Pediatric Cardiac Arrest Management: Epinephrine and Atropine Dosing for a 10-Year-Old Child
For a 10-year-old child undergoing CPR, administer epinephrine at 0.01 mg/kg (0.1 mL/kg of 1:10,000 concentration) IV/IO every 3-5 minutes with a maximum dose of 1 mg, and atropine at 0.02 mg/kg IV/IO with a minimum dose of 0.1 mg and maximum single dose of 0.5 mg. 1, 2
Epinephrine Administration
Dosing
- Dose: 0.01 mg/kg (0.1 mL/kg of 1:10,000 concentration)
- Route: IV/IO preferred
- Frequency: Every 3-5 minutes
- Maximum dose: 1 mg (10 mL)
Alternative Route
- If IV/IO access is unavailable but endotracheal tube is in place:
- Endotracheal dose: 0.1 mg/kg (0.1 mL/kg of 1:1,000 concentration)
- Note: Endotracheal administration is less effective than vascular routes 1
Important Considerations
- High-dose epinephrine (0.1 mg/kg) provides no survival benefit and may be harmful, particularly in asphyxia-related arrests 1, 3
- A study comparing high-dose vs. standard-dose epinephrine as rescue therapy found potentially worse outcomes with high-dose epinephrine 3
- Continue epinephrine administration during chest compressions to minimize interruptions 1
Atropine Administration
Dosing
- Dose: 0.02 mg/kg IV/IO
- Minimum dose: 0.1 mg
- Maximum single dose: 0.5 mg
- May repeat once if needed 2
FDA Labeling
- The FDA label for atropine indicates a usual initial pediatric dose of 0.01 to 0.03 mg/kg, which aligns with the AHA guideline recommendation 4
CPR Quality Considerations
Ensure high-quality CPR with:
Rotate compressor every 2 minutes to prevent fatigue and maintain quality 1, 2
For a 10-year-old without advanced airway: use 15:2 compression-ventilation ratio
With advanced airway: provide 8-10 breaths per minute with continuous chest compressions 1
Rhythm-Specific Considerations
For Non-shockable Rhythms (Asystole/PEA)
- Continue CPR with epinephrine administration every 3-5 minutes
- Search for and treat reversible causes 1
For Shockable Rhythms (VF/Pulseless VT)
- Defibrillate at 2 J/kg initially, then 4 J/kg for subsequent shocks
- Resume CPR immediately after shock delivery
- Administer epinephrine during CPR as described above
- Consider amiodarone (5 mg/kg IV/IO) or lidocaine (1 mg/kg IV/IO) for refractory VF/VT 1, 2
Common Pitfalls to Avoid
- Delaying epinephrine administration beyond 5 minutes
- Using high-dose epinephrine as initial therapy
- Inadequate chest compression depth or allowing incomplete recoil
- Excessive interruptions in chest compressions
- Failure to identify and treat reversible causes 2
Remember to search for and treat the "H's and T's" of cardiac arrest: Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo/Hyperkalemia, Hypothermia, Tension pneumothorax, Tamponade, Toxins, Thrombosis (pulmonary), and Thrombosis (coronary) 1, 2.