cards · checks stay on this phone
Pediatric emergencies
207 values across 16 cards. Rows check off; per-kg doses compute on the weight.
— kg kg SET WEIGHT drives every per-kg dose below
age mo yr ESTIMATE KG no scale? APLS estimate — prefer a measured weight
Anaphylaxis 9 40 kg AND OVER — ADULT CARD ▸ NOT YET REVIEWED BY A CLINICIAN. Written for this site and cited, but nobody has read it line by line. Check it against your own practice before you use it.
TIME SINCE EPINEPHRINE 0:00 START ✕ CLEAR
Epinephrine IM (1:1000) anaphylaxis: IM (1:1000), anterolateral thigh · 0.01 mg/kg q5–15min
max: 0.5 mg · IM, anterolateral thigh
Crystalloid 20 mL/kg (max 1 L). Repeat for persistent hypotension.
IV
Refractory: start the EPI infusion at 0.1 mcg/kg/min (range 0.1–1 mcg/kg/min) on a pump — no push-dose for a child.
IV infusion on a pump
Diphenhydramine IV/IM · 1 mg/kg · Max: 50 mg
Famotidine IV · 1 mg/kg · Max: 20 mg
Dexamethasone IV/IM/PO · 0.6 mg/kg
max: 10 mg
Albuterol nebulizer (bronchospasm/wheeze) unit-dose neb, may repeat q20min ×3
nebulized
Racemic epinephrine 2.25% neb (stridor/upper-airway edema) · 0.5 mL in 3 mL NS (0.25 mL if <5 kg)
nebulized
SOURCES ▸ WAO 2020 Ruled 2026-09-16 (issue #47): "I agree with infusion instead of push dose for non-cardiac arrest pediatric" — supersedes the 2026-09-08 child push-dose (1 mcg/kg, cap 10 mcg). The rate is the pediatric anaphylaxis card's own (peds p02: 0.1–1 mcg/kg/min); the Resuscitation Council UK 2021 refractory anaphylaxis algorithm corroborates the start (1 mg in 100 mL, "in both adults and children, start at 0.5–1.0 mL/kg/hour" ≈ 0.1 mcg/kg/min; read 2026-09-16). Replaces the harvest's "1 mcg/kg slow IV (max 50 mcg), then 0.1–1 mcg/kg/min" — the infusion range is the harvest's own number, the bolus is gone PowerPlan Asthma Exacerbation 14 40 kg AND OVER — ADULT CARD ▸ OPEN THE LIVE PATHWAY — CRASHING ASTHMA — WEIGHT-DRIVEN ▸ Mild (ESI 4): dexamethasone + albuterol MDI 2–4 puffs. Spacer teaching, discharge.
Moderate (ESI 3): dexamethasone + albuterol neb q20min ×3 PRN. Allow ≥2 h before disposition.
Severe (ESI 1–2): dexamethasone + albuterol/ipratropium neb. Consider magnesium.
Supplemental O₂ for persistent SpO₂ <90%.
Prednisone/methylprednisolone (alternative): 2 mg/kg PO/IV, max 60 mg.
Magnesium 50 mg/kg (max 2 g) + saline 20 mL/kg. Vitals q15min, observe 60 min.
IV
Terbutaline 10 mcg/kg IV over 5 min (max 250 mcg), q15–30min, max 3 doses.
Albuterol — 5–10 kg · 2.5 mg (0.5 mL) · MDI puffs: 4 · 7.5 mg/hr
nebulized/MDI
Albuterol — >10–20 kg · 3.75 mg (0.75 mL) · MDI puffs: 6 · 11.25 mg/hr
nebulized/MDI
Albuterol — >20 kg · 5 mg (1 mL) · MDI puffs: 8 · 15 mg/hr
nebulized/MDI
Ipratropium — 5–10 kg · 500 mcg over 1h in uniNeb, or 250 mcg q20min ×2 · MDI puffs: 4
nebulized/MDI
Ipratropium — >10–20 kg · 1000 mcg over 1h in uniNeb, or 500 mcg q20min ×2 · MDI puffs: 6
nebulized/MDI
Ipratropium — >20 kg · 1000 mcg over 1h in uniNeb, or 500 mcg q20min ×2 · MDI puffs: 8
nebulized/MDI
Airway Obstruction (Choking) 9 Effective cough → do not intervene. Let them cough and watch.
Intervene now signs — Weak cough, cyanosis, stridor, poor air movement → intervene now.
Unresponsive, any age: start CPR. Look in the mouth before each set of breaths.
Infant <1 yr: 5 back blows, then 5 chest thrusts. NO abdominal thrusts.
Child ≥1 yr and adults: alternate 5 back blows with 5 abdominal thrusts.
At or below the cords and removal fails → needle cricothyrotomy with jet ventilation.
Judge by anatomic size, not by age. Do not rely on one cutoff number.
Epiglottitis / Upper Airway Emergency 18 Recognition features — Abrupt fever, toxic, tripod or sniffing position, drooling, muffled voice, stridor.
Keep the child sitting up with the parent. Blow-by oxygen only.
Call the PICU transport team and the receiving ED in parallel.
Monitor continuously without repeated exams. Do not send the child to CT.
Disturb the patient as little as possible, prepare for the worst.
Hib vaccination does not rule it out.
Racemic epinephrine 2.25%: 0.5 mL in 3 mL NS as blow-by (0.25 mL if <5 kg).
nebulized blow-by
Dexamethasone 0.6 mg/kg IV/IM (max 10 mg) — after the airway, or at induction.
Ceftriaxone 50–100 mg/kg/day IV (max 2 g/day). Add vancomycin 15 mg/kg q6h if MRSA.
Immunocompromised: cefepime 50 mg/kg IV q8h (max 2 g) + vancomycin 15 mg/kg IV q6h.
Age · Croup: 6mo–3y · Epiglottitis: 2–7y (shifting older) · Bacterial tracheitis: 6mo–14y
Cause · Croup: Viral · Epiglottitis: Bacterial · Bacterial tracheitis: Bacterial (post-viral)
Onset · Croup: Gradual · Epiglottitis: Very rapid (hours) · Bacterial tracheitis: Rapid
Cough · Croup: Barking · Epiglottitis: Suppressed/absent · Bacterial tracheitis: Present, brassy
Position · Croup: Comfortable supine · Epiglottitis: Tripod, neck extended · Bacterial tracheitis: Can lie supine, toxic
Imaging · Croup: Steeple sign (AP) · Epiglottitis: Thumbprint sign (lateral) · Bacterial tracheitis: Steeple + irregular tracheal air
Drooling · Croup: No · Epiglottitis: Yes · Bacterial tracheitis: No
Bronchiolitis 12 Nasal suctioning — often the single most helpful intervention; infants are obligate nasal breathers.
Oxygen to a target SpO₂ of about ≥90%.
Hydration; bolus only for dehydration/shock — Oral intake if tolerated; IV or NG if not. Bolus only for real dehydration or shock.
Antipyretics (acetaminophen) for fever/comfort as needed.
Escalate to high-flow or NIPPV if low-flow O₂ and suctioning are not holding.
No routine bronchodilators — Albuterol, nebulized epinephrine and ipratropium are not routinely recommended.
Steroids do not work in bronchiolitis — systemic or inhaled.
Chest physiotherapy and hypertonic saline nebs — not routinely recommended in the ED setting.
Bronchodilator trial with no change → stop. Do not re-dose.
Apnea can be the FIRST sign, not a late one.
Intubated → call the receiving PICU immediately and arrange transfer.
Altered Mental Status 9 POC glucose immediately. Treat if <60 mg/dL, or <40 in a neonate.
Naloxone — Neonates: 0.01 mg/kg IV/IM/SC, repeat q2–3min.
Children: naloxone 0.01 mg/kg IV, up to 0.1 mg/kg if no response. Auto-injector 0.4 mg.
Naloxone 0.01 mg/kg IV initial. Escalate up to 0.1 mg/kg if the response is inadequate.
“One pill can kill”: opioids, sulfonylureas, TCAs, CCB/beta-blockers, clonidine.
Behavioral Agitation 14 40 kg AND OVER — ADULT CARD ▸ Verbal de-escalation — Neutral tone, eye level, simple concrete language, reflective listening.
Move to a low-stimulation, sharps-free space; offer food, comfort items, sensory kits.
Autism: ask the parent first. If a drug is needed, use their OWN home medication.
Diphenhydramine: 1 mg/kg PO/IM, max ~50 mg, q6h. Avoid if agitation looks like delirium.
Hydroxyzine (age-banded): 12.5 mg (5–10y), 25 mg (11–15y), 50 mg (16y+), q6–8h. QT-prolongation caution.
Lorazepam 0.05 mg/kg PO (max 2 mg; avoid in autism spectrum disorder). Not in delirium.
Olanzapine 2.5–5 mg (<45 kg) or 5–10 mg (≥45 kg) PO/IM.
Risperidone PO: ~0.25 mg (<22 kg) to 0.5–1 mg (≥45 kg); watch for akathisia at higher doses.
Haloperidol 0.05 mg/kg IM (max 5 mg; continuous EKG/SpO₂ after).
No ketamine or barbiturates without sign-off
Renew the restraint order: q1h under 9 years · q2h 9–17 · q4h 18+.
LIP face-to-face within 1 hour, again at every renewal, and at least q24h.
Restraint documentation — Document: time started, alternatives tried, rationale, time stopped.
Multiple sedating doses → continuous monitoring.
SOURCES ▸ ruled 2026-08-25 (C03) ruled 2026-08-25 (C04) 42 CFR §482.13 / CMS CoP Status Epilepticus 17 40 kg AND OVER — ADULT CARD ▸ OPEN THE LIVE PATHWAY — PEDS STATUS — WEIGHT-DRIVEN DOSES ▸ SEIZURE CLOCK — TIME SEIZING 0:00 START ✕ CLEAR
ABCs, cardiorespiratory/BP monitoring, O₂ 10–15 L/min via non-rebreather.
Give the first benzodiazepine dose as early as possible — before checking glucose, not after.
If febrile: acetaminophen IV 12.5 mg/kg (<29 d) / 15 mg/kg (≥29 d)
Consider additional workup: full septic workup, antibiotics/antivirals, brain imaging.
Persistent altered LOC may reflect non-convulsive status epilepticus or a severe underlying brain disorder.
Third-line: an infusion — midazolam, pentobarbital, propofol or ketamine.
IV infusion
Midazolam IM/IN (no IV/IO) · ≤13 kg · 0.2 mg/kg · Max: 10 mg
Midazolam IM/IN — 13–40 kg · 5 mg fixed dose · Max: 10 mg
IM/IN (no IV/IO)
Midazolam IM/IN — >40 kg · 10 mg fixed dose · Max: 10 mg
IM/IN (no IV/IO)
Lorazepam IV/IO · 0.1 mg/kg · Max: 4 mg
Midazolam IV/IO · 0.1 mg/kg · Max: 10 mg
Levetiracetam IV/IO (5 min infusion) · 60 mg/kg (max 3000 mg) · Age: Any age · ↓ side effects/interactions, low psychosis risk
Fosphenytoin IV/IO/IM (10 min infusion) · 20 mg PE/kg (max 1000 mg PE) · Age: Any age, less common <6mo · ↓BP, ↓HR, arrhythmia; avoid in toxicologic seizures
Valproic acid IV/IO (10 min infusion) · 40 mg/kg (max 3000 mg) · Age: ≥2 years · Caution: liver dysfunction, mitochondrial disease, urea-cycle disorder, thrombocytopenia, unexplained developmental delay
Phenytoin IV/IO (20 min infusion) · 20 mg/kg (max 1000 mg) · Age: Any age, less common <6mo · Same as fosphenytoin; use only if fosphenytoin unavailable
Phenobarbital IV/IO (20 min infusion) · 20 mg/kg (max 1000 mg) · Age: <6 months · Respiratory depression, especially with benzodiazepines
SOURCES ▸ Neonatal / Young Infant Fever 14 Inflammatory markers: CRP >20 mg/L · procalcitonin >0.5 ng/mL · ANC >4,000/mm³.
Any one abnormal marker triggers escalation of workup for that band.
61–90 days: PECARN, not this algorithm. Do not mix thresholds.
Ampicillin + gentamicin. Add acyclovir if there are HSV risk factors.
IV
Ampicillin (meningitis dosing): ≤7 days old — 100 mg/kg/dose IV q8h; >7 days old — 75 mg/kg/dose IV q6h.
Gentamicin interval: ask pharmacy or NICU. Do not use a fixed bedside number.
🚫 No ceftriaxone in neonates. Never with IV calcium.
29–60 days going home (e.g. UTI): ceftriaxone, or oral cephalexin or cefixime.
LP not done, traumatic, or deferred → treat as if the CSF were positive.
Cultures if they do not delay transfer. First antibiotic dose now. Then transfer.
Get your medical director's sign-off before treating this as protocol.
8–21 days · Blood culture, UA+urine culture, and LP — full workup mandatory for all · Admit — mandatory for this entire band, regardless of results
22–28 days · Blood culture, UA+culture, inflammatory markers (ANC, CRP, procalcitonin) always. LP depends on marker/UA results — can be deferred only if all markers negative and follow-up (~24h) is assured. · If LP deferred: one dose empiric parenteral antibiotic + admit, or shared-decision discharge with close follow-up
29–60 days · Blood culture, UA, inflammatory markers. LP is selective — reserved for abnormal markers or positive UA in some pathways. · If UA and all markers negative → may forgo LP/antibiotics with close (24–36h) follow-up
SOURCES ▸ Non-Accidental Trauma 12 TEN-4: ANY bruise to Torso, Ears or Neck at ≤4 months is a red flag.
FACESp: Frenulum, Angle of jaw, Cheeks, Eyelids, Subconjunctivae, or any pattern.
This is a screening tool. A positive finding triggers evaluation, not an accusation.
Sentinel injury — A prior “minor” injury in a non-mobile infant is a sentinel injury.
Skeletal survey under age 2 — a full dedicated survey, never a babygram. Repeat at 2 weeks.
Non-contrast CT head: any abuse finding under 6 months, facial bruising under 12, or neuro signs.
Retinal exam under 5 with coma, seizures, ICH or death — dilated, by ophthalmology, within 24 h.
Bleeding-disorder labs — CBC with platelets, PT, PTT — rule out a bleeding disorder first.
Once abuse is suspected, image comprehensively — PECARN does not apply.
NH law: report immediately to DCYF Central Intake. Written report may be due in 48 h.
Social work, for the CPS liaison. Child-abuse-pediatrics consult if available.
Quote each caregiver separately, verbatim and attributed. Describe, do not conclude.
Death of a Child in the ED 14 Private space, chaplain and social work called before you go in.
Say “died” or “dead.” Not “passed,” not “didn't make it.” Then stop and wait.
Ask questions / view the body
Adapt the tone (mnemonic not pediatric-specific)
Offer family presence during the resuscitation.
Assign one support person — not a clinical team member — to stay with the family.
No validated pediatric termination rule exists for medical arrests.
Trauma arrest? Pull the joint AAP/ACEP/NAEMSP policy statement directly.
Notify the medical examiner — essentially every pediatric ED death.
Notify the OPO on EVERY death. The OPO decides suitability, not you.
Possibly non-natural: photograph before cleaning, leave lines in, paper bags.
Structured team debrief on the same shift. Offer employee support.
Offer memory-making — handprints, a lock of hair — if the ME permits.
SOURCES ▸ Procedural Sedation 18 Do not delay sedation for NPO time.
Monitoring: oximetry, cardiac, capnography for deep: Continuous pulse oximetry and cardiac monitoring. Capnography for deep sedation.
Two people: proceduralist, plus a PALS-trained monitor with no other job. Vitals q10min, q5min deep.
Airway rescue equipment and reversal agents at hand before you start.
Laryngospasm: jaw thrust, 100% O₂, positive-pressure BVM. If it fails → succinylcholine and intubate. → sizes:
Airway Equipment Sizes Apnea: reposition the airway, oxygen, BVM. Reversal agents rarely needed.
Do NOT give prophylactic midazolam with ketamine.
Discharge: baseline mental status: Return to age-appropriate baseline mental status.
Discharge: airway/reflexes/ventilation: Airway patent, protective reflexes intact, adequate spontaneous ventilation.
Discharge: vitals near baseline: Vital signs (including room-air SpO₂) at or near baseline.
No need to prove they tolerate oral intake before discharge.
Ketamine · IV: 1–2 mg/kg (max 100 mg), repeat 0.5–1 mg/kg q5–15min · Onset / duration: <30 sec / 5–10 min
Ketamine IM · 4–5 mg/kg (max 200 mg) · Onset / duration: 3–5 min / 15–25 min
Propofol · 1–2 mg/kg, then 0.5–1 mg/kg q3–5min · Onset / duration: <50 sec / 3–10 min
IV
Etomidate (≥6mo) · 0.2–0.3 mg/kg · Onset / duration: 30–60 sec / 2–5 min
IV
Fentanyl · 1–2 mcg/kg (max 50 mcg), repeat q3–5min · Onset / duration: 2–4 min / 30–60 min
IV
Midazolam · 0.025–0.1 mg/kg (max 6 mg <6y, 10 mg ≥6y) · Onset / duration: 1–5 min / 0.5–2 hr
Intranasal midazolam (imaging) · ~0.3 mg/kg (max 10 mg) · Onset / duration: 7–10 min
Croup 6 All croup: dexamethasone 0.6 mg/kg PO/IV/IM, max 10 mg. One dose.
Stridor at rest: racemic epinephrine 2.25%, 0.5 mL in 3 mL NS (0.25 mL if <5 kg).
nebulized
Keep the child calm — parent's lap, blow-by. No tongue blade, no IV.
Home if no stridor at rest 3–4 h after the last epi, drinking, reliable caregivers.
Admission criteria — Admit for recurrent stridor at rest, >1–2 epi doses, hypoxia, poor PO, or uncertainty.
Airway Equipment Sizes 12 Cuffed tube first-line; have a half-size larger and smaller
Confirm with waveform capnography
DOPE for sudden deterioration
GREY band tube (3–5 kg)
cuffed 3.0 mm · or micro-cuff equivalent · uncuffed 3.0 mm · 2.5–3.5 on the tray · depth 9 cm at lip (3 × the tube)
PINK band tube (6–7 kg)
cuffed 3.0 mm · uncuffed 3.5 mm · 2.5–3.5 on the tray · depth 9 cm at lip (3 × the tube)
RED band tube (8–9 kg)
cuffed 3.5 mm · uncuffed 3.5–4.0 mm · 3.0–4.0 on the tray · depth 11 cm at lip (3 × the tube)
PURPLE band tube (10–11 kg)
cuffed 3.5 mm · uncuffed 4.0 mm · 3.0–4.0 on the tray · depth 11 cm at lip (3 × the tube)
YELLOW band tube (12–14 kg)
cuffed 4.0 mm · uncuffed 4.5 mm · 3.5–4.5 on the tray · depth 12 cm at lip (3 × the tube)
WHITE band tube (15–18 kg)
cuffed 4.5 mm · uncuffed 5.0 mm · 4.0–5.0 on the tray · depth 14 cm at lip (3 × the tube)
BLUE band tube (19–23 kg)
cuffed 5.0 mm · uncuffed 5.5 mm · 4.5–5.5 on the tray · depth 15 cm at lip (3 × the tube)
ORANGE band tube (24–29 kg)
cuffed 5.5 mm · uncuffed 6.0 mm · 5.0–6.0 on the tray · depth 17 cm at lip (3 × the tube)
GREEN band tube (30–36 kg)
cuffed 6.0 mm · uncuffed 6.5 mm · 5.5–6.5 on the tray · depth 18 cm at lip (3 × the tube)
SOURCES ▸ Ruled 2026-09-10 (cuffed and uncuffed columns supplied in full) Site-configured values 16 Stale weight strip minutes
Cuffed ETT ID formula addon
Uncuffed ETT ID formula addon
GREY band airway sizes (ETT/blade/SGA)
PINK band airway sizes (ETT/blade/SGA)
RED band airway sizes (ETT/blade/SGA)
PURPLE band airway sizes (ETT/blade/SGA)
YELLOW band airway sizes (ETT/blade/SGA)
WHITE band airway sizes (ETT/blade/SGA)
BLUE band airway sizes (ETT/blade/SGA)
ORANGE band airway sizes (ETT/blade/SGA)
GREEN band airway sizes (ETT/blade/SGA)
SOURCES ▸ The weight engine 13 Broselow-Luten GREY kg range
Broselow-Luten PINK kg range
Broselow-Luten RED kg range
Broselow-Luten PURPLE kg range
Broselow-Luten YELLOW kg range
Broselow-Luten WHITE kg range
Broselow-Luten BLUE kg range
Broselow-Luten ORANGE kg range
Broselow-Luten GREEN kg range
3 kg Broselow-Luten floor
Age->weight estimate <12 months
Age->weight estimate 1-5 years
Age->weight estimate 6-12 years
SOURCES ▸ CLEAR CHECKS & TIMERS — THIS PAGE Checks, weight and timers stay on this phone — no names, no record numbers, nothing leaves the device. Verbatim from the v1 harvest (@ ee60d25). Contested values were ruled 2026-08-25 — the ruling wins over anything shown here that lost. Each card's sources sit closed at its foot.