Pediatric code companion

At the start of any arrest: compressions and bag-mask breaths with oxygen, pads or monitor on, and IV or IO access as fast as you can get it. Pause for rhythm checks of 10 s or less, roughly every 2 min, and change compressors at the same time (sooner if the compressor tires).

VF or pulseless VT: defibrillate at 2 J/kg first and 4 J/kg second, with 2 min of compressions after every shock. Epinephrine starts once two shocks have been given (earlier only if a shock can't be delivered quickly) and repeats every 3–5 min. From the third shock on, add amiodarone or lidocaine and keep working through the reversible causes. Later shocks use 4 J/kg, rising if needed to 10 J/kg or the adult dose, whichever is lower. An advanced airway with capnography is an option along the way.

Asystole or PEA: epinephrine comes first and fast (Class 2a), then every 3–5 min (Class 2b), between 2-min blocks of compressions. Consider an advanced airway, hunt for reversible causes, and move to the shock pathway if a check shows VF or pulseless VT.

Adult dose (energy): once a weight-based energy would pass 200 J, the tool stops showing a number and points you to your defibrillator's recommended energy (the 2025 adult algorithm: biphasic per manufacturer, e.g. 120–200 J first shock; maximum available if unknown).

Timers: elapsed time runs from the first logged event. The cycle countdown restarts at Start, at each rhythm check and at each shock. During an arrest the epinephrine timer turns "due" at 3:00 and "overdue" after 5:00 since the last dose. Times are wall-clock differences, so they stay right if the phone throttles the tab.

Infant (<1 y): at least one-third of the anterior-posterior chest diameter, about 1.5 in (4 cm); heel of one hand or two thumb-encircling hands (two-finger technique eliminated in 2025).

Child (1 y to puberty): at least one-third AP diameter, about 2 in (5 cm); one or two hands.

Signs of puberty: adult BLS — at least 2 in (5 cm), avoid more than 2.4 in (6 cm).

All: 100–120/min, full recoil, pauses <10 s. Without an advanced airway: 30:2 for one rescuer at any age; 15:2 for two rescuers before puberty; 30:2 for two rescuers after puberty onset. With an advanced airway: continuous compressions, 1 breath every 2–3 s (20–30/min), adjusted for age and condition; don't bag faster.

With an arterial line: diastolic pressure ≥25 mm Hg in infants, ≥30 mm Hg in children ≥1 y (Class 2b). Do not use an ETCO₂ cutoff alone to stop (Class 3: Harm).

Caps applied: epinephrine 1 mg; amiodarone 300 mg first dose, 150 mg later doses, up to 3 doses (the button locks after the third dose even without a weight); adenosine 6 mg then 12 mg; atropine minimum 0.1 mg, maximum single dose 0.5 mg (may repeat once); defibrillation not above 10 J/kg or the adult dose. No numeric cap is stated for lidocaine 1 mg/kg. For synchronized cardioversion the pediatric algorithm gives no cap; the tool flags values above 120 J (low end of the adult biphasic example) and replaces values above 200 J with the device's adult setting, as the 2025 adult tachycardia algorithm defers to device-specific energy.

Weight checks: the tool shows weight in both kg and lb, asks before converting or relabeling when you change units, and, if you pick an age group, holds doses for a clearly implausible weight (infant over 15 kg; child before puberty under 5 kg or over 60 kg; signs of puberty under 20 kg) until you confirm. These are plausibility checks, not weight estimates.

Volumes are shown only for epinephrine, the one drug whose concentration (0.1 mg/mL) the 2025 algorithm names. Other drugs are shown in mg; draw up per your stock concentration.

Weight: use a measured weight. Weight-based dosing was carried over from 2020 without re-review. This tool does not estimate weight from age or length, and it does not list tube or blade sizes; we could not verify those in the 2025 guideline text.

Not included: endotracheal drug doses, infusion doses, and doses for procainamide, amiodarone or sotalol in refractory SVT (the 2025 guideline names them, Class 2b, but gives no doses). Get expert consultation for wide-complex tachycardia and refractory SVT.