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Pediatric Critical Care Reference guide (PICU Charts): PICU Handbook

Provider Education
May 20, 2022

PICU Charts

Drug Dose (IV) Comment
Levetiracetam
(Keppra)		 50 mg/Kg load over
15 minutes		 Max dose: 2500 mg
Phenobarbital 15–20 mg/Kg load
at 1 mg/Kg/min		 May cause
hypotension
Max dose: 1Gm
Phenytoin or
Fosphenytoin		 15–20 mg/Kg load
at 1 mg/Kg/min
15–20 mg PE*/Kg at
2–3 mg PE*/Kg/min		 Max dose: 1Gm,
must dilute phenytoin
in NS and fi lter

*PE Phenytoin Equivalents

Drug Dose (IV)
Alprostadil 0.01–0.1 mcg/Kg/min
0.02–0.05 mcg/Kg/min typical range
Amiodarone 10 mg/Kg/day for 4–5 days then
5 mg/Kg/day
Dobutamine** Renal dose: 1–3 mcg/Kg/min;
β dose 5–10 mcg/Kg/min;
α dose 10–20 mcg/Kg/min
Epinephrine** 0.01–1 mcg/Kg/min
0.01–0.5 mcg/Kg/min typical range
Esmolol Load: 500 mcg/Kg
Maintenance: 50–1000 mcg/Kg/min
Isoproterenol 0.05–2 mcg/Kg/min
0.1–0.5 mcg/Kg/min typical range
Lidocaine Load: 1 mg/Kg
Maintenance: 10–50 mcg/Kg/min
Milrinone Load: 50–75 mcg/Kg IV over 10 minutes
0.25–1 mcg/Kg/min
0.5–1 mcg/Kg/min typical range
Nitroglycerin 0.5–20 mcg/Kg/min
0.5–5 mcg/Kg/min typical range
Nitroprusside 0.3–10 mcg/Kg/min
0.5–2 mcg/Kg/min typical range
Norepinephrine** 0.02–2 mcg/Kg/min
0.01–0.5 mcg/Kg/min typical range
Phentolamine 0.5–20 mcg/Kg/min
1–5 mcg/Kg/min typical range
Phenylephrine** 0.1–10 mcg/Kg/min
0.5–5 mcg/Kg/min typical range
Vasopressin** Cardiovascular support:
0.05–2 milli–units/Kg/min
0.1–0.5 milli–units/Kg/min typical range
Diabetes Insipidus dose:
1–10 milli–units/Kg/hr

** Central line preferred

*** Central line preferred, but short duration peripheral IV acceptable

Drug Dose (IV) Comment
Adenosine 0.1 mg/Kg
(Max dose: 6 mg) IV		 Give rapidly
No effect in 2 min:
0.2–0.3 mg/Kg
(Max dose: 12mg)
Albuterol MDI: 4–8 puffs q 20 min with spacer or through ETT
Neb: 2.5 mg (<20 Kg) and 5 mg (> 20 Kg) q 20 min
Continuous Neb: 0.5 mg/Kg/hr		 Asthma, Anaphylaxis,
Hyperkalemia
Amiodarone 5 mg/Kg IV/IO* Give rapid bolus for V. Fib/pulseless VT
Give over 20–60 min for SVT and ventricular dysrhythmias
Atropine 0.02 mg/Kg IV
(may give ETT)		 Max dose: 0.5 mg (child)
1 mg (adolescent)
Calcium Chloride 10%** 20 mg/Kg IV Give slowly
(Max. rate 100 mg/min)
Max dose: 1 Gm/dose
Give in central line if
available**
Dexamethasone 0.6 mg/Kg PO/IM/IV Max dose: 16 mg
Dextrose 500 mg/Kg IV 1–2 ml/Kg D50W Child
2–4 ml/Kg D25W Infant
2–3 ml/Kg D10W NICU
Epinephrine (Anaphylaxis) Anaphylaxis
IM: 0.01 mg/Kg
(0.01 ml/Kg) 1:1,000		 Anaphylaxis Max dose:
0.3 mg or 0.3 ml
Epinephrine (Code)

PICU/PEDS
IV/IO*: 0.01–0.03 mg/
Kg 1:10,000 concentration
ETT: 0.1 mg/Kg 1:1,000
concentration

NICU
1:10,000 only all routes
IV/IO: 0.1–0.3 ml/Kg
(0.01–0.03 ml/Kg)
1:10,000
ETT: 0.5–1 ml/Kg
(0.05–0.1 mg/Kg) 1:10,000

 Repeat q 3–5 min. for
code
Epinephrine (Racemic) 0.25–0.5 ml racemic
solution (2.25%) mixed in
3 ml saline via inhalation
3 ml of 1:1000
epinephrine mixed with
3 ml saline via inhalation
is alternative if racemic epi
not available		 Croup
Flumazenil 0.01 mg/Kg IV
(Max dose: 0.2 mg)		 Give over 15 seconds
May repeat at 1 minute
intervals up to 4 times
Max total dose: 0.05 mg/
Kg or 1 mg, whichever is
lower
Furosemide 0.5–1 mg/Kg IV Congestive heart failure
Use lower dose in
furosemide naive patients
Hydrocortisone 2 mg/Kg IV bolus Adrenal insuffi ciency,
catecholamine refractory
shock
Insulin (regular) 0.05–0.1 Units/Kg bolus
IV or SQ
0.05–0.1 Units/Kg/hr
infusion		 Diabetic Ketoacidosis
(Infusion preferred to bolus dosing)
Lidocaine 2% 1 mg/Kg IV/IO* May repeat dose in
10–20 min.
Magnesium Sulfate 25 mg/Kg IV/IO* Give over 10–20 min; faster in Torsades de Pointes
Max dose: 2 Gm
Methylprednisolone 2 mg/Kg IV/IO/IM Status Asthmaticus,
Anaphylaxis
Max dose: 60 mg; use
only acetate salt for IM
Naloxone 0.01 mg/Kg IV/ET Titrate to effect
Max dose: 2 mg
Nicardipine 0.5–4 mcg/Kg/min IV Hypertensive urgency/Emergency
Sodium Bicarbonate 1 mEq/Kg IV Use 1 mEq/ml for > 6 months
Use 0.5 mEq/ml for < 6 months
Terbutaline 10 mcg/Kg SQ q 15 min
0.1–10 mcg/Kg/min IV		 Refractory status
Asthmaticus
Max dose: 0.4 mg
Vasopressin 0.5 units/Kg IV/IO* Max dose: 40 units

** Central line preferred
*** Central line preferred, but short duration peripheral IV acceptable

Equipment < 3Kg 3-5 Kg Small Infant
6-7 Kg		 Infant
8-9 Kg		 Toddler
10-11 Kg		 Small child
12-14 Kg		 Child
15-18 Kg		 Child
19-23 Kg		 Large Child
24-29 Kg		 Adult
30-36 Kg
Resuscitation Bag     Infant/Child Infant/Child Child Child Child Child Child Adult
Oxygen Mask (NRB)     Pediatric Pediatric Pediatric Pediatric Pediatric Pediatric Pediatric Pediatric/Adult
Oral Airway (mm)     50 50 60 60 60 70 80 80
Laryngoscope Blade (size)     1 Straight 1 Straight 1 Straight 2 Straight 2 Straight 2 Straight or Curved 2 Straight or Curved 3 Straight or Curved
ET Tube (mm)† < 1 Kg 2.5
Uncuffed
1-2 Kg 3.0
Uncuffed		 2-4 Kg 3.5
Uncuffed
5 Kg 3.5
Uncuffed		 3.5 Uncuffed
3.0 Cuffed		 3.5 Uncuffed
3.0 Cuffed		 4.0 Uncuffed
3.5 Cuffed		 4.5 Uncuffed
4.0 Cuffed		 5.0 Uncuffed
4.5 Cuffed		 5.5 Uncuffed
5.0 Cuffed		 6.0 Cuffed 6.5 Cuffed
ET Tube Insertion Length (cm) 0.5 Kg: 6.5
1 Kg: 7
2 Kg: 8		 3 Kg: 9-9.5
4 Kg: 9.5-10
5 Kg: 10-10.5		 10.5-11 10.5-11 11-12 13.5 14-15 16.5 17-18 18.5-19.5
Suction Catheter (F)     8 8 10 10 10 10 10 10-12
BP Cuff   Neonatal #5/Infant Infant/Child Infant/Child Child Child Child Child Child Small Adult
IV Catheter (ga)     22-24 22-24 20-24 18-22 18-22 18-20 18-20 16-20
IO (ga)     18/15 18/15 15 15 15 15 15 15
NG Tube (F)     5-8 5-8 8-10 10 10 12-14 14-18 16-18
Urinary Catheter (F)   5 8 8 8-10 10 10-12 10-12 12 12
Chest Tube (F)     10-12 10-12 16-20 20-24 20-24 24-32 28-32 32-38

Abbreviations: BP, blood pressure; ET, endotracheal; F, French; IO, intraosseous; IV, intravenous; NG, nasogastric; NRB, nonrebreathing; ga, gauge; mm, millimeters; cm, centimeters

†Per 2010 AHA Guidelines, in the hospital cuffed or uncuffed tubesmay be used (see below for sizing of cuffed tubes).
Modified with permission from Artemis Pediatric software © 2012 eBroselow.

  • Fluid Bolus: LR, NS, 5% Albumin 10–20 ml/Kg bolus
  • PRBC: 10 ml/Kg will increase Hct 5%
  • FFP: 10 ml/Kg for prolonged INR/PT/PTT
  • Platelets: 10ml/Kg for platelet counts <25,000/mm3 with active bleeding

  Child Infant Score
Eye Opening Spontaneous Spontaneous 4
To speech To speech 3
To pain To pain 2
None None 1
Best Verbal Response Oriented, Appropriate Coos and babbles 5
Confused Irritable, cries 4
Inappropriate words Cries in response to pain 3
Incomprehensible sounds Moans in response to pain 2
None None 1
Best Motor Response Obeys commands Moves spontaneously and purposefully 6
Localizes painful stimuli Withdraws in response to touch 5
Withdraws in response to pain Withdraws in response to pain 4
Flexion in response to pain Abnormal flexion posture to pain 3
Extension in response to pain Abnormal extension posture to pain 2
None None 1
Total Score     3–15

Age Systolic Pressure (mmHg)
Term Neonates < 60
Infants < 70
Children 1–10 years < 70 + (age in years x 2)
Children > 10 years < 90

Ventilation support required

Drug Dose (IV)
Rocuronium* 1 mg/Kg/dose
Succinylcholine* 1 mg/Kg/dose
Vecuronium 0.1 mg/Kg/dose

* Preferred for Rapid Sequence Intubation (RSI)

Drug Dose (IV) Comment
Dexmedetomidine Bolus 0.5–1 mcg/Kg
over 10 minutes
Infusion: 0.25–1 mcg/
Kg/hr		 Avoid in patients with
heart block
Etomidate 0.3 mg/Kg/dose Avoid in septic shock
Adrenal suppression
Fentanyl 1 mcg/Kg/dose IV
q 30–60 minutes
Max dose: 300 mcg total
Continuous: 1 mcg/Kg/hr		 Rigid chest with rapid
administration
Ketamine 1 mg/Kg/dose (consider
with asthma)		 Bronchodilator
Lorazepam 0.05–0.1 mg/Kg/dose q
4–6 hours Max dose: 4 mg		  
Midazolam 0.1 mg/Kg Avoid in hemodynamically
unstable patient
Morphine 0.1– 0.15 mg/Kg IV
q 3–4 hours
Continuous:
10 –30 mcg/Kg/hr		 Ventilated patients may
receive larger doses, more
frequent intervals
Avoid in asthma patients
Pentobarbital 1–3 mg/Kg (max 100
mg) –– sedation
10–15 mg/Kg load (< 5
mg/Kg/hr), then 1–5 mg/
Kg/hr–– therapeutic coma		 Avoid in hemodynamically
unstable patient
Propofol 25–100 mcg/Kg/min
(short term use only)		 Avoid in hemodynamically
unstable patient

Age Systolic Diastolic
Neonate 60–90 20–60
Infant 87–105 53–66
Toddler 95–105 53–66
Preschooler 95–110 56–70
School–Aged Child 97–112 57–71
Adolescent 112–128 66–80

50th precentile systolic blood pressure= 90 mmHg + (2 x age in years)

Age Awake Asleep
Newborn to 3 months 85-200 80-160
3 months–2 years 100-190 75-160
2–10 years 60-140 60-90
> 10 years 60-100 50-90

Age Respiratory Rate
(breaths/min)
Infant 30–60
Toddler 24–40
Preschooler 22–34
School–Aged Child 18–30
Adolescent 12–16

Educational Resources

Monitoring Devices: PICU Handbook
Medications: PICU Handbook
Procedural Sedation: PICU Handbook
Trauma Protocols: PICU Handbook
Toxicology: PICU Handbook
Respiratory: PICU Handbook
Neurology: PICU Handbook
Nephrology: PICU Handbook
Hematology and Oncology: PICU Handbook
Fluids, Electrolytes, and Nutrition: PICU Handbook
ECMO: PICU Handbook
Cardiology: PICU Handbook
PICU Handbook
Suicidal Adolescent Family Empowerment (SAFE) Program