Paediatric Emergency Drug Preparation

Dilute Vol. to Final drug Volume Delivery Max single

Drug Indications Route with dilute to concentration Dose to give speed dose Other comments

0.3mg/kg/dose
Decant exact
Rapid push (<1m)
0.1mg/kg then incremental Proximal vein or
adenosine of exact dose 0.5mg/kg/dose
SVT IV IO NEAT NEAT 3mg/mL 0.2mg/kg then doses for CVL preferred;
6mg/2mL then large (1m-12yr)
0.3mg/kg easy/rapid see SVT algorithm.
volume flush 12mg/dose
administration
(>12yr)

adrenaline 1000 10 0.5mg Recommended injection site

Anaphylaxis IM N/A N/A 0.01mL/kg
1:1000 micrograms/mL micrograms/kg (0.5mL)/dose is the anterolateral thigh

adrenaline
100 10 See VF/Pulseless VT and
1mg/10mL minijet Cardiac arrest IV IO N/A N/A 0.1 mL/kg Rapid push 1mg
micrograms/mL micrograms/kg Asystole/PEA protocol
1:10,000

amIODAROne Over Arrest dose: Incompatible

Pulseless VT/VF IV IO 5% glucose 15mL 10mg/mL 5mg/kg 0.5mL/kg 300mg
150mg/3mL 1-2 min with 0.9% NaCl

1mg
aTROpine Prevention or Rx 200 20 See Bradycardia
IV IO N/A N/A 0.1mL/kg Rapid push Repeat to
1mg/5mL minijet of bradycardia micrograms/mL micrograms/kg protocol
total 2mg

1mg
aTROpine Prevention or Rx 100 20 See Bradycardia
IV IO N/A N/A 0.2mL/kg Rapid push Repeat to
1mg/10mL minijet of bradycardia micrograms/mL micrograms/kg protocol
total 2mg

aTROpine
Adjunct 100 20
600micrograms/mL IV IO 0.9% NaCl 6mL 0.2 mL/kg Slow push 1mg
during RSI micrograms/mL micrograms/kg
(adjunct to RSI)

3-5 min Use large vein.

calcium GLUCONate Hypocalcaemia
BOLUS: 100mg/mL 50mg/kg/dose 50-100mg/min 2g or NB: Vasodilation,
1g/10mL = 10% Hyperkalaemia IV IO N/A 0.5mL/kg/dose
N/A 0.22mmol/mL 0.11mmol/kg 0.11-0.22 4.4mmol bradycardia, hypotension;
2.2mmol/10mL Mg toxicity
mmol/min do not mix with Na HCO3.

dexamethasone Cerebral Draw up prescribed dose

IV IO 0.9% NaCl 1.5mg/kg Over 1-3 min 20mg
4mg/mL oedema & make up to 10mL

Over 3min
DIazepam Beware hypotension and
Seizures IV IO 0.9% NaCl 10mL 1mg/mL 0.1-0.4mg/kg 0.1-0.4mL/kg Max rate 10mg
10mg/2mL respiratory depression
1-2mg/min

15 Medical Officer
digOXIN Atrial Draw up prescribed dose 250microg
IV IO 0.9% NaCl micrograms/kg 3-5 min to administer;
500micrograms/2mL fibrillation & make up to 10mL (half load)
(HALF LOAD) dosing varies with age.
Endorsed by Medical Emergency Advisory Committee and Medicines Advisory Committee September 2017 – v2.1 Children’s Health Queensland Hospital and Health Service
 Paediatric Emergency Drug Preparation
Dilute Vol. to Final drug Volume Delivery Max single
Drug Indications Route with dilute to concentration Dose to give speed dose Other comments

1 to 2
fentaNYL 10 Use with caution under
Analgesia IV IO 0.9% NaCl 10mL micrograms/kg 0.1-0.2mL/kg Over 3-5 min 100 micrograms
100 micrograms/2mL micrograms/mL 6 months
(less in infants)

Monitor ECG for

flecainide Draw up prescribed dose Over
Arrhythmia IV IO 5% glucose 2mg/kg 150mg arrhythmias.
150mg/15mL & make up to 50mL 10-30 min
Cardiac consult.

Repeat every 60 seconds

as needed to max
cumulative dose of
FluMAZenil
Benzodiazepine 100 5 Over 40micrograms/kg or 2mg
500 IV IO N/A N/A 0.05mL/kg 1mg
antagonist micrograms/mL micrograms/kg 15 seconds whichever is smaller;
micrograms/5mL
caution in known epilepsy
or potential multi agent
overdose.

Infuse over Avoid extravasation

glucose 10% Hypoglycaemia IV IO N/A N/A N/A 2mL/kg 2mL/kg
1 minute especially if peripheral

Slow push Monitor blood pressure and

hydrALAZINe Add 20mL
Hypertension IV IO 0.9% NaCl 1mg/mL 0.1-0.5mg/kg 0.1-0.5mL/kg over at least 20mg heart rate; incompatible with
20mg powder 0.9% NaCl
5 min glucose containing solutions

Over
hydroCORTisone Water for Add 0.04- 30 seconds
IV IO 50mg/mL 2-4mg/kg 240mg Inject over 10 minutes
100mg powder Injection 2mL WFI 0.08mL/kg for doses
under 100mg

ketamine Do not use in child

100mg (1mL) Over
200mg/2mL Induction IV IO 0.9% NaCl 10mg/mL 1-2mg/kg 0.1-0.2mL/kg 2mg/kg <6 months; beware
in 10 mL 60 seconds
(use 1mL) laryngospasm

LevETIRAcetam
Prolonged Infuse over IPA for emergency
(Keppra) IV IO 0.9% NaCl 10mL 50mg/mL Load 40mg/kg 0.8mL/kg 2500mg
seizures 5 minutes seizure management
500mg/5mL

Monitor blood pressure,

heart rate, respiratory rate,
magnesium
Draw up prescribed dose 0.2mmol/kg or Over 10mmol LOC and signs of muscle
SULFate 49.3% Severe asthma IV IO 0.9% NaCl
& dilute to 0.5mmol/mL (50mg/kg) 20 minutes (2500mg) weakness; contraindicated
(10mmol/5mL)
in patients with heart block
or myocardial damage
Endorsed by Medical Emergency Advisory Committee and Medicines Advisory Committee September 2017 – v2.1 Children’s Health Queensland Hospital and Health Service
 Paediatric Emergency Drug Preparation
Dilute Vol. to Final drug Volume Delivery Max single
Drug Indications Route with dilute to concentration Dose to give speed dose Other comments

Administer via a 170-260

mannitol 20% Infused over micron filter (blood filter);
Increased ICP IV IO N/A N/A 200mg/mL 250-2000mg/kg 1.25-10mL/kg 2g/kg/dose
1g/5mL 30 to 60 min do not mix with other drugs/
fluids; may repeat 1-2 times

Drop into
NB: Apnoea and respiratory
MIDazolam Sedation Buccal alternate
N/A N/A 5mg/mL 0.3mg/kg 0.06mL/kg 10mg depression, especially if
5mg/mL seizures Nasal nostrils over
used with opiate
15 seconds
NB: Apnoea and respiratory
MIDazolam Sedation Slow push in depression, especially if
IV IO 0.9% NaCl 5mL 1mg/mL 0.15mg/kg 0.15mL/kg 10mg
5mg/mL seizures aliquots used with opiate; reversal
agent: Flumazenil
NB: Apnoea and respiratory
MIDazolam Sedation
IM N/A N/A 5mg/mL 0.2mg/kg 0.04mL/kg 10mg depression, especially if
5mg/mL seizures
used with opiate

Slow push in NB: Apnoea and respiratory

morphine 0.1mg/kg 0.1mL/kg
Analgesia IV IO 0.9% NaCl 5mL 1mg/1mL small aliquots, 5mg depression, especially if
5mg/mL (less in infants) (less in infants)
titrate to pain used with benzodiazepine

naloxone 400 10 Initial dose

Narcotic reversal IV IO N/A N/A Rapid push 2mg Repeat as necessary
400 micrograms/mL micrograms/mL micrograms/kg 0.025mL/kg

Unstable in plastic syringe;

paraldehyde 100% 5mL drug 20mL
Seizures Rectal 0.9% NaCl 50% 0.4mL 100%/kg 0.8mL 50%/kg Rapid push draw up immediately
5mL in 10mL 50% dilution
before use

PHENobarbitone Draw up prescribed dose Administration rate

Seizures IV IO 0.9% NaCl Load 20mg/kg Over 20 min 1000mg
200mg/1mL & make up to 30mL 1mg/kg/min

Not to exceed 1-3mg/kg/min;

phenyTOIN Draw up prescribed dose use 0.22 micron filter;
Seizures IV IO 0.9% NaCl Load 20mg/kg Over 20 min 1500mg
250mg/5mL & dilute to 10mg/mL preferably administer into
large vein; cardiac monitoring

Weight
propOFol Caution in the
Induction/seizure IV IO N/A N/A 10mg/mL 1-2mg/kg 0.1-0.2mL/kg Over 30 sec dependent as
200mg/20mL unstable patient
lipophilic

Onset 1-3mins;
rocuronium
Muscle relaxant IV IO N/A N/A 10mg/mL 1mg/kg 0.1mL/kg Rapid push 1.2mg/kg lasts 20-35min; use red
50mg/5mL
barrel syringe if available
Endorsed by Medical Emergency Advisory Committee and Medicines Advisory Committee September 2017 – v2.1 Children’s Health Queensland Hospital and Health Service
 Paediatric Emergency Drug Preparation
Dilute Vol. to Final drug Volume Delivery Max single
Drug Indications Route with dilute to concentration Dose to give speed dose Other comments

salBUTamol Draw up prescribed dose Load 100 Minimum

Severe asthma IV IO 0.9% NaCl 5mg Cardiac monitoring
500 micrograms/mL & make up to 20mL micrograms/kg 20 min
sodium 1mmol/kg then Do not mix with other drugs;
Slowly via
BICARBonate 8.4% Severe Acidosis IV IO N/A N/A 1mmol/mL 1mmol/kg at 1-2mL/kg 100mmol administer preferably
large vessel
100mmol/100mL 10 min intervals via CVL
sodium chloride 3% Raised ICP/ Administer preferably via
IV IO N/A N/A 0.5mmol/mL 3mL/kg 3mL/kg Over 15 min 250mL
0.5mmol/mL (250mL) Hyponatraemia CVL or large vein

sugammadex Rocuronium Over Not recommended for

500mg/5mL IV IO N/A N/A 100mg/mL 16mg/kg 0.16mL/kg
reversal only 10 seconds children <2 years

Consider pre-treatment with

75mg atropine; onset 1 min; lasts
single dose 5 mins; beware malignant
suxamethonium 1mg/kg >1yr 0.1mL/kg >1yr Over 10-30
Muscle relaxant IV IO 0.9% NaCl 10mL 10mg/mL hyperthermia, myopathy,
100mg/2mL 2mg/kg <1yr 0.2mL/kg <1yr seconds 150mg burns spinal or crush injury;
total dose use red barrel syringe if
available
Avoid extravasation; monitor
thioPENTone Water for Add 20mL Over 10-15 hypotension and respiratory
Sedation/seizure IV IO 25mg/mL 3-5mg/kg 0.12-0.2mL/kg
500mg powder injection WFI seconds depression; caution in the
unstable patient
Haemostatic/ Slow push,
tranexamic acid Max 1500mg Rapid administration may
haemorrhage IV IO N/A N/A 100mg/mL 15mg/kg 0.15mL/kg no more than
1000mg/10mL per dose cause hypotension
control 50 mg/min
Onset 2-3 min; lasts
vecuronium Water for Add
Muscle relaxant IV IO 1mg/mL 0.1mg/kg 0.1mL/kg Rapid push 10mg 20-40 min; use red barrel
4mg powder injection 4mL WFI
syringe if available
Onset 2-3 min; lasts
vecuronium Water for Add
Muscle relaxant IV IO 1mg/mL 0.1mg/kg 0.1mL/kg Rapid push 10mg 20-40 min; use red barrel
10mg powder injection 10mL WFI
syringe if available
References:
Advanced Life Support Group (2011). Advanced Paediatric Life Support The practical approach 5th ed. London: Queensland Health. (2011). Acute Asthma Management in Children. Brisbane, Australia: Children’s Health Queensland Hospital
BMJ Publishing Group. and Health Service.
Australian Government Department of Health and Ageing (2013). The Australian Immunisation Handbook 10th ed. Queensland Health. (2011). Phenytoin Paediatric Drug Use Guideline. Brisbane, Australia: Children’s Health Queensland Hospital
Canberra, Australia: Commonwealth of Australia. and Health Service.
Australian Resuscitation Council (2010). Paediatric advanced life support guidelines. Queensland Health. (2013). Seizures – Emergency Management in Children. Brisbane, Australia: Children’s Health Queensland
Australian Society of Clinical Immunology and allergy (2013). Anaphylaxis. Hospital and Health Service.
British National Formulary for Children (2013/14). London: BMJ Group, RPS Publishing, RCPCH Publications Ltd. Shann, F. (2010). Drug Doses 15th ed. Intensive Care Unit, Royal Children’s Hospital, Melbourne.
Kilham H, Isaacs D, ed. (2004). The Children’s Hospital at Westmead handbook: clinical practice guidelines for paediatrics. Tinning K, Acworth J (2007). Make your Best Guess: An updated method for paediatric weight estimation in emergencies.
North Ryde, NSW: McGraw-Hill Australia Pty Ltd. Emergency Medicine Australasia 19, 528–534.
Phelps SJ, Hak EB, Crill CM. (2007). Pediatric injectable drugs, 8th ed. Bethesda: American Society of Health-System Pharmacists. The Society of Hospital Pharmacists of Australia. (2011) Australian Injectable Drugs Handbook 5th ed.

Endorsed by Medical Emergency Advisory Committee and Medicines Advisory Committee September 2017 – v2.1 Children’s Health Queensland Hospital and Health Service
 Paediatric Resuscitation Table
WEIGHT CALCULATION
< 12 mths = (Age in months +9) / 2 kg
3 5 10 15 20 25 30 35 40 45 50
1 - 5yrs = (Age in years x 2) + 10 

 ROUTE
5 - 14yrs = Age in years x 4

Adrenaline
IV mL
(1:10,000 – minijet) 0.3 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5
IO 
0.1 mL/kg (10 micrograms/kg)
Adrenaline
mL
(1:1000 – ampoule) IM 0.03 0.05 0.1 0.15 0.2 0.25 0.3 0.35 0.4 0.45 0.5

0.01 mL/kg (10 micrograms/kg)
Adenosine
IV mL
6mg/2mL 0.1 0.17 0.3 0.5 0.67 0.83 1 1.2 1.3 1.5 1.6
IO 
Dose: 0.03mL/kg (0.1mg/kg)
Atropine
IV mL
(1mg/5mL – minijet) 0.3 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5
IO 
0.1 mL/kg (20 micrograms/kg)
Atropine
IV mL
(1mg/10mL – minijet) 0.6 1 2 3 4 5 6 7 8 9 10
IO 
0.2 mL/kg (20 micrograms/kg)
Amiodarone
(150 mg/3 mL ampoule) (5 mg/kg)
IV mL
Final concentration = 10 mg/mL 1.5 2.5 5 7.5 10 12.5 15 17.5 20 22.5 25
IO 
mL post dilution. See Emergency
Drug Preparation sheet for Dilution POST DILUTION

Calcium Gluconate 10% IV mL

1.5 2.5 5 7.5 10 12.5 15 17.5 20 20 20
0.5 mL/kg slowly IO 

Midazolam

EMERGENCY DRUGS
mL
(5 mg/1 mL – ampoule) 0.18 0.3 0.6 0.9 1.2 1.5 1.8 2.0 2.0 2.0 2.0

Nasal
Buccal

0.06 mL/kg (0.3 mg/kg)

Midazolam
(5 mg/1 mL – ampoule) (0.15 mg/kg)
IV mL
Final concentration = 1 mg/mL 0.45 0.75 1.5 2.25 3.0 3.75 4.5 5.25 6.0 6.75 7.5
IO 
mL post dilution. See Emergency
Drug Preparation sheet for Dilution POST DILUTION

Glucose 10% IV mL
6 10 20 30 40 50 60 70 80 90 100
2 mL/kg IO 

Sodium Bicarbonate 8.4% 3 5 10 15 20 25 30 35 40 45 50

(1mmol/mL) IV mL
1 - 2 mL/kg slowly IO 
6 10 20 30 40 50 60 70 80 90 100
Then 1 mL/kg at 10min intervals

Volume expansion 10 mL/kg 30 50 100 150 200 250 300 350 400 450 500
10 - 20 mL/kg IV mL
IO 
20 mL/kg 60 100 200 300 400 500 600 700 800 900 1000

Defibrillation VF / pulseless VT: 4 J/kg J 12 20 40 60 80 100 120 140 160 180 200

Cardioversion Synchronised: 1 J/kg 3 5 10 15 20 25 30 35 40 45 50

J

DEFIB FLUID

Synchronised: 2 J/kg 6 10 20 30 40 50 60 70 80 90 100

Endotracheal Uncuffed (age/4) +4 3.0 3.5 4.0 4.5 5.0 5.5 6.0 6.0 6.5 6.5 7.0
tube size
mm
Microcuffed 3.0 3.0 3.5 4.0 4.5 5.0 5.5 5.5 6.0 6.0 6.5

ETT

Oral Length (age/2) +12 9 10 12.5 13.5 14.5 15 16 16.5 17 17.5 18

FrG
Nasogastric tube size 5-8 10 12

NGT

WEIGHT kg 3 5 10 15 20 25 30 35 40 45 50
Endorsed by Medical Emergency Advisory Committee and Medicines Advisory Committee September 2017 – v2.1 Children’s Health Queensland Hospital and Health Service
 Paediatric Emergency Drug Preparation
The use of this Paediatric Emergency Drug Preparation table in other Queensland Health facilities is outside the scope of this document. The local Executive Director of Medical
Services (EDMS) must be consulted prior to the implementation of this document at a regional site. The information contained in this document should be read in conjunction with
hospital specific protocols and procedures as specialised work areas may use different methods to those included in this guideline. Whilst every effort has been taken in preparing
this resource, Children’s Health Queensland accepts no responsibility for any errors, omissions or inaccuracies contained in this document. If in doubt, refer to the manufacturer’s
product information and the references contained within the document.