PALS Pharmacological Therapy
Only use the ACLS medication shown in Table 9 if it is within your scope of practice, and only after you have thoroughly studied the side effects and actions involved. This table is more of a reminder for those who are already experienced with the listed medications.
Table 9 also only describes pediatric routes of administration, indications, and doses for the most widely used PALS drugs. Although cited for reference, regular administration of drugs via an ET tube is discouraged; delivery through IO is preferred, as absorption from the ET tube route cannot always be predicted.
| DRUG | MAIN PALS USE | PEDIATRIC DOSE (IV/IO) | NOTES |
|---|---|---|---|
| Adenosine | Supraventricular Tachycardia | First dose: 0.1 mg/kg (MAX DOSE 6 mg) Second dose: 0.2 mg/kg (MAX DOSE 12 mg) |
Rapid IV/IO bolus (no ET) Flush with saline Monitor ECG |
| Amiodarone | Tachyarrhythmia | 5 mg/kg over 20 to 60 minutes Repeat up to 15 mg/kg (MAX DOSE 300 mg) |
Very long half-life Monitor ECG & BP |
| Atropine | Bradycardia | 0.02 mg/kg ET: 0.03 mg/kg Repeat once if needed (MAX single dose 0.5 mg) |
Also used to treat specific toxins (e.g. organophosphate poisoning) |
| Epinephrine | Cardiac Arrest/Shock | IV/IO: 0.01 mg/kg [1:10,000] (MAX DOSE 1 mg) ET: 0.1 mg/kg [1:1,000] (MAX DOSE 2.5 mg) |
Multiple uses, multiple routes Repeat every 3 to 5 min if needed |
| Glucose | Hypoglycemia | 0.5 to 1 g/kg | Newborn: 5 to 10 mL/kg D10W Infants/Children: 2 to 4 mL/kg D25W Adolescents: 1 to 2 mL/kg D50W |
| Lidocaine | Tachyarrhythmia | Initial: 1 mg/kg Infusion: 20 to 50 mcg/kg/min (MAX DOSE 100 mg) ET: 2 to 3 mg |
|
| Magnesium Sulfate | Torsades de Pointes Refractory Asthma |
20 to 50 mg/kg over 10 to 20 min (MAX DOSE 2 grams) |
May run faster for Torsades |
| Milrinone | Cardiogenic Shock | Initial: 50 mcg/kg over 10 to 60 min Maintain: 0.5 to 0.75 mcg/kg/min |
Longer infusion times and euvolemia will reduce risk of hypotension |
| Naloxone | Opioid Reversal | Less than 5 y/o OR under 20 kg: 0.1 mg/kg Over 5 y/o OR over 20 kg: 2 mg IV q 2 to 3 min prn |
Decrease dose to reverse respiratory depression due to therapeutic opioid use (1 to 5 mcg/kg, titrate to effect) |
| Procainamide | Tachyarrhythmia | 15 mg/kg over 30 to 60 minutes | Do NOT give with amiodarone Monitor ECG & BP |
| Sodium Bicarbonate | Metabolic Acidosis Hyperkalemia | 1 mEq/kg slow bolus (MAX DOSE 50 mEq) |
Monitor ABG & ECG After adequate ventilation |
Table 9