Pediatric Critical Care Reference guide (PICU Charts): PICU Handbook
May 20, 2022
PICU Charts
| Drug | Dose (IV) | Comment |
| Levetiracetam (Keppra) |
50 mg/Kg load over 15 minutes |
Max dose: 2500 mg |
| Phenobarbital | 15–20 mg/Kg load at 1 mg/Kg/min |
May cause hypotension Max dose: 1Gm |
| Phenytoin or Fosphenytoin |
15–20 mg/Kg load at 1 mg/Kg/min 15–20 mg PE*/Kg at 2–3 mg PE*/Kg/min |
Max dose: 1Gm, must dilute phenytoin in NS and fi lter |
*PE Phenytoin Equivalents
| Drug | Dose (IV) |
| Alprostadil | 0.01–0.1 mcg/Kg/min 0.02–0.05 mcg/Kg/min typical range |
| Amiodarone | 10 mg/Kg/day for 4–5 days then 5 mg/Kg/day |
| Dobutamine** | Renal dose: 1–3 mcg/Kg/min; β dose 5–10 mcg/Kg/min; α dose 10–20 mcg/Kg/min |
| Epinephrine** | 0.01–1 mcg/Kg/min 0.01–0.5 mcg/Kg/min typical range |
| Esmolol | Load: 500 mcg/Kg Maintenance: 50–1000 mcg/Kg/min |
| Isoproterenol | 0.05–2 mcg/Kg/min 0.1–0.5 mcg/Kg/min typical range |
| Lidocaine | Load: 1 mg/Kg Maintenance: 10–50 mcg/Kg/min |
| Milrinone | Load: 50–75 mcg/Kg IV over 10 minutes 0.25–1 mcg/Kg/min 0.5–1 mcg/Kg/min typical range |
| Nitroglycerin | 0.5–20 mcg/Kg/min 0.5–5 mcg/Kg/min typical range |
| Nitroprusside | 0.3–10 mcg/Kg/min 0.5–2 mcg/Kg/min typical range |
| Norepinephrine** | 0.02–2 mcg/Kg/min 0.01–0.5 mcg/Kg/min typical range |
| Phentolamine | 0.5–20 mcg/Kg/min 1–5 mcg/Kg/min typical range |
| Phenylephrine** | 0.1–10 mcg/Kg/min 0.5–5 mcg/Kg/min typical range |
| Vasopressin** | Cardiovascular support: 0.05–2 milli–units/Kg/min 0.1–0.5 milli–units/Kg/min typical range Diabetes Insipidus dose: 1–10 milli–units/Kg/hr |
** Central line preferred
*** Central line preferred, but short duration peripheral IV acceptable
| Drug | Dose (IV) | Comment |
| Adenosine | 0.1 mg/Kg (Max dose: 6 mg) IV |
Give rapidly No effect in 2 min: 0.2–0.3 mg/Kg (Max dose: 12mg) |
| Albuterol | MDI: 4–8 puffs q 20 min with spacer or through ETT Neb: 2.5 mg (<20 Kg) and 5 mg (> 20 Kg) q 20 min Continuous Neb: 0.5 mg/Kg/hr |
Asthma, Anaphylaxis, Hyperkalemia |
| Amiodarone | 5 mg/Kg IV/IO* | Give rapid bolus for V. Fib/pulseless VT Give over 20–60 min for SVT and ventricular dysrhythmias |
| Atropine | 0.02 mg/Kg IV (may give ETT) |
Max dose: 0.5 mg (child) 1 mg (adolescent) |
| Calcium Chloride 10%** | 20 mg/Kg IV | Give slowly (Max. rate 100 mg/min) Max dose: 1 Gm/dose Give in central line if available** |
| Dexamethasone | 0.6 mg/Kg PO/IM/IV | Max dose: 16 mg |
| Dextrose | 500 mg/Kg IV | 1–2 ml/Kg D50W Child 2–4 ml/Kg D25W Infant 2–3 ml/Kg D10W NICU |
| Epinephrine (Anaphylaxis) | Anaphylaxis IM: 0.01 mg/Kg (0.01 ml/Kg) 1:1,000 |
Anaphylaxis Max dose: 0.3 mg or 0.3 ml |
| Epinephrine (Code) |
PICU/PEDS NICU |
Repeat q 3–5 min. for code |
| Epinephrine (Racemic) | 0.25–0.5 ml racemic solution (2.25%) mixed in 3 ml saline via inhalation 3 ml of 1:1000 epinephrine mixed with 3 ml saline via inhalation is alternative if racemic epi not available |
Croup |
| Flumazenil | 0.01 mg/Kg IV (Max dose: 0.2 mg) |
Give over 15 seconds May repeat at 1 minute intervals up to 4 times Max total dose: 0.05 mg/ Kg or 1 mg, whichever is lower |
| Furosemide | 0.5–1 mg/Kg IV | Congestive heart failure Use lower dose in furosemide naive patients |
| Hydrocortisone | 2 mg/Kg IV bolus | Adrenal insuffi ciency, catecholamine refractory shock |
| Insulin (regular) | 0.05–0.1 Units/Kg bolus IV or SQ 0.05–0.1 Units/Kg/hr infusion |
Diabetic Ketoacidosis (Infusion preferred to bolus dosing) |
| Lidocaine 2% | 1 mg/Kg IV/IO* | May repeat dose in 10–20 min. |
| Magnesium Sulfate | 25 mg/Kg IV/IO* | Give over 10–20 min; faster in Torsades de Pointes Max dose: 2 Gm |
| Methylprednisolone | 2 mg/Kg IV/IO/IM | Status Asthmaticus, Anaphylaxis Max dose: 60 mg; use only acetate salt for IM |
| Naloxone | 0.01 mg/Kg IV/ET | Titrate to effect Max dose: 2 mg |
| Nicardipine | 0.5–4 mcg/Kg/min IV | Hypertensive urgency/Emergency |
| Sodium Bicarbonate | 1 mEq/Kg IV | Use 1 mEq/ml for > 6 months Use 0.5 mEq/ml for < 6 months |
| Terbutaline | 10 mcg/Kg SQ q 15 min 0.1–10 mcg/Kg/min IV |
Refractory status Asthmaticus Max dose: 0.4 mg |
| Vasopressin | 0.5 units/Kg IV/IO* | Max dose: 40 units |
** Central line preferred
*** Central line preferred, but short duration peripheral IV acceptable
| Equipment | < 3Kg | 3-5 Kg | Small Infant 6-7 Kg |
Infant 8-9 Kg |
Toddler 10-11 Kg |
Small child 12-14 Kg |
Child 15-18 Kg |
Child 19-23 Kg |
Large Child 24-29 Kg |
Adult 30-36 Kg |
| Resuscitation Bag | Infant/Child | Infant/Child | Child | Child | Child | Child | Child | Adult | ||
| Oxygen Mask (NRB) | Pediatric | Pediatric | Pediatric | Pediatric | Pediatric | Pediatric | Pediatric | Pediatric/Adult | ||
| Oral Airway (mm) | 50 | 50 | 60 | 60 | 60 | 70 | 80 | 80 | ||
| Laryngoscope Blade (size) | 1 Straight | 1 Straight | 1 Straight | 2 Straight | 2 Straight | 2 Straight or Curved | 2 Straight or Curved | 3 Straight or Curved | ||
| ET Tube (mm)† | < 1 Kg 2.5 Uncuffed 1-2 Kg 3.0 Uncuffed |
2-4 Kg 3.5 Uncuffed 5 Kg 3.5 Uncuffed |
3.5 Uncuffed 3.0 Cuffed |
3.5 Uncuffed 3.0 Cuffed |
4.0 Uncuffed 3.5 Cuffed |
4.5 Uncuffed 4.0 Cuffed |
5.0 Uncuffed 4.5 Cuffed |
5.5 Uncuffed 5.0 Cuffed |
6.0 Cuffed | 6.5 Cuffed |
| ET Tube Insertion Length (cm) | 0.5 Kg: 6.5 1 Kg: 7 2 Kg: 8 |
3 Kg: 9-9.5 4 Kg: 9.5-10 5 Kg: 10-10.5 |
10.5-11 | 10.5-11 | 11-12 | 13.5 | 14-15 | 16.5 | 17-18 | 18.5-19.5 |
| Suction Catheter (F) | 8 | 8 | 10 | 10 | 10 | 10 | 10 | 10-12 | ||
| BP Cuff | Neonatal #5/Infant | Infant/Child | Infant/Child | Child | Child | Child | Child | Child | Small Adult | |
| IV Catheter (ga) | 22-24 | 22-24 | 20-24 | 18-22 | 18-22 | 18-20 | 18-20 | 16-20 | ||
| IO (ga) | 18/15 | 18/15 | 15 | 15 | 15 | 15 | 15 | 15 | ||
| NG Tube (F) | 5-8 | 5-8 | 8-10 | 10 | 10 | 12-14 | 14-18 | 16-18 | ||
| Urinary Catheter (F) | 5 | 8 | 8 | 8-10 | 10 | 10-12 | 10-12 | 12 | 12 | |
| Chest Tube (F) | 10-12 | 10-12 | 16-20 | 20-24 | 20-24 | 24-32 | 28-32 | 32-38 |
Abbreviations: BP, blood pressure; ET, endotracheal; F, French; IO, intraosseous; IV, intravenous; NG, nasogastric; NRB, nonrebreathing; ga, gauge; mm, millimeters; cm, centimeters
†Per 2010 AHA Guidelines, in the hospital cuffed or uncuffed tubesmay be used (see below for sizing of cuffed tubes).
Modified with permission from Artemis Pediatric software © 2012 eBroselow.
- Fluid Bolus: LR, NS, 5% Albumin 10–20 ml/Kg bolus
- PRBC: 10 ml/Kg will increase Hct 5%
- FFP: 10 ml/Kg for prolonged INR/PT/PTT
- Platelets: 10ml/Kg for platelet counts <25,000/mm3 with active bleeding
| Child | Infant | Score | |
| Eye Opening | Spontaneous | Spontaneous | 4 |
| To speech | To speech | 3 | |
| To pain | To pain | 2 | |
| None | None | 1 | |
| Best Verbal Response | Oriented, Appropriate | Coos and babbles | 5 |
| Confused | Irritable, cries | 4 | |
| Inappropriate words | Cries in response to pain | 3 | |
| Incomprehensible sounds | Moans in response to pain | 2 | |
| None | None | 1 | |
| Best Motor Response | Obeys commands | Moves spontaneously and purposefully | 6 |
| Localizes painful stimuli | Withdraws in response to touch | 5 | |
| Withdraws in response to pain | Withdraws in response to pain | 4 | |
| Flexion in response to pain | Abnormal flexion posture to pain | 3 | |
| Extension in response to pain | Abnormal extension posture to pain | 2 | |
| None | None | 1 | |
| Total Score | 3–15 |
| Age | Systolic Pressure (mmHg) |
| Term Neonates | < 60 |
| Infants | < 70 |
| Children 1–10 years | < 70 + (age in years x 2) |
| Children > 10 years | < 90 |
Ventilation support required
| Drug | Dose (IV) |
| Rocuronium* | 1 mg/Kg/dose |
| Succinylcholine* | 1 mg/Kg/dose |
| Vecuronium | 0.1 mg/Kg/dose |
* Preferred for Rapid Sequence Intubation (RSI)
| Drug | Dose (IV) | Comment |
| Dexmedetomidine | Bolus 0.5–1 mcg/Kg over 10 minutes Infusion: 0.25–1 mcg/ Kg/hr |
Avoid in patients with heart block |
| Etomidate | 0.3 mg/Kg/dose | Avoid in septic shock Adrenal suppression |
| Fentanyl | 1 mcg/Kg/dose IV q 30–60 minutes Max dose: 300 mcg total Continuous: 1 mcg/Kg/hr |
Rigid chest with rapid administration |
| Ketamine | 1 mg/Kg/dose (consider with asthma) |
Bronchodilator |
| Lorazepam | 0.05–0.1 mg/Kg/dose q 4–6 hours Max dose: 4 mg |
|
| Midazolam | 0.1 mg/Kg | Avoid in hemodynamically unstable patient |
| Morphine | 0.1– 0.15 mg/Kg IV q 3–4 hours Continuous: 10 –30 mcg/Kg/hr |
Ventilated patients may receive larger doses, more frequent intervals Avoid in asthma patients |
| Pentobarbital | 1–3 mg/Kg (max 100 mg) –– sedation 10–15 mg/Kg load (< 5 mg/Kg/hr), then 1–5 mg/ Kg/hr–– therapeutic coma |
Avoid in hemodynamically unstable patient |
| Propofol | 25–100 mcg/Kg/min (short term use only) |
Avoid in hemodynamically unstable patient |
| Age | Systolic | Diastolic |
| Neonate | 60–90 | 20–60 |
| Infant | 87–105 | 53–66 |
| Toddler | 95–105 | 53–66 |
| Preschooler | 95–110 | 56–70 |
| School–Aged Child | 97–112 | 57–71 |
| Adolescent | 112–128 | 66–80 |
50th precentile systolic blood pressure= 90 mmHg + (2 x age in years)
| Age | Awake | Asleep |
| Newborn to 3 months | 85-200 | 80-160 |
| 3 months–2 years | 100-190 | 75-160 |
| 2–10 years | 60-140 | 60-90 |
| > 10 years | 60-100 | 50-90 |
| Age | Respiratory Rate (breaths/min) |
| Infant | 30–60 |
| Toddler | 24–40 |
| Preschooler | 22–34 |
| School–Aged Child | 18–30 |
| Adolescent | 12–16 |