PALS Pharmacological Therapy

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Only use the ALCS 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 1 mEq/kg slow bolus
(MAX DOSE 50 mEq)
Monitor ABG & ECG
After adequate ventilation

Table 9

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