Paediatric Calculator | Royal Hobart Hospital Emergency Department

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Medications, Fluids & Shocks
Cardiac Arrest cardiopulmonary resuscitation cpr advanced life support als	Dose	Volume	Comment
defibrillation shock	… J 4 J 200		Round up to nearest available setting. Consider increasing if first shock unsuccessful.
adrenaline epinephrine IV/IO	… microg 10 microg 1000	… mL 1 mg/10 mL = 1:10,000 100	Flush with 5 mL of sodium chloride 0.9%.
adrenaline epinephrine ETT ETT	… microg 100 microg 3000	… mL 1 mg/1 mL = 1:1,000 1000	Only until IV/IO access obtained.
amiodarone IV/IO	… mg 5 mg 300	… mL 150 mg/3 mL 50	Flush with 5 mL of glucose 5%.
sodium chloride 0.9% normal saline IV/IO	… mL 20 mL 1000
atropine bradycardia asystole IV/IO	… microg 20 microg 600	… mL 600 microg/1 mL 600	Consider for persistent asystole / bradycardia.
Induction intubation rapid sequence rsi	Dose	Volume	Comment
fentanyl opioid opiate IV/IO	… microg 4 microg 200	… mL 100 microg/2 mL 50	First line induction agent <3 months. Reduce dose in shock.
ketamine IV/IO	… mg 2 mg 200	… mL 200 mg/2 mL 100	First line induction agent in shock but reduce dose. Not recommended <3 months.
propofol IV/IO	… mg 2.5 mg 200	… mL 200 mg/20 mL 10	Avoid or reduce dose in shock. Not recommended <3 months.
midazolam IV/IO	… mg 0.15 mg 10	… mL 5 mg/5 mL 1	Optional adjunct to ketamine induction especially in head injury. Avoid or reduce dose in shock.
atropine IV/IO	… microg 20 microg 600	… mL 600 microg/1 mL 600	Adjunct prior to suxamethonium to prevent bradycardia. Not usually required ≥1 year.
suxamethonium succinylcholine paralysis relaxation neuromuscular muscular IV/IO	… mg 3 2 mg 100	… mL 100 mg/2 mL 50	Pretreat with atropine <1 year.
rocuronium paralysis relaxation neuromuscular muscular IV/IO	… mg 1.5 mg 100	… mL 50 mg/5 mL 10	Pretreat with atropine <3 months.
pancuronium paralysis relaxation neuromuscular muscular IV/IO	… mg 0.1 mg 4	… mL 4 mg/2 mL 2	First choice in babies with cardiac disease (no bradycardia). Not generally used ≥1 year.
metaraminol aramine push dose pressor vasopressor IV/IO	… microg 10 microg 500		Dilute 10 mg/1 mL ampoule in 100 mL sodium chloride 0.9% → 100 microg/mL. Bolus … mL, repeat as needed. Not recommended <1 year or if bradycardic (use adrenaline).
adrenaline epinephrine push dose pressor vasopressor IV/IO	… microg 1 microg 100		Add 1 mL of 1 mg/10 mL (1:10,000) to 9 mL sodium chloride 0.9% → 10 microg/mL. Bolus … mL, repeat as needed. Recommended push dose vasopressor in infants or if bradycardia.
sugammadex IV/IO	… mg 16 mg 1500	… mL 500 mg/5 mL 100	Reverses rocuronium. [RHH ED: kept in anaesthetic trolley, key in disaster corridor cupboard].
Post Intubation Sedation	Dose	Volume	Comment
morphine opioid opiate infusion infusion	… mg 1 mg 70	… mL 10 mg/1 mL 10	Make up to 50 mL with sodium chloride 0.9%. Titrate 1-3 mL/h (20-60 microg/kg/h).
midazolam infusion infusion	… mg 3 mg 210	… mL 50 mg/10 mL 5	Make up to 50 mL with sodium chloride 0.9%. Titrate 1-5 mL/h (1-5 microg/kg/min).
propofol infusion infusion		50 mL 500 mg/50 mL	Neat. Titrate …-… mL/h (1-4 mg/kg/h). Not recommended <5 years.
Procedural Sedation anaesthetic	Dose	Volume	Comment
ketamine IV/IO	… mg 1 mg 100	… mL 200 mg/2 mL 100	Give further incremental doses … mg as needed. Not recommended <3 months.
ketamine intramuscular intramuscular	… mg 4 mg 200	… mL 200 mg/2 mL 100	Repeat half to full dose after 10 min if sedation inadequate. Not recommended <3 months.
propofol IV/IO	… mg 2 1 mg 200	… mL 200 mg/20 mL 10	Required dose very variable, titrate carefully. Avoid in shock. Not generally recommended <5 years.
fentanyl opioid opiate IV/IO	… microg 2 microg 100	… mL 100 microg/2 mL 50
Asthma life-threatening, ≥1 year old status	Dose	Volume	Comment
salbutamol albuterol ventolin nebulised nebules nebulised	… 5 mg		Continuous for 1 hour.
ipratropium atrovent nebulised nebules nebulised	… 250 microg		Three nebules in first hour, added to salbutamol.
hydrocortisone IV/IO	… mg 4 mg 200	… mL 100 mg/2 mL water 50	Repeat 6 hourly.
methylprednisolone prednisolone prednisone IV/IO	… mg 1 mg 60	… mL 1,000 mg/10 mL water 100	Repeat 6 hourly. Use methylprednisolone sodium succinate (not acetate).
magnesium sulfate 50% IV/IO load	… mmol 0.2 mmol 10	… mL 10 mmol/5 mL 2	Dilute with … mL sodium chloride 0.9% (total volume … mL). Give over 20 min. If response, follow with infusion.
magnesium sulfate 50% infusion infusion	… 40 mmol	… mL 10 mmol/5 mL 2	Precede with IV/IO load. Make up to 50 mL with sodium chloride 0.9%. Give at … mL/h (0.12 mmol/kg/h).
aminophylline IV/IO load	… mg 10 mg 500	… mL 250 mg/10 mL 25	Dilute with … mL glucose 5%. Give over 60 min.
salbutamol albuterol ventolin IV/IO load	… mg 0.3 mg 12	… mL 5 mg/5 mL 1	Neat. Give over 60 min (5 microg/kg/min). Follow with infusion.
salbutamol albuterol ventolin infusion infusion	… 25 mg	… mL 5 mg/5 mL 1	Precede with IV/IO load. Neat. Titrate …-… mL/h (1-2 microg/kg/min).
adrenaline epinephrine intramuscular intramuscular / infusion			Consider if peri-arrest. Dosing as per Anaphylaxis.
Croup severe	Dose	Volume	Comment
adrenaline epinephrine nebulised nebules nebulised	… mg 0.5 mg 5	… mL 1 mg/1 mL = 1:1,000 1	Repeat as necessary. Consider discharge if stridor free at rest 4 hours after single dose.
dexamethasone oral intramuscular oral, IV/IO, intramuscular	… mg 0.6 mg 12		Reduce dose to … mg in non-severe croup.
Apnoea neonatal apnea prematurity	Dose	Volume	Comment
caffeine citrate IV load	… mg 20 mg 100	… mL 40 mg/2 mL 20	Neat. Give over 30 min. 2 mg of caffeine citrate is equivalent to 1 mg of caffeine base.
Shock hypotension hypovolaemia	Dose	Volume	Comment
sodium chloride 0.9% normal saline IV/IO	… mL 20 mL 1000		If inadequate response, repeat bolus. Consider inotropes beyond … mL (40 mL/kg).
metaraminol aramine push dose pressor vasopressor IV/IO	… microg 10 microg 500		Dilute 10 mg/1 mL ampoule in 100 mL sodium chloride 0.9% → 100 microg/mL. Bolus … mL, repeat as needed. Not recommended <1 year or if bradycardic (use adrenaline).
adrenaline epinephrine push dose pressor vasopressor IV/IO	… microg 1 microg 100		Add 1 mL of 1 mg/10 mL (1:10,000) to 9 mL sodium chloride 0.9% → 10 microg/mL. Bolus … mL, repeat as needed. Recommended push dose vasopressor in infants or if bradycardia.
noradrenaline / adrenaline epinephrine norepinephrine infusion infusion	… mg 0.15 mg 12	… mL 1 mg/1 mL = 1:1,000 1	Make up to 50 mL with sodium chloride 0.9%. Titrate 1-20 mL/h (0.05-1 microg/kg/min). Central vein only. Use low concentration adrenaline infusion in Anaphylaxis section peripherally while obtaining central access.
dobutamine infusion infusion	… mg 30 15 mg 600	… mL 250 mg/20 mL 12.5	Make up to 50 mL with sodium chloride 0.9%. Titrate 0.5-2 mL/h (5-20 microg/kg/min). Titrate 1-4 mL/h (5-20 microg/kg/min).
dopamine infusion infusion	… mg 30 mg	… mL 200 mg/5 mL 40	Make up to 50 mL with sodium chloride 0.9%. Titrate 0.5-2 mL/h (5-20 microg/kg/min). Not recommended ≥3 months.
Anaphylaxis allergy	Dose	Volume	Comment
adrenaline epinephrine intramuscular intramuscular	… microg 10 microg 500	… mL 1 mg/1 mL = 1:1,000 1000	Administer lateral thigh. Repeat after 5 min if not improving, then consider infusion.
EpiPen Jr adrenaline epinephrine intramuscular intramuscular	… 150 300 microg		EpiPen Jr 7.5-20 kg. EpiPen >20 kg. Administer lateral thigh. Repeat after 5 min if not improving, then consider infusion.
adrenaline epinephrine infusion infusion	1 mg	1 mL 1 mg/1 mL = 1:1,000	Dilute in 1 L sodium chloride 0.9%. Titrate …-… mL/h (≈0.1-0.4 microg/kg/min). Initial infusion only, use standard high concentration infusion after 1 hour.
Haemorrhage severe hemorrhage massive crimson transfusion ctp mtp bleeding blood	Dose	Volume	Comment
tranexamic acid txa IV/IO	… mg 15 mg 1000	… mL 1000 mg/10 mL 100	Within 3 hours of trauma.
sodium chloride 0.9% normal saline IV/IO	… mL 10 mL 500		Warmed. Only until blood products available. If inadequate response, repeat bolus.
PRBC (packed red blood cells) rbc IV/IO	… mL 5 mL 500		Warmed. Repeat bolus while shock remains. Aim 1:1 ratio with FFP.
FFP (fresh frozen plasma) IV/IO	… mL 5 mL 500		Warmed. Repeat bolus while shock remains. Aim 1:1 ratio with PRBC.
cryoprecipitate IV/IO	… mL 10 mL 500		Warmed. Bolus aiming fibrinogen >1 g/L.
calcium CHLORIDE 10% IV/IO	… mL 0.1 mL 10		Slow IV push into a large vein. Aim VBG Ca²⁺ >1.0 mmol/L.
platelets IV/IO	… mL 10 mL 500		Warmed. Bolus aiming platelets >50 /nL (>100 /nL if head injury).
Arrhythmia	Dose	Volume	Comment
adenosine supraventricular tachycardia svt IV/IO	… mg 0.1 mg 3	… mL 6 mg/2 mL 3	For SVT (supraventricular tachycardia). Increase to … mg, then … mg if unsuccessful. Use most central vein available (eg antecubital) & follow with rapid flush.
magnesium sulfate 50% vt polymorphic ventricular tachycardia torsades de pointes IV/IO load	… mmol 0.2 mmol 10	… mL 10 mmol/5 mL 2	For polymorphic VT (ventricular tachycardia) / torsades de pointes. Dilute with … mL sodium chloride 0.9% (total volume … mL). Give over 5 min.
cardioversion shock supraventricular tachycardia svt vt polymorphic ventricular tachycardia torsades de pointes atrial fibrillation flutter af	… J 0.5 J 50		Round up to nearest available setting. Ensure defibrillator is synchronised. Increase to … J, then … J if unsuccessful. Use procedural sedation.
Congenital Heart Disease cyanosis	Dose	Volume	Comment
alprostadil Prostin VR prostaglandin e1 infusion infusion	… microg 60 microg	… mL 500 microg/1 mL 500	Make up to 50 mL with sodium chloride 0.9%. Titrate 0.5-3 mL/h (10-60 nanogram/kg/min). Maintains patent ductus arteriosus. Only indicated in neonates.
Hyperkalaemia potassium	Dose	Volume	Comment
calcium GLUCONATE 10% hypocalcaemia IV/IO	… mmol 0.11 mmol 4.4	… mL 2.2 mmol/10 mL 0.22	Give into a large vein over 2-5 min if unstable (over 20 min if stable). Repeat dose after 5 min if ECG hasn't normalised. Dose also appropriate for critical hypocalcaemia.
insulin Actrapid IV/IO	… units 0.1 units 10	… mL 100 units/mL 100	Give over 10 min with glucose 10%.
glucose 10% dextrose IV/IO	… mL 5 mL 250		Give over 10 min with insulin.
salbutamol albuterol ventolin nebulised nebules nebulised	5 mg
sodium bicarbonate 8.4% IV/IO	… mmol 1 mmol 50	… mL 1 mmol/1 mL 1	Only if metabolic acidosis. Give over 10 min.
Hypoglycaemia sugar bsl glucose bgl	Dose	Volume	Comment
glucose 10% dextrose IV/IO	… mL 2 mL 100		Response should occur within 4-5 min. Give oral carbohydrates once patient responsive.
Seizure epilepsy convulsion status fit	Dose	Volume	Comment
midazolam intramuscular IV/IO, intramuscular	… mg 0.15 mg 10	… mL 5 mg/5 mL 1	First line (except neonates). Repeat once after 5 min if seizure ongoing.
phenytoin IV/IO load	… mg 20 mg 1000	… mL 250 mg/5 mL 50	Second line. Neat (preferred) or dilute with … mL sodium chloride 0.9%. Give over 20 min.
levetiracetam Keppra IV/IO load	… mg 40 mg 3000	… mL 500 mg/5 mL 100	Second line. Dilute with … mL sodium chloride 0.9%. Give over 5 min.
phenobarbital phenobarbitone IV/IO load	… mg 20 mg 1000	… mL 200 mg/1 mL 200	First line in neonates. Dilute with … mL sodium chloride 0.9%. Give over 20 min.
midazolam infusion infusion	… mg 3 mg 210	… mL 50 mg/10 mL 5	Make up to 50 mL with sodium chloride 0.9%. Titrate 2-18 mL/h (2-18 microg/kg/min).
Raised Intracranial Pressure icp ich haemorrhage hemorrhage coning	Dose	Volume	Comment
sodium chloride 3% hypertonic saline IV/IO load	… mL 3 mL 300		Give over 10 min. Repeat once after 20 min if no effect.
mannitol 20% IV/IO load	… g 0.5 g 50	… mL 100 g/500 mL 0.2	Give over 20 min. Repeat once after 30 min if no effect.
Overdose toxicology poisoning	Dose	Volume	Comment
naloxone narcan opioid opiate morphine fentanyl heroin oxycodone endone oxycontin targin codeine methadone intramuscular IV/IO, intramuscular	… microg 10 microg 400	… mL 400 microg/1 mL 400	Repeat as necessary (max total 2,000 microg). Observe for at least 2 hours after last dose.
flumazenil benzodiazepine midazolam diazepam clonazepam temazepam nitrazepam oxazepam alprazolam IV/IO	… microg 5 microg 200	… mL 500 microg/5 mL 100	Repeat every minute as necessary (max 5 doses). Observe for several hours after last dose.
Acute Behavioural Disturbance behavioral sedation aggression aggressive agitation agitated violent violence chemical restraint code black	Dose	Volume	Comment
diazepam valium oral oral	… 5 10 mg 10		First line after unsuccessful verbal de-escalation. Max two doses. Proceed to parenteral sedation if no effect in 45 min or behaviour escalates.
olanzapine wafer zyprexa oral oral	… 2.5 5 10 mg 10		First line after unsuccessful verbal de-escalation. Single dose. Proceed to parenteral sedation if no effect in 45 min or behaviour escalates.
droperidol intramuscular intramuscular	… mg 0.2 mg 10	… mL 2.5 mg/1 mL 2.5	Second line after oral therapy. Repeat dose after 15 min if necessary.
ketamine intramuscular intramuscular	… mg 4 mg 400	… mL 200 mg/2 mL 100	Third line.
ketamine IV/IO	… mg 1 mg 100	… mL 200 mg/2 mL 100	Third line.
midazolam IV/IO	… mg 0.05 mg 20	… mL 5 mg/5 mL 1	Third line. Give up to 4 doses (max total … mg).
Analgesia pain	Dose	Volume	Comment
fentanyl opioid opiate intranasal intraNASAL	… microg 1.5 microg 100	… mL 100 microg/2 mL 50	Administer with atomiser quickly, dividing dose between both nostrils. Second dose if ongoing pain after 5 min, then consider IV route.
morphine opioid opiate IV/IO	… mg 0.02 0.05 0.1 mg 5	… mL 10 mg/1 mL 10
paracetamol acetaminophen panadol panamax oral oral, IV/IO	… mg 10 15 mg 1000
ibuprofen nurofen brufen oral oral	… mg 10 mg 400
Antiemetics nausea vomiting	Dose	Volume	Comment
ondansetron oral oral	… 2 4 8 mg		Not recommended <8 kg.
ondansetron IV/IO	… mg 0.15 mg 8
Antibiotics for Sepsis ? Source infection bacterial bacteraemia bacteremia septicaemia septicemia	Dose	Volume	Comment
amoxicillin amoxycillin IV/IO	… mg 100 50 mg 2000		Recommended <3 months in combination with cefOTAXIME.
cefOTAXIME IV/IO	… mg 50 mg 2000		Recommended <3 months in combination with amoxicillin.
cefTRIAXONE IV/IO	… mg 50 mg 2000		Recommended ≥3 months in combination with gentamicin.
gentamicin IV/IO	… mg 7.5 6 mg 400		Recommended ≥3 months in combination with cefTRIAXONE. Give over 3-5 min.
aciclovir acyclovir IV/IO	… mg 20 10 mg 750	… mL 250 mg/10 mL 25	Dilute with … mL sodium chloride 0.9%. Give over 60 min. For suspected acute encephalitis: fever plus persisting altered conscious state.

Equipment
Airway equipment intubation	Size / Depth
laryngoscope blade mac miller	0-1 straight 1 straight 2 curved or straight 2-3 curved 3 curved …
bougie / stylet gum elastic geb introducer	6 Fr stylet 10 Fr stylet or bougie 14 Fr bougie …
ETT (endotracheal tube) diameter	3.0 mm cuffed 3.5 mm uncuffed 3.5 mm cuffed 4.0 mm uncuffed 4.0 mm cuffed 4.5 mm uncuffed 4.5 mm cuffed 5.0 mm cuffed 5.5 mm cuffed 6.0 mm cuffed 6.5 mm cuffed 7.0 mm cuffed …
ETT oral depth endotracheal tube length insertion	10 10.5 11 11.5 12 12.5 13 13.5 14 14.5 15 15.5 16 16.5 17 17.5 18 18.5 19 19.5 20 20.5 … cm at lips
ETT nasal depth endotracheal tube length insertion	11 11.5 12 12.5 13 13.5 14 15.5 16 16.5 17 17.5 18 18.5 19 19.5 20 20.5 21 21.5 22 22.5 … cm at nare
suction catheter	8 Fr 8 Fr 10 Fr 10 Fr 12 Fr …
LMA (laryngeal mask airway) supraglottic	1 1.5 2 2.5 3 4 5 …
nasopharyngeal airway NPA nasal trumpet	14 18 20 24-32 … Fr
Other Equipment miscellaneous	Size
naso/orogastric feeding tube NGT OGT gastric nasogastric nasal oral	6 8 10 14 … Fr
chest drain (air / effusion) icc intercostal catheter tube thoracic thoracostomy pneumothorax fluid	8 12 … Fr
chest drain (trauma / blood) icc intercostal catheter tube thoracic thoracostomy haemothorax hemothorax	12 18 20-24 24-28 … Fr
indwelling urinary catheter IDC foley	6 8 10 12 14 … Fr
femoral central venous line CVL catheter vein	4 4-5 5 7 … Fr

Observations	Normal Range
respiratory rate observations vitals signs breaths RR	30-55 20-45 15-35 15-30 15-25 … bpm
heart rate observations vitals signs pulse HR	100-160 100-150 90-130 80-120 60-110 … bpm
systolic blood pressure observations vitals signs SBP BP	65-110 75-120 80-125 85-130 90-150 … mmHg

Administration Route Colours
IV/IO stat or load
IV/IO infusion
other (ETT, intramuscular, intraNASAL, nebulised, oral)

Abbreviations
bpm beats or breaths per minute cm centimetres ECG electrocardiogram ED Emergency Department ETT endotracheal tube Fr French g grams h hours IO intraosseous IV intravenous J joules kg kilograms L litres max maximum mg milligrams microg micrograms min minutes mL millilitres mm millimetres mmHg millimetres of mercury mmol millimoles RHH Royal Hobart Hospital VBG venous blood gas

Disclaimer
This calculator has been designed to assist clinicians with weight based calculations in children. The calculator does not replace a medication prescription or clinical judgement. All drug calculations are based on established paediatric resuscitation resources (ARC & APLS) and protocols at the RHH ED. Please review your local protocols before prescribing these drugs. Please check all prescriptions and medications carefully as the author takes no responsibility for the accuracy of doses or calculations. The calculator is designed to be used in conjunction with an appropriate formulary which contains information on drug interactions, compatibilities, precautions, side effects, rates of delivery, maximum/minimum doses and drug monitoring.

This calculator has been designed to assist clinicians with weight based calculations in children. The calculator does not replace a medication prescription or clinical judgement. All drug calculations are based on established paediatric resuscitation resources (ARC & APLS) and protocols at the RHH ED. Please review your local protocols before prescribing these drugs. Please check all prescriptions and medications carefully as the author takes no responsibility for the accuracy of doses or calculations. The calculator is designed to be used in conjunction with an appropriate formulary which contains information on drug interactions, compatibilities, precautions, side effects, rates of delivery, maximum/minimum doses and drug monitoring.