A healthcare prescriber orders medications. If a prescriber is not available, medications are administered following Pediatric Advanced Life Support (PALS) protocol.

Medications are administered by a physician, registered nurse (RN), or pharmacist who is knowledgeable about techniques of administering endotracheal medication to a child as well as the particular medication being used and its possible effects on the child.

In most emergent hospital situations when a child requires endotracheal medications, a number of healthcare professionals are involved, each with specific responsibilities. Typically, a code leader (physician or advanced practice registered nurse [APRN]) manages the situation; licensed nurses monitor vital signs and suction, perform chest compressions, prepare and administer medications (within their scope of practice) (one nurse may prepare the medications, while another nurse actually delivers the medications), perform or assist with procedures, record and document, and assist the family; a respiratory therapist assists in managing the airway; and a pharmacist may also prepare and administer medications (within their scope of practice) (see Chapter 25). The staff member who is with the family should elicit information about the child’s drug and latex allergies.

Principles of pharmacologic management (see Chapter 6) are followed.

Medication administration guidelines are followed, including correct patient, medication, dose, route, time, and approach to child.

Because it is more efficacious, the intravenous (IV) route is the preferred method of administration of emergency medications. If, however, an emergent situation develops and IV or intraosseous access is not established within 3 to 5 minutes, there are four medications for children that can be administered through the endotracheal tube: lidocaine, epinephrine, atropine, and naloxone. These can be remembered by the mnemonic “LEAN.”