Pharmacology
PALS drug questions usually hinge on the concentration as much as the milligram dose, so learn both together.
Epinephrine for cardiac arrest is 0.01 mg/kg (0.1 mL/kg of 1:10,000) IV/IO, repeated every 3–5 minutes, maximum 1 mg per dose. The endotracheal dose, 0.1 mg/kg of 1:1000, is a fallback only because absorption is unpredictable. Amiodarone 5 mg/kg IV/IO may be repeated to a cumulative 15 mg/kg (max 300 mg) for shock-refractory VF or pulseless VT; lidocaine 1 mg/kg is an alternative. Atropine 0.02 mg/kg has a minimum dose of 0.1 mg to avoid paradoxical bradycardia, with maximums of 0.5 mg in a child and 1 mg in an adolescent.
Adenosine 0.1 mg/kg (max 6 mg), then 0.2 mg/kg (max 12 mg), must be pushed rapidly and flushed because its half-life is seconds. For hypoglycemia give 0.5–1 g/kg; dextrose 10% at 5 mL/kg delivers 0.5 g/kg. Isotonic crystalloid 20 mL/kg is the standard initial bolus, with reassessment before repeating. Calcium chloride 20 mg/kg and sodium bicarbonate 1 mEq/kg have narrow indications; bicarbonate is not routine in arrest.
Traps: giving 1:1000 epinephrine intravenously, omitting the atropine minimum dose, exceeding the amiodarone cumulative cap, and forgetting the adenosine flush.
Worked example: a 10 kg child in arrest needs 0.01 mg/kg × 10 kg = 0.1 mg, which is 1 mL from a 1:10,000 (0.1 mg/mL) syringe.