EMERGENCY DRUGS Epinephrine 0.01-0.03 mkd q3-5min Atropine 0.02-0.03 mkd(max0.5mg) Adenocard 6 mg initially; 12mg nxt Adenosine 6mg/2mL Ca Gluc 10% 0.1-0.2 mkd Captopril 0.3-0.5 mkd q6-12h Capoten 25mg/tab Hydralazine 0.1-0.2 mkd Apresoline PO: 10mg; 25 IV: 20mg/amp L-Carnitine 50 mkd q4-6h(N) 30-40mkd?? Carnicor PO: 1/10; 330 IV: 1/5 Lidocaine 1.0 mkd bolus 20-50 ugKmin Mannitol 20% 1-2 mkd Prep 1.2% soln (1 med/mL) NaHCO3 1.5-2.0 mkd Naloxone 0.1 mkd Plain 0.4mg/1mL Neonatal 0.02mg/1mL Nifedipine 0.25-0.5 mkdq4-6h Nipride 0.5-1.5 ugkm** Urecholine 2.9mg/m2/d q8 PO**
CEPHALOSPORINS 1st Generation Cephalexin 25-100 mkD q6-8h/ 250-500 Cefadroxil 30 mkD BID(max:2g) Cefalothin 50-100 mkD QID Cefazolin 50-100 mkD q8 Cephradine 50-100 mkD q6-12 2nd Generation Cefamandole 50-100 QID Cefaclor 20-40 mkD q8-12 Ceclor 125/5; 250/5 DS Cefuroxime IV: 200-240 mkD q8 PO: 20-30 mkD BID 3rd Generation Cefotaxime 150 mkD q6-8 (menin:200) NB:<7 100mkd q 12H; 1g q8-12 for > 12yo & 2g-adults Claforan 500mg; 1g; 2g Ceftriaxone NB 50-75mkDOD Child: 50-75 mkD OD Meningitis LD:75mkd,80-100mkDq12-24 Adult: 1-2 g OD
AMINOGLYCOSIDES Amikacin Kanamycin Tobramycin Gentamycin
10-15 mkD/15-25mkDq8-12 Prep: 100/2; 250/2 30-50 mkD 6-8 mkD (Nebcin) 5-8 mkD IV
MACROLIDES Erythromycin Erythrocin
30-50 mkD 200/5; 400/5 ds; 100/2.5gtts
Azithromycin 10 mkD ODx1D,5mkDx4D Grp. A Strep 12mkDx5 D Clarithromycin Klaricid
15 mkD q12 or 7.5 mkd 125/5 (don’t ref)
ANTI-STAPH Nafcillin 100-200 mkD q6 Vigopen 250/5 Co-Amoxiclav 40-60 mkD Augmentin 156/5; 312/5 Stafloxin 100-200 mkD Vancomycin 40-60 mkD Cloxacillin 50-100 mkD q6 Prostaphlin-A 125/5 Orbenin 250; 500 Oxacillin 100-200 mkD IV (Prostaphlin) OTHER B-LACTAMS Imepenem 60-100 mkD q 6 or 8 NB: 20 mk q 12 Piperacillin (Cypercil) Less Serious: 100-200 MKD q6 Serious: 200-300 MKD Vancomycin 40-60 MKD (give in 2h) q 8 or 12 Meropenem 20 mkd q 8 or 60 mkD q 8 hrs 40 mkd q 8 hrs newborn septic
Ceftazidime 150 mkD q 8 hrs (Fortum) < 2mo: 25-50 mkD BID > 2mo: 30-100 mkD TID Adult: 1-6 g/day TID Cefoperazone 100-150 mkD Child: 50-200 mkD BID Adult: 2-4 gkD q12 Cefobis Cefoxitin 50-100 mkD q6-12 Mefoxin 1 g/vial Ceftizoxime Child: 40-80 mkD bid-qid Adult: 0.5-2 g/d 2-4 doses IV/IM Cefixime 3-6 mkD BID Tergicef 100/5 (50mg/ml) Cefdinir 9-18 mkD q8 Omnicef 50mg/sachet; 100mg/cap Cedax 9 mkD OD (180/5) Cefetamet 20 mkD OD q12 Globocef 250/5 4th Generation Cefepime for severe infection, 50 mkd q8 2mo old, BW <40kg = 50 mkq12x10d Newborns 30 mkd q 8 hrs
ANTI-TB INH Tx: 5 mkD liver Px: 10-15 mkD peri. neuritis Trisovit 50/5 Nicetal 100/5 Primafort 100/5 Odinah 150/5 Trisofort 200/5 Pyrobin H 150/5 Comprilex 200/5 Ethambutol 20mkD optic neuritis Myambutol 200/5 Ethambin 125/5 Isoetham 150/5 Ethambin/INH 150/5; 125 Rifampicin 10 mkD (liver) Rimactane 100/5; 200/5 150; 300; 450; 600 Meningo Px: Adult: 600 q12 x 4 doses 1-12yo: 10 mk q12 x 4 doses 3mo-1y: 5 mk q12 x 4 doses Streptomycin 20-30 mkD OD IM ototoxic PZA 15 mkD Give PO pre breakfast
ANALGESICS
PENICILLINS
Fentanyl
PCN:
Low: 2 mkD Mod: 2-20 mkD High: 2-50 mkD Sublimaze (Janssen): 50ug/2mL Ibuprofen 5-10 mkd q6-8 Dolan FP 100/5 Mefenamic acid 3-5 mkD Ponstan 50/5 Midazolam 0.1 mkD Dormicum IV: 5/1;5/5;15/3 PO: 5mg/tab Morphine 0.1-0.2 mkD Morphine 10/mL Nalbuphine 0.1 mkD Nubain 10/mL Pancuronium 0.04-0.1 mkD Promethazine Phenergan IV: 50/2 PO: 1/1; 10mg Ketorolac 0.25 mkd q 6 hrs
50-100TUKD or 25-30 mkD 625mg = 1 MU 250/5 = 400 TU 312.5/5= 500 TU 500mg = 800 TU Oral PCN 100-200 TUKD Pentacillin 50/5; 500mg Sumapen 25/5; 250; 500 Megapen 50 TU/mL gtts 312.5/5; 625mg Amoxicillin 20-50 mkD q8 80-90mkD-OM Nafcillin 100-200 mkDq6 Stafloxin 100-200 mkD Ampicillin 100-200 mkD (NB: 50-100 BID; men: 300-400 mkd q6) Unasyn 25 mkD q 6 hrs Ampicin/Pentrexyl/Aldribid Bacampicillin 25-50 mkD Penglobe 200/5
ANTI-HELMINTHIC Oxantel pamoate 10-20 mkd Quantrel 100/5; 100 Tetramizole 2.5-5 mkd SD TMZ 25mg/10mL Mebendazole 100 mkd BID x 3 days Antiox: 100; 500mg/tab; 20mg susp Combantrin 125mg; 250mg/tab 125mg/5mL susp >15yo = 500 mg 10-14yo = 375 mg 5-9 yo = 250 mg 5 yo = 125 mg ANTI-VIRAL Methisoprinol 50-100 mkD Isoprinosine 250/1; 500 Inosiplex 50 mkD Immunosine 250/5 Amantadine 5-8 mkD Symmetrel 50/5 Virazole 10 mkD Acyclovir 10-15 mkD q6 x 5D Zovirax 250/5; 200
ANTI-ASTHMA Aminophylline LD: 8-10 mk MD: 3-5 Drip: 0.4-0.9 mkH Neonate: 1 mkd q8 or 2 mkd q12 Apnea: LD: 5-6 mkd (o.5-0.9 m/k/hr infusion) MD: 2 mk 12h post-LD Prep: 250/10 Drip: eg: 5kg at 0.4 mkH in 8h drip: 5 x 0.4 x 8 = 16mg in 8h if IVF rate is 5cc/h, fill soluset with 40cc IVF+ 16mg Amino (0.64mL) Theophylline 3-5 mkd Nuellin 80/15; 50; 125; 250 Terbutaline SQ: 0.005 mkd PO: 0.075 mkd Drip: 0.003 mkH Bricanyl IV: 0.5/1 PO: 1.5/5; 2.5 Salbutamol 0.12-0.15 mkd Ventolin 2/5 sy; 1.2/5 exp; 2 Librentin 2/5; 2mg Prox-S 2/5; 2mg Atrovent 4-8gtts/mL NSS
ANTI-DERMATOSES
COUGH
Hydrocortisone 1% TID x 2 wks Hytone/Hydrotpic/Eczacort Betamethasone BID-TID Betnovate/Diprolene/Diprosone Fluocinolone acetonide BID-TID Aplosyn 10; 25; HP Synalar 10; 25; HP Mometasone furoate OD Elica/Momate Clobetasole propionate Dermovate Diflucortolone valerate BID-TID Nensona Desoximetasone BID-TID Esperson Triamcinolone acetonide BID-TID Kenacort A/Ladercort A
Ambroxol 1.2-1.6 mkD q12 Mucosulvan 15/5; 7.5/1.5 Zobrixol 15/5; 7.5/1.25 Salvotran 15/5; 30/5 Bromhexine 7-12y = 1 tsp TID 2-6y = ½ tsp TID Bromulex 4mg/5mL; 8mg SCMC 20-30 mkD Loviscol 50/1; 100/5 Solmux 40/1; 200/5 Cemetol 200/5 Erdosteine
10 m/dk/d BID 175mg/mL
DIAZEPAM DRIP 0.3 mkH dilute in NSS makes 0.1mg/mL conc = mg/total vol (mL
ANTI-HISTAMINES Diphenhydramine 3-5 mkD TID-QID Benadryl IV: 50/1x3 dose PO: 12.5; 25; 50 Methdilazine 0.3 mkD q12-q6 Tacaryl 4/5; 4; 8 Clemastine 0.05 mkD q12 Tavegyl 0.5/5; 1mg Hydroxyzine 1 mkD Iterax 2mg/ml; 10; 25 Cetirizine 0.25 mkD Virlix 10mg/1mL Loratadine 2-12yo, < 30k: 1 tsp OD >30k: 2 tsp OD Claritin 5mg/5mL Ketotifen 0.025 mkd q12 Zadec 1mg/5mL; 1mg Zaditen 0.2mg/1mL; 1 ATROPINE SULFATE Pedia 1-2 mg SQ q 20min 0.2 Mkd q 3-5min Adult 2mg q 10 min IV/IM 0.5mg (5mL) q 3-5min Mkd PRN after 24h
DIURETICS Furosemide 1.0-2.0 mkd Lasix 20/2; 40mg Frusema 20/2; 20mg; 40 Diazoxide 5-10 mkd Diazoxide 300/2 Acetazolamide 20-30 mkD Diamox 250mg/tab Spironolactone 1.5-3.0 mkD Aldactone 25mg/tab Hydrochlorothiazide 1-2 mkD Dichlotride 25mg; 50mg/tab Mannitol 20% 1.5-2 gkD or 5cckd 200g/1L; (1gm = 5 cc; 0.5-1gkd) DOPAMINE DRIP 1-5 ug/k/min = VD, inc renal & splan circ 5-10ug/k/min = inotropic; no effect on HR 10-20 ug/k/min = inc BP
Prep: Dopamine: 200/5 Conc Dopa S 800 1 cc DS 1600 2 cc QS 3200 4 cc
D5W 49 cc 48 cc 46 cc
Prep: Dobutamine: 250/2 Conc Dobu S 1000 4cc DS 2000 8 cc QS 4000 16 cc
D5W 46 cc 42 cc 34 cc
Computation for concentration: 1. D5W 250 + 200 mg/amp 200/250 = 0.8 mg/cc = 800 ug/cc 1 cc = 60 ugtts conc = 600/60 = 13.33 ug/ugtts 2. Lidocaine 2% 2 g/100 mL = 20 mg/mL AD = rate x conc Wt x 60
Rate = RD x Wt x 60 Conc
STEROIDS
ELECTROLYTES
PARACETAMOL
Dexamethasone Decadron Hydrocortisone
Vitamin K 0.3 Mkd (max 5 mg) x 3 dys
Aeknil Afebrin Biogesic Calpol Crocin Defebrol Naprex Opigesic Rexidol Tempra Tylenol Winadol
0.2-0.4 mkd 4/1 LD: 10 mk MD: 5 mkD Solu-cortef 100/2; 250/2 Act-o-vial 100 Prednisolone 0.7 mkD Solumedrol 125/2 Prednisone 0.5 mkD 1 mkD (BA) Methylprednisolone 1.5 mkD q 6 hrs ALBUMIN Albumin: 1 g/K/dose Alburein 12.5g/50mL (25%) Formula: Desired-Actual x 1.2 x Wt Albumin 0.5-1.0 g/K (max 6 gKD) Albumer/Albutein 50/1 (5%) 250/1 (25%)
Calcium gluconate 10% 1 cc/k/shift IV MD: 200-500MKD q6 or drip (Max 200 Mkd in 10 min) IV: 100/1 (9 el. Ca/ml or 0.45mg Ca/ml) PO: 500 mg (45 mg Ca) 650 mg (58.5 mg Ca) Iron
Tx: 4-6 MKD Px: 1-2 MKD Iberet 500 mg (26.25 elem Fe) Odiron 50mg/10mL; 25mg/5mL Fer-in-sol 15mg/0.6ml; 18mg/5mL Propan 25mg/5mL Ferlin 30mg/5mL; 15mg/1mL Incremin 30mg/5mL Polyvifer 10mg/1mL
Glucagon
0.25-0.3 mkd 0.3 mkd-1mg in IDM 1 mg (1 “U”) vial
10-15 mkd
300mg/2mL 120mg/5mL; 325mg; 500 100mg/1ml; 250/5; 500 120mg/5mL; 250mg/5mL 125mg/5mL; 500mg 60mg/0.6mL; 120mg/5mL 250mg/5m; 500mg 125mg; 250mg 150mg/5mL; 60/0.06; 600 120mg/5mL; 60mg/0.06mL 120mg/5mL 120mg/5mL; 500mg
SALICYLATES Anti-rheumatic Asaped Ascriptin Aspirin Gr V Neo-Novaldin Superin
65-130 mkD 81mg 325mg Gr 1 = 65 mg 325mg 180mg/5mL; 3g
LUMBAR TAP Pressure (in cmH2O) G 22 (1 ½) = gtts in 21 sec G 22 (3 ½) = gtta in 39 sec G 20 (3 ½) = gtts in 12 sec
HS METHOD for IVF Infusion
BALLARD’S MATURITY TESTING
2.5-10kg 100cc/k/day 10-20kg 1000cc+50cc/k over 10k >20kg 1500cc+20cc/k over 20k
Score
AOG (wks)
WBC correction in traumatic tap: Periph WBC x 1000 = WBC 5,000,000 1000 RBC
TF/4 = cc/hr or ugtt/min
5 10 15 20 25 30 35 40 45 50
26 28 30 32 34 36 38 40 42 44
C/I: increased ICP severe CP depression infected skin decreased platelet count or blood d/o brain abscess colorless, 50-80 mmH2o, WBC 5/mm3 CHON <45 Glucose 60-75% of blood glucose PHOTOTHERAPY Indication: PT: 10 mg% bilirubin FT: 15 mg% bilirubin Complications: osmotic diarrhea rashes bronze baby syndrome dehydration
Phototx +20% Tachypnea +25-50% Fever +12% q 1oC > 37.5oC Hypermetabolic +25-50% Burns +14% for 1st Degree Sweating +10-25%
CHARACTERISTICS OF PROXIMAL & DISTAL SBO KVO: ugtt = 3.5 gtt = 10
HIGH SBO Acute onset Prominent vomiting Vomit not feculent Pain frequent minimal distension
LOW SBO less acute less prominent often feculent less frequent prominent
SA = Wt x 4 + 7 x 400 (renal) Wt + 90
RANSON’S CRITERIA for ACUTE PANCREATITIS
Men Preterm CHF Cardiac Renal MF
SA x 1500 SA x 1200 SA x 800 SA x 200 SA x 400 + 24h UO < 2yo = SA x 1500 > 2yo = SA x 1200
On Admission:
0-5 kg 6-10 kg 10-15k 15-20k
wt x 0.05 + 0.05 wt x 0.04 + 0.1 wt x 0.03 + 0.2 wt x 0.02 + 0.3
CRITERIA FOR RHEUMATIC FEVER Major: carditis, polyarthritis, chorea, subcutaneous nodules, erythema marginatum Minor: hx of RF/RHD, arthralgia, fever, elevated ASO, CRP & ESR, prolonged PR interval, (+) culture of Grp. A strep
1. age > 55 yrs 2. leukocytosis > 16,000 3. hyperglycemia > 200mg/dL (11mmol/L) 4. serum LDH > 400 IU/L 5. serum AST > 250 IU/L During the initial 48hrs: 1. hematocrit fall > 10% 2. fluid sequestration > 4000 mL 3. hypocalcemia < 8mg/dL (1.9mmol/L) 4. hypoxemia (PO2 <60mmHg) 5. BUN rise >1.85mg/dL (>1.8mmol/L) post IVF 6. hypoalbuminemia < 3.2g/dL (32g/L)
CRITERIA FOR AMI 1.typical pain: retrosternal, severe, pain lasting >30min, unrelieved by nitrates, cold, clammy perspiration 2. evolutionary ST elevation followed by Q wave formation and ST segment inversion 3. elevation of serum CPK-MB Labs: Onset CPK-MB 4-6h SGOT 8-12h LDH 12-24h
Peak 12-24h 36-48h 2-4days
Duration 24-48h 3-5days 7-10days
ABG H=
∆ 24 x pCO2 HCO3
Chronicity: ∆ H – 40 ; if < 0.3 = chronic pCO2 0.3-0.7 = ac/chr > 0.8 = acute Oxygenation: 80-100 adequate 60-80 mild hypoxemia 40-60 moderate < 40 severe
CPAP TFR = wt x TV(10-15) x RR x IE ratio(2) + 2000 (2L) FiO2 = CA (0.2) + 02 (1) x 100 TFR CA = 100 – FiO2 x TFR 79 O2 = FR – CA ET Size: > 2 yo = age(yrs) + 16 4 HR RR 2-12 mo = <160 < 2 mo = up to 60 1-2 yo = <120 2mo-2yr = 50 2-8 yo = <110 1-5 yo = 40 IE: 60/RR - IT IT PEFR Ht= x – 100 x 5 + 170 (F)/175 (M) % PEFR = actual x 100 expected
pH 7.35-7.45 = 7.4 pCO2 35-45 = 40 HCO3 22-26 = 24 O2 80-100 Neonates: 7.3-7.4; 35-45; 24-26 Metabolic Acidosis: pCO2 = 1.5 (HCO3) + 8.4 ± 2 limit 10 Metabolic Alkalosis: q 1meq/L inc HCO3 there is 0.5-1.0 increase in pCO2 limit 55 Respiratory Acidosis: Acute: 3-4 meq/L inc HCO3 q 10mmHg inc pCO2 Chron: 0.4 meq inc HCO3 q 10mmHg inc pCO2 Respiratory Alkalosis: Ac: 2-4meq dec HCO3 q 10mmHg dec pCO2 limit 18 Chr: 0.5meq dec HCO3 q 10mmHg dec pCO2 def: 0.3 x ABE x wt (half correction)
JAUNDICE VITAL SIGNS Clinical Jaundice manifestation of color starting at serum bilirubin levels 5-7 mg% Criteria to rule out physiologic jaundice: 1. Clinical jaundice in the 1st 24 hrs of life. 2. Increase in total serum bilirubin at > 5 mg/dL/day (85 umol/L). 3. Total serum bilirubin > 12 mg/dL in full term, and > 15 mg/dL in preterm. 4. Direct bilirubin > 1.5-2 mg/dL (26-34 umol/L). 5. Jaundice lasting for more than 1 week for term, 2 weeks for preterm.
I. HEART RATE <2 mo 140-160 2-12 mo 120-140 1-2 yo 100-120 2-8 yo 90-110 II. RR <2 mo up to 60 2mo-1yr 50 1y-5y 40 III. BP syst upper :yrs x 2 + 90 lower: yrs x 2 + 70 diast 30 mm Hg lower
INTUBATION/EXTUBATION INTUBATION ET SIZE > 2yo: age (yrs) + 16 -------------------------------------
4 PT: 2 or 2.5 FT: 3 or 3.5 ET LENGTH age/2 + 12 kg cm 1 7 2 8 3 9 EXTUBATION CRITERIA FiO2 < 50 P/F no electrolyte imbalance control of infection good muscle mass racemic epi (0.3 mL + 4.7 PNSS) 2.5 mL x 3 d (q4-6) Dexamethasone 6 hrs prior then 24 hrs
CARI
MALCOLM HOLIDAY (1/4 1st hr; ¾ 7 hrs)
2mo-2 yo: Mild Pneumonia: send home, TMP-SMX, Tx fever, ff-up in 2-4 days
< 2 yo > 2 yo
Severe Pneumonia: Admit, give IV/IM Benzyl PCN, Tx fever, tx wheezing, supportive care, reassess daily
Hydrite 1 tab in 100cc water = 8h Glucost 1 sachet in 100cc water = 8h Oresol 1 sachet in 1L water = 24h Glucolyte 1 sachet in 200cc water
Very Severe Pneumonia: Admit, give O2, Chloramphenicol, tx fever and wheezing, reassess BID (q 15min if possible)
FLUIDS AND ELECTROLYTES
< 2 mos: Severe Pneumonia: Hospitalize, keep warm, give 1st dose antibiotic Benzyl PCN/ Garamycin/Gentamycin
Mild 50 30
Moderate Severe 100 150 60 90
1. Hypotonic: D5W; D5NM; D5 0.3NaCl; D5 IMB; Isolyte; D5 Maintresol 2. Isotonic: D5LR; D5 NSS; PLR; PNSS 3. Hypertonic: D50W; D10W
STAGES OF DHF 1. Febrile 2. Afebrile 3. Convalescent GRADING OF DHF 1. Fever + non-specific ssx; (+) tourniquet test 2. Gr. 1 + spontaneous bleeding 3. Gr.2 + manifestations of circulatory failure: rapid, weak pulse; narrow pulse pressure; HPOT; cold, clammy extremities 4. Profound Shock with undetectable BP & pulse Days 1-5: petecchiae, fever Days 5-7: bleeding > Day 6 : shock CLASSICAL DENGUE FEVER 1. Thrombocytopenia not < 100T 2. Hemoconcentration not > 20% of baseline
IV FLUIDS Na IMB 25 NM 40 NSS 154 LR 130 NMR 40 IsolyteM 40 IsolyteP 25 PLP48 25 0.3% 51 0.6% 102 0.45 77 0.9% 154 ORS 90 P-lyte90 90 P-lyte Pl 45
IVF OF CHOICE K 20 13
Cl 22 40 154 4 109 30 35 40 20 20 20 22 51
HCO3 Ca PO4 23 3 3 16 3 3 28
3
3
102 77 20 20 20
154 80 30 (20 gluc) 80 35
Na = 1 meq = 23 mg K = 1 meq = 39.1 mg
LBM Vomiting Maintenance BA Fever & Sweating Drowning Ascitis CHF HPN CHF (NPO) 2o to HPN Heat Stroke Burns Azotemia Inc BUN Bleeding UTI Profuse Bleeding Dengue Fever DM
ELECTROLYTES PLR D5 NSS D5 NM D5 0.3% NaCl D5 0.3% NaCl; D5W D5W; D10W D5 NSS D5W/D5LR(BP) D5 NSS D5W D5 NSS PLR D5W D10W D5 LR D5 NSS D5 LR D5 0.3% NaCl PNSS
Na = 135-145 meq K = 4-5.6 meq Ca = 8-10 meq Cl = 98-106 meq
(RV= 136 meq) (RV= 4 meq)
Deficit = (desired-actual) x Wt x 0.6 Adult = desired-actual x 350 3 Maintenance: Na = 3 meq/kg K = 2 meq/kg Na/K deficit is given in 3 days Na/K delivery = 0.1-0.4 meq/kg Full incorporation = 40 meq/L
IBW 2-12 mo = age in mo x 10 = wt in lbs < 6 mo = age in mo x 600 + BW = wt in gms 6-12 mo = age in mo x 500 + BW = wt in gms < 1 yo = Age (mo) + 9 2 > 2 yo = age in yrs x 2 + 8 = wt in kg = age in yrs x 5 + 17 = wt in lbs
1 yo 2 yo 3 yo 5 yo 7 yo 10 yo
4.5 BW = 3 x BW = 4 xBW = 5 x BW = 6 x BW = 7 x BW = 10 x BW
MOTOR GRADING
COMPOSITION OF BODY FLUIDS
0 1
Na Gastric 50 Panc 140 Bile 130 Ileosto 130 Diarrh 50 Sweat 50 Blood 140 Urine 0-100
2 2 3 4 =2x
no movement flicker of contraction with no associated movement at a joint movement present but can’t sustain against gravity movement against gravity but not with resistance movement against some resistance movement against full resistance
K Cl HCO3 10-15 150 0 5 50-100 100 5 100 40 15-20 120 25-30 35 40 50 5 55 0 4-5 100 25 20-100 70-100 0
Osm = 2 (Na meq/L + K meq/L) + Urine mg/dL – glucose mg/dL 2.8 18
BCE NB 3-10kg
> 60
45-50 cal/kg 60-80 10.15 15.25 25.35 35.60 25-30
45-65 40-45 35-40 30-35
MF = BCE x Wt x 1.5 = cc/hr 24 or ugtt/min Fever = +12% for every oC rise > 37.5oC Hyperventilation/dyspnea = + 25% Bronchial asthma = + 50% Bililight therapy = + 20%
CALORIC REQUIREMENTS < 1 mo 110-140 cal/k/day 1-11 mos 110-115 1-2 yrs 100-110 3-6 yrs 90-100 7-9 yrs 80-90 10-12 yrs 70-80 13-15 yrs 55-65 16-19 yrs 45-50 PROTEINS RDA 0-5 mos 6-11 mos 1-6 yo 7-12 yo 13-15 yo 16-19 yo
2.5 g/kg/day 2.5-3.0 2.0-2.5 1.5-2.0 1.5 1.0-1.5
Milk Formula Similac 20 cal NAN 20 S-26 20 Pre-NAN 21 BM 22 Enfalac 21
CHON 1.5/100 1.5/100 2.25/100 2/100 1.1/100 2.25/100
K infusion rate = IV rate x amt of K (mEq) Vol of IVF x wt Normal KIR: 0.1 – 0.3 Vit K = 0.3 mg/kg for IV antibiotics >7 D Ca gluconate - 1 cc/kg/shift Maintenance/ DAY: 30X WT 9 Ca deficit - 53-75 mEq/k/day Ca requirement - 27-32 mEq/day Wt x dose 9.8
in 24H
Eg. 75 mEq x 3 kg in 24 H In q shift = 75 mEq x 3 kg = 75 mEq 3 shifts = 75 mEq = 8.3 cc = 72 mEq 9 (1 cc = 9 mEq) Ideal tracheal aspirate: EC <25 PMN’s >10 Max steroids for NS : 2 mkD or 60 Mkm ≈ 4-6 wks
ALL HIGH RISK PROTOCOL
Anaphylaxis
PHASE induction consolidation maintenance
epinephrine. 1:1000 0.01 mkd max of .5 ml IM
Vincristine 15 mg/m2 on D0,7,14,21 Doxorubicin 25 mg/m2 on D0,7,14,21 Prednisone 40 mg/m2 on D21-25L aspariginase 6mg/m2 for 9 doses (3 doses per week; mwf/mtw)
diphenhydramine 1-2 mkd IM/IV up to 50 mg q 4-6 Ranitidine 1-2 mkD up to 50 mg IV q 6H Hydrocortisone 5-10 mkd up to 100-500 mg IV q 4-6H
ANTHROPOMETRY 1. Body Weight A. Ideal Body Weight At birth 3000 gms < 6 mo (g) age in mo x 600 + BW 6-12 mo (g) age in mo x 500 + BW Nelson's: 3-12 mos (age in mo + 9)/2 1-6 yr (kg) age in yr x 2 + 8 7-12 (kg) (age in y x 7- 5) / 2 B. Expected Body Weight (up to 1 mo) Term EBW=(age in days-10) x 20 + BW Preterm EBW=(age in days-14) x 15 + BW Where: 10=time to recover over physiologic wt loss 20=g/day gained C. Estim wt 4-5mo 2 x BW 5 yo 6 x BW 1 yo 3 x BW 7 yo 7 x BW 2 yo 4 x BW 10 yo 10 x BW 3 yo 5 x BW
ASTHMA CLASSIFICATION BASED ON SEVERITY intrmtnt day sx <1/w night sx «2/mo PEFR exp »80 PEFR var <20 FEV1 »80
persistent mild mod severe >1/w >2/mo »80 20-30 »80
daily daily >1/w >1/w 60-79 <60 >30 >30 60-79 <60
ATHMA SCORING WOOD'S SCORE 0 1 2 p02 or 50-100 «70 in «70 in cyanosis rm air 40fio2 Breath snds N unequal absent Acc muscles N mod max Exp wheeze N mod extrem Cerebal fxn N depresd/coma agitated 1-3 mild asthma attack 4-6 moderate, bedside 7 up severe, intubate
SILVERMAN'S SCORE 0 1 2 Flaring - min marked Lower chest Retractions - visible marked Upper chest Retractions - synch in- seesaw drawing Xyphoid retractions - visible marked Grunting steth ears (audible) 3-4 »7
give 02 intubate
Personal best Predictive Value of PEF females: ht(cm) - 100 x 5 + 175 males:ht(cm) - 100 x 5 + 170 actual PEF >80%, normal
CHF CLASSIFICATION *Anatomic I II
acquired congenital
*Physiologic (disturbance in) A heart rhythm and conduction B myocardial contraction C clinical syndrome (HPN,DM) *Functional I asymptomatic II symptomatic w >ordinary act III symptomatic w minimal activity IV symptomatic at rest *Therapeutics A no restriction of act B restriction of severe act C restriction of moderate act D sharp restriction of ordinary act] E complete rest in a chair or bed
MILK Abbot,wyeth = 1:2 MILK alfare bm(t) bm (pt) bonna caro syr corn oil enfalac gain lactum nan1 nan ha neosure nutren jr prenan promil s26 s26lbw
CPAP GUIDELINES MJ & Nestle = 1:1
CAL CHON g FAT CHO 72/dL 2.5 3.6 7.8 699/L 9.09 41.96 72.7 75/dl 1.1 4.5 20/oz 671/L 14.09 38.93 66.4 22/oz 1.1/dl 120/oz 31 813/dL 82 67.6/dL 2 3.5 7.4 21/oz 2.25/dl 22/oz 2.8g/dL 21.4/oz 3.42g/dL 67/dL 1.2 3.6 7.5 20/oz 1.5/dl 67/dL 1.51 22/oz 100/dL 3 3.9 13.3 80/dL 2.3 4.2 8.6 21/oz 2/dl 81/dL 2.4 4.1 8.9 20/oz 2.25/dl 100/ 2.4/dL 125ml 24/oz
1. Initially CPAP is set @ 6cm water. If there is no inc in PO2 in 15 min pressure must be increased in 2cm increments to a maximum of 10cm. (If by ETT) or by 12cm (in other method). 2. If there is an increase in PaO2, reduce pressure. 3. If 10-12cm water pressure is attained and if PaO2 reamins under50, FiO2 must be increased by 5-10% increments. 4. CPAP failure is evident if PaO2 remains less than 50 in 100% FiO2 with 10-12cm water. *If CPAP fails under non invasive method, an ETT must be inserted. *If CPAP fails w/ ETT, mechanical ventilation is indicated.
Parameters To Be Met B4 Weaning 1. Improvement in CXR 2. AABG showing PO2 >/= 50 mmHg 3. Blood PH >/= 7.3 4. PCO2 70 2. With FiO2 of 40%, reduce pressure by increments of 2 cm water every 2-4H until pressure of 2-3cm is achieved. 3. transfer ptient to oxygen hood with FiO2 of 15-50%
CSF Normal Values OPENING Pressure Newborn 80-110 mm H2O Infant <200 mm H2O GLUCOSE Premature Term PROTEIN Premature Term WBC ct Premature Term
24-63 mg/dl (csf-bld ratio 55-105%) 44-128 mg/dl (csf-bld ratio 44-158%) 65-150 mg/dl 20-170 mg/dl 0-25 /cumm (57 % PMNs) 0-22 /cumm (61% PMNs)
ELECTROLYTE COMPUTATION I. POTASSIUM normal =4-5.6 meq (4) N K deliverance = 0.1 - 0.4 meq/kg Deficit = (KD-KA) x wt x 0.6 Maintenance K= 2 x wt Total K def = deficit + maintenance Full incorporation: 40meq/L or 20meq/500cc K INFUSION RATE K delivery = ivf rate x K in ivf / vol/ wt normal=0.2-0.4meq/kg II.SODIUM maintenance Na=3 x wt maximum target/day=10 meq Na = 1 mEq = 2.3 mg/dl K = 1 mEq = 3.91 mg/dl NaHC03= gr x=650 mg=7.7 meq gr v=325 III. CALCIUM normal = 8-10 meq IV. CHLORIDE normal = 98-106 meq V. CO2 normal = 15 meq
ET Tube Sizes and Distances According to Infant Weight Weight (gms) 500-1000 1000-1400 1400-1900 1900-2200 2200-2600 2600-3000 3000-3400 3400-3700 3700-4100 4100-4500 >4500
l.D. (mm) Depth (cm) 2.5 N 7.0 3.0 7.5 3.0 8.0 3.5 8.5 3.5 9.0 3.5 9.5 3.5 10.0 3.5 10.5 4.0 11.0 4.0 11.5 4.0 12.0
DOUBLE VOLUME EXCHANGE TRANSFUSION = KBW x EST. Blood vol. x 2 materials: 1. NGT fr. 5 #1 (umbilical cath.) 2. Three way stop cock 3. FWB 4. suture 5. 50cc syringe 6. Ca gluconate 7. HGT strip
EFW station fundic ht (in) - 13 x 155 12 11
0 +
normal wt for term: 2500-3800 g Naloxone Narcan cc=0.1 x efw ----------------0.4 given to bb whose mothers were given Demerol with in 4 hrs PTD LBW VLBW ELBW
2000-2499 1500-1999 1000-1499
GROWTH I. WT GAIN age wt gain (g/day) 0-3 mo 30 3-6 mo 20 6-9 mo 15 9-12mo 12 1-3y 8 4-6y 6
length (cm/mo) 3.5 2 1.5 1.2 1 3/y
hc cm/mo 2 1 0.5 0.5 0.25 1/y
II. Nails 1cm/3mo III. Hair 1cm/mo IV. Liver span 1 w : 4.5 5 cm 12 yo : M 7-8 cm F 6-6.5 >12 yo: M: 0.032 x wt(lbs) + 0.18 x ht (in) - 7.86 F: 0.027 x wt + 0.22 x ht - 10.75 V. Gallbladder length infants: 1.5-5.5 cm adolesc: 4-8 cm width neonates: 0.8 cm
all ages : 0.5-2.5
AGE GROUP
FREQUENT PATHOGENS (IN ORDER OF FREQUENCY)
Neonates (<1 mo)
Group B streptococcus, Escherichia coli, other gramnegative bacilli, Streptococcus pneumoniae, Haemophilus influenzae (type b,[*] nontypable)
1–3 mo Febrile Respiratory syncytial virus, other respiratory viruses pneumonia (parainfluenza viruses, influenza viruses, adenoviruses), S. pneumoniae, H. influenzae (type b,[*] nontypable) Afebrile Chlamydia trachomatis, Mycoplasma hominis, pneumonia Ureaplasma urealyticum, cytomegalovirus 3–12 mo
Respiratory syncytial virus, other respiratory viruses (parainfluenza viruses, influenza viruses, adenoviruses), S. pneumoniae, H. influenzae (type b,[*] nontypable), C. trachomatis, Mycoplasma pneumoniae, group A streptococcus
2–5 yr
Respiratory viruses (parainfluenza viruses, influenza viruses, adenoviruses), S. pneumoniae, H. influenzae (type b,[*] nontypable), M. pneumoniae, Chlamydophila pneumoniae, S. aureus, group A streptococcus
5–18 yr
M. pneumoniae, S. pneumoniae, C. pneumoniae, H. influenzae (type b,[*] nontypable), influenza viruses, adenoviruses, other respiratory viruses
≥18 yr
M. pneumoniae, S. pneumoniae, C. pneumoniae, H. influenzae (type b,[*] nontypable), influenza viruses, adenoviruses, Legionella pneumophila
ANTI-AMOEBIC Metronidazole
35-50 mkD (7.5 mkd)q8 < 7 or <1.2kg = 7.5 mkDq12 > 7 or > 2 g = 30 mkD Flagyl PO: 125/5; 250 Servizole 200mg/5mL Etofamide 15-20 mkD Kitnos 40/5; 250; 500 Cotrimoxazole Clindamycin
6-20 mkD bid (TMP) <7d.o./<2kg:10mkD 10-40mkDq6-8 Dalacin C 75/5ml Chloramphenicol 50-75 mkD Chloromycetin Tetracycline 40-60 mkD
Other Antibiotics
Antacids
GLUCOSE INFUSION RATE
ciprofloxacin
Cimetidine 10-20 mkD Tagamet syr 200mg/5ml; 100mg/5mL
GIR: RATE X DEXTROSITY WT X 60 PERIPHERAL LINE: 5-6 CENTRAL LINE 9-12
Ranitidine 4-5 mkD q 8 Zantac IV 50 mg/2mL PO 150mg; 300 mg
Dextrosity d5 50 D 7.5 75 D10 100 D50 500
10 mkd q 12 hrs
Co-trimoxazole 8-10 mkD BID (based on TMP) Triglobe 45 mg/5mL Bactrim 160 mg/5mL; 40 mg/tab; 80 mg/tab Macrobid 40mg/5 mL Clindamycin :
30 mkD for osteomyelitis 30-50 mkD q 8 or 6 Granules: 75mg/5mL 150/mL
Omeprazole 0.6-0.7 mk OD Losec 20 mg/tab; 40 mg/tab Famotidine 0.7 mkd q 12 H2Bloc 20mg/2mL
Converwsion: Conc desired-actual x 2 1000
x total vol
Eg: d10- d5x2= 0.1 Chloramphenicol Chloromycetin Chloramol
50-100 mkD
Tetracycline 40-60 mkD
Lanzoprazole
15-30 mg/24 hrs 25 mg OD PO Prevacid FDT
Anti emetic Metoclopramide 0.1 mkd q 8 hrs
Conversion: d7.5= 0.055 D10= 0.11 Calories:
D5 D7.5 D10 D12
0.2 kcal/cc 0.3 0.4 0.5
PULMONARY VOLUMES
BLOOD TRANSFUSION
ACTUAL RETIC COUNT (ARC)
1. Total Volume (TV) = 500 mL = volume inspired or expired with each normal breath 2. Insp. Reserve Volume (IRV) = 3.0 L = volume that can be inspired over and above the TV 3. Exp. Reserve Volume (ERV) = 1.1L 4. Residual Volume (RV) = 1.2 L = volume that remains in the lungs after maximal expiration 5. Dead Space = 150 mL a. Anatomical: volume of the conducting airways b. Physiological functional measurement; volume of the lungs that does not eliminate CO2 (usually greater in lung diseases with V/Q inequalities)
FWB
Actual Hct Desired Hct
20 cc/k (max)
Vol = desired – actual Hb x 6 x Wt = desired – actual Hct x Wt rate = vol x 12 gtts/mL 60 min x 4h
x reticulocyte ct
RETICULOCYTE INDEX = Arc / 2 = Hct / ret ct x 2
= gtts/min
10-15 cc/k 15 cc/K in neonates Vol = desired – actual Hb x 2 x Wt = desired – actual Hct x Wt Desired Hct = volume/wt + Actual Hct
> 2 = hemolysis < 2 = BM suppression
PRBC
DOUBLE VOLUME EXCHANGE TRANSFUSION = KBW x estim body vol x 2
Sedimented RBC
15 cc/k PARTIAL EXCHANGE TRANSFUSION
Platelet Conc: 1 U / 6 KBW 1U = 30-50 cc (raises platelet ct by 10T) FFP = Fluid rate (5-20 cc/k/h in 4h) 1O-15 CC/KG CRYOPPT: 1 UNIT/7 KG
= KBW x estim vol x Hct A-D Actual Hct 1 u = increases Hgb by 2; Hct by 3
Insulin Drip
DOPA- DOBU COCKTAIL
Secure regular insulin (100 iu/mL) Prepare as follows: 1. aspirate 0.1 mL from vial + 0.9mL NSS to make 10 iu/mL 2. aspirate 0.1mL from (1) + 0.9 NSS to make 1 iu/mL Start dose at 0.05 iu/ k/ H Ex. Weight 1.55 kg 1.55 x 0.05 = 0.08 mL/H Calculate for vol nedded in 8 hours 0.08mL x 8 = 0.6 mL Instructions: aspirate 0.6 ml from (2) + 7.4mL to make 8 mL and run at 1 mL/ hour
•
Get rate of dopa according to desired dose • Get volume of dobu according to desired dose using Vol= __wt x RD x 60__ Dopa rate
conc. of dobu
• Eg.: wt 3kg , Dopa 15, Dobu 15 Dopa 1 cc Dobu 0.8 cc D5Water 48.2 cc 50cc at 3.4 cc/hour
