The Critical Vector · Pocket Reference

Emergency Medicine Drug Guide: Pediatric & Adult

Built from a UW Health Kids pediatric emergency card, expanded with adult dosing throughout and organized for actual EM use: a function-based quick-recall table up front (vasopressors, antiarrhythmics, paralytics, reversal agents, and more, all in one scan), then full clinical-scenario context after. Verified against current ACLS/PALS, status epilepticus, and toxicology literature — including a real 2026 dosing change and an adult/peds divergence worth knowing. Verified against AHA, ANZCOR, and primary emergency medicine literature. July 2026.

Two things changed or diverged recently and are flagged where they appear: the 2026 AHA update doubled the adult atropine starting dose for symptomatic bradycardia from 0.5 mg to 1 mg, and vasopressin has been removed from the adult ACLS algorithm entirely — while pediatric arrest protocols (including the source card) still use it. Don't cross-apply doses between the two populations.
01

Quick Recall: Dosing by Drug Function

One scan, whatever the scenario — organized by what you reach for, not which diagnosis it's filed under

This is the fast-access index. Every number here is repeated in its full clinical-scenario context later in the document (sections 3–13) — use this table to grab a dose in seconds, and the later sections when you need the surrounding decision-making.

Resuscitation Drugs

The core code-cart drugs — mirrors the source card's own dedicated "resuscitation drugs" list, first and fastest to find.

DrugPediatricAdult
Epinephrine0.01 mg/kg IV/IO (0.1 mg/mL); 0.1 mg/kg ETT (1 mg/mL)1 mg IV/IO q3–5min (arrest); 0.3–0.5 mg IM (1 mg/mL) for anaphylaxis
DextroseD50 1–2 mL/kg (adolescent); D25 2–4 mL/kg (child); D10 5–10 mL/kg (infant)D50 25–50 mL IV
Atropine0.02 mg/kg IV/IO or ETT (min 0.1 mg, max child 0.5 mg, adolescent 1 mg)1 mg IV q3–5min, max 3 mg (2026 update — was 0.5 mg)
Amiodarone5 mg/kg IV/IO push, refractory VT/VF (max 300 mg); 5 mg/kg over 20 min for perfusing VT300 mg first dose, 150 mg second dose, refractory VF/pVT
Calcium chloride10–30 mg/kg IV/IO (central access preferred)500–1000 mg IV via central line
Calcium gluconate50–100 mg/kg IV/IO (max 3 g)1–3 g IV over 2–3 min
Lidocaine1 mg/kg IV/IO bolus; 2–3 mg/kg ETT (min volume 1 mL)1–1.5 mg/kg IV/IO (repeat to max 3 mg/kg); drip 20–50 mcg/kg/min
Magnesium sulfate25–50 mg/kg IV/IO (max 2 g); torsades dosing1–2 g IV (torsades)
Vasopressin0.5 units/kg IV/IO (max 40 units)Removed from adult arrest algorithm (see section 9)
Sodium bicarbonate1–2 mEq/kg IV/IO50 mEq IV
Mannitol0.25–1 g/kg IV/IO0.25–1 g/kg IV; avoid if osmolality >320 mOsm/L

Vasopressors / Inotropes

DrugPediatricAdult
Epinephrine (infusion)0.1–1 mcg/kg/min1–10 mcg/min (peri-arrest); titrate to effect
Norepinephrine0.05–2 mcg/kg/min0.05–2 mcg/kg/min typical, some critical care protocols extend to 3 mcg/kg/min — current first-line adult vasopressor
Dopamine2–20 mcg/kg/min2–20 mcg/kg/min — second-line, largely supplanted by norepi
Dobutamine2–20 mcg/kg/min2–20 mcg/kg/min
Vasopressin0.5 units/kg bolus (arrest); infusion 0.0002–0.002 units/kg/minRemoved from adult arrest algorithm; 0.01–0.04 units/min as adjunct vasopressor in septic shock
Phenylephrine5–20 mcg/kg slow push (max 200 mcg); drip 0.1–0.5 mcg/kg/min50–200 mcg IV push; drip 0.5–6 mcg/kg/min (septic/vasodilatory shock, FDA label) or 0.5–1.4 mcg/kg/min (routine perioperative maintenance) — not exceed 200 mcg/min; doses above 6 mcg/kg/min show no further BP benefit

Antiarrhythmics

DrugPediatricAdult
Amiodarone5 mg/kg IV/IO push, refractory VT/VF (max 300 mg)300 mg first dose, 150 mg second, refractory VF/pVT; 150 mg over 10 min for stable wide-complex tachycardia
Lidocaine1 mg/kg IV/IO bolus1–1.5 mg/kg IV/IO (can repeat to max 3 mg/kg); drip 20–50 mcg/kg/min
Adenosine0.1 mg/kg rapid push (max 6 mg), then 0.2 mg/kg (max 12 mg)6 mg rapid push + flush; repeat 12 mg once
Procainamide15 mg/kg IV/IO over 30–60 min15–17 mg/kg (or 20–50 mg/min) IV, max total 17 mg/kg

Bradycardia / Chronotropic

DrugPediatricAdult
Atropine0.02 mg/kg IV/IO (min 0.1 mg, max 0.5 mg child/1 mg adolescent)1 mg IV q3–5min, max 3 mg (2026 update — was 0.5 mg)

Induction / Sedation

DrugPediatric (RSI)Adult (RSI)
Etomidate0.2–0.4 mg/kg IV/IO0.3 mg/kg IV
Ketamine2 mg/kg IV/IO1–2 mg/kg IV
Propofol2 mg/kg IV/IO1.5–2.5 mg/kg IV
Midazolam0.1–0.3 mg/kg IV/IO0.1–0.3 mg/kg IV

Paralytics (Neuromuscular Blockers)

DrugPediatricAdult
Succinylcholine1–2 mg/kg IV/IO1–1.5 mg/kg IV
Rocuronium1.2 mg/kg IV/IO1–1.2 mg/kg IV
Vecuronium0.1–0.2 mg/kg, then 0.1 mg/kg/hr0.08–0.1 mg/kg, then 0.8–1.2 mcg/kg/min

Reversal Agents

DrugPediatricAdult
Naloxone0.1 mg/kg IV/IO/IM/ETT (max 2 mg)0.4–2 mg IV/IM/IN, titrate
Flumazenil0.01 mg/kg IV/IO (max 0.2 mg)0.2 mg IV, repeat q1min (max 1 mg)

Anticonvulsants

DrugPediatricAdult
Lorazepam0.05–0.1 mg/kg IV/IO4 mg IV push (up to 8 mg)
Midazolam (seizure)0.3 mg/kg IN (max 10 mg)10 mg IM if no IV access
Diazepam0.05–0.1 mg/kg IV/IO; 0.3–0.5 mg/kg PR10–20 mg IV
Fosphenytoin20 mg PE/kg IV/IO/IM20 mg PE/kg IV (max ~1500 mg PE)
Levetiracetam20 mg/kg IV/IO60 mg/kg IV (max 4500 mg)
Phenobarbital20 mg/kg IV/IO15–20 mg/kg IV, slow infusion

Steroids

DrugPediatricAdult
Methylprednisolone2 mg/kg IV/IO/IM (max 125 mg)125 mg IV
Hydrocortisone1–2 mg/kg IV/IO/IM100 mg IV stress-dose
Dexamethasone0.6 mg/kg IV/IO/IM/PO (max 10 mg, croup)10 mg IV (post-extubation stridor, off-label)
Prednisolone2 mg/kg PO (max 60 mg)40–60 mg PO

Antihistamines / H2 Blockers

DrugPediatricAdult
Diphenhydramine1 mg/kg IV/IO/IM/PO (max 50 mg)25–50 mg IV/IM/PO
FamotidineNot standard first-line pediatric (ranitidine historically used, now withdrawn)20 mg IV — current H2 blocker of choice since ranitidine's 2020 withdrawal

Antihypertensives

DrugPediatricAdult
Labetalol0.25–1.5 mg/kg IV/IO (max 20 mg); drip 0.25–1 mg/kg/hr10–20 mg IV, double q10min (max 300 mg); drip 0.5–2 mg/min
Hydralazine0.1–0.4 mg/kg IV/IO10–20 mg IV q4–6h
Nitroprusside0.3–8 mcg/kg/min0.3–10 mcg/kg/min
NicardipineNot standard pediatric first-line5–15 mg/hr infusion — often preferred over nitroprusside

Analgesics

DrugPediatricAdult
Fentanyl1–2 mcg/kg IV/IO; 1.5 mcg/kg IN (max 50 mcg)50–100 mcg IV/IN, titrate
Morphine0.05–0.1 mg/kg IV/IO/IM2–4 mg IV, titrate
Hydromorphone0.01–0.015 mg/kg IV/IO/IM0.5–1 mg IV, titrate
Ketorolac0.5 mg/kg IV/IO/IM (max 30 mg)15–30 mg IV/IM
Acetaminophen15 mg/kg/dose PO/PR q4h650–1000 mg PO/PR/IV q4–6h
Ibuprofen10 mg/kg/dose PO q6h400–800 mg PO q6–8h

Antiemetics

DrugPediatricAdult
Ondansetron0.15 mg/kg IV/IO/PO (max 4 mg)4–8 mg IV/PO

Metabolic / Electrolyte Emergency

DrugPediatricAdult
Calcium gluconate50–100 mg/kg IV/IO over 3 min (max 3 g)1–3 g IV over 2–3 min
Calcium chloride10–30 mg/kg IV/IO (central access preferred)500–1000 mg IV via central line
Sodium bicarbonate1–2 mEq/kg IV/IO50 mEq IV
Dextrose (hypoglycemia)D10 5–10 mL/kg (infant); D25 2–4 mL/kg (child); D50 1–2 mL/kg (adolescent)D50 25–50 mL IV
Insulin (DKA)0.1 units/kg/hr IV (no bolus)0.1 units/kg/hr IV infusion (no bolus)
Magnesium sulfate25–50 mg/kg IV over 20 min (max 2000 mg)1–2 g IV (torsades); 2 g over 20 min (asthma)
Glucagon0.02 mg/kg IV/IM/SQ (max 1 mg)1 mg IV/IM/SQ (0.5–1 mg for beta-blocker/CCB OD)
02

Vitals & Airway Parameters by Age

AgeWeight (kg)HR rangeRR/minSBPET tube ID (mm, cuffed)Laryngoscopy bladeChest tube (Fr)
Preterm<3120–16040–6040–602.5–3.0 (uncuffed)Miller 08–10
Term3100–16540–6060–802.5–3.0Miller 110–12
1 month4120–18040–6065–952.5–3.0Miller 110–12
6 months8110–18525–4065–1053.5–4.0Miller 112–16
12 months10110–17020–3070–1103.5–4.0Miller 1–214–24
2 years1290–15020–3070–1104.0–4.5Miller/Mac 1–214–24
4 years1675–13520–3080–1104.5–5.0Mac 220–32
6 years2060–13012–2590–1155.0–5.5Mac 220–32
8 years2660–12012–2590–1156.0Mac 2–328–38
10 years3260–12012–2595–1206.0–6.5Mac 2–328–38
12 years4260–12012–2595–1206.5Mac 332–42
14 years5060–12012–18100–1306.5–7.0Mac 332–42
Adult—60–10012–2090–1407.0–8.0 (M), 6.5–7.5 (F)Mac 3–428–40 (36–40 trauma/hemothorax)

Adult ET tube size is a starting estimate — always confirm with the patient's actual anatomy; adult chest tube sizing follows the indication-based table in the ballistics manual (simple pneumothorax vs. hemothorax vs. empyema) rather than a single fixed number.

03

Rapid Sequence Intubation

Premedication

Pediatric

Atropine0.02 mg/kg IV/IO (min 0.1 mg, max 0.5 mg child/1 mg adolescent)
Lidocaine1.5 mg/kg IV/IO (if ↑ICP)
Fentanyl1 mcg/kg IV/IO (if ↑ICP)

Adult

AtropineNot routinely used for RSI premedication in adults — reserved for symptomatic bradycardia (section 8)
Lidocaine1–1.5 mg/kg IV, 2–3 min pre-induction if ↑ICP (evidence for blunting ICP response is weaker than historically taught)
Fentanyl1–3 mcg/kg IV, blunts sympathetic response to laryngoscopy

Sedation / Induction

Pediatric

Etomidate0.2–0.4 mg/kg IV/IO
Midazolam0.1–0.3 mg/kg IV/IO
Ketamine2 mg/kg IV/IO
Propofol2 mg/kg IV/IO (drip 25–125 mcg/kg/min)

Adult

Etomidate0.3 mg/kg IV — caution: adrenal suppression, avoid as sole agent in septic shock per some guidance
Midazolam0.1–0.3 mg/kg IV — less hemodynamically predictable than etomidate/ketamine for RSI
Ketamine1–2 mg/kg IV — preferred in hypotension/bronchospasm; caution with severe hypertension or psychosis history
Propofol1.5–2.5 mg/kg IV — caution: hypotension, avoid as primary induction in shock

Paralysis

Pediatric

Succinylcholine1–2 mg/kg IV/IO — avoid if hyperK, malignant hyperthermia, neuromuscular disease
Rocuronium1.2 mg/kg IV/IO
Vecuronium0.1–0.2 mg/kg, then 0.1 mg/kg/hr maintenance

Adult

Succinylcholine1–1.5 mg/kg IV — same contraindications; additionally caution in burns/crush >24–48h old, denervation
Rocuronium1–1.2 mg/kg IV — full details on high-dose rationale and reversal in the dedicated rocuronium/first-pass-success reference
Vecuronium0.08–0.1 mg/kg, then 0.8–1.2 mcg/kg/min maintenance
04

Seizures / Status Epilepticus

Pediatric

Lorazepam0.05–0.1 mg/kg IV/IO
Midazolam0.3 mg/kg IN (max 10 mg)
Diazepam0.05–0.1 mg/kg IV/IO; 0.3–0.5 mg/kg PR
Phenobarbital20 mg/kg IV/IO
Fosphenytoin20 mg PE/kg IV/IO/IM
Levetiracetam20 mg/kg IV/IO

Adult

Lorazepam4 mg IV push (up to 8 mg in alcohol use/high BMI); repeat q2–3 min
Midazolam10 mg IM if no IV access (RAMPART protocol)
Diazepam10–20 mg IV (0.15 mg/kg, up to 10 mg per some guidelines)
Fosphenytoin20 mg PE/kg IV (max ~1500 mg PE)
Levetiracetam60 mg/kg IV (max 4500 mg) — increasingly favored second-line agent

The most common real-world failure isn't drug choice — it's underdosing. A 2025 ED cohort study found guideline-adherent initial benzodiazepine dosing in only 17% of patients, with inadequate dosing rates of 77% for lorazepam, 90% for midazolam, and 97% for diazepam — and inadequate total dosing was independently associated with higher in-hospital mortality. Push the full weight-based or fixed adult dose; don't split it "to be safe."

05

Increased Intracranial Pressure

Pediatric

Mannitol0.5–1 g/kg IV/IO
3% Saline2–6 mL/kg IV/IO

Adult

Mannitol0.25–1 g/kg IV; avoid if osmolality >320 mOsm/L
3% Saline150–250 mL bolus; cap correction at 8 mEq/L/24h

Full mechanism comparison, the meta-analytic evidence (including where it contradicts itself), and the bedside decision framework for choosing between these two agents live in the dedicated hypertonic saline vs. mannitol reference — this table is the dosing quick-reference only.

06

Hyperkalemia & Endocrine

Hyperkalemia

Pediatric

Albuterol neb0.15 mg/kg/dose (2.5 or 5 mg)
Sodium bicarbonate1–2 mEq/kg IV/IO
Calcium gluconate50–100 mg/kg IV/IO over 3 min (max 3 g)
Dextrose + insulinRegular insulin 0.1 units/kg (max 10 units) IV/IO + dextrose 0.5 g/kg (max 25 g; D10W 5 mL/kg) given together; check glucose for hypoglycemia
Sodium polystyrene sulfonate1 g/kg PO/PR (max 30 g PO, 50 g PR)
Furosemide1–2 mg/kg IV/IO/PO

Adult

Albuterol neb10–20 mg nebulized (higher than the standard bronchodilator dose)
Sodium bicarbonate50 mEq IV, most useful if concurrent metabolic acidosis
Calcium gluconate1–3 g IV over 2–3 min (or calcium chloride 500–1000 mg via central line)
Dextrose + insulinD50 25 g IV + regular insulin 10 units IV
Sodium zirconium/patiromerNewer binders, onset hours not minutes — not for acute stabilization
Furosemide20–40 mg IV if adequate renal function/urine output

Endocrine

Pediatric

DextroseD50 1–2 mL/kg (adolescent); D25 2–4 mL/kg (child); D10 5–10 mL/kg (infant)
Glucagon0.02 mg/kg IV/IM/SQ (max 1 mg)
Hydrocortisone1–2 mg/kg IV/IO/IM (~25 mg infant, 50 mg child, 100 mg adolescent)
Insulin0.1 units/kg/hr IV (no bolus)

Adult

DextroseD50 25–50 mL (12.5–25 g) IV
Glucagon1 mg IV/IM/SQ (0.5–1 mg if beta-blocker/CCB overdose, may need repeat dosing or infusion)
Hydrocortisone100 mg IV (stress-dose) — 50–100 mg IV q6–8h if adrenal crisis
Insulin (DKA)0.1 units/kg/hr IV infusion (no bolus per current guidance in most protocols)
07

Anaphylaxis

Pediatric

Epinephrine0.01 mg/kg IM (1 mg/mL) (max 0.5 mg/dose)
Diphenhydramine1 mg/kg IV/IO/IM/PO (max 50 mg)
Methylprednisolone2 mg/kg IV/IO/IM initial (max 125 mg)
Ranitidine/H2 blocker2 mg/kg IV/IO/PO (max 150 mg)

Adult

Epinephrine0.3–0.5 mg IM (1 mg/mL), anterolateral thigh — repeat q5–15 min as needed
Diphenhydramine25–50 mg IV/IM/PO
Methylprednisolone125 mg IV (or prednisone 40–60 mg PO if tolerating oral)
Famotidine20 mg IV (ranitidine largely withdrawn from the US market since 2020 — famotidine is the current H2 blocker of choice)

Epinephrine is the only intervention proven to reduce mortality in anaphylaxis — antihistamines and steroids treat symptoms and prevent biphasic reactions but are not substitutes for epi, in either population.

08

Asthma & Croup

Asthma / Bronchospasm

Pediatric

Albuterol0.15 mg/kg/dose neb (2.5–5 mg); MDI 4–8 puffs
Continuous albuterol0.5 mg/kg/hr (max 15 mg/hr)
Ipratropium250 mcg (child), 500 mcg (adolescent)
Methylprednisolone2 mg/kg IV/IO (max 125 mg)
Magnesium sulfate25–50 mg/kg IV over 20 min (max 2000 mg)
Terbutaline2–10 mcg/kg loading, then 0.1–0.8 mcg/kg/min infusion

Adult

Albuterol2.5–5 mg neb q20min x3, then q1–4h; MDI 4–8 puffs
Continuous albuterol10–15 mg/hr continuous nebulized
Ipratropium500 mcg neb, combined with albuterol first 3 doses
Methylprednisolone125 mg IV (or prednisone 40–60 mg PO)
Magnesium sulfate2 g IV over 20 min — reserved for severe exacerbations
Terbutaline0.25 mg SQ, may repeat once in 15–30 min

Upper Airway Obstruction / Croup

Pediatric

Racemic epinephrine0.5 mL (2.25%) in 3 mL NS nebulized
Dexamethasone0.6 mg/kg IV/IO/IM/PO (max 10 mg)

Adult

Croup is overwhelmingly a pediatric condition (narrow subglottic airway). Adult upper airway obstruction from other causes (angioedema, epiglottitis, anaphylaxis) is managed per the specific etiology — nebulized racemic epinephrine is used off-label in adult post-extubation stridor at similar dosing, with dexamethasone 10 mg IV as a common adjunct.
09

Cardiac Arrest & Electrical Therapy

Two recent changes worth knowing precisely: the 2026 AHA update doubled the adult atropine starting dose for symptomatic bradycardia from 0.5 mg to 1 mg IV, repeated q3–5 min to a max of 3 mg. Separately, vasopressin has been removed from the adult ACLS cardiac arrest algorithm — ANZCOR explicitly suggests against substituting vasopressin for epinephrine or adding it alongside epinephrine, since combined trial evidence (PARAMEDIC2, PACA) showed no neurological outcome benefit. Pediatric arrest protocols, including the source card here, still specify vasopressin 0.5 units/kg — the two populations have genuinely diverged on this drug.

Pediatric

Epinephrine0.01 mg/kg IV/IO (0.1 mg/mL); 0.1 mg/kg ETT (1 mg/mL)
Amiodarone5 mg/kg IV/IO push, refractory VT/VF (max 300 mg)
Lidocaine1 mg/kg IV/IO bolus; 2–3 mg/kg ETT
Vasopressin0.5 units/kg IV/IO (max 40 units)
Defibrillation2 J/kg, then 4 J/kg (do not exceed adult max)
Synchronized cardioversion0.5–1 J/kg, then 2 J/kg

Adult

Epinephrine1 mg IV/IO q3–5 min
Amiodarone300 mg IV/IO first dose, 150 mg second dose, refractory VF/pVT
Lidocaine1–1.5 mg/kg IV/IO, alternative to amiodarone
Atropine1 mg IV q3–5 min, max 3 mg (2026 update — was 0.5 mg)
VasopressinRemoved from current adult ACLS algorithm
DefibrillationBiphasic, manufacturer-recommended (commonly 120–200 J)
Synchronized cardioversionPer rhythm — narrow regular 50–100J, narrow irregular/wide 120–200J

Calcium chloride (10–30 mg/kg peds; 1 g adult, central line preferred) and sodium bicarbonate (1–2 mEq/kg peds; 1 mEq/kg adult) are not routine cardiac arrest drugs in either population per current guidance — reserved specifically for suspected hyperkalemia, calcium channel blocker toxicity, or severe pre-existing acidosis.

10

Pressors & Antihypertensives

Pediatric

Dopamine2–20 mcg/kg/min IV/IO
Dobutamine2–20 mcg/kg/min IV/IO
Adenosine0.1 mg/kg rapid IV/IO push (max 6 mg 1st dose); repeat 0.2 mg/kg (max 12 mg)
Labetalol0.25–1.5 mg/kg IV/IO (max 20 mg); drip 0.25–1 mg/kg/hr
Nitroprusside0.3–8 mcg/kg/min IV/IO
Hydralazine0.1–0.4 mg/kg IV/IO

Adult

Norepinephrine0.05–2 mcg/kg/min IV typical, some protocols extend to 3 mcg/kg/min — current first-line vasopressor in most shock states
Dopamine2–20 mcg/kg/min IV — largely supplanted by norepinephrine as first-line
Adenosine6 mg rapid IV push + flush; repeat 12 mg once if needed
Labetalol10–20 mg IV, repeat/double q10min (max 300 mg); drip 0.5–2 mg/min
Nitroprusside0.3–10 mcg/kg/min IV, titrate to effect
Hydralazine10–20 mg IV q4–6h
Nicardipine5–15 mg/hr IV infusion — commonly preferred over nitroprusside for controllable titration

The single biggest adult/peds framing difference here: adult septic/vasodilatory shock management has moved decisively toward norepinephrine as the first-line agent, with dopamine now a second-line or historical choice — the peds card's dopamine-forward framing reflects standard pediatric practice, which hasn't shifted the same way.

11

Antimicrobials

DrugPediatric doseAdult dose
Ceftriaxone50 mg/kg IV/IO (max 2g); 100 mg/kg meningitis dosing1–2 g IV q24h; 2g q12h meningitis dosing
Cefepime50 mg/kg IV/IO1–2 g IV q8–12h
Vancomycin15 mg/kg/dose IV15–20 mg/kg IV (actual body weight) q8–12h, trough-guided
Piperacillin/Tazobactam100 mg/kg IV/IO (max 3.375 g)3.375–4.5 g IV q6–8h
Metronidazole7.5 mg/kg/dose IV/IO500 mg IV/PO q8h
Clindamycin10 mg/kg/dose IV/IO/PO600–900 mg IV q8h
Gentamicin2.5 mg/kg/dose IV/IO5–7 mg/kg IV once-daily dosing (level-guided)
Acyclovir20 mg/kg/dose IV/IO (encephalitis dosing)10 mg/kg IV q8h (encephalitis dosing)
Azithromycin10 mg/kg/dose x1, then 5 mg/kg/day x4d500 mg IV/PO x1, then 250 mg daily x4d
TMP-SMX5 mg TMP/kg/dose BID1–2 DS tablets PO BID (dose varies substantially by indication)

Adult dosing above is presented as typical starting doses for common serious infections — renal dosing adjustment, actual-vs-ideal body weight considerations (especially vancomycin and aminoglycosides), and indication-specific duration all modify these in practice and should be confirmed against local antibiogram and pharmacy guidance.

12

Volume Resuscitation

Pediatric

Crystalloid bolus20 mL/kg IV/IO
PRBC10–20 mL/kg/dose IV/IO
5% Albumin10 mL/kg IV/IO
FFP10–15 mL/kg IV/IO
Platelets1 unit/10 kg raises count ~50,000

Adult

Crystalloid bolus500 mL–1L boluses, reassess — permissive hypotension favored in active hemorrhage (see volemic status reference)
PRBC1 unit (~300–350 mL) raises Hgb ~1 g/dL; transfuse over 1–4h (faster if actively hemorrhaging)
FFP10–15 mL/kg, or 2–4 units typical initial dose; 1 unit ≈200–250 mL
Platelets1 apheresis unit (or 4–6 pooled units) raises count ~30,000–50,000/μL
Massive transfusion ratio1:1:1 PRBC:FFP:platelets — full evidence discussion (including that PROPPR itself didn't reach mortality significance) in the volemic status/blood-product reference
5% Albumin250–500 mL, targeted uses only (paracentesis, SBP, hepatorenal) — not routine resuscitation

Full crystalloid selection (composition, indications/contraindications by fluid type), the sepsis-vs-TBI evidence reversal, and blood product ratio evidence all live in the dedicated IV fluids and volemic status references — this table is dosing only.

13

Pain, Sedation & Antiemetic

Analgesics

Pediatric

Acetaminophen15 mg/kg/dose PO/PR q4h
Fentanyl1.5 mcg/kg IN (max 50 mcg); 1–2 mcg/kg IV/IO
Morphine0.05–0.1 mg/kg IV/IO/IM
Hydromorphone0.01–0.015 mg/kg IV/IO/IM
Ketorolac0.5 mg/kg IV/IO/IM (max 30 mg)
Ibuprofen10 mg/kg/dose PO q6h

Adult

Acetaminophen650–1000 mg PO/PR/IV q4–6h (max 3–4 g/day)
Fentanyl50–100 mcg IV/IN, titrate
Morphine2–4 mg IV, titrate q5–10min
Hydromorphone0.5–1 mg IV, titrate
Ketorolac15–30 mg IV/IM
Ibuprofen400–800 mg PO q6–8h

Sedatives & Antiemetic

Pediatric

Etomidate0.2 mg/kg IV/IO
Midazolam0.5 mg/kg PO (max 20 mg); 0.3 mg/kg IN; 0.05–0.1 mg/kg IV/IO
Ketamine1–2 mg/kg IV/IO; 4 mg/kg IM
Propofol1–2 mg/kg IV/IO
Ondansetron0.15 mg/kg IV/IO/PO (max 4 mg)

Adult

Etomidate0.1–0.15 mg/kg IV for procedural sedation (lower than RSI dose)
Midazolam1–2 mg IV titrated (procedural sedation) — see remimazolam/ciprofol reference for newer alternatives
Ketamine1–1.5 mg/kg IV; 3–4 mg/kg IM (procedural sedation)
Propofol0.5–1 mg/kg IV increments (procedural sedation)
Ondansetron4–8 mg IV/PO
14

Reversal Agents

Pediatric

Naloxone0.1 mg/kg IV/IO/IM/ETT (max 2 mg/dose)
Flumazenil0.01 mg/kg IV/IO (max 0.2 mg/dose)

Adult

Naloxone0.4–2 mg IV/IM/IN, titrate to reverse respiratory depression without precipitating withdrawal; up to 2 mg per dose repeated
Flumazenil0.2 mg IV over 15 sec, repeat 0.2mg q1min (max 1 mg) — precipitated-withdrawal risk in chronic benzo users, use cautiously
15

GCS, Pupils & Pain Scale

CategoryScoreAdult/ChildInfant modification
Eye opening4SpontaneousSpontaneous
3To voiceTo voice
2To painTo pain
1NoneNone
Verbal5OrientedCoos/babbles
4ConfusedIrritable cry
3Inappropriate wordsCries to pain
2IncomprehensibleMoans to pain
1NoneNone
Motor6Obeys commandsSpontaneous movement
5Localizes painWithdraws to touch
4Withdraws to painWithdraws to pain
3Abnormal flexionAbnormal flexion
2Abnormal extensionAbnormal extension
1NoneNone

Total 3–15. Adult GCS is identical to the "Child" column above — the infant-specific verbal/motor modifications exist because standard verbal and command-following criteria don't apply below roughly 2 years of developmental age.

Pupil size reference: 2–7 mm scale used identically in both populations. Pain scale: the 0–10 FACES scale (0/2/4/6/8/10) is validated primarily for pediatric and nonverbal use; cognitively intact adults are more commonly scored on a direct 0–10 numeric rating scale, though FACES remains usable across ages when verbal numeric self-report isn't reliable.

16

Formulas & Equations

FormulaEquationPopulation
Minimum SBP<1mo: 60 mmHg · 1mo–10y: (2 × age) + 70 · >10y: 90 mmHgPediatric
ET tube size (cuffed)age/4 + 3.5Pediatric, >2 years
ET tube size (uncuffed)age/4 + 4Pediatric, >2 years
ET tube depth (lip to tip)3 × ET tube sizePediatric
Low-line UA catheter lengthbirth weight (kg) + 7Neonatal
High-line UA catheter length(3 × birth weight) + 9Neonatal
UV catheter length(0.5 × high-line UA) + 1Neonatal
Parkland formula4 mL × weight (kg) × %BSA burned (2nd/3rd degree); half over first 8h, remainder over next 16h from time of burnBoth — same formula, adult and pediatric alike
Predicted body weight (adult)Male: 50 + 2.3×[height(in)−60] · Female: 45.5 + 2.3×[height(in)−60]Adult — for lung-protective VT dosing, full detail in mechanical ventilation reference

The Parkland formula is genuinely one of the few calculations on this page that doesn't change between populations — weight and %BSA already scale the answer appropriately for pediatric patients without a separate pediatric-specific version.

17

Quick Reference Card & Primary Sources

SituationKey number to remember
Symptomatic bradycardia, adultAtropine 1 mg IV (2026 update, was 0.5 mg) — not vasopressin
Symptomatic bradycardia, pediatricAtropine 0.02 mg/kg IV/IO, min 0.1 mg
Adult cardiac arrest vasopressorEpinephrine only — vasopressin removed from algorithm
Status epilepticus, adultLorazepam 4 mg IV (up to 8 mg) — don't underdose
Anaphylaxis, adultEpinephrine 0.3–0.5 mg IM, repeat q5–15min
Massive transfusion ratio1:1:1 PRBC:FFP:platelets, adult
Parkland formulaSame formula both populations — 4mL × kg × %BSA

Primary sources checked for this guide: