Maximum Dose Wins
A 48-kg child with severe asthma requires dexamethasone. Calculate the dose that should actually be administered.
0.6 mg/kg = 28.8 mg, but the maximum pediatric dose is 10 mg.
Final Answer: 10 mg IV/PO
A 16-kg child requires D10 for hypoglycemia. How many mL should be administered?
5 mL/kg
80 mL
Which pediatric medication has the longest half-life among the corticosteroids commonly used by EMS?
Dexamethasone
A 22-month-old (12 kg) develops urticaria after a bee sting. She is scratching but has no respiratory distress or hypotension. According to the NCOEMS protocol, what medication should be administered, and what is the correct dose?
Diphenhydramine 1 mg/kg = 12 mg IV/IM/PO (maximum 50 mg)
A 4-year-old child (18 kg) has symptomatic sinus bradycardia caused by increased vagal tone that does not improve with oxygenation and ventilation. What medication should be administered, and what is the dose?
Atropine 0.02 mg/kg IV/IO = 0.36 mg
A 45-kg child is in status asthmaticus. Calculate the magnesium sulfate dose.
50 mg/kg = 2250 mg
Maximum = 2 grams
Final Answer: 2 grams IV
A 27-kg child requires naloxone.
0.1 mg/kg
2.7 mg
Maximum = 2 mg
Which medication used for hypoglycemia may not work in a child with depleted glycogen stores?
Glucagon
A 3-year-old (16 kg) presents with altered mental status. Blood glucose is 42 mg/dL, and IV access has been established. According to the NCOEMS pediatric hypoglycemia protocol, what concentration of dextrose should be administered, and how many milliliters should the child receive?
D10, 5 mL/kg = 80 mL IV
A 7-year-old child (25 kg) has stable supraventricular tachycardia that does not respond to vagal maneuvers. What medication should be administered first, and what is the dose?
Adenosine 0.1 mg/kg rapid IV/IO push = 2.5 mg
A 39-kg child requires IM epinephrine for anaphylaxis.
0.01 mg/kg = 0.39 mg
Maximum = 0.3 mg
Final Answer: 0.3 mg IM (1 mg/mL)
A 34-kg child is actively seizing. Calculate the intranasal midazolam dose.
0.2 mg/kg
6.8 mg
A 9-year-old (31 kg) has a fever of 103.8°F and is alert enough to take oral medication. Which medication should be administered, and what is the correct dose?
Acetaminophen 15 mg/kg = 465 mg PO (maximum 650 mg)
A 5-year-old (20 kg) is actively seizing. You are unable to obtain IV access. What medication should be administered intranasally, and what is the correct dose?
Midazolam 0.2 mg/kg = 4 mg IN
The first dose of adenosine fails to convert the rhythm in the same 25-kg child. What is the second dose?
Adenosine 0.2 mg/kg = 5 mg
A 60-kg adolescent has severe hyperkalemia. Calculate the calcium chloride dose.
20 mg/kg = 1200 mg
Maximum = 1 gram
Final Answer: 1 gram IV
A 13-kg child develops severe anaphylaxis. Calculate the IM epinephrine dose.
0.13 mg IM
A 20-kg child is vomiting after swallowing an unknown medication 20 minutes ago. Which medication may be considered to reduce GI absorption, and what is the pediatric dose?
Activated Charcoal 1 g/kg PO = 20 grams
A 7-year-old (26 kg) has severe anaphylaxis with inspiratory stridor, wheezing, and hypotension. What medication should be administered first, what concentration should be used, and what is the dose?
Epinephrine 1 mg/mL (1:1,000), 0.01 mg/kg = 0.26 mg IM
A 10-year-old child (35 kg) remains in ventricular fibrillation after the third defibrillation. What antiarrhythmic should be administered, and what is the dose?
Amiodarone 5 mg/kg IV/IO = 175 mg
A 50-kg adolescent requires glucagon.
1 mg IM
A 7-kg infant has severe asthma requiring magnesium sulfate.
350 mg IV
A 4-year-old (15 kg) remains profoundly bradycardic despite effective oxygenation and ventilation. The bradycardia is not due to increased vagal tone or primary AV block. Which medication should be administered, and what is the dose?
Epinephrine 0.01 mg/kg IV/IO of the 0.1 mg/mL (1:10,000) concentration = 0.15 mg (1.5 mL) IV/IO.
A 10-year-old (35 kg) with status asthmaticus has already received three albuterol treatments, ipratropium, and dexamethasone but continues to deteriorate. According to the NCOEMS protocol, what medication should be administered next, and what is the correct dose?
Magnesium Sulfate 50 mg/kg = 1,750 mg (1.75 grams) IV over 10–20 minutes
The same 35-kg child remains in ventricular fibrillation despite defibrillation, epinephrine, and amiodarone. The physician requests lidocaine instead of additional amiodarone. What is the correct dose?
Lidocaine 1 mg/kg IV/IO = 35 mg