | Monitor ECG and BP; contraindicated in digtoxicity or hypercalcemia; flush IV tubing before and after administration; do not administer with phosphorus-containing solutions |
| Dexamethasone | Corticosteroid | Croup, asthma | 0.6 mg/kg for one dose (max dose 16 mg) | Headache, insomnia, seizures, psychosis, visual difficulties, hypertension, edema, tachycardia, osteoporosis, diarrhea, nausea, GI bleeding, flushing, sweating, poor wound healing, hyperglycemia, sodium and fluid retention, hemorrhage, hypokalemia | Can be given PO, IM or IV |
| Dextrose | Carbohydrate | Hypoglycemia | 0.5-1 g/kg | Sclerosis of veins, hyperglycemia | Do not administer during resuscitation unless hypoglycemia is documented; use point of care glucose monitoring |
| Diphenhydramine | Antihistamine | Anaphylaxis after epinephrine | 1-2 mg/kg every 4 to 6 hours to a max dose of 50 mg | Dizziness, drowsiness, CNS symptoms, blurred vision, pupil dilation, dry nose/mouth/throat, hypotension, tachycardia, nausea, vomiting, urinary retention or frequency photosensitivity | Monitor oxygen saturations and BP; use with caution in presence of glaucoma, ulcer, hyperthyroidism |
| Dobutamine | Beta-adrenergic | Ventricular dysfunction | 2-20 mcg/kg/minute infusion | Headache, dizziness, hypotension, palpitations, angina, nausea, vomiting thrombocytopenia | Monitor ECG and BP; do not mix with sodium bicarbonate or alkaline solutions |
| Dopamine | Catecholamine vasopressor, inotrope | Ventricular dysfunction, cardiogenic or distributive shock | 2-20 mcg/kg/minute infusion titrated to response | Headache, dyspnea, palpitations, PVCs, SVT, VT, nausea, vomiting, acute renal failure | Headache, dyspnea, palpitations, PVCs, SVT, VT, nausea, vomiting, acute renal failure |
| Etomidate | Short acting sedative with no analgesic properties | Sedation for intubation or for patients with hypotension or multiple trauma | 0.2-0.4 mg/kg IV over 30 to 60 seconds with max dose of 20 mg | Fast or slow respiratory rate, high or low blood pressure, tachycardia nausea, vomiting, cough | Sedation will last 10-15 minutes; monitor oxygen, BP and respiratory function; avoid use in septic shock |
| Furosemide | Loop diuretic | Pulmonary edema, fluid overload | 1 mg/kg IV or IM to max dose of 20 mg | Headache, weakness, vertigo, hearing and vision problems, dry mouth, ECG changes, nausea, vomiting, diarrhea, abdominal cramping, polyuria, glycosuria, muscle cramps, sweating, hives, hyperglycemia, anemia, hypokalemia, hyponatremia, metabolic alkalosis | Monitor BP, BUN, serum creatinine and electrolytes (especially potassium) |
| Hydrocortisone | Corticosteroid | Adrenal insufficiency associated with septic shock | 2 mg/kg IV bolus to max dose of 100 mg | Psychological signs, infections, blurred vision, hypertension, diarrhea, nausea, vomiting, osteoporosis, flushing, sweating, slow wound healing, hyperglycemia | Watch for signs of infection |
| Inamrinone | Inotrope | Myocardial dysfunction, cardiogenic shock, CHF | Loading dose 0.75-1 mg/kg bolus over 5-10 minutes may repeat twice to max dose of 3mg/kg Infusion at 5-10 mcg/kg/minute | Hypoxemia, hypotension, angina, arrhythmias nausea, vomiting, abdominal pain, jaundice, allergic reactions, thrombocytopenia | Monitor ECG, oxygen, and BP |
| Ipratropium | Anticholinergic bronchodilator | Asthma | 250-500 mcg every 20 minutes via nebulizer for 3 doses | Anxiety, dizziness, headache, dry mouth, blurred vision, cough, bronchospasm, palpitations, nausea, vomiting, rash | Monitor oxygen; if medication gets in eyes, will cause pupil dilation |
| Lidocaine | Antiarrhythmic | VF, pulseless VT, wide complex tachycardia, RSI | Tachyarrhythmias and VF: 1 mg/kg IV bolus followed by infusion of 20-50 mcg/kg/minute infusion RSI: 1-2 mg/kg IV | CNS symptoms, tinnitus, blurred vision, hypotension, heart block, bradycardia, cardiac arrest, dyspnea, respiratory depression, nausea, vomiting, rash | Monitor ECG and BP; May cause seizures; contraindicated for wide complex bradycardia |
| Magnesium sulfate | Electrolyte, bronchodilator | Asthma; torsades de pointes; hypo-magnesemia | Asthma: 25-50 mg/kg over 15-30 minutes IV Pulseless torsades: 25-50 mg/kg bolus VT with pulses and torsades: 25-50 mg/kg over 10-20 minutes | Confusion, sedation, weakness, respiratory depression, hypotension, heart block, bradycardia, cardiac arrest, nausea, vomiting, muscle cramps, flushing, sweating | Monitor ECG, oxygen and BP; rapid bolus may cause hypotension and bradycardia; calcium chloride can be used if needed to reverse hypermagnesemia |
| Methylprednisolone | Corticosteroid | Asthma, anaphylactic shock | 2 mg/kg to max of 60 mg IV as loading dose; 0.5 mg/kg every 6 hours as maintenance dose | Depression, headache, weakness, hypertension, diarrhea, nausea, pancreatitis, ulcer, osteoporosis, hyperglycemia | Watch for rare anaphylaxis |
| Milrinone | Inotrope, vasodilator | Cardiogenic shock or post-surgery CHF | 50 mcg/kg IV over 10-60 minutes as loading dose 0.25-0.75 mcg/kg/minute IV infusion as maintenance dose | Headache, tremor, hypotension, ventricular arrhythmias, angina, nausea, vomiting, jaundice, hypokalemia | Monitor ECG, BP and platelet count; hypovolemia may make hypotension worse; use longer infusion time |
| Naloxone | Opioid antagonist | Narcotic reversal | For total reversal: 0.1 mg/kg IV bolus every 2 minutes to max dose of 2 mg Total reversal not needed: 1-5 mcg/kg IV (titrate to response required) | Seizures, drowsiness, rapid respiratory rate, pulmonary edema, VF, VT, tachycardia, asystole, hypertension nausea, vomiting | Monitor ECG, oxygen and BP; repeat doses often needed; establish assisted ventilation before administration; monitor newborn of addicted mother |
| Nitroglycerine | Vasodilator, antihypertensive | CHF, cardiogenic shock | Begin infusion at 0.25-0.5 mcg/kg/minute and titrate every 15-20 minutes to max dose of 10 mcg/kg/minute | Headache, dizziness, hypoxemia, hypotension, cardiac arrest, tachycardia, flushing, pallor | Monitor ECG and BP; watch for hypotension in hypovolemic children |
| Nitroprusside | Vasodilator antihypertensive | Cardiogenic shock Hypertension | 0.3-1 mcg/kg/minute for initial dose then titrate to max 8 mcg/kg/minute | Seizures, dizziness, headache, agitation, hypotension, slow or fast heart rate, nausea, vomiting | Monitor ECG and BP; if used for prolonged times; thiocyanate and cyanide levels should be monitored |
| Norepinephrine | Inotrope vasopressor | Hypotensive shock | 0.1-2 mcg/kg/minute titrated to desired BP | Headache respiratory distress hypertension arrhythmias renal failure | Monitor ECG and BP; IV infiltration may lead to tissue necrosis; should be administered via central line; do not mix in alkaline solution |
| Procainamide | Antiarrhythmic | SVT, atrial flutter, VT with pulse | 15 mg/kg as loading dose over 30-60 minutes | Headache, dizziness, confusion, weakness, hypotension, prolonged QT interval, heart blocks and cardiac arrest, nausea, vomiting, diarrhea, rash, edema, anemia, neutropenia | Monitor ECG (particularly QT interval) and BP; expert consultation should be called before administration |
| Sodium bicarbonate | Electrolyte to produce alkalinity | Severe metabolic acidosis, hyperkalemia, tricyclic overdose | 1 mEq/kg slow IV bolus to max of 50 mEq For overdose 1-2 mEq/kg bolus repeating until pH >7.45 follow with infusion of sodium bicarb solution to maintain alkalosis | CNS symptoms, arrhythmia, hypotension, cardiac arrest, renal calculi, cyanosis, edema, metabolic alkalosis and other derangements, water retention | Monitor ECG, oxygen and ABGs; ensure adequate ventilatory support to reduce the chance of carbon dioxide accumulation; not recommended in cardiac arrest |
| Terbutaline | Bronchodilator, beta adrenergic agonist | Asthma, hyperkalemia | 0.1-10 mcg/kg/ minute IV Infusion 10 mcg/kg SQ every 10-15 minutes until IV is established | CNS symptoms, palpitations, tachycardia, nausea, vomiting, arrhythmias, hypotension | Monitor ECG, oxygen and BP; use cautiously in children with hypokalemia |
| Vasopressin | Antidiuretic hormone analogue | Cardiac arrest, septic shock | 0.4-1 unit/kg bolus to max of 40 units | Fever, vertigo, dysrhythmias, hypertension, nausea, vomiting, abdominal cramps, urticaria | Monitor BP and distal pulses; watch for signs of water intoxication; tissue necrosis may develop from IV extravasation |
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