Paediatric Emergency Card
Age in, everything out. A measured weight always beats an estimate.
Working weight
Every number below is driven by this one.
Writes back to the patient strip as a fraction of a year. 3 months = 0.25 yr.
Enter age, or a measured weight, in the patient strip
Enter age above
APLS age-based formulae (5th/6th edition): under 1 yr = (0.5 × months) + 4 · 1–5 yr = (2 × age) + 8 · 6–12 yr = (3 × age) + 7. The 6–12 yr formula is Luscombe MD, Owens BD, Burke D, Emerg Med J 2011;28:590–3, adopted by APLS after the older 2(age+4) was shown to underestimate.
Enter age above
Resuscitation Council UK / RCPCH Paediatric emergency drug chart, 2021 — 50th-centile weights averaged across sexes on lean body mass. A third opinion, not a replacement for the scales.
Estimates are for the minutes before a weight exists. Weigh the child as soon as it is safe, or use a length-based tape (Broselow, PAWPER XL) — both beat age alone, particularly at the extremes of body habitus.
Airway
Formula first, RCUK chart alongside — they diverge in older children.
Enter age above
Uncuffed ID = (age ÷ 4) + 4, the classic APLS formula (APLS 5th ed.). Chart column from Resuscitation Council UK Paediatric emergency drug chart 2021, which stops offering uncuffed sizes from 8 years.
Enter age above
Cuffed ID = (age ÷ 4) + 3.5 (Motoyama, in Smith's Anesthesia for Infants and Children; supported by Duracher C et al, Paediatr Anaesth 2008;18:113–8). Khine HH et al, Anesthesiology 1997;86:627–31 give (age ÷ 4) + 3, half a size smaller, and is still used under 2 years. ERC 2021 recommends cuffed tubes for paediatric ALS except in small infants, with cuff pressure monitored.
Enter age above
Over 1 year the two published formulae disagree by 1 cm and both are shown: (age ÷ 2) + 12 (APLS) and (age ÷ 2) + 13 (Lau N, Playfor SD, Rashid A, Dhanarass M, Paediatr Anaesth 2006;16:1238–43). Under 1 year: weight + 6 cm (Tochen ML, J Pediatr 1979;95:1050–1). Confirm with auscultation, chest rise and capnography — no formula places a tube.
Enter age above
(age ÷ 2) + 15 — Lau et al, Paediatr Anaesth 2006;16:1238–43, derived in children over 1 year and not extrapolated below it here.
Enter age above
Bell G, Homer R. Equipment in paediatric anaesthesia. Update in Anaesthesia (WFSA) 2014;30:13–22 — size 1 blade for a term baby, size 0 below 3 kg, Macintosh 3 usable from 1 year, straight blades preferred by many to 5 years. Passi Y et al, Br J Anaesth 2014;113:869–74 favour the Miller under 2 years.
Enter age or weight above
Classic LMA sizes and maximum cuff volumes from the manufacturer's guide, tabulated in Bell & Homer, Update in Anaesthesia 2014;30:13–22. i-gel weight bands from the Intersurgical i-gel User Guide — the bands overlap by design, so two sizes are offered where they do. Both are sized on weight, not age.
Enter age above
Fr ≈ 2 × tube ID, taken to the nearest even French size — the bedside rule that generates the standard table (3.0 → 6 Fr, 3.5 → 8, 4.5 → 10, 5.5 → 12). It leaves the catheter's outer diameter at roughly two-thirds of the lumen; the AARC ceiling is 50–70% of the internal diameter, above which suctioning strips airway pressure and can collapse the lung. American Association for Respiratory Care, Endotracheal Suctioning of Mechanically Ventilated Patients with Artificial Airways 2010, Respir Care 2010;55:758–64.
Circulation
10 ml/kg is now the standard first bolus in the UK and Europe.
Enter age or weight above
Resuscitation Council UK Paediatric advanced life support Guidelines 2021 and Van de Voorde P et al, Resuscitation 2021;161:327–87 — balanced isotonic crystalloid, reassess after every bolus, stop on any sign of overload (hepatomegaly, basal crackles, raised JVP).
Enter age or weight above
RCUK 2021: repeated 10 ml/kg boluses to 40–60 ml/kg in the first hour of septic shock, titrated to response, with vasoactive drugs started early rather than late.
Enter age or weight above
RCUK / ERC 2021: in haemorrhagic shock keep total crystalloid to a maximum of 20 ml/kg and move to blood products early, with tranexamic acid 15–20 mg/kg (max 1 g) within 3 hours of injury.
Septic, hypovolaemic or undifferentiated shock: 10 ml/kg, reassess, repeat. Diabetic ketoacidosis: 10 ml/kg only if shocked, repeatable to 40 ml/kg, and it is not subtracted from the deficit (BSPED 2021). Haemorrhage: 20 ml/kg crystalloid in total, then blood. The AHA still permits 10 or 20 ml/kg aliquots in septic shock (2020 PALS, Class 2a) — European practice has settled on 10.
Enter age or weight above
4 J/kg for every shock, monophasic or biphasic, then select the nearest energy the machine offers — RCUK 2021 and ERC 2021. Escalation above 4 J/kg (to a maximum of 8 J/kg and not above the adult dose) is only for refractory VF/pVT.
Enter age or weight above
Synchronised. RCUK 2021 gives 1 J/kg then 2 J/kg; ERC 2021 adds that the energy is doubled for each subsequent attempt to a maximum of 4 J/kg. Sedate or anaesthetise a conscious child first; get expert help before a third attempt.
Emergency drugs
Volumes are at the concentration named on each line. Read your ampoule.
Enter age or weight above
10 mcg/kg (0.1 ml/kg of 1:10,000), maximum 1 mg, repeated every 3–5 minutes — RCUK Paediatric ALS 2021; ERC 2021. Higher doses are explicitly not recommended: they worsen outcome.
Enter age above
1:1000 into the anterolateral mid-thigh, by age band, repeatable after 5 minutes: under 6 months 100–150 mcg · 6 months–6 years 150 mcg · 6–12 years 300 mcg · over 12 years 500 mcg. After two IM doses treat as refractory and start a low-dose IV infusion. RCUK / RCPCH Paediatric emergency drug chart 2021. Note this is a different dose and a different dilution from the arrest dose above.
Enter age or weight above
20 mcg/kg. Maximum single dose 600 mcg (RCUK 2021) or 500 mcg (ERC 2021) — the two guidelines differ and both are shown. AHA 2020 PALS sets a minimum single dose of 100 mcg. Reserve it for bradycardia from vagal tone or AV block; hypoxia is the usual cause in children and oxygen is the treatment.
Enter age or weight above
5 mg/kg IV/IO bolus after the 3rd and again after the 5th shock, flushed. Maximum 300 mg for the first dose and 150 mg for the second (RCUK 2021 · ERC 2021). Lidocaine 1 mg/kg is an alternative for those competent in its use.
Enter age or weight above
The two guidelines differ: RCUK 2021 gives 2 ml/kg of 10% (2.5 ml/kg in newborns); ERC 2021 gives 0.3 g/kg, which is 3 ml/kg of 10% or 1.5 ml/kg of 20%. The range covers both. Recheck the glucose after 10 minutes, repeat if needed, and start a maintenance infusion of 6–8 mg/kg/min.
Enter age or weight above
Neonates and infants need 2 mg/kg; from about 1 year 1 mg/kg is the licensed dose, though 1.5–2 mg/kg is common practice for rapid sequence induction. Total not to exceed 500 mg. If there is no IV access, 4 mg/kg IM (up to 5 mg/kg in infants) works in about 3 minutes. Suxamethonium Chloride 50 mg/ml Summary of Product Characteristics (emc). Contraindicated in known or suspected myopathy, hyperkalaemia, major burns beyond 24 h and a personal or family history of malignant hyperthermia.
Enter age or weight above
0.6 mg/kg for routine intubation (rocuronium bromide Summary of Product Characteristics; paediatric label data at 0.45, 0.6 and 1 mg/kg). 1.0–1.2 mg/kg gives intubating conditions comparable to suxamethonium — Tran DTT et al, Cochrane Database Syst Rev 2015;CD002788. At 10 mg/ml the volumes are small: dilute for infants.
Doses are per kilogram of the working weight above and capped at the adult maximum where one exists. This is a reference card, not a prescription — the drug, the dose and the ampoule are checked by the person giving it.
Normal values for age
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AHA 2020 PALS thresholds: term neonate < 60 · 1–12 months < 70 · 1–10 years < 70 + (2 × age) · over 10 years < 90 mmHg. ERC 2021 gives the 5th centile systolic as 50 at 1 month, 70 at 1 year, 75 at 5 years and 80 at 10 years. A normal blood pressure does not exclude shock — children compensate by tachycardia and vasoconstriction until they suddenly do not.
Bands from APLS 5th edition, reproduced in Hewitson R, Fertleman C, The Hands-on Guide to Practical Paediatrics, Wiley 2014. Cross-checked against Van de Voorde P et al, Resuscitation 2021;161:327–87, Tables 1–3, whose limits are wider because they are 1st–99th centiles for sleeping and waking children.