Important: This medication reference is intended for study and exam preparation purposes only. Always refer to current AHA guidelines, your institution's protocols, and verify all dosages before clinical use. All doses are weight-based for pediatric patients.
Cardiac Arrest Medications
These medications are used during pediatric cardiac arrest as part of the PALS Cardiac Arrest Algorithm.
| Medication | Indication | Dose | Route |
|---|---|---|---|
| Epinephrine | Cardiac arrest (all rhythms), symptomatic bradycardia | 0.01 mg/kg (0.1 mL/kg of 1:10,000 concentration) | IV/IO |
| Amiodarone | VF/pulseless VT refractory to defibrillation | 5 mg/kg IV/IO | IV/IO |
| Lidocaine | Alternative to amiodarone for VF/pulseless VT | 1 mg/kg IV/IO | IV/IO |
Epinephrine: Repeat every 3-5 minutes. Max single dose: 1 mg. For ETT: 0.1 mg/kg (0.1 mL/kg of 1:1,000).
Amiodarone: May repeat up to 2 times for refractory VF/pVT. Max single dose: 300 mg. Infuse rapidly during cardiac arrest.
Lidocaine: Can follow with infusion at 20-50 mcg/kg/min. Use if amiodarone is unavailable.
Arrhythmia Medications
Used for the management of symptomatic bradycardia, SVT, and ventricular tachycardia with a pulse.
| Medication | Indication | Dose | Route |
|---|---|---|---|
| Adenosine | SVT (supraventricular tachycardia) | 1st dose: 0.1 mg/kg (max 6 mg); 2nd dose: 0.2 mg/kg (max 12 mg) | Rapid IV push (follow with NS flush) |
| Atropine | Symptomatic bradycardia (vagal-mediated or AV block) | 0.02 mg/kg IV/IO | IV/IO |
| Procainamide | SVT unresponsive to adenosine, VT with pulse | 15 mg/kg IV/IO over 30-60 minutes | IV/IO (slow infusion) |
Adenosine: Must be given as rapid push followed immediately by 5-10 mL NS flush. Use the IV site closest to the heart.
Atropine: Minimum dose: 0.1 mg. Maximum single dose: 0.5 mg (child), 1 mg (adolescent). May repeat once.
Procainamide: Do not use with amiodarone (risk of prolonged QT). Monitor ECG and BP during infusion. Stop if QRS widens >50%.
Emergency Medications
Additional medications used during pediatric emergencies for specific conditions and reversible causes.
| Medication | Indication | Dose | Route |
|---|---|---|---|
| Dextrose (D10W) | Hypoglycemia | 5 mL/kg of D10W (0.5 g/kg) | IV/IO |
| Calcium Chloride (10%) | Hyperkalemia, hypocalcemia, calcium channel blocker overdose | 20 mg/kg (0.2 mL/kg) IV/IO | IV/IO (slow push) |
| Sodium Bicarbonate | Severe metabolic acidosis, hyperkalemia, tricyclic overdose | 1 mEq/kg IV/IO | IV/IO |
| Magnesium Sulfate | Torsades de pointes, hypomagnesemia, status asthmaticus | 25-50 mg/kg IV/IO (max 2 g) | IV/IO |
| Naloxone | Opioid-induced respiratory depression | 0.1 mg/kg IV/IO/IM/IN (max 2 mg) | IV/IO/IM/Intranasal |
Dextrose (D10W): Check blood glucose frequently. Neonates: use D10W. Avoid D50W in pediatric patients (risk of hypertonicity).
Calcium Chloride (10%): Administer slowly. Can cause tissue necrosis if extravasated. Preferably via central line. Do not mix with sodium bicarbonate.
Sodium Bicarbonate: Only after adequate ventilation established. Not routinely recommended in cardiac arrest. Do not mix with calcium.
Magnesium Sulfate: For torsades: give as rapid infusion. For asthma: infuse over 15-30 minutes. Monitor for hypotension.
Naloxone: Titrate to restore adequate breathing. Duration may be shorter than opioid — monitor for re-sedation.
Fluids for Resuscitation
Isotonic crystalloid solutions used for volume resuscitation in pediatric shock.
| Medication | Indication | Dose | Route |
|---|---|---|---|
| Normal Saline (0.9% NaCl) | Hypovolemic shock, dehydration, fluid resuscitation | 20 mL/kg IV/IO bolus | IV/IO |
| Lactated Ringer's | Alternative to NS for fluid resuscitation | 20 mL/kg IV/IO bolus | IV/IO |
Normal Saline (0.9% NaCl): May repeat up to 3 times (60 mL/kg total). Reassess after each bolus. Consider blood products if hemorrhagic shock.
Lactated Ringer's: Similar efficacy to NS. Avoid in patients with renal failure or hyperkalemia.
Key Dosing Principles for PALS
Always use weight-based dosing
Unlike adult ACLS, pediatric medications are dosed by weight (mg/kg). The Broselow tape is an essential tool for rapid weight estimation in emergencies.
Know your concentration conversions
Epinephrine 1:10,000 = 0.1 mg/mL (for IV/IO). Epinephrine 1:1,000 = 1 mg/mL (for ETT). This is one of the most commonly tested medication concepts on the PALS exam.
IV/IO access is preferred
Intravenous and intraosseous are the preferred routes. IO access should be attempted if IV access cannot be established within 90 seconds or after 2 attempts.
Do not delay CPR for medications
High-quality CPR is more important than any medication. Medications should be administered during rhythm checks or immediately after, without interrupting compressions.