Page 177 - PJ MED OPS Handbook 8th Ed

• Epi 0.1mg/kg for asystole or PEA
• Defib 2 joules/kg then 4 joules/kg for each following for VT/VF
Burn:
• Body surface area percentages differ for children:

Infant Body
Surface Area

• Airway patency can be lost early in small children with facial or extensive burns
•  Carefully secure the ETT and provide adequate sedation is important to prevent unplanned
extubation
• Burn resuscitation in children uses the Modified Brooke formula:
○ 2mL/kg/%TBSA divided over 24hr
○ One-half given during the first 8hr
○ Consider using D5LR if patient is unable to eat/drink
• Children presenting for care 24–48hr following burns injury generally do not require a formal
fluid resuscitation, rather fluid should be administered based on clinical need
• Monitoring of resuscitation should be based on physical examination, input and output mea-
surement, and analysis of laboratory data
○ Physical evidence of effective resuscitation includes: an alert sensorium, full peripheral
pulses, warm distal extremities; urine output target should be a glucose-negative urine
output of 1mL/kg/hr
• Children with burns over 20% should have a Foley catheter placed using size 6 Fr for infants
and 8 Fr for most small children
• Children with burns under 20% usually do not need a calculated resuscitation. They can be
given 1.5x calculated maintenance fluid rate and have diapers weighed for urine output. If
they can eat, they should be allowed access to bottle feeds PRN.
• Children may rapidly develop tolerance to analgesics and sedatives, dose escalation is com-
monly required

Chapter 10. Pediatric Care and OB-GYN n 175