In Obesity, use Paeds Prescribing Pro.

Normal Physiological Values
SBP mmHg (– mmHg)*
HR – bpm†
RR – bpm†
*50th centile (5th – 95th)
†5th – 95th centile

APLS 6e Paediatric Normal Values

Airway and Ventilation
Endotracheal tube (ETT)
Laryngoscope
Uncuffed ETT
Cuffed ETT
Depth at lips cm

Supraglottic airway device (SAD)
LMA
i-Gel

Breathing circuits
T-piece 0–10 kg (Up to 20 kg)
Paediatric circle 10–30 kg
Adult circle >30 kg

Ventilation
Tidal volume (6-8 ml/kg)
Neonates/ARDS (4-6 ml/kg)
Emergency Intubation
Induction
Fentanyl 1–2 mcg/kg mcg
Ketamine 1–2 mg/kg mg
Rocuronium 1 mg/kg mg

Maintenance infusions
Morphine 10–40 mcg/kg/h (0.5–2 ml/h)
Midazolam 1–3 mcg/kg/min (1–3 ml/h)
Propofol 1–4 mg/kg/h
(4–10 mg/kg/h in routine anaesthesia)

Emergency Drugs
Atropine 20 mcg/kg mcg
Adrenaline IV 1:10,000 0.1 mL/kg mL
Suxamethonium IV 1–2 mg/kg mg
Suxamethonium IM 4 mg/kg
(Max 150 mg) 		mg

Other
Fluid bolus 10–20 mL/kg mL
Glucose 10% 2 mL/kg mL
Defibrillation energy 4 J/kg J

For other drugs and infusions, use Paediatric Emergency Tools: Apple / Android.

Premedication & Sedation
Midazolam - PO 0.5 mg/kg mg
Max 20 mg per dose; 6 months - 14 years. Peak effect at 20-30 mins.
Midazolam - NAS 0.2 mg/kg mg
Max 10 mg. Given via short atomiser: 0.1 ml dead space. Peak effect at 10 mins.
Dexmedetomidine - NAS 2–4 mcg/kg mcg
Max 200 mcg per dose. Given 30 mins before intervention.
Routine General Anaesthetic
Induction
Fentanyl 1–2 mcg/kg mcg
Propofol 3–5 mg/kg mg
Rocuronium 0.6 mg/kg mg

Antiemetics
Dexamethasone 0.15 mg/kg mg
Ondansetron 0.15 mg/kg mg
Cyclizine 0.5–1 mg/kg mg

Intraoperative analgesia
Paracetamol IV mg
Ibuprofen IV mg
Ketorolac 0.5–1 mg/kg mg
Morphine 0.05–0.1 mg/kg mg

Reversal of neuromuscular blockade
Neostigmine &
Glycopyrulate 		0.02 mL/kg mg
Sugammadex 2 mg/kg mg

Moderate block: Return of T2 in response to TOF.
Sugammadex 4 mg/kg mg

Deep block: 1-2 PTCs, no twitch responses to TOF.

Postoperative analgesia
Paracetamol PO mg
Ibuprofen PO 5–10 mg/kg mg
Morphine PO mg

Emergency Drugs
Atropine 20 mcg/kg mcg
Suxamethonium IV 1–2 mg/kg mg
Suxamethonium IM 4 mg/kg
(Max 150 mg) 		mg
Antibiotics - Surgical prophylaxis
Amoxicillin 30 mg/kg (Max 1 g) mg
Cefuroxime 50 mg/kg (Max 1.5g) mg
Co-Amoxiclav 30 mg/kg (Max 1.2 g) mg
Flucloxacillin 12.5–25 mg/kg (Max 1 g) mg
Gentamicin 2.5 mg/kg (Max 480 mg) mg
Metronidazole 30 mg/kg (Max 500 mg) mg
Teicoplanin mg
Lines
Arterial lines - Radial
Neonates/Infants <10 kg 24 G
Pressure transducer: 150 mmHg (generates a flow rate of 1.5 mL/hr)
Children >10 kg 22 G
Pressure transducer: 300 mmHg (generates a flow rate of 3 mL/hr)
Children >50 kg 20 G

Arterial lines - Femoral
Neonates 22 G, 8cm
Children 20 G, 8cm

Central venous access - Femoral (preferred)
<6 months 4–5 Fr, triple lumen, 6–8cm lines
6 m–5 y 5 Fr triple lumen, 8–12 cm
>5 y 7 fr, triple lumen, 15 cm

Central venous access - Internal jugular
<15 kg 5 cm
16–40 kg 8 cm
>40 kg 13 cm
Useful Links and Guidelines

Other calculators

Paeds Prescribing Pro Drug Calculator

Paediatric Emergency Tools: Apple / Android


Retrieval Teams

South Thames Retrieval Service (STRS) Clinical Guidelines

Children’s Acute Transport Service (CATS) Clinical Guidelines

Southampton Oxford Retrieval Team (SORT) Clinical Guidelines


Specific Emergency Guidelines

STRS Intubation Guideline and Checklist

CATS Intubation Checklist

APLS Emergency Drug Chart

STRS Bronchiolitis

STRS Sepsis

STRS Peripheral inotropes

STRS Neonatal collapse


Airway Guidelines

DAS Difficult mask ventilation during routine induction of anaesthesia in a child aged 1–8 years guideline

DAS Difficult intubation during routine induction of anaesthesia in a child aged 1–8 years guideline

DAS Cannot Intubate and Cannot Ventilate (CICV) in a paralysed anaesthetised child aged 1–8 years


Anaphylaxis Guidelines

APLS Perioperative Anaphylaxis algorithm

APLS Anaphylaxis algorithm

APLS Refractory Anaphylaxis algorithm


Advanced Paediatric Life Support (APLS) 2021 Resources

APLS Algorithm

Neonatal Life Support Algorithm

APLS Paediatric Cardiac Arrhythmias Algorithm

APLS Paediatric Emergency Algorithms and Resources

Paediatric Advanced Life Support Guidelines (Resuscitation Council UK)


Calculations and tables
Weight (kg)
Age 1-12 months

0.5 x Age (months) + 4
Age 1-5 years

2 x Age (years) + 8
Age 6-14 years

2 x Age (years) + 8

3 x Age (years) + 7

Airway and Ventilation
ETT size

Uncuffed ETT size = (Age/4) + 4 [Cole formula]

Cuffed ETT size = (Age/4) + 3.5 [Modified Cole]
ETT depth (oral)

Above 1 year: Depth ≈ Age/2+12

Neonates: Depth ≈ 1.17 × Birth weight (kg) + 5.58 (“7-8-9” rule)
ETT depth (nasal)

Above 1 year: Depth ≈ Age/2+15


Circulation
Lowest acceptable SBP

<1 month: ≥60 mmHg

1 month to 1 year: ≥70 mmHg

1–10 years: 2 x Age + 70 mmHg
Lowest acceptable MAP

Age (in years) x 1.5 + 40 mmHg
Premature Neonates

Gestational age ≈ Mean Arterial Pressure