Intraosseous access is ESSENTIAL for resuscitation of children. It
is easy, safe and effective. Why do you not have this capability in
your system? I agree that any child who needs intubation probably
needs IV (or IO) access.
We don't have the opportunity the need naloxone very often, but we
use it in children without reservation when needed, including
neonates who have respiratory depression from maternal anesthesia (eg
a big bolus of fentanyl just prior to delivery - a rare occurance).
We typically use a dose of 0.1 mg/kg, although my reference indicates
that doses 1/10 to 1/2 this amount are commonly used as well.
I am boggled that you can treat pain in adults but not children. If
you use the medications appropriately, narcotics and other analgesic
are incredibly helpful to the injured patient. In particular,
fentanyl 2-5 mcg/kg is effective and short-acting. Also, if you're
worried about respiratory depression, is BVM not an adequate
temporizing intervention? Were adults given narcotics in the field
prior to the availabilty of narcotic reversal agents?
For ET epi the dose should be 100 mcg/kg, right? For a 16 kg child,
this is 1.6 mL of the 1:1000. So I would suggest not abandoning the
1:1000 form in peds entirely, just when the required volume is too
small to handle. For the larger kids, use the 1:1000 and you won't
have the volume limitation.
PL-2, UCSF Pediatrics
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