Question: If a pediatric patient is significantly larger than expected (for example, a 6 year old female who weighs 120lbs), do we still use the pediatric dosing chart OR calculation OR adult settings? Personally, if I'd done this call today, I probably would have chosen to use the pediatric calculations of 2J/kg then 4J/kg etc.
i.e.: If using peds dosing chart, this 6 year old would only get a shock of 50J 100J 100J 100J
i.e.: If using peds calculation, she would receive 110J 220J 220J 220J
i.e.: If using adult settings, she would receive 200J 300J 360J 360J
The patient in question is not your average sized peds patient for whom the age based peds dosing chart was developed. Any time there is a discrepancy between the actual and calculated weight of a pediatric patient (be it over or under) choosing to use the peds calculation would result in a more accurate dosage of electricity being delivered. However, in this case, given the importance of early defibrillation, a lower dose of electricity would be better than a delayed dose of electricity due to the time required to calculate the proper dose based on weight or needing to reference additional dosing cards.
Key message being early defibrillation is more important than delayed defibrillation.
It also should be of note that the maximum dose of electricity delivered should not exceed that of the adult dose.