Intravenous administration, pediatric dosing

In mass casualty situations, intravenous antidotes may not be available. In that case, the intramuscular administration is acceptable. Most Emergency Medical Systems in the United States now stock military Autoinjector units containing atropine and pralidoxime, although kits with pediatric doses may not be available. However, in critical situations, children older than 2 or 3 years of age weighing at least 13 kg might benefit from 2 mg of atropine and 600 mg pralidoxime administered intramuscularly with auto-injectors (7). Experience with the accidental atropine auto-injection in 240 Israeli children unexposed to nerve agents revealed that... 

Since staphylococcal and streptococcal cellulitis are indistinguishable clinically," administration of a semisynthetic penicillin (nafcillin or oxacillin) is recommended until a definitive diagnosis, by skin or blood cultures, can be made " " (Table 108-3). Mild to moderate infections not associated with systemic symptoms may be treated orally with dicloxacillin. If documented to be a mild cellulitis secondary to streptococci, oral penicillin VK or intramuscular procaine penicillin may be administered. More severe infections, either staphylococcal or streptococcal, should be treated initially with intravenous antibiotic regimens. Ceftriaxone 50-100 mg/kg as a single daily dose is efficacious in the treatment of celluMs in pediatric patients. The usual duration of therapy for cellulitis is 7 to 10 days. " ... 

Although adrenaline is a first-line drug for pediatric advanced life support, there are emerging concerns that it impairs resuscitation with intravenous lipid emulsion in rats above a dose threshold of lOmicro-grams/kg [66 ]. In bupivacaine-induced cardiac arrest in rabbits adrenaline seemed to be necessary for return of spontaneous circulation, but was also associated with declining hemodynamic variables when the animals were resuscitated with intravenous lipid emulsion [67 ]. Some benefit to cardiac conduction may be achieved by hjqjer-tonic saline co-administration with lipid emulsion, as shown in rabbits [68 ]. 

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