PALS Emergency Snapshot

Instantly compute weight-based resuscitation doses, equipment sizing, and hemodynamic targets. Data sourced from the Harriet Lane Handbook, 23rd edition—always verify locally before acting.

Chronologic Age

5.0 y

+ 0.0 months

Weight

18.0 kg

39.7 lb

Age (decimal)

5.0 y

Used for size & hemodynamic formulas

Emergency Drugs

Supraventricular tachycardia

Adenosine (initial)

Guideline: 0.1 mg/kg IV/IO rapid bolus

1.8 mg

Raw calculation: 1.8 mg

Flush immediately with 10 mL normal saline using a 3-way stopcock.

Supraventricular tachycardia

Adenosine (second dose)

Guideline: 0.2 mg/kg IV/IO

3.6 mg

Raw calculation: 3.6 mg

Give 2 minutes after initial dose if rhythm persists.

Supraventricular tachycardia

Adenosine (third dose)

Guideline: 0.3 mg/kg IV/IO

5.4 mg

Raw calculation: 5.4 mg

Maximum subsequent dose 12 mg.

Refractory VF/pVT or VT

Amiodarone

Guideline: 5 mg/kg IV/IO

90 mg

Raw calculation: 90 mg

No pulse: push undiluted. Pulse present: dilute and infuse over 20-60 minutes. Do not exceed 15 mg/kg or 2200 mg in 24 hours. Monitor for hypotension.

Symptomatic bradycardia / AV block

Atropine

Guideline: 0.02 mg/kg IV/IO/IM

0.36 mg

Raw calculation: 0.36 mg

May repeat once in 5 minutes to a max cumulative dose of 1 mg. ETT dose 0.04-0.06 mg/kg.

Hypocalcemia / Hyperkalemia / Calcium blocker toxicity

Calcium chloride 10%

Guideline: 20 mg/kg IV/IO

360 mg

Raw calculation: 360 mg

Administer slowly; may be given peripherally during arrest.

Hypocalcemia / Hyperkalemia / Calcium blocker toxicity

Calcium gluconate 10%

Guideline: 60 mg/kg IV/IO

1080 mg

Raw calculation: 1080 mg

Preferred for peripheral administration.

Hypoglycemia

Dextrose

Guideline: 0.5-1 g/kg IV/IO

9 – 18 g

Rule of 50: D10 5-10 mL/kg (<5 kg), D25 2-4 mL/kg (5-44 kg), D50 1-2 mL/kg (≥45 kg).

Pulseless arrest / bradycardia

Epinephrine (IV/IO)

Guideline: 0.01 mg/kg IV/IO (0.1 mg/mL)

0.18 mg

Raw calculation: 0.18 mg

Repeat every 3-5 minutes

ETT dosing: 0.1 mg/kg using 1 mg/mL concentration (max 2.5 mg).

Anaphylaxis

Epinephrine (IM for anaphylaxis)

Guideline: 0.01 mg/kg IM (1 mg/mL)

0.18 mg

Raw calculation: 0.18 mg

Auto-injectors: 0.1 mg for 7.5-15 kg, 0.15 mg for 15-30 kg, 0.3 mg for ≥30 kg. Repeat every 5-15 minutes as needed.

Adrenal crisis / insufficiency

Hydrocortisone

Guideline: 2 mg/kg IV/IM/IO

36 mg

Raw calculation: 36 mg

Single dose up to 100 mg.

Hyperkalemia

Insulin (regular)

Guideline: 0.1 units/kg IV/IO

1.8 units

Raw calculation: 1.8 units

Administer with 0.5 g/kg dextrose. Dilute for doses under 5 units (e.g., 1 unit/mL).

Antiarrhythmic

Lidocaine

Guideline: 1 mg/kg IV/IO

18 mg

Raw calculation: 18 mg

May repeat every 5 minutes to a total of 3 mg/kg. ETT dose 2-3 mg/kg.

Torsades / hypomagnesemia

Magnesium sulfate

Guideline: 50 mg/kg IV/IO

900 mg

Raw calculation: 900 mg

Dilute and infuse over 20-60 minutes when a pulse is present. Monitor for hypotension and bradycardia.

Opioid overdose

Naloxone (titrated)

Guideline: 0.001-0.005 mg/kg IV/IO/IM/SQ

0.02 – 0.09 mg

Max initial dose 0.1 mg. Titrate to adequate ventilation.

Opioid arrest

Naloxone (full reversal)

Guideline: 0.1 mg/kg IV/IO/IM/SQ

1.8 mg

Raw calculation: 1.8 mg

ETT dose is 2-3 times IV dose. Intranasal dosing up to 8 mg. Repeat every 2 minutes as needed.

Severe metabolic acidosis / hyperkalemia / TCA toxicity

Sodium bicarbonate 8.4%

Guideline: 1 mEq/kg IV/IO

18 mEq

Raw calculation: 18 mEq

Dilute 8.4% solution 1:1 with sterile water for patients under 10 kg (final 0.5 mEq/mL). Max single dose 50 mEq for hyperkalemia.

Airway & Vascular Equipment

Harriet Lane profile 4-6 years · 20-25 kg

Airway

Bag-valve mask: Child
Nasal airway: 14-18 Fr
Oral airway: Small (70-80 mm)
Laryngoscope blade: Miller 2 or Mac 2
Endotracheal tube: 4.5-5.0 mm
Laryngeal mask airway: Size 2.5
Video laryngoscope: Size 3

Vascular & Adjuncts

Peripheral IV catheter: 18-22 g
Central venous catheter: 5 Fr
NG/OG tube: 12-14 Fr
Chest tube: 20-28 Fr
Foley catheter: 8 Fr

Hemodynamics & Volumes

Systolic BP target (50th %)

100 mm Hg

Approximate normotensive systolic pressure.

Minimum systolic BP (5th %)

80 mm Hg

Use 60 mm Hg for neonates (<1 month) and 70 mm Hg for 1-12 months.

MAP (50th percentile)

62.5 mm Hg

Per Harriet Lane table; for premature infants MAP approximates gestational age.

MAP (5th percentile)

47.5 mm Hg

Per Harriet Lane table; consider gestational age for premature infants.

Estimated circulating blood volume

1440 mL

Liters: 1.44 L

80 mL/kg assumption

Resuscitation Adjuncts

Crystalloid bolus

360 mL

Liters: 0.36 L

Administer 20 mL/kg isotonic crystalloid; reassess after each bolus.

Defibrillation Energy

First shock: 36 J/kg
Second shock: 72 J/kg
Subsequent: 180 J/kg

Escalate up to 10 J/kg or adult dose.

Continuous Infusions

Medication	Dose (mcg/kg/min)	Dilution	Reference rate
Alprostadil (PGE1)	0.05-0.1	0.3 mg/kg in 100 mL compatible fluid	1 mL/hr = 0.05 mcg/kg/min
Amiodarone	5-15	6 mg/kg in 100 mL	1 mL/hr = 1 mcg/kg/min
Dobutamine	2-20	6 mg/kg in 100 mL	1 mL/hr = 1 mcg/kg/min
Dopamine	5-20	6 mg/kg in 100 mL	1 mL/hr = 1 mcg/kg/min
Epinephrine infusion	0.05-2	0.6 mg/kg in 100 mL	1 mL/hr = 0.1 mcg/kg/min
Lidocaine (post-arrest)	20-50	6 mg/kg in 100 mL	1 mL/hr = 1 mcg/kg/min
Phenylephrine	0.1-2	0.3 mg/kg in 100 mL	1 mL/hr = 0.05 mcg/kg/min
Terbutaline	0.1-4	0.6 mg/kg in 100 mL	1 mL/hr = 0.1 mcg/kg/min
Vasopressin (pressor)	0.17-0.8	6 units/kg in 100 mL	1 mL/hr = 1 milliunit/kg/min Confirm institutional protocol for titration.

Glasgow Coma Scale Reference

Domain	Child / Adult	Infant
Eye opening	4Spontaneous 3To speech 2To pain 1None	4Spontaneous 3To speech/sound 2To painful stimuli 1None
Verbal	5Oriented 4Confused 3Inappropriate words 2Incomprehensible sounds 1None	5Coos/babbles 4Irritable cry 3Cries to pain 2Moans to pain 1None
Motor	6Obeys commands 5Localizes to pain 4Withdraws to pain 3Abnormal flexion (decorticate) 2Abnormal extension (decerebrate) 1None (flaccid)	6Normal spontaneous movement 5Withdraws to touch 4Withdraws to pain 3Abnormal flexion (decorticate) 2Abnormal extension (decerebrate) 1None (flaccid)

Reference: Harriet Lane Handbook, 23rd ed. (matches bedside card gcs_pediahelper.png).

Derived from Harriet Lane Handbook, 23rd ed.. Emergency parameters adapted from resuscitation medication and equipment tables. Always cross-check with the latest institutional protocols and patient-specific contraindications.