Paediatric Guidelines

Question 1

IM Adrenaline dose for paediatric anaphylaxis

Answer 1

10mcg/kg to a max dose of 500mcg repeat PRN

Question 2

NEB Adrenaline dose for upper airway angioedema for paediatric anaphylaxis

Answer 2

< 6mths 2.5mg, add saline to make 5mls
> 6mths 5mg (Including adults)

Question 3

Fluid administration for hypotension in anaphylaxis for paediatric anaphylaxis

Answer 3

IV saline 10ml/kg up to 20ml/kg Target - SBP lower end of normal range for age

Question 4

Bronchospasm treatment

Answer 4

Salbutamol:
< 6 yrs: MDI - 600mcg (6 puffs), NEB - 2.5mg add saline to make 5mL Repeat 20 mins PRN 3 doses
> 6 yrs: MDI - 1200mcg (12 puffs), NEB - 5mg Repeat PRN 20 mins PRN 3 doses
Ipratropium bromide:
< 6 yrs: MDI - 84mcg (4 puffs), NEB - 250mcg add saline to make 5mL
> 6 yrs: MDI - 168mcg (8 puffs), NEB - 500mcg
Prednisolone:
1mg/kg Max single dose 50mg

Question 5

Mild asthma paediatric

Answer 5

Salbutamol:
< 6 yrs: MDI - 600mcg (6 puffs),
> 6 yrs: MDI - 1200mcg (12 puffs),
Ipratropium bromide:
< 6 yrs: MDI - 84mcg (4 puffs),
> 6 yrs: MDI - 168mcg (8 puffs),

Question 6

Moderate asthma paediatric

Answer 6

Salbutamol:
< 6 yrs: MDI - 600mcg (6 puffs), NEB - 2.5mg add saline to make 5mL Repeat 20 mins PRN 3 doses
> 6 yrs: MDI - 1200mcg (12 puffs), NEB - 5mg Repeat PRN 20 mins PRN 3 doses
Ipratropium bromide:
< 6 yrs: MDI - 84mcg (4 puffs), NEB - 250mcg add saline to make 5mL
> 6 yrs: MDI - 168mcg (8 puffs), NEB - 500mcg
Prednisolone:
1mg/kg Max single dose 50mg

Question 7

Severe asthma paediatric

Answer 7

Salbutamol:
< 6 yrs: NEB - 7.5mg add saline to make 5mL Repeat 20 mins PRN 3 doses
> 6 yrs: NEB - 15mg Repeat PRN 20 mins PRN 3 doses
Ipratropium bromide:
< 6 yrs: NEB - 250mcg add saline to make 5mL
> 6 yrs: NEB - 500mcg
Prednisolone:
1mg/kg Max single dose 50mg

Question 8

Life-threatening asthma paediatric

Answer 8

Continuous nebulised salbutamol IPPV if required via inline NEB
Nebulised Ipratropium < 6 yrs: NEB - 250mcg
> 6 yrs: NEB - 500mcg Repeat every 20 mins Max 3 doses
Consider IM adrenaline 10mcg/kg single max dose 500mcg
IV Saline 10ml/kg up to 20mg/kg

Question 9

Severe croup

Answer 9

Nebulised adrenaline:
< 6 months nebulised adrenaline 2.5 mg
make to 5 mL with saline
repeat prn

≥ 6 months nebulised adrenaline 5 mg/5 mL
repeat prn

Oral prednisolone (if tolerated)
only after adrenaline neb
1 mg/kg to max 50 mg

Question 10

nausea and vomiting

Answer 10

Ondansetron:
ODT
2 mg (2 to 5 yrs)
4 mg (≥ 6 yrs)
or
IM/IV ondansetron (1 - 15 yrs)
150 microg/kg to single max dose 4 mg
if IV, slow push over ≥ 1 min
consult EOC Clinician for < 1 yr

Question 11

Paediatric sepsis

Answer 11

Rapid IV saline 10 mL/kg aliquots (max 250 mL) up to 20 mL/kg:
regularly assess response to fluid therapy - Lower SBP normal range

Suspected Meningococcal
Administer benzylpenicillin (IV preferred but not essential):
Adults and paediatrics ≥ 40 kg:
IV or IM benzylpenicillin 2400 mg
Paediatrics < 40 kg:
IV or IM benzylpenicillin 60 mg/kg (single max dose 2400 mg)

Rapid IV saline 10 mL/kg aliquots (max 250 mL) up to 20 mL/kg:
regularly assess response to fluid therapy - Lower SBP normal range