Knowing the Medications on the PALS Exam

In order to be prepared to pass your Pediatric Advanced Life Support (PALS) exam, you are going to need to spend a fair portion of your preparation time studying medications. We’ve created a reference sheet to help you study!

While general medical knowledge and experience may help you with some of the basic questions regarding medications on the PALS exam, your knowledge has to be deeper than that.

 

You are going to need to know more than just drug names; you will need to know what they are used how to use them properly and in what dosages. Beyond that, there will be drug specific information about each medication that you will also be required to know.

You will need to study to learn the proper dosage for each medication. Without having that knowledge securely memorized, you will not be able to pass the exam. Luckily for you, we have compiled a list of all the relevant information on these drugs to make your test preparation easier.

Here is a quick reference sheet that shows you everything you need to know about the medications that will appear on your PALS exam:

 

Adenosine

Primary Use: 

– SVT/PSVT

– Wide QRS Tachycardia

Dose:

– First Dose: 0.1 mg/kg IV Push (Max: 6 mg.)

– Second Dose: 0.2 mg/kg IV Push (Max: 12 mg.)

Cautions/Notes: 

– Must be given as a bolus, followed by a flush

– Can cause bronchospasm – use caution in asthmatics

– Flushing/chest tightness are common

 

Amiodarone 

Primary Uses:

– Pulseless VT

– Ventricular Fibrillation (V-Fib)

– Recurrent Hemodynamically Unstable Ventricular Tachycardia

– Hypertrophic Cardiomyopathy

– Supraventricular Tachyarrhythmias (SVT)

Dose:

– Pulseless VT / V-Fib: 5 mg/kg bolus (Max Dose: 300 mg)

– VT / SVT: 5 mg/kg over 20-60 minutes (Max Dose: 300 mg)

Cautions/Notes:

– Rapid infusion causes hypotension

– If cumulative dosing exceeds 2.2 grams in 24 hours, significant hypotension can occur. Avoid administration with any drug that may prolong QT interval

 

Atropine

Primary Uses:

– Symptomatic Bradycardia

Dose:

– 0.02 mg/kg IV (Repeat every 3 – 5 minutes

– Max single dose: 0.5 mg

Cautions/Notes:

– Dose less than 0.1 mg may cause Paradoxical Bradycardia

– Max Total Dose: 1 mg (Child) / 3 mg (Adolescent)

 

Dopamine

Primary Uses:

– Bradycardia

– Hypotension

Dose:

– 2 – 20 mcg/kg/min infusion

– Titrated based on clinical response; tapered on/off slowly

Cautions/Notes:

– Extravasation causes tissue damage and necrosis

– Use caution if giving high doses through peripheral IV site

– May cause excessive vasoconstriction / tachyarrhythmias

– Adequate volume resuscitation required before initiating dopamine therapy

 

Epinephrine

Primary Uses:

– Cardiac Arrest

– Symptomatic Bradycardia

– Severe Hypotension

– Anaphylaxis / Severe Allergic Reactions

Dose:

– 0.01 mg/kg IV/IO (0.1 mL of 1:10,000 solution)

– Repeat every 3 – 5 minutes

– IV fluid Flush following each dose

Cautions/Notes:

– Higher doses often needed in cases of beta-blocker or calcium channel blocker overdoses. A continuous infusion may be required

– High dose does not improve survival / neurological outcome

– High dose ceases myocardial dysfunction in post-resuscitation period

 

Glucose

Primary Uses:

– Hypoglycemia

Dose:

– 0.5 – 1 g/kg IV/IO

Cautions/Notes:

– < 30 Days Old: D₁₀W 5 – 10 mL/kg IV/IO

– 30 Days – 2 Years Old: D₂₅W 2 – 4 mL/kg IV/IO

– > 2 Years Old: D₅₀W 1 – 2 mL/kg IV/IO

 

Lidocaine

Primary Uses:

– Cardiac Arrest from VT / VF

– Ventricular Tachycardia

– Ventricular Fibrillation

Dose:

– 1 mg/kg IV/IO bolus

– Maintenance Infusion: 20 – 50 mcg/kg/min

Cautions/Notes:

– Can also be used for stable polymorphic ventricular tachycardia with normal baseline QT AND torsades

– Decrease maintenance doses if left ventricular dysfunction or if impaired liver function

– Not used prophylactically after myocardial infarction

 

Magnesium

Primary Uses:

– Torsades de Pointes

– Hypomagnesemia (low magnesium)

– Digitalis Toxicity

Dose:

– Initial Dose: 25 – 50 mg/kg IV/IO over 15 – 30 minutes, diluted in 10 mg/mL D₅W

– Max: 2 g

Cautions/Notes:

–  Rapid administration may drop blood pressure

– Very high doses can cause respiratory distress (calcium is antidote)

– Use with caution for patients with renal failure

 

Naloxone

Primary Uses:

– Opioid Reversal

Dose:

– 0.01 – 0.1 mg/kg

– Max single dose:2 mg

 

Procainamide

Primary Uses:

– Ventricular Arrhythmias

– Supraventricular Arrhythmias (SVT)

Dose:

– Loading Dose: 15 –mg/kg IV/IO. Give over at least 30 minutes

Cautions/Notes:

– Serious reactions can occur for ventricular fibrillation, asystole, seizures, decreased platelets, neutrophils (and can result in hemolytic anemia)

– Other common reactions include hypertension, bradycardia, angioedema, flushing and urticaria

 

Sodium Bicarbonate

Primary Uses:

– Metabolic Acidosis

Dose:

– 1 mEq/kg IV/IO (given slowly)

– Max: 50 mEq

Cautions/Notes:

– Ensure adequate ventilation before administering (prevent or correct respiratory acidosis)

– Monitor pH with ABG results

 

These notes can be used to drill yourself until you know all the drug indications, dosages, and uses by heart. Good luck on your PALS test!