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PediHero

40 kg child: emergency doses and equipment

Reference for healthcare professionals. Check every dose against your local protocol.

40  kg

Estimated age and height for this weight: ≈  12 y 140–150 cm Brown zone

PediHero · 40  kg ·Data v1.0.0 · updated 2026-11-04

PediHero is a reference for healthcare professionals. Always check doses against your local protocol and clinical judgement.

Normal values

Systolic Blood Pressure

90 to 120 millimeters of mercury

Details
  • Hypertension is rare
  • Delayed Hypotension in hypovolemia (due to tachycardia!)

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Tidal Volume

6 mL/kg

240 milliliters

Details
  • Tidal volume = 6 mL/kg in all age groups
  • Greater alveolar ventilation; smaller FRC
  • Faster drop of saturation in apnea!

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Fluid Requirements

4-2-1 rule

80 milliliters per hour

Details
  • 4 mL/kg/h for the first 10 kg
  • plus 2 mL/kg/h for the second 10 kg (10–20 kg)
  • plus 1 mL/kg/h for every kg after 20 kg
  • Exceptions:
  • PB: 5–8 mL/kg/h (Preterm birth)
  • NB: 2–3 mL/kg/h (first 2–3 days)
  • Baby: 4–6 mL/kg/h (Babies)
  • with fever: +10 % for every °C

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Metabolism

100-50-20 rule

1900 kilocalories per day

Details
  • 100 kcal/kg/d for the first 10 kg
  • plus 50 kcal/kg/d for the second 10 kg (10–20 kg)
  • plus 20 kcal/kg/d for every kg after 20 kg

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Equipment

E.T. Tube (uncuffed)

Not listed for this weight

Details
  • PB 1 kg: 2.5 (Preterm birth)
  • PB 2 kg: 3 (Preterm birth)
  • NB 3 kg: 3.5
  • Baby 6 Mo: 4
  • Child>1 year: Tube ID = 4.5 + Age/4

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Insertion Length (oral)

18 centimeters

Details
  • PB 1 kg: 7 cm (Preterm birth)
  • PB 2 kg: 8 cm (Preterm birth)
  • NB 3 kg: 9 cm
  • Baby 5 kg: 10 cm
  • Baby 7 kg: 11 cm
  • Baby 9 kg: 12 cm
  • >1 year: Insertion length (oral) = 12 + years/2

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Face Mask

Size 3 to 4

Details
  • Newborns: round masks
  • Babies: round masks
  • Infants: masks with air cushion in the edge
  • Children: masks with air cushion in the edge

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Vascular Access

16 to 20 gauge

Details
  • G24 - 15 mL/min (yellow)
  • G22 - 35 mL/min (blue)
  • G20 - 60 mL/min (magenta)
  • G18 - 100 mL/min (green)
  • G17 - 130 mL/min (white)
  • G16 - 200 mL/min (grey)
  • G14 - 340 mL/min (orange)

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Resuscitation

Ventilation

15 compressions to 2 ventilations

Details
  • Use breathing aids if needed
  • Keep the mouth slightly open if necessary
  • Good coordination with chest compressions required!

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Chest Compressions

100 to 120 compressions per minute

Details
  • Compression depth = 1/3 of the thorax
  • Full relief of the thorax between compressions
  • 'push hard and fast!'
  • Good coordination with ventilation!
  • Rotate every 2 min

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Cardioversion 1st/2nd

1–2–4 J/kg

40, then 80, then 160 joules

Details
  • first Cardioversion: 1 Joule/kg
  • second Cardioversion: 2 Joule/kg
  • more Cardioversions: 4 Joule/kg

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Defibrillation 1st/2nd

4 J/kg

160 joules

Details
  • first Defibrillation: 4 Joule/kg
  • second Defibrillation: 4 Joule/kg
  • more Defibrillations: 6–8 Joule/kg
  • Continue CPR immediately!

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Epinephrine endotracheal

Adrenaline

0.1 mg/kg

Not listed for this weight

Details
  • obsolete!
  • Dilute 1:10 with Sodium chloride 0.9 %

Concentrations: 1 mg/1 mL

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Amiodarone i.v./i.o.

Cordarone®

5 mg/kg

200 milligrams

Details
  • Class III antiarrhythmic
  • Maximum dose = 300 mg
  • Maximum daily dose = 15 mg/kg

Concentrations: 150 mg/3 mL

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Fluid Bolus i.v./i.o.

Balanced Electrolyte Solution (or Normal Saline 0.9%)

10 mL/kg

400 milliliters

Details
  • Balanced electrolyte solution; possibly repeat
  • Possibly Sodium chloride 0.9 %
  • Possibly other isotonic crystalloid solutions

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Lidocaine i.v./i.o.

Rapidocain®

1 mg/kg

40 milligrams

Details
  • Antiarrhythmic
  • Repeat if necessary
  • Maintenance dose: 20–50 mcg/kg/min after bolus

Concentrations: 0.5 % · 1 % · 2 %

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Magnesium Sulfate i.v./i.o.

25–50 mg/kg

1000 to 2000 milligrams

Details
  • Electrolyte
  • Maximum dose: 2 g

Concentrations: 10 % · 20 % · 50 %

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Anesthesia

Premedication

Midazolam rect./p.o.

Dormicum®

0.5–1 mg/kg

7.5 to 15 milligrams

Details
  • Hypnotic; sedative; benzodiazepine
  • 0.5–1 mg/kg; but not more than 15 mg

Concentrations: 5 mg/5 mL · 5 mg/1 mL · 15 mg/3 mL · 50 mg/10 mL · 2 mg/2 mL

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Midazolam nas./buc.

Dormicum®

0.2 (up to 0.4) mg/kg

7.5 milligrams, up to 15 milligrams

Details
  • Hypnotic; sedative
  • Benzodiazepine

Concentrations: 5 mg/5 mL · 5 mg/1 mL · 15 mg/3 mL · 50 mg/10 mL · 2 mg/2 mL

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Midazolam i.v.

Dormicum®

0.1 mg/kg

3 milligrams

Details
  • Hypnotic; sedative
  • Benzodiazepine

Concentrations: 5 mg/5 mL · 5 mg/1 mL · 15 mg/3 mL · 50 mg/10 mL · 2 mg/2 mL

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Anesthesia Induction

Thiopental i.v.

Pentothal®; Trapanal®

3–8 mg/kg

200 milligrams

Details
  • Hypnotic; sedative
  • Barbiturate

Concentrations: 0.5 g · 1 g · 2.5 g · 5 g

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Etomidate i.v.

Hypnomidate®

0.2–0.3 mg/kg

8 to 12 milligrams

Details
  • Hypnotic; sedative
  • Side effects: Myoclonus; Cortisolsynthesis↓
  • Age < 6 mo: Ø

Concentrations: 20 mg/10 mL

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Mivacurium i.v.

Mivacron®

0.2 mg/kg

8 milligrams

Details
  • Non-depolarising Muscle relaxant
  • Age < 2 mo: Ø

Concentrations: 10 mg/5 mL · 20 mg/10 mL

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Rocuronium i.v. RSI

Esmeron®

1 mg/kg

40 milligrams

Details
  • Non-depolarising Muscle relaxant
  • Age < 1 year: Ø

Concentrations: 50 mg/5 mL · 100 mg/10 mL

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Atracurium i.v.

Tracrium®

0.3–0.5 mg/kg

12 to 20 milligrams

Details
  • Non-depolarising Muscle relaxant
  • Age < 1 mo: Ø

Concentrations: 25 mg/2.5 mL · 50 mg/5 mL

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Succinylcholine i.v.

Lysthenon®; Midarine®

1.5–2 mg/kg

60 milligrams

Details
  • Depolarising Muscle relaxant
  • <20 kg: no Precurarisation
  • >20 kg: Precurarisation necessary
  • Age < 1 year: 2 mg/kg
  • Age > 1 year: 1.5 mg/kg

Concentrations: 100 mg/2 mL · 100 mg/5 mL

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Alfentanil i.v.

Rapifen®

5–20 mcg/kg

200 to 800 micrograms

Details
  • Opioid analgesic
  • Thoracic rigidity possible!

Concentrations: 1 mg/2 mL · 5 mg/10 mL

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Remifentanil i.v.

Ultiva®

0.5–2 mcg/kg

20 to 80 micrograms

Details
  • Opioid analgesic
  • Thoracic rigidity possible!

Concentrations: 1 mg · 2 mg · 5 mg

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Syringe Pump

Regional Anesthesia

Prilocaine max.

Xylonest®

5 mg/kg/6 h

200 milligrams per 6 hours

Details
  • Local anaesthetic; amino amide group
  • Age < 6 months: Ø (Met-Hb!)

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Malignant Hyperthermia

Dantrolen i.v.

2.5 mg/kg

100 milligrams

Details
  • Muscle relaxant
  • Ca release↓ from the SR in the muscle
  • Repeat every 5 min
  • Up to 10 mg/kg total

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Emergencies

Anaphylaxis

deleted

Zantic®

1 mg/kg

40 milligrams

Details
  • out of the market
  • Histamine-H2-Antagonist

Concentrations: 50 mg/5 mL

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Asthma Attack

Salbutamol-Inhal.

Ventolin®

1.25–2.5 mg

2.5 milligrams

Details
  • β2-agonist
  • repeat every 20 min
  • 5 mg/1 mL (1 mL = 20 drops)

Concentrations: 5 mg/1 mL

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Bleeding

Intracranial Pressure

Hypoglycemia

Glucose i.v. Bolus

Dextrose

0.2–0.5 g/kg

8 to 20 grams

Details
  • Hypoglycemia in Newborn: <2.5 mmol/L
  • Glucose10 % contains 0.1 g/mL = 100 mg/mL
  • 0.5 g/kg Glucose = 10 mL/kg Glucose 5 %
  • 0.5 g/kg Glucose = 5 mL/kg Glucose 10 %
  • 0.5 g/kg Glucose = 2.5 mL/kg Glucose 20 %
  • 0.5 g/kg Glucose = 1 mL/kg Glucose 50 %

Concentrations: 5 % · 10 % · 20 % · 50 %

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Glucose i.v. Infusion

Dextrose

10 mg/kg/min

400 milligrams per minute

Details
  • Hypoglycemia in Newborn: <2.5 mmol/L
  • Glucose10 % contains 0.1 g/mL = 100 mg/mL

Concentrations: 5 % · 10 % · 20 %

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Infection

Amoxicillin i.v. Tagesdosis

Amoxi®; Clamoxyl®; Augmentin®

100–200 mg/kg/day

8000 milligrams per day

Details
  • Penicillin; antibiotic
  • < 4 kg: 100 mg/kg/d divided in 2 doses/day
  • Age < 3 mo: 150 mg/kg/d divided in 3 doses/day
  • Age > 3 mo: 200 mg/kg/d divided in 4 doses/day
  • Note: Renal function!

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Cefazolin i.v. Tagesdosis

Kefzol®

25–100 mg/kg/day

1000 to 4000 milligrams per day

Details
  • Cephalosporin 1st generation; antibiotic
  • Age < 1 month: Ø
  • mild Inf.: 25 mg/kg/d divided in 3–4 doses/day
  • moderate Inf.: 50 mg/kg/d divided in 3–4 doses/day
  • severe Inf.: 100 mg/kg/d divided in 3–4 doses/day
  • Note: Renal function!

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Cefuroxim i.v. Tagesdosis

Zinacef®

30–100 mg/kg/day

1200 to 4000 milligrams per day

Details
  • Cephalosporin 2nd generation; antibiotic
  • Age < 3 mo: Divided dose in 2(–3) doses/day
  • Age > 3 mo: Divided dose in 3(–4) doses/day
  • mild Inf.: 30 mg/kg/d
  • moderate Inf.: 60 mg/kg/d
  • severe Inf.: 100 mg/kg/d
  • Higher Doses in Meningitis! (initially 150–250 mg/kg)
  • Note: Renal function!

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Ceftriaxon i.v. Tagesdosis

Rocephin®

20–50–80 mg/kg/day

800 to 3200 milligrams per day

Details
  • Cephalosporin 3rd generation; antibiotic
  • Age < 15 days: 20–50 mg/kg/d - 1 x/day
  • Age > 15 days: 20–80 mg/kg/d - 1 x/day
  • Dosage in Meningitis: 100 mg/kg/d
  • No adaption to renal function necessary!

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Clindamycin i.v. Tagesdosis

Dalacin®

20–40 mg/kg/day

800 to 1600 milligrams per day

Details
  • Lincosamide; antibiotic
  • Age < 1 mo: Ø
  • Age > 1 mo: dose divided over 4 doses/day
  • Severe infections: 20 mg/kg/day
  • Very severe infections: up to 40 mg/kg/day
  • No dose adjustment in mild to moderate renal impairment

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Metronidazol i.v. Einzeldosis

Flagyl®

7.5 mg/kg

300 milligrams

Details
  • Nitroimidazole antibiotic
  • First 3 days: Repeat doses every 8 h
  • Following days: Repeat doses every 12 h
  • No dose adjustment in renal impairment

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Vancomycin i.v. Tagesdosis

Vancocin®

20–40 mg/kg/day

1600 milligrams per day

Details
  • Glycopeptide antibiotic
  • Age < 1 week: 20 mg/kg/day in 2 doses/day
  • Age < 1 mo: 30 mg/kg/day in 3 doses/day
  • Age > 1 mo: 40 mg/kg/day in 2–4 doses/day

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Seizure

Phenytoin i.v.

Phenhydan®

15–20 mg/kg

600 to 800 milligrams

Details
  • Antiepileptic
  • Infusion max. 1 mg/kg/min; blood level 10–20 mcg/mL

Concentrations: 250 mg/5 mL

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Phenobarbital i.v.

20 mg/kg

800 milligrams

Details
  • Antiepileptic; hypnotic; sedative
  • Barbiturate; blood level 20–40 mcg/mL

Concentrations: 20 mg/mL · 200 mg/2 mL

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Nausea

Ondansetron i.v.

Zofran®

0.1 mg/kg

4 milligrams

Details
  • Antiemetic
  • Serotonin (5-HT3)-antagonist
  • Age < 6 mo: Ø (1–6 mo: "Off-Label")

Concentrations: 4 mg/2 mL · 8 mg/4 mL

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Tropisetron i.v.

Navoban®

0.05–0.1 mg/kg

2 milligrams

Details
  • Antiemetic
  • Serotonin (5-HT3)-antagonist
  • Age < 2 years: Ø

Concentrations: 2 mg/2 mL · 5 mg/5 mL

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Meclozine p.o./rect.

Itinerol® B6

≈ 1 mg/kg

50 milligrams

Details
  • Antiemetic
  • Antihistamine-H1-Antagonist

Concentrations: Baby 10 mg · Child 20 mg · Adult 50 mg

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Dexamethasone i.v.

Mephameson®; Fortecortin®

0.15 mg/kg

4 milligrams

Details
  • Glucocorticoid
  • Dose max. 4 mg

Concentrations: 4 mg/1 mL · 8 mg/2 mL · 50 mg/3 mL

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Droperidol i.v.

DHBP

20–75 mcg/kg

Not listed for this weight

Details
  • Antiemetic neuroleptic
  • Side effects: dystonia; dysphoria
  • Not recommended in children

Concentrations: 1 mg/2 mL

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Pain

Paracetamol max./day

Dafalgan®; Tylenol®

60–100 mg/kg

4000 milligrams

Details
  • Analgesic; max. daily dose
  • Age < 3 months: <60 mg/kg/d max.48 h
  • Age > 3 months: <100 mg/kg/d max. 72 h

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Paracetamol i.v.

Perfalgan®

15–20 mg/kg

600 to 800 milligrams

Details
  • Analgesic
  • Loading dose = Repetition dose
  • as short infusion
  • max. 60 mg/kg/d

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Fentanyl nasal MAD®

Sintenyl®

1–2 mcg/kg

40 to 80 micrograms

Details
  • Off-Label-Use!
  • Opioid-Analgesic
  • MAD® = mucosal atomization device

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Nalbuphine i.v.

Nubain®

0.1–0.2 mg/kg

4 to 8 milligrams

Details
  • Opioid-Analgesic
  • κ-Agonist + µ-Antagonist (partially)

Concentrations: 20 mg/2 mL

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Pethidine i.v.

Meperidine; Dolantin®; Demerol®

0.5–1 mg/kg

20 to 40 milligrams

Details
  • Opioid-Analgesic
  • µ-Agonist

Concentrations: 100 mg/2 mL · 50 mg/1 mL

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Tramadol i.v./p.o.

Tramal®

1–2 mg/kg

40 to 80 milligrams

Details
  • Opioid-Analgesic
  • Agonist on µ-; δ- and κ-Opioid-Receptors
  • Daily dose max. 8 mg/kg/d

Concentrations: 100 mg/1 mL · 100 mg/2 mL

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Oxycodone p.o. Drops

Oxynorm®

0.1 mg/kg

Not listed for this weight

Details
  • Opioid-Analgesic
  • for patients < 19 y. not approved

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Overdose

Neostigmin i.v.

Robinul Neostigmine® Combination

40 mcg/kg

1600 micrograms

Details
  • Parasympatholytic + cholinesterase inhibitor

Concentrations: 1 mL: glycopyrrolate 0.5 mg + neostigmine 2.5 mg

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Sugammadex i.v.

Bridion®

2 mg/kg

80 milligrams

Details
  • Children and adults:
  • 2 mg/kg for T2 (2 TOF)
  • only adults:
  • 4 mg/kg for PTC1-2 (1–2 post tetanic counts)
  • 16 mg/kg for total block

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Naloxon i.v./i.m.

Narcan®; Narcanti®

0.01 mg/kg

0.4 milligrams

Details
  • Opioid antagonist
  • Dose may be titrated (2 mg dose max.)

Concentrations: 0.4 mg/1 mL

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