1.The 1-2-4 Rule
| Dose | Drug / therapy |
|---|---|
| 0.01 mg/kg | Epinephrine IV |
| 0.02 mg/kg | Atropine IV |
| 0.1 mg/kg | Adenosine IV, 1st dose |
| 0.2 mg/kg | Adenosine IV, 2nd dose |
| 1 mg/kg | Lidocaine IV/IO |
| 1 J/kg | Cardioversion (synchronized) |
| 2 J/kg | Defibrillation, 1st shock |
| 4 J/kg | Defibrillation, subsequent shocks |
Cardioversion is commonly rounded to 1 J/kg for recall; the precise PALS range is 0.5 to 1 J/kg for the first attempt, increasing to 2 J/kg if that fails. Everything else on this list matches the numeric PALS dosing exactly, including the max single doses: epinephrine caps at 1 mg, atropine has a 0.1 mg minimum and a 0.5 mg maximum single dose, adenosine at 6 mg first dose and 12 mg second dose.
2.Bonus Pearls
| Dose | Drug | Indication |
|---|---|---|
| 0.5 g/kg | Dextrose | Hypoglycemia |
| 5 mg/kg | Amiodarone IV/IO | VF / pulseless VT |
| 50 mg/kg | Magnesium sulfate IV | Severe bronchospasm or Torsades |
| 20 mg/kg | Calcium chloride IV | Hypocalcemia / hyperkalemia |
| 60 mg/kg | Calcium gluconate IV | Hyperkalemia |
Magnesium sulfate's PALS range is actually 25 to 50 mg/kg over 15 to 30 minutes, capped at 2 g total; 50 mg/kg is the correct number to use for a severe presentation, at the upper end of that range rather than a fixed single value.
3.CPR Tempo
Target compression rate: 100 to 120 per minute, per AHA guidance.
| Song | Tempo |
|---|---|
| Stayin' Alive | 104 BPM (commonly cited as 103-104) |
| Uptown Funk | 115 BPM |
| Can't Stop the Feeling! | 113 BPM |
| Dancing Queen | 101 BPM |
All four songs fall within the 100-120 BPM target range, and the two spot-checked against independent tempo listings (Uptown Funk, Can't Stop the Feeling) matched exactly.
4.Quick Reference Card & Primary Sources
| Category | Numbers to remember |
|---|---|
| Bradycardia | Epi 0.01 mg/kg, atropine 0.02 mg/kg |
| SVT | Adenosine 0.1 then 0.2 mg/kg |
| Shockable arrest | Defib 2 then 4 J/kg, amiodarone 5 mg/kg, lidocaine 1 mg/kg |
| Unstable tachycardia | Cardioversion 0.5-1 J/kg, then 2 J/kg if ineffective |
| Metabolic emergencies | Dextrose 0.5 g/kg, calcium chloride 20 mg/kg, calcium gluconate 60 mg/kg |
| Torsades / severe bronchospasm | Magnesium sulfate 25-50 mg/kg |
| Compression rate | 100-120/min; any song in that BPM range works as a mental metronome |
Primary sources checked for this guide:
- PALS Pediatric Cardiac Arrest Algorithm, current AHA-aligned reference (epinephrine, amiodarone, lidocaine, defibrillation energies).
- PALS Pediatric Bradycardia with a Pulse Algorithm (epinephrine, atropine dosing and maximums).
- PALS Pediatric Tachycardia with a Pulse Algorithm (adenosine dosing and maximums, cardioversion energies).
- Pediatric Drug Dose Chart, Queen's University Department of Anesthesiology, 2021 (dextrose, magnesium sulfate, lidocaine cross-reference).
- Calcium chloride and calcium gluconate hyperkalemia/hypocalcemia dosing, multiple cross-referenced pediatric emergency drug references.
- American Heart Association / American Red Cross CPR tempo guidance, 100-120 BPM; song-tempo cross-references (iHeart, ProCPR, Red Cross).