NOTES
72
NOTES
72
FLUIDS (Ludan’s Method)
NOTES
Fluid Challenge: 20cc/kg/h of D5LRS; can be done 3x; max of 500cc Maint
Hydration
Wt (kg)
(kg)
Mil
Mod
Sev
0 – 3 – 3
75
<15
50 cc
100 cc
150 cc
3 – 10 – 10
100
>15
30 cc
60 cc
90 cc
11 – 11 – 20 20
75
21 – 21 – 30 30
60
31 – 31 – 40 40
50
>40
40
Mil
D50.3 NaCl in 6 hours
Mod
¼ D5LRS in 1 hour; ¾ D50.3 NaCl in 5 hours Sev 1/3 D5LRS in 1 hour; 2/3 D5 0.3 NaCl in 5 hours Insensible water loss = 400 ml/m2 + daily urine loss
<15 kg – kg – D5 D5 IMB >15 kg – kg – D5 D5 NM FLUID RESTRICTION
Total Fluids = BSA (400) + ½ urine output IVF = TF – TF – rate KVO = 5 cc/h Oral = TF – TF – IVF super KVO = 2cc/h M2 – Cardiac – Cardiac 1 – 5 – 5 kg
(wt) (0.05) + 0.05
6 – 11 – 11 kg
(wt) (0.04) + 0.1
12 – 12 – 20 20 kg
(wt) (0.03) + 0.2
>20 kg
(wt) (0.02) + 0.4
M2 – Renal – Renal / Hema
[(wt) (4) + 7] (wt) + 90
If no UO; ½ (1cc/k/h) + BSA (400)
2
71
FLUIDS (Ludan’s Method)
NOTES
Fluid Challenge: 20cc/kg/h of D5LRS; can be done 3x; max of 500cc Maint
Hydration
Wt (kg)
(kg)
Mil
Mod
Sev
0 – 3 – 3
75
<15
50 cc
100 cc
150 cc
3 – 10 – 10
100
>15
30 cc
60 cc
90 cc
11 – 11 – 20 20
75
21 – 21 – 30 30
60
31 – 31 – 40 40
50
>40
40
Mil
D50.3 NaCl in 6 hours
Mod
¼ D5LRS in 1 hour; ¾ D50.3 NaCl in 5 hours Sev 1/3 D5LRS in 1 hour; 2/3 D5 0.3 NaCl in 5 hours Insensible water loss = 400 ml/m2 + daily urine loss
<15 kg – kg – D5 D5 IMB >15 kg – kg – D5 D5 NM FLUID RESTRICTION
Total Fluids = BSA (400) + ½ urine output IVF = TF – TF – rate KVO = 5 cc/h Oral = TF – TF – IVF super KVO = 2cc/h M2 – Cardiac – Cardiac 1 – 5 – 5 kg
(wt) (0.05) + 0.05
6 – 11 – 11 kg
(wt) (0.04) + 0.1
12 – 12 – 20 20 kg
(wt) (0.03) + 0.2
>20 kg
(wt) (0.02) + 0.4
M2 – Renal – Renal / Hema
[(wt) (4) + 7] (wt) + 90
If no UO; ½ (1cc/k/h) + BSA (400)
2
71
NOTES
Solution
Na
K
Cl
Mg
Cal
Breastmilk
22
36
28
28
24/oz
Intralipid 10%
2.5
0.5
4
1100
Intralipid 20%
2.5
0.5
4
2000
Aminosyn
40
18.4
40
3
140
3.5%
Albumin
100
<120
1000
FLUIDS (Holliday-Segar Method) Weight [kg]
Caloric Expenditure in 24h
0-10
100 kcal/kg
11-20
1000 kcal + 50 kcal/kg for each kg>10
Above 20
1500 kcal + 20 kcal/kg for each kg>20
FLUIDS (BSA Method) Weight [kg]
Caloric Expenditure in 24h 1500 ml/m2
Water
70
Sodium
1000 kcal + 50 kcal/kg for each kg>10
potassium
1500 kcal + 20 kcal/kg for each kg>20
3
NOTES
Solution
Na
K
Cl
Mg
Cal
Breastmilk
22
36
28
28
24/oz
Intralipid 10%
2.5
0.5
4
1100
Intralipid 20%
2.5
0.5
4
2000
Aminosyn
40
18.4
40
3
140
3.5%
Albumin
100
<120
1000
FLUIDS (Holliday-Segar Method) Weight [kg]
Caloric Expenditure in 24h
0-10
100 kcal/kg
11-20
1000 kcal + 50 kcal/kg for each kg>10
Above 20
1500 kcal + 20 kcal/kg for each kg>20
FLUIDS (BSA Method) Weight [kg] Water
70
3
Caloric Expenditure in 24h 1500 ml/m2
Sodium
1000 kcal + 50 kcal/kg for each kg>10
potassium
1500 kcal + 20 kcal/kg for each kg>20
l 0 a 7 C 1
0 7 1
g M
0 7 1
0 7 1
0 7 1
3
3
3
5
8 2
a C 3
D k s i P R A h C i g P H
v c i / l a g C c r a a + S + + + + / r h t p C I u e L S
, l a U i c C I e o p s t t s t o i i t m r e d f A r e
e C t a k P r s e i A d C o R P M
e l C S + + - - b a + / t i C r I r I
o t t i d r m a d w A
-
e k - - - a w A
F D F 3 r + t e D f P a O p u
-
e k - - - a w A
x F t F r e + t f D a P p O u
3
O 8 C 2 H
l 9 C 0 1
6 1
4 5 1
1 5
K 4
a 0 N 3 1
n o i t S u R l 5 o L S D
4 5 1
S S N P
1 5
7 2
2 2
0 4
8 9
0 2
3 1
5
0 2
5 2
0 4
0 4 1
0 9
l C a N % 3 0 .
B M I
M N
R N
D
D
D
D
5
5
5
5
0 3
l o s e r O
8 2
0 2
0 2
0 2
0 2
5 4
0 9
0 9
0 3
0 9 e t y l a i d e P
5 4 e t y l a i d e P
e t i r d y H
B k s i P R A w C o P L k s A i R P l A a m C i n P i M
s e l b a i r a V
e t y l o c u l G
4
-
-
y r o t a r i n p e i o s r t c e l u a R i r a t f F e o R s n g i S
g n i s g m b i u n a b s i r e i t o o n n o B n p u s a r d y A n a C G e S e H
s n o i t a c i l p m o C
n a l P n o i t c A
69
l 0 a 7 C 1
0 7 1
g M
0 7 1
0 7 1
0 7 1
3
3
3
8 2
5
a C 3
D k s i P R A h C i g P H
v c i / l a g C c r a a + S r + + + + h / t p C u I e L S
, l a U i c C I e o p s t t s t t o i i m r e d f A e r
e C t a k P r s e i A d C o R P M
e l C S + + - - b a + / t i C r I r I
o t t d i r m a d w A
-
e k - - - a w A
F D F 3 r + t e D f P a O p u
-
e k - - - a w A
x F t F r e + t f D a P p O u
3
O 8 C 2 H
l 9 C 0 1
6 1
4 5 1
1 5
K 4
a 0 N 3 1
n o i t S u R l 5 o L S D
4
4 5 1
S S N P
1 5
7 2
2 2
0 4
8 9
0 2
3 1
5
0 2
5 2
0 4
0 4 1
0 9
l C a N % 3 0 .
B M I
M N
R N
D
D
D
D
5
5
5
5
0 3
l o s e r O
8 2
0 2
0 2
0 2
0 2
5 4
0 9
0 9
0 3
0 9 e t y l a i d e P
5 4 e t y l a i d e P
e t i r d y H
B k s i P R A w C o P L
-
k s A i R l P a A m C i n P i M
s e l b a i r a V
e t y l o c u l G
69
-
y r o t a r i p s e r e i u R l a f F o s n g i S
n o i t c a r t e R
g n s i g a m b i n u b s i r t e i o o n n o B n s p u a d y r A n e a C G S e H
s n o i t a c i l p m o C
n a l P n o i t c A
DAILY FLUID REQUIREMENT
Y T I L A T R O M D E T A L E R A I N O M U E N P F O N O I T A C I F I S S A L C K S I R
D k s i P R + A h C i g P H
e C t a k P r s ` e i + A d C o R P M
B k s i P R A w + C o P L k s A i R P l A a m C i n P i M
s e l b a i r a V
-
-
-
+
+
-
-
+
+
c
p u d n r i e F a b i v r l i F o p g o M t m e o r a l e o C C b C A
b
t c
e r e v e S
e t a r e d o M
-
-
d l i + M
-
+
s o m 1 1 <
cc/kg/day
n i n i n i m m m / / / 0 0 5 7 5 3 > > >
s o m 1 1 <
n i n i n i m m m / / / 0 0 5 6 5 3 > > >
s o m 1 1 >
n i n i n i m m m / / / 0 0 0 5 4 3 > > >
s o m 1 1 >
n i n i n i m m m / / / 0 0 0 5 4 3 > > >
D
T
PT
SGA
VLBW
0 – 6 d
120
1
80
70
60
40 –60
150
2
90
80
80
50
10d 12m 1 – 3y
3
100
90
100
60
4 – 6y
120
4
110
100
150
70
7 – 9y
180
5
120
110
180
80
10 – 12y
80
6
130
120
200
90
13 – 15y
70
7
140
130
220
100
>15y
50
8
150
140
240
110
BURN: GALVESTON FORMULA
1st 24 h d
n o i t a r d y h e D
d e e F n a C
e g A
140
s o r s s m y r y R 2 5 R 1 - 5 - 1 > 2
5 L/m2 burned BSA + 2 L/m2 total BSA
e
½ in 8h using LRS ½ in 16 3.750 L/m2 burned BSA + 1.500 L/m2 total BSA
2nd 24 h
à 24h maintenance fluid 68
5
DAILY FLUID REQUIREMENT
Y T I L A T R O M D E T A L E R A I N O M U E N P F O N O I T A C I F I S S A L C K S I R
D k s i P R A h + C i g P H
e C t a k P r s ` e i + A d C o R P M
B k s i P R A w + C o P L k s A i R l P a A m C i n P i M
-
-
-
+
+
-
-
+
+
c
s e l b a i r a V
p b c u d t n r i e a F b i i v F r l o p g o e t M m r o a l e o C C b C A
e r e v e S
e t a r e d o M
-
-
d l i + M
-
+
s o m 1 1 <
cc/kg/day
n i n i n i m m m / / / 0 0 5 7 5 3 > > >
s o m 1 1 <
n i n i n i m m m / / / 0 0 5 6 5 3 > > >
s o m 1 1 >
n i n i n i m m m / / / 0 0 0 5 4 3 > > >
s o m 1 1 >
n i n i n i m m m / / / 0 0 0 5 4 3 > > >
D
T
PT
SGA
VLBW
0 – 6 d
120
1
80
70
60
40 –60
10d 12m
150
2
90
80
80
50
1 – 3y
140
3
100
90
100
60
4 – 6y
120
4
110
100
150
70
7 – 9y
180
5
120
110
180
80
10 – 12y
80
6
130
120
200
90
13 – 15y
70
7
140
130
220
100
>15y
50
8
150
140
240
110
BURN: GALVESTON FORMULA
1st 24 h d
n o i t a r d y h e D
d e e F n a C
e g A
s o s r s m y r y R 2 R 1 5 - 5 - 1 > 2 e
2nd 24 h
5 L/m2 burned BSA + 2 L/m2 total BSA ½ in 8h using LRS ½ in 16 3.750 L/m2 burned BSA + 1.500 L/m2 total BSA à 24h maintenance fluid
68
5
BURN: PARKLAND FORMULA 1st 24 h
2nd 24 h
ALLERGIC RHINITIS
½ in 8h using LRS ½ in 16 50 – 70% of 1st day
TFR = __ x BW Target Feed = TFR/8 (or # of feeding/ day)
(0.167 x dext) IV rate present wt (kg)
D5 = 5 D7.5 = 0.0555 D10 = 0.111 D12.5 = 0.166
CAL
Dext x 4 x 24 x rate -----------------------100 wt in kg FT = 20 cal/oz PT = 24 cal/oz
MF
Vol cc x 8◦ x ___ cal -----------------------30 oz wt in kg
Corn Oil Karo MCT Total Cal = Cal IV + Cal MF Target Feed: TPN > 8 divided feeds (q3º)
8 cal/cc 6 cal/cc 7.7 cal/cc
6
Sneezers and Runners
Blockers
Sneezing
Especially paroxysmal
Little or none
Rhinorrhea
Watery, anterior and posterior
Thick mucous, more posterior
Itching
Yes
No
Nasal blockage
Variable
Often severe
Diurnal rhythm
Worse during day, improving at night
Constant, day and night, may be worse at night
Conjunctivitis
Often present
67
BURN: PARKLAND FORMULA 1st 24 h
2nd 24 h
ALLERGIC RHINITIS
½ in 8h using LRS ½ in 16 50 – 70% of 1st day
normal sleep normal daily activities normal work and school no trouble some symptoms
GIR (4-8 CC/K/H)
TFR = __ x BW Target Feed = TFR/8 (or # of feeding/ day)
(0.167 x dext) IV rate present wt (kg)
IV
100 wt in kg FT = 20 cal/oz PT = 24 cal/oz
D5 = 5 D7.5 = 0.0555 D10 = 0.111 D12.5 = 0.166
Corn Oil Karo MCT Total Cal = Cal IV + Cal MF Target Feed: TPN > 8 divided feeds (q3º)
CAL
PERSISTENT > 4 days per week OR >4 weeks MILD abnormal sleep impairment of daily activities, sport, leisure problems caused at work and school troublesome symptoms
History of nasal discharge, blockage, sneeze/itch 2 or more symptoms for >1 hour on most days
Rate = TFR/24h
Dext x 4 x 24 x rate ------------------------
6
INTERMITTENT < 4 days per week OR <4 weeks MILD
3 ml/kg/% burned BSA (<30%) 4 ml/kg/% burned BSA (>30%)
TFR
CAL
abnormal sleep impairment of daily activities, sport, leisure problems caused at work and school troublesome symptoms
History of nasal discharge, blockage, sneeze/itch 2 or more symptoms for >1 hour on most days
Rate = TFR/24h
IV
PERSISTENT > 4 days per week OR >4 weeks MILD
normal sleep normal daily activities normal work and school no trouble some symptoms
GIR (4-8 CC/K/H)
TFR
CAL
INTERMITTENT < 4 days per week OR <4 weeks MILD
3 ml/kg/% burned BSA (<30%) 4 ml/kg/% burned BSA (>30%)
MF
Vol cc x 8◦ x ___ cal -----------------------30 oz wt in kg 8 cal/cc 6 cal/cc 7.7 cal/cc
67
Sneezers and Runners
Blockers
Sneezing
Especially paroxysmal
Little or none
Rhinorrhea
Watery, anterior and posterior
Thick mucous, more posterior
Itching
Yes
No
Nasal blockage
Variable
Often severe
Diurnal rhythm
Worse during day, improving at night
Constant, day and night, may be worse at night
Conjunctivitis
Often present
r r r e o o v ( e C ) r f e F º t h º a 5 . 1 g i 8 0 e r H 3 1 g
, s n s i g a s h f e t o r e r e n n e r g v i e o i e t t o n a s a a m r p r d s d a y e o e s h h h o t e e e w h f I t t h d
C e s n a U l P
e , r 0 h o 0 c t m s n e n a 1 n r i - e f e o g o 5 r o i s m o i t 2 f s t a a f o m o e r t p s s o s r a w e a d t y e s m g h g h s t h h i s a l h o e t a f e e o r i f L g k w I h o h d
e B s n a U l P
h t n c h a a g i h t e r e o e w r f f o s o m f m r m o a a s g r g s 0 l o o 0 i L 1 k
t g n a h i e g r i u o e d r w s h r a o s i o d N l m e T e e r u k t a T a r . e 4 p
t s s d - - i - a e t n t o h t r e u e l c n t a a e a r e r t r t h a e r s c n i c , d e e u l , y t r e r i e o r o r t t i n a n , e t h m o e d o m t h i r o u r t t t e a r o n v r t o I f o s v c d n s p h h e f n o e e e i . e t f f a a d e f e c t e c r r r i e i r h e o h h p h y t h s r t a i n n e l t r a v g r o t i g s a i u i r e e l u e i f h d s n h o n c m n h s t I b i w
t s n n i g a r e i t s d y a o h p n e e d n h s a f i o T h o t
Na Maint = 3 mEqs x 4 kg = 12 mEqs D5IMB Na: 25:1000::?:391.2cc ? = 9.78mEqs 12 mEqs – 9.78mEqs = 2.22mEqs/2.5 NaCl = 0.88cc NaCl incorporation K Maint = 2 mEqs x 4 kg = 8 mEqs K Def = (4 – 3.2mEqs) 4kg x 0.6 = 1.92 mEqs Total K = 8 + 1.92 = 9.92 mEqs D5IMB K: 20:1000:: ?:391.2 ? = 7.82 mEqs 9.92 mEqs – 7.82mEqs = 2.1mEqs/2.0 KCl = 1 cc KCl incorprtn Anion Gap= (Na+K) - (Cl+HCO3) *NV: 12=/-2
f i , h e g l i i e b s W s . o 5 p
Ca Gluconate hypocal, tetany
e d i c e D . 6
Wt x 200 100
100/1x10 amp
7
r r r e ( v o o r e C ) e f F º t h º . 1 a g 5 e i 8 0 r H 3 1 g
t s s d - - i u n n t o r a t t e h e l t a e a e a r r c e r h a u l c n i r t c t e e i e d , s y t , r e n a n o r o e t h m o r i d r i m t o u , e t h r t r t o e t d t a r e n v r t o f o s v p h o e f I n n o f e f e c e s . d i f r e h e t t a e c i c n o h h p a e r r i r h e r e h h t a i n e l t s r t a v g r o t i g s y a i u i r e e l e i f h d s n h o n c m n h u I b i s t w , s n s i g a s h f e r r t o e e n r n g e e o i o n v e i t a s t a m a r p r d s d a y e o e h s h h t o e e e w h f I t t h d
e C s n a U l P
e r , 0 h s 0 c t o n e n a 1 n m - e f g m o i r e 5 r o t i i s o t o 2 f o s a f m o e r t a p s s o s a w r h e t e a d y s g g m h h i s a l h s t h o e t o r i a f e e f h o h d L g k w I
e B s n a U l P
h t n c h a a g i h t e r e o w e f r o s f o m f m m a r o g r a s g s 0 l o o 0 i L 1 k
t g n a h i e g r i u o e d r w s h r a o s i o N l d
66
Na++[135 – 145 meqs/ L] Na Corxn = Deficit + K+ [3.5 – 5.5 meqs/L] Maintenance K Corxn = Deficit + MainteDeficit = (D - A) x 0.6 x nance kg Deficit = (4 - A) x 0.6 x kg Maintenance = 3 Maintenance = 2 mEqs x kg mEqs x kg KCl Prep = 2 mEqs/L NaCl Prep = 2.5 mEqs/L Eg: 4kg; Na = 130; K = 3.2; using 391.2cc D5IMB (Na = 25; K = 20)
e A s n a U l P
66
m e T e e r k t u a T a r . e 4 p
ELECTROLYTES
t s n n i a e g r i t s d y a o h p n e e s d n h a f i o T h o t
ELECTROLYTES
Na++[135 – 145 meqs/ L] Na Corxn = Deficit + K+ [3.5 – 5.5 meqs/L] Maintenance K Corxn = Deficit + MainteDeficit = (D - A) x 0.6 x nance kg Deficit = (4 - A) x 0.6 x kg Maintenance = 3 Maintenance = 2 mEqs x kg mEqs x kg KCl Prep = 2 mEqs/L NaCl Prep = 2.5 mEqs/L Eg: 4kg; Na = 130; K = 3.2; using 391.2cc D5IMB (Na = 25; K = 20) Na Maint = 3 mEqs x 4 kg = 12 mEqs D5IMB Na: 25:1000::?:391.2cc ? = 9.78mEqs 12 mEqs – 9.78mEqs = 2.22mEqs/2.5 NaCl = 0.88cc NaCl incorporation K Maint = 2 mEqs x 4 kg = 8 mEqs K Def = (4 – 3.2mEqs) 4kg x 0.6 = 1.92 mEqs Total K = 8 + 1.92 = 9.92 mEqs D5IMB K: 20:1000:: ?:391.2 ? = 7.82 mEqs 9.92 mEqs – 7.82mEqs = 2.1mEqs/2.0 KCl = 1 cc KCl incorprtn
A e s n a U l P
Anion Gap= (Na+K) - (Cl+HCO3) *NV: 12=/-2
f i , h e g l i i e b s W s . o 5 p
Ca Gluconate hypocal, tetany
e d i c e D . 6
7
Wt x 200 100
100/1x10 amp
ACID – BASE BALANCE
ARTERIAL BLOOD GASES Normal Values: PH 7.35 – 7.45 (7.4) pCO2 35 – 49 (40) pO2 80 – 100 HCO3 22 – 26BE ±2 O2 Sat ≥ 97% Anion Gap = 12 ± 2
Metabolic Acidosis Correction HCO3 = (BE) (0.3) (weight) / 2 OR 1mEq/kg ½ slow IV push; ½ drip à 30 mins
n a a r u h t d n r s o e k i g e t n e o w L 3
y a d r e p s l o o t s d i u q i l
0.3 x wt x BE ÷ 2 + D5W without O2: Adequate = 80 – 100 More than adequate >100 Mild Hypoxemia 60 – 79
8
ACID – BASE BALANCE
ARTERIAL BLOOD GASES Normal Values: PH 7.35 – 7.45 (7.4) pCO2 35 – 49 (40) pO2 80 – 100 HCO3 22 – 26BE ±2 O2 Sat ≥ 97% Anion Gap = 12 ± 2
Metabolic Acidosis Correction HCO3 = (BE) (0.3) (weight) / 2 OR 1mEq/kg ½ slow IV push; ½ drip à 30 mins
d n a y y r r d n e d k y r n y r e u e V s V
d n a t s a f y r p e e e V d
y r e v k c a b l y s w e o o l g s
y p e e e l s l , b l a t l t n e i r r e w i s n r b U o A
n e k n u S
n a h t l r a e t m s r a o F n
k c a b y s l e w o l g o s
t r e l A , l l e W
t n e s e r P
l l a a m m t r r e o o N W N
s r a e T
g n & e i h u h t g t u n a o o e r M T B
n o i t i d n o C
s e y E
y r D
l , e e k f a t e o n w n e , n k t n s a c a u u f s y y r o r e y r e V o V
n a h t r l e a t s m a r o F n
k c a y l b l a s k m c r e i o u o g q N r
l o e g e r u F t . n 3 i
k S
e s l u P
n e k n u S
l a m r o N e l l e n a t n o F
65
a n r a u h t d n r s o e k t g e i n e o w L 3
y a d r e p s l o o t s d i u q i l
t A k o o L . 2
65
u n r e d n u e r n e o v i t e i r S t
d n a y y r r d n e d y k r y r e n u e V s V
d n a t s a f y p r e e e V d
y r e v k c a b l y s w e o o l g s
l , e e k f a t e o n w n e , n k t n s a c a u u f s o y r y y r e r e V o V
y p e e e l s l , b l a t l n i e t r r e w i s n r b U o A
n e k n u S
n a h t r l e a t s m r a o F n
k c a b y s l e w o l g o s
n a h t l r a e t s m r a o F n
t r e l A , l l e W
t n e s e r P
l l a a m m t r r e o o N W N
s r a e T
g n & e i h h u t t a u g o n r o e M T B
y p 0 1 n u p o l , f n y a p , h t e s u e i e l o t r c n o s e M y r s s e n o b V c A
0 1 o t 4
4 n a h t s s e L
0.3 x wt x BE ÷ 2 + D5W
8
0 1 o t 4
t A k o o L . 2
Chronic Respiratory Alkalosis
without O2: Adequate = 80 – 100 More than adequate >100 Mild Hypoxemia 60 – 79
y p 0 1 n u p o , l n y f a p , h t e s u e i e o t r l n o s c e y M r s s e n b o V c A
4 n a h t s s e L
Chronic Respiratory Alkalosis
u n r e d n u e r e n o v t e i i r S t
n o i t i d n o C
s e y E
y r D
k c a y l b l a s k c m r e i o u o g q N r
l o e g e r u F t . n 3 i
k S
e s l u P
n e k n u S
l a m r o N e l l e n a t n o F
ACID – BASE DISORDERS CORRECTION
A E O H R R A I D F O T N E M T A E R T E H T
s r e k r o w h t l a e h r o i n l e o s r t r n e o h C t o e d s n a a e s s n i D i a c y r i o s t y a h r i p p r s f o e l R a e u t u n c a A m d A n : a a l e a h e r r h a r r i D a i f D o f t o n n e o t m i s a i v e i r D T
n o t a n i a e a r h u h r t d r r i a e s d g k n e i c o e n l w o r 3 h C
n i s u c u M r l o o o d t o s o e l h B t
0 t 1 n e n u a q e h r t f e y r o r e M V y a d r e p s l o o t s d i u q i l
Met Acidosis: pCO2 = 1.5 (HCO3) + 8.4 ± 2 ≥10 mmHg Met Alkalosis: meq/L inc in HCO3 = 0.5 – 1 mmHg inc in PCO2 ≤55 Acute Resp Acidosis: HCO3 inc by 3 – 4 meq/L≤30 when pH is normal
6 r o f o t e n e i l s b k r u r a i u n n r o o U d N h
0 1 o t 4
k n r a a h d t , r l l t e a l a n e t u a m m o m e o r r o s m S G n A a
4 n a h t s s e L
l l a m s a r t l o n a l a e u m r m n o r o m o o N a N N
a k t e s u o o h A b . A r 1 r a i D
g n i t i m o V
t s r i h T
Acute Resp Alkalosis: HCO3 dec by 2 – 4 meq/L≥18 when pH is normal Chronic Resp Acidosis: mmHg inc in pCO2 = 0.4 meq/L inc in HCO3 ≤45 Chronic Resp Alkalosis: mmHg dec in pCO2 = 0.5 meq/L dec in HCO3 ≥12 – 15 Indications for Intubation
Absolute Indications Prolonged apnea pO2 < 50 on FiO2 > 80, may not apply to Infant with cyanotic CHD (38.5) pCO2 > 60 with persistent acidemia (75) General anaesthesia Relative Indications Frequent intermittent apnea unresponsive to drug therapy early treatment when use of a mechanical ventilator is anticipated because of deteriorating gas exchange relieving “work of breathing” in an infant with signs of respiration difficulty initiation of exogenous surfactant therapy in infants with RDS
REFLOW PHENOMENON à elimination of CPAP produces closure of alveoli, causing atelectasis ET Size (mm)= (16+ age in yrs. )/4
e n i r U
64
9
ACID – BASE DISORDERS CORRECTION
A E O H R R A I D F O T N E M T A E R T E H T
64
s r e k r o w h t l a e h r o i n l e o r s t r n e h o t C o e d s n a a e s s n i D i a c y r i o t s y a r h i p p r s f e o R l a e u t u n c a A m d A n : a a l e a h r e r h a r r i D a f i D o f t o n n e o t m i s a i v i e r D T
n o t a n i e a a h r r u h t r d r i a e s d g k n e i c o e n l w o r 3 h C
n i s u c u M r l o o o d t o s o e l B h t
0 t 1 n e n u a q e h r t f e y r o r e M V y a d r e p s l o o t s d i u q i l
Met Acidosis: pCO2 = 1.5 (HCO3) + 8.4 ± 2 ≥10 mmHg Met Alkalosis: meq/L inc in HCO3 = 0.5 – 1 mmHg inc in PCO2 ≤55 Acute Resp Acidosis: HCO3 inc by 3 – 4 meq/L≤30 when pH is normal
6 r o o f t e n e i l b k r r u s a i u n n r o o U d N h
0 1 o t 4
k n r a a h d t , r l l t e a l a n e t u a m m o m r o e r o s m S G n A a
4 n a h t s s e L
l l a m s a r t l o n a l a e u m n o m r r o m o o N a N N
t a k e s u o o h A b r . 1 A r a i D
g n i t i m o V
t s r i h T
Acute Resp Alkalosis: HCO3 dec by 2 – 4 meq/L≥18 when pH is normal Chronic Resp Acidosis: mmHg inc in pCO2 = 0.4 meq/L inc in HCO3 ≤45 Chronic Resp Alkalosis: mmHg dec in pCO2 = 0.5 meq/L dec in HCO3 ≥12 – 15 Indications for Intubation
Absolute Indications Prolonged apnea pO2 < 50 on FiO2 > 80, may not apply to Infant with cyanotic CHD (38.5) pCO2 > 60 with persistent acidemia (75) General anaesthesia Relative Indications Frequent intermittent apnea unresponsive to drug therapy early treatment when use of a mechanical ventilator is anticipated because of deteriorating gas exchange relieving “work of breathing” in an infant with signs of respiration difficulty initiation of exogenous surfactant therapy in infants with RDS
REFLOW PHENOMENON à elimination of CPAP produces closure of alveoli, causing atelectasis ET Size (mm)= (16+ age in yrs. )/4
e n i r U
9
Indications for Blood Transfusion Shock associated with blood loss Hgb <13, Hct <40 and pulmonary failure: CHD or CHF commulative loss of 10% or more of blood volume within 72 hours Hgb <8, Hct <25 in a stable neonate with clinical manifestations of anemia: tachcardia, tachpnea, poor feeding
) s e n i l e d i u G A N I G ( Y T I R E V E S D N A N O I T A C I F I S S A L C A M H T S A
Wt x blood volume x (desired Hct – actual Hct) Hct of blood to be transfused pRBC
10cc/kg = 2ml/kg pRBC will inc Hgb by 0.5 – 1 g/dl FWB 20cc/kg = inc Hgb by 10 Platelet concentrate 15 – 20cc/kg Fresh Frozen Plasma 15 cc/kg Cryoprecipitate 1 “u”/6kg Total blood volume = wt (Kg) x 80cc/Kg = ____ cc Transfusion Reaction – Fever/Chills due to transfused leucocytes; Tx: steroids Urticaria due to transfused protein; Tx: Benadryl ABO setup à no manifestation ABO disease à ABO setup with disease (+) coombs à hemolytic, congenital (-) coombs à acquired Band:Neutro Ratio= (Stabs+ Mono)/Neutro *NV= <0.02 IT= (Stabs+ Mono)/ Total WBC ANC= WBC x segs *NV=>1500
10
% % 0 0 3 8 > < d t y i d t l i n e b c a i i a r 0 d 6 e r a > p V
% 0 d 3 e – t c i d 0 2 e r t y p i l i b % a 0 i 8 r a > v
d % e 0 t c 2 i d < e y r t i p l i b % a 0 i 8 r a > V
S M
S M
n S I
e v a h n F a E c P t n e i t a p y n A ; y r h P h t o t k n M g n e o e Y o t e t m S a n w m S c e a E M a a r u s e M q s e I e O h e e T T r m g m i i i m T t F i t h t H 1 s 2 e k 2 > G h I > t c < N a t o t t n a i n e r o e i v t v i d t t a y e n l s c S c i s a i a a a n t k e s f d k i M c e e c i o b s i c e a e t k s O s g e w e w a F c l T s y a - f f a a u h E t P t c a a a t m a m o p i P t o M s u d y l a t s e e t e k Y p n e i t a 1 i n B m m m m e n t v l t i c i S y l < i y a t t n i i e a r i t t y r t r m o i c a s a t y 1 u 1 s o e w a C L a D U d A t i > b < a n t w e r t u t n a t e e t f T n s e i S t 1 L E E N t s n f s r A R R E i e o e t t C M s I U O r e P s n i T e c F N T e e s I A E A P n t t r t L E B E 4 e i a e 3 2 1 e s r C F R r P m e e P P r e P d r T P E v E E d E e l P T e T o T i T t d e t c % i d 0 e 3 > p r t y p i l i b % a 0 i 6 r a < v
S S
63
Indications for Blood Transfusion Shock associated with blood loss Hgb <13, Hct <40 and pulmonary failure: CHD or CHF commulative loss of 10% or more of blood volume within 72 hours Hgb <8, Hct <25 in a stable neonate with clinical manifestations of anemia: tachcardia, tachpnea, poor feeding
) s e n i l e d i u G A N I G ( Y T I R E V E S D N A N O I T A C I F I S S A L C A M H T S A
Wt x blood volume x (desired Hct – actual Hct) Hct of blood to be transfused pRBC
10cc/kg = 2ml/kg pRBC will inc Hgb by 0.5 – 1 g/dl FWB 20cc/kg = inc Hgb by 10 Platelet concentrate 15 – 20cc/kg Fresh Frozen Plasma 15 cc/kg Cryoprecipitate 1 “u”/6kg Total blood volume = wt (Kg) x 80cc/Kg = ____ cc Transfusion Reaction – Fever/Chills due to transfused leucocytes; Tx: steroids Urticaria due to transfused protein; Tx: Benadryl ABO setup à no manifestation ABO disease à ABO setup with disease (+) coombs à hemolytic, congenital (-) coombs à acquired Band:Neutro Ratio= (Stabs+ Mono)/Neutro *NV= <0.02 IT= (Stabs+ Mono)/ Total WBC ANC= WBC x segs *NV=>1500
10
63
d e t c % i d 0 e 3 p > r y p t i l i b % a 0 i 6 r < a v
% % 0 0 3 8 > < d t y i l d t i n e b c a a i i 0 d e r a 6 r > p V
% 0 d 3 e – t c i d 0 2 e r t y p l i i b % a 0 i 8 r > a v
d % e 0 t c 2 i d < e y r t p i l i b % a 0 i 8 r a > V
S S
S M
S M
n S I
e v a h n F a E c P t n e i t a p y n A ; y r h P h t o t k n M g n e o e Y o t e t m S a n w m S c e a E M a a r u s e M q s e I O e h e e T T r m g i m i i m T t F i t h t H 1 2 e s 2 > G h k I > c t < N a o t t t n a i e n r o e i v t v d t i a e y l s t c S c s i a k n i a a a k f n d e i M c e a e i c s s i o t O e t b s s g c e e y a F k T c l s h a w w a e f f a u E P m t m a o P t c a a a i o p t M t s t a u l s e e e y Y n d 1 m p a n t e t i n i y B y k m t t c t S i i < i a v m e l m t i l n m i e i a r t y r r o i t t t c a s a t y 1 u 1 s o e w a C L a D U d A i > b < a n t w e r t u t n a t e e t f T n s e i t 1 t L S N s E n E f s r A R R E i e o e t t C U O M s I r e P s n i T c e N T F A e e s I n t P t r E A t L B E 4 e i a e 3 2 1 e s r C E r P P m F R e e P P P r r T E e E d d E l E t v e P T e T o T i T
t t n s e n e i r r A m m I
) ) s s y l r o i b g e ( ( r 5 0 e 7 7 v 1 1 e + + S 5 5 x x 0 0 0 0 1 1 – – ) ) e m m c t c ( a ( t t r e H H d o : M R
s i s o n a y c e l b i s s o P
s t d t l t s e s u l e d a t b c i l a e d a n s e i n ) r n s p o m o p r s / r s u % e L o e r h 0 p 0 6 t 0 r 2 1 < a ( o <
g H m m 0 6 <
y l e t a m % i x 0 o 8 r p – p 0 A 6
g H m m 0 6 >
d l i M
% 0 8 r e v O
t s t e o y t r , n a l y s a l l s e m r a c o u s e N u n
r e t e m a r a P
) r l i - d a a e n r o r t n o i c o n e r t t f ( a d r s o l a B l i e e t 2 r a d F i O t o p r p s E i e a n h P i c % o % b P
F E P
r o / d n A
d n a s t l u d a n i n a h t n e r i d s l i s y h o r c p o ; t g g a n r i u H p o m s e y r m e % r i u 5 e i 0 n l 4 l a 9 l y > b f < i s d t a n e r e c e r s e o l o g m d H s a % p m o 5 l m 9 e 5 4 1 v e < 9 d ) n o i t a l i g t H n e m v m % o 5 5 p 4 9 y < > h ( a i n p n a c o r ( e p 2 % y 2 O H C O ) r a a i P S a
62
Inc PTT, N PT, N plt, N BT à cryoprecipitate Inc PTT, inc PT, N plt, N BT à plasma Inc PTT, N PT, platelet <100,000, BT >9 à platelet conc Inc PTT, inc PT, platelet <100,000, BT >9 à replace blood Phlebotomy: Goal Hct = 65 total blood volume = Wt x 80 x 0.15 or 0.10 PNSS = 10% of total blood volume FFP = 15% of total blood volume; run 50% in 30 mins prior to phleb; 50% at IV maint during phleb Desired – actual x 80 (wt) Hct of blood component pRBC = 70 = IV Mild (D5 0.3% NaCl) Poisoning: NathioSO6 – 15g/100ml H2O Activated Charcoal: 100g/ 200ml H2O Mg Citrate: 150-300ml + H2O Soap Suds Enema: ½ bar Perla + 16 H2O
11
t t n s e n e i r r A m m I
) ) s s y l r o i b e g r ( ( 5 0 e 7 7 v 1 1 e + + S 5 5 x x 0 0 0 0 1 1 – – ) ) e m m c t a c ( ( t t r e H H d o : M R
s i s o n a y c e l b i s s o P
s t d t l t s e s u a e d t b c l a l i d a n e s e i n ) r n o r s p o m s r / p s u % e L o e 0 0 p 0 r h 6 t 1 r 2 < a ( o <
g H m m 0 6 <
y l e t a m % i x 0 o r 8 p – p 0 A 6
g H m m 0 6 >
d l i M
% 0 8 r e v O
t s t e o y t r , n a l y s a l l s e m r a c o u s e N u n
r e t e m a r a P
) r l i - d e a a r r n t n o i c n e o r t o ( t o f B a d s r a l l i e 2 r e d t a F t i o p p s O E i a r e h n c % o % P i b P
F E P
62
In Dengue Hemoconcentration={(Hgbx3)-Hct]/Hgbx3
r o / d n A
d n a s t l u d a n i n a h t n e r i d s l i s y h o r c p o ; t g a g r n u H i p o m s e y e m r r % n i u 5 e l 0 4 l i y l a 9 > b f < i s d t a n e r e c e r s e o l o g m d H s a % p m o 5 l m 9 e 5 4 1 v e < 9 d ) n o i t a l i g t H n e m v m % o 5 5 p 4 9 y < > h ( a i n p n a c r o ( e p 2 % y 2 O H C O ) r a a i P S a
In Dengue Hemoconcentration={(Hgbx3)-Hct]/Hgbx3 Inc PTT, N PT, N plt, N BT à cryoprecipitate Inc PTT, inc PT, N plt, N BT à plasma Inc PTT, N PT, platelet <100,000, BT >9 à platelet conc Inc PTT, inc PT, platelet <100,000, BT >9 à replace blood Phlebotomy: Goal Hct = 65 total blood volume = Wt x 80 x 0.15 or 0.10 PNSS = 10% of total blood volume FFP = 15% of total blood volume; run 50% in 30 mins prior to phleb; 50% at IV maint during phleb Desired – actual x 80 (wt) Hct of blood component pRBC = 70 = IV Mild (D5 0.3% NaCl) Poisoning: NathioSO6 – 15g/100ml H2O Activated Charcoal: 100g/ 200ml H2O Mg Citrate: 150-300ml + H2O Soap Suds Enema: ½ bar Perla + 16 H2O
11
Age hours
TSB Level, mg/dL (pmol/L) Photo?
Photo!
Xtrans if Photo Fails‡
Xtrans and Photo Fails‡
<=24
...
...
...
...
25-48
>12 (210)
>15 (260)
>20 (340)
>25 (430)
49-72
>15 (260)
>18 (310)
>25 (430)
>30 (510)
>72
>17 (290)
>20 (340)
>25 (430)
>30 (510)
t t n s e n e i r r m A m I
e r e v e S
Hyperbilirubinemia: Healthy Term Newborn † Phototherapy at these TSB levels is a clinical option, meaning that the intervention is available and may be used on the basis of individual clinical judgment. ‡ Intensive phototherapy (Appendix) should produce a decline of TSB of 1 to 2 mg/dL within 4 to 6 hours and the TSB level should continue to fall and remain below the threshold level for exchange
e t a r e d o M
S
WT FOR HT
>90
>95
>90
0
N
1
MILD
75-90
90-95
81-90
2
MOD
60-74
85-89
70-80
3
SEV
<60
<85
<70
12
0 2 1 >
0 2 1 0 0 1
d u o L
d l i M
t o n y l l a u s U
; y a r e l i t n p a r o x e e 0 d n 0 e d y o f t n r o 1 M o e t <
r e t e m a r a P
d l n a s y r n r a n e o e o s t s e s i t z s l c e c e s a e a c u r r h p c u t A m s e r W
n i m / e s l u P
l a l t f c a n o i n e e x c e o o i n z m m d c e a o e a r d v e r s e o b o b h a h P t a m A w
a i d r a c y d a r b
e t n a i r m l / a 0 6 m r 1 o < N
n i m / 0 2 1 <
n i m / 0 1 1 <
s h s t s r n r a o a e e m y y 5 8 2 - 1 - 1 6 2
l e o g o a s h t n c l a s o f o n e h I r c P S
l i h c n i e s l u p l a m r o n o f t o e s i n d t i u i m e r G l d
61
Age hours
TSB Level, mg/dL (pmol/L) Photo?
Photo!
Xtrans if Photo Fails‡
Xtrans and Photo Fails‡
<=24
...
...
...
...
25-48
>12 (210)
>15 (260)
>20 (340)
>25 (430)
49-72
>15 (260)
>18 (310)
>25 (430)
>30 (510)
>72
>17 (290)
>20 (340)
>25 (430)
>30 (510)
t t n s e n e i r r m A m I
e r e v e S
Hyperbilirubinemia: Healthy Term Newborn † Phototherapy at these TSB levels is a clinical option, meaning that the intervention is available and may be used on the basis of individual clinical judgment. ‡ Intensive phototherapy (Appendix) should produce a decline of TSB of 1 to 2 mg/dL within 4 to 6 hours and the TSB level should continue to fall and remain below the threshold level for exchange
e t a r e d o M
W
S
WT FOR HT
>90
>95
>90
0
N
1
MILD
75-90
90-95
81-90
2
MOD
60-74
85-89
70-80
3
SEV
<60
<85
<70
y l l a u s U
d u o L y l l a u s U
0 2 1 >
0 2 1 0 0 1
y l l a u s U
d u o L
d l i M
t o n y l l a u s U
; y a r e l i t n p a r o x e e 0 d n e d y 0 o t f n r o 1 M o e t <
r e t e m a r a P
d l a n s y n a r r n e i o s t o e s l e t z s c s e a e s r c e a c r h c u p u t e W A m s r
NUTRITION
12
y l l a u s U
d u o L y l l a u s U
a i d r a c y d a r b
y l l a u s U
NUTRITION
W
l a l t f c a n o i n e e x c e o o i z m m d c e n e a o a v e e r r s d o b o b h a h P t a m A w
61
n i m / e s l u P
e t n a r i m l / a 0 6 m r 1 o < N
n i m / 0 2 1 <
s h s s t r n a r o e a e m y y 8 2 5 1 - 1 6 2
l e o s o g a t h n c l o a s f o n h e I r c P S
l i h c n i e s l u p l a m r o n f o o t e t s d n i i e u i m r G l d
n i m / 0 1 1 <
t t n s e n e i r r A m m I ) s e n i l e d i u G A N I G ( S K C A T T A A M H T S A F O Y T I R E V E S
e r e v e S
e t a r e d o M
d l i M
r e t e m a r a P
DAILY CALORIC REQUIREMENT
d e s u f n o c / y s w o r D d e e – f t t s n s e r a p o g t f n t n A I s i s – r t r e e y f n t t e a r l r f o u n h c P I i ; s f g g , f n g n r i i i e d n k t d ; i l t y a f o r e i e t T s c f s
g n i k l a W
s s e l h t a e r B
s d r o W
y d l e l a t a u t i s g U a
s e s a r h P
d e t a t i g a y l l a u s U
s e c n e t n e S
i g a e b d y e a t a M t
n i s k l a T
s s e n t r e l A
n i n i n i n i m m m m / / / / 0 0 0 0 6 5 4 3 < < < < / 0 3 > n e n t f i O m
d e s a e r c n I
d e s a e r c n I
R R
s s h s r s h r t t a a n n o o e y e y m m 5 2 - 8 2 1 1 - 6 < 2
- n i o s s s s a e r g t s n i i h d t a y r e r o b t a r f i o p n s s e e e r r t l a h d r t i i h o w c t e e d k d t e a i u i a w G c a
60
e r e v e S
e t a r e d o M
d l i M
r e t e m a r a P
60
Cal/kg
CHON g/kg
0 – 6 mo
110 – 115
2.5
7 – 12
110 – 115
2.5 – 3.0
1 – 3 yr
110
2.0 – 2.5
4 – 6
90 – 100
2.25
7 – 9
80 – 90
1.5 – 2.0
10 – 12
70 – 80
1.5 – 2.0
13 – 15
55 – 65
1.5
16 – 19
45 – 55
1.0 – 1.5
TCR = Wt x Cal Rqt CHON = 4 x (g/kg); max 10% Fats = rest as fats Catch up: + 50% TCR 13
DAILY CALORIC REQUIREMENT
d e s u f n o c / y s w o r D
t t n s e n e i r r A m m I ) s e n i l e d i u G A N I G ( S K C A T T A A M H T S A F O Y T I R E V E S
AGE
d e e – f t t s n s e a p r o g t f n t n A I s i
s d r o W
y d l e l a t a t u s i g U a
s – r t r e e y f n t e t r a r f o l P n h u I c ; i f g s f , i g n g n r i i d e ; d i n k l t f t y t a r e e i T o s c f s
s e s a r h P
d e t a t i g a y l l a u s U
g n i k l a W
s e c n e t n e S
i g a e b d y e a t a M t
s s e l h t a e r B
n i s k l a T
s s e n t r e l A
n i n i n i n i m m m m / / / / 0 0 0 0 6 5 4 3 < < < < / 0 3 > n e i n t f O m
d e s a e r c n I
d e s a e r c n I
R R
s s h s h r s r t t a a n n e o o e y y m m 5 8 2 - 2 1 1 - 6 < 2
- n o i s s s s a e r g t s n i i d h t y a r e r o b t a r f i o p n s s e e e r r d t l a i r h t h o i w c t e e d k d e a i t u i a w G c a
AGE
Cal/kg
CHON g/kg
0 – 6 mo
110 – 115
2.5
7 – 12
110 – 115
2.5 – 3.0
1 – 3 yr
110
2.0 – 2.5
4 – 6
90 – 100
2.25
7 – 9
80 – 90
1.5 – 2.0
10 – 12
70 – 80
1.5 – 2.0
13 – 15
55 – 65
1.5
16 – 19
45 – 55
1.0 – 1.5
TCR = Wt x Cal Rqt CHON = 4 x (g/kg); max 10% Fats = rest as fats Catch up: + 50% TCR 13
RESPIRATORY DISTRESS
CIRCUMSTANCES THAT INCREASE CALORIC REQUIREMENTS fever 12% for @ degree above 37
Signs / 0 1 Symptoms SILVERMAN-ANDERSON RETRACTION SCORING
cardiac failure
15-25%
major surgery
20-30%
burns
upto 100%
severe sepsis
40-50%
Lower chest
long term growth failure
50-100%
Upper chest
CALORIC REQUIREMENTS ON TOTAL PARENTERAL NUTRITION age (yr) kcal/kg/d 0-1
90-120
1-7 yr
75-90
7-12 yr
60-75
12-18 yr
30-60
2.5-3
infants 0-1 yr
2.5
children 2-13
1.5-2
adolescent
1-1.5
Lag on inspiration Just visible
See saw
Xiphoid retraction Nares dilatation
None
Just visible
Marked
None
Minimal
Marked
Expiratory grunt
None
Marked
ASTHMA WOOD’S SCORE
PaO2
70 – 100 in room air
<70
< 70 in FiO2 40
Cyanosis
None
Slight
Present
Breath Sounds
Normal
Uneven
Accessory Muscles
None
Moderate
Decreased to normal Maximal
Wheezing
None
Moderate
Extreme to normal comatose
Cerebral FuncNormal Depressed tion or agitated Score > 5 impending respiratory arrest; 6 needs ICU confinement; paCO2 of 65 respiratory distress or flare
14
59
RESPIRATORY DISTRESS
CIRCUMSTANCES THAT INCREASE CALORIC REQUIREMENTS fever 12% for @ degree above 37 cardiac failure
15-25%
major surgery
20-30%
burns
upto 100%
severe sepsis long term growth failure
Signs / 0 1 Symptoms SILVERMAN-ANDERSON RETRACTION SCORING
0-1
90-120
1-7 yr
75-90
7-12 yr
60-75
12-18 yr
30-60
Synchronized
Lag on inspiration
See saw
40-50%
Lower chest
Just visible
Marked
50-100%
Xiphoid retraction Nares dilatation
No retraction None
Just visible
Marked
None
Minimal
Marked
Expiratory grunt
Stethoscope Naked ear only RESPIRATORY DIFFICULTY: Grade 0: none; Grade I: moderate; Grade 2: maximum
2.5-3
infants 0-1 yr
2.5
children 2-13
1.5-2
adolescent
1-1.5
None
ASTHMA WOOD’S SCORE
PaO2
AMINO ACID REQUIREMENTS OF PARENTERALLY FED INFANTS AND CHILDREN g/kg/d premature neonates
2
Upper chest
CALORIC REQUIREMENTS ON TOTAL PARENTERAL NUTRITION age (yr) kcal/kg/d
14
Synchronized No retraction
Stethoscope Naked ear only RESPIRATORY DIFFICULTY: Grade 0: none; Grade I: moderate; Grade 2: maximum
AMINO ACID REQUIREMENTS OF PARENTERALLY FED INFANTS AND CHILDREN g/kg/d premature neonates
2
Cyanosis
70 – 100 in room air None
<70
< 70 in FiO2 40 Present
Slight
Breath Sounds
Normal
Uneven
Decreased to normal
Accessory Muscles Wheezing
None
Moderate
Maximal
None
Moderate
Cerebral Function
Normal
Depressed or agitated
Extreme to normal comatose
Score > 5 impending respiratory arrest; 6 needs ICU confinement; paCO2 of 65 respiratory distress or flare 59
INFLUENZA Inactivated virus; viral components IM -----------------------------------------------MEASLES Live virus 9 months SC -----------------------------------------------MMR Live virus 12 months – 2 y/o booster at 4-12 y/o SC -----------------------------------------------PNEUMOCOCCAL Polysaccharide IM or SC -----------------------------------------------TYPHOID Parenteral (inactivated virus) SC Oral (live bacteria) >5 y/o booster every 3-5 years -----------------------------------------------VARICELLA Live virus 12-18 months >13 y/o, 2 shots are given SC ------------------------------------------------
58
INFLUENZA Inactivated virus; viral components IM -----------------------------------------------MEASLES Live virus 9 months SC -----------------------------------------------MMR Live virus 12 months – 2 y/o booster at 4-12 y/o SC -----------------------------------------------PNEUMOCOCCAL Polysaccharide IM or SC -----------------------------------------------TYPHOID Parenteral (inactivated virus) SC Oral (live bacteria) >5 y/o booster every 3-5 years -----------------------------------------------VARICELLA Live virus 12-18 months >13 y/o, 2 shots are given SC ------------------------------------------------
58
Lactate à liver à HCO3 Acetate à muscle à HCO3 Lactate is converted to HCO3 Cell produces acid lactate during metab LRS à Na lactate à doesn‟t cause acidosis USE OF IV FAT (10% SOLUTION) g/kg/d PT/ SGA initial dose 0.5 1g/kg/d increase daily dose by
0.25
max dose
3
FT/ AGA
older child
1g/kg/d
5ml/kg/d
10ml/kg/d
0.5g/kg/d
0.5g/kg/d
2.5ml/k/d
5ml/kg/d
4g/kg/d
2g/kg/d
3g/kg/d
4g/kg/d
10ml/kg/d
5ml/kg/d 2g/kg/d
CALORIC REQUIREMENTS ON TOTAL ENTERAL NUTRITION age (yr)
kcal/kg/d
0-0.5 yr
117
0.5-1
105
1-3 yr
100
4-6 yr
85-90
7-10yr
80-85
11-14 yr
M 60-64
F 48-55
15-18
M 43-49
F 38-40
15
Lactate à liver à HCO3 Acetate à muscle à HCO3 Lactate is converted to HCO3 Cell produces acid lactate during metab LRS à Na lactate à doesn‟t cause acidosis USE OF IV FAT (10% SOLUTION) g/kg/d PT/ SGA initial dose 0.5 1g/kg/d increase daily dose by
0.25
max dose
3
FT/ AGA
older child
1g/kg/d
5ml/kg/d
10ml/kg/d
0.5g/kg/d
0.5g/kg/d
2.5ml/k/d
5ml/kg/d
4g/kg/d
2g/kg/d
3g/kg/d
4g/kg/d
10ml/kg/d
5ml/kg/d 2g/kg/d
CALORIC REQUIREMENTS ON TOTAL ENTERAL NUTRITION
15
age (yr)
kcal/kg/d
0-0.5 yr
117
0.5-1
105
1-3 yr
100
4-6 yr
85-90
7-10yr
80-85
11-14 yr
M 60-64
F 48-55
15-18
M 43-49
F 38-40
Age (mos)
wt gain/ mon 2 lb
growth (cm/ mo) 3.5
hc cm / mo
RDA kcl/k/d
0-3
wt gain (g) 30
2
115
3-6
20
1 1/4 lb
2
1
1100
6-9
15
1 lb
1.5
0.5
100
9-12
12
13 oz
1.2
0.5
100
1-3 y
8
8 oz
1
0.25
100
4-6 yr
6
6 oz
3cm/yr
1cm/yr
90-100
LIVER SPAN
Male
1 week old
4.5 - 5.0 cm
12 years old
7.0 – 8.0 cm
>12 years old
0.032 x wt (lbs) + 0.18 x ht (in) ___ 7.86
Female
6.0 – 6.5 cm 0.027 x wt (lbs) + 0.22 x ht (in)
16
Age (mos)
57
wt gain/ mon 2 lb
growth (cm/ mo) 3.5
hc cm / mo
RDA kcl/k/d
0-3
wt gain (g) 30
2
115
3-6
20
1 1/4 lb
2
1
1100
6-9
15
1 lb
1.5
0.5
100
9-12
12
13 oz
1.2
0.5
100
1-3 y
8
8 oz
1
0.25
100
4-6 yr
6
6 oz
3cm/yr
1cm/yr
90-100
LIVER SPAN
Male
1 week old
4.5 - 5.0 cm
12 years old
7.0 – 8.0 cm
>12 years old
0.032 x wt (lbs) + 0.18 x ht (in) ___ 7.86
16
BCG Live bacteria Birth 0.05 cc right deltoid 0.05 cc left deltoid school-age ID -----------------------------------------------DPT Toxoid and inactivated bacteria DT-acellular-P (toxoid and bacterial products or fractions) 6,10,14 boosters at 12months – 2 years booster at 4-6 years Td booster >12 y/o 0.5 cc IM -----------------------------------------------Hepa A >2 y/o 2nd shot 6-12 months after 1st shot IM -------------------------------HepB Yeast or plasma derived recombinant 0,1,6 IM -----------------------------------------------IPV/OPV Inactivated/live virus 6,10,14 booster at 4-6 y/o SC/oral -----------------------------------------------HIB 6,10,14 booster 12months – 2 y/o IM
BCG Live bacteria Birth 0.05 cc right deltoid 0.05 cc left deltoid school-age ID -----------------------------------------------DPT Toxoid and inactivated bacteria DT-acellular-P (toxoid and bacterial products or fractions) 6,10,14 boosters at 12months – 2 years booster at 4-6 years Td booster >12 y/o 0.5 cc IM -----------------------------------------------Hepa A >2 y/o 2nd shot 6-12 months after 1st shot IM -------------------------------HepB Yeast or plasma derived recombinant 0,1,6 IM -----------------------------------------------IPV/OPV Inactivated/live virus 6,10,14 booster at 4-6 y/o SC/oral -----------------------------------------------HIB 6,10,14 booster 12months – 2 y/o IM
Female
6.0 – 6.5 cm 0.027 x wt (lbs) + 0.22 x ht (in)
57
HEPATITIS PROFILE
BLOOD TRANSFUSION >may transfuse x cc pRBC properly typed and cross matched to run for 4 hours >hold IVF while on BT >monitor VS q 15 for 1st hour, q30 for 2nd hour and q1 until stable >BT precutions please >please give Furosemide 20 mg IV post BT >Total blood volume = wt(Kg) x 80cc/Kg = ____ cc > if PPF, give 20 % of total blood >if PNSS 10% > = 7Kg=70cc run 70 cc NSS ex. 7Kg Wt. = 560ccx20% / 112 cc 1.2 hours ;same FFP volume
anti HAV IgM
HbsAg
anti HBC IgM
+
-
-
acute Hep A
-
-
+
Acute Hep B
-
-
-
r/o other hep
+
+
-
acute Hep A/B
+
+
+
acute hep A/B
REFERRAL >Px seen and examined >Will inform service consultant >PJIIC to do referral notes >Will follow-up px >Thank you for the referral.
SCREENING
anti HBS
HbsAg
anti HBC
-
+
+
prob hep B carrier
-
+
-
prob false (+) test rpt after 6 months
+
-
+
prev exposure to HepB with recovery
-
-
+
prev exposure to HepB with possible recovery
+
-
-
immunity after vaccination
ANAPHYLAXIS SC or IM epi 1:1,000 (aqueous): 0.01ml/kg per dose repeated q10-20 min. usual dose: if infant: 0.05 to 0.1 ml if children: 0.1 to 0.3 ml IV epi 1:1,000 (aqueous): 0.1 cc/kg diluted to 1:10,000 with NSS dose may be repeated q 10-20 minutes. a continuous infusion should be started if repeated doses are required (one milligram (1ml) of 1:1,000 dilution of epinephrine added to 250ml D5W, resutling in a concentration of 4 ug/ml, infused initially at a rate of 0.1 ug/kg/min, and increased gradually to 1.5 ug/kg/min to maintain blood pressure) nebulize with albuterol or IV aminophylline as indicated for bronchospasm
56
17
HEPATITIS PROFILE
BLOOD TRANSFUSION >may transfuse x cc pRBC properly typed and cross matched to run for 4 hours >hold IVF while on BT >monitor VS q 15 for 1st hour, q30 for 2nd hour and q1 until stable >BT precutions please >please give Furosemide 20 mg IV post BT >Total blood volume = wt(Kg) x 80cc/Kg = ____ cc > if PPF, give 20 % of total blood >if PNSS 10% > = 7Kg=70cc run 70 cc NSS ex. 7Kg Wt. = 560ccx20% / 112 cc 1.2 hours ;same FFP volume
anti HAV IgM
HbsAg
anti HBC IgM
+
-
-
acute Hep A
-
-
+
Acute Hep B
-
-
-
r/o other hep
+
+
-
acute Hep A/B
+
+
+
acute hep A/B
REFERRAL >Px seen and examined >Will inform service consultant >PJIIC to do referral notes >Will follow-up px >Thank you for the referral.
SCREENING anti HBS
HbsAg
anti HBC
-
+
+
prob hep B carrier
-
+
-
prob false (+) test rpt after 6 months
+
-
+
prev exposure to HepB with recovery
-
-
+
prev exposure to HepB with possible recovery
+
-
-
immunity after vaccination
ANAPHYLAXIS SC or IM epi 1:1,000 (aqueous): 0.01ml/kg per dose repeated q10-20 min. usual dose: if infant: 0.05 to 0.1 ml if children: 0.1 to 0.3 ml IV epi 1:1,000 (aqueous): 0.1 cc/kg diluted to 1:10,000 with NSS dose may be repeated q 10-20 minutes. a continuous infusion should be started if repeated doses are required (one milligram (1ml) of 1:1,000 dilution of epinephrine added to 250ml D5W, resutling in a concentration of 4 ug/ml, infused initially at a rate of 0.1 ug/kg/min, and increased gradually to 1.5 ug/kg/min to maintain blood pressure) nebulize with albuterol or IV aminophylline as indicated for bronchospasm
56
17
MOM’S S/SX PPD (+) Current Dse w tx
DX OF MOM TB Infxn TB Dse
Current Dse w/o tx
TB Dse
Hematogenous Spread
TB Dse w/ spread
MGT OF BABY BCG PPD at 4 wks of age PPD, CXR at once PPD, CXR, AFB of gastric aspirate
PTB Relapse
INITIAL TX
RIU D/C > May go home with mother > PJIIC to do fundoscopy and provide DS prior to discharge > Home instructions given (burp, bath, cord care, feeding) > Ff up at Pedia OPD on next Tuesday for BCG & Hep B > Milk feeding Q3 hours or per demand, preferably breast feeding > Daily bath : T 36.5-37.2 > Daily cord care with 70 % isopropyl alcohol 3x/day > Burping every end- feeding for 20 minutes S/P BMA >Please send specimen for the ff: BMA slides = for staining BMA C/S = >Maintain patient on prone position x 4 hours >May have milk feedings/ DAT once fully awake >Monitor VS q15 min for the 1st hour q30 min for the 2nd hour q1 hour thereafter until stable >watch out for bleeding on BMA site and refer to PROD stat for LP >Secure consent for LP >Prepare the ff materials: LP set Gloves size 7 ½ #2 Needle, gauge 23 OS, 4x4 Sterile cotton balls Betadine solution >NPO now S/P Lumbar tap >Hgt now >Please send specimen as ff: bottle #1 : WBC, diff count bottle #2 : CSF C/S bottle #3 : protein, sugar >Flat on bed for 4 hours > NPO temporarily >Montior VS q15 min x 1 hour q30 min x next hour q1 hour thereafter until stable
None INH
INH or RIF
HRZS
2HREZS or 1HREZ, 5 HRE
LIVER FXN TESTS 0 – 5 days 1 – 19 years 10 – 19 years
SGPT / ALT 6 – 50 5 – 45
SGOT / AST 35 – 140 15 – 55 5 - 45
TOTAL BILIRUBIN ( ACTUAL/17.1) Preterm Full term Cord Blood 0 – 1 day 1 – 2 days 2 – 5 days > 5 days
<2.0 <8.0 <12.0 <16.0 <20.0
<2.0 <6.0 <8.0 <12.0 <10.0
ALBUMIN
Premature Full term, <6days < 5 years 5 – 19 years
1.8 – 3.0 2.5 – 3.4 3.9 – 5.0 4.0 – 5.3
18
55
MOM’S S/SX PPD (+) Current Dse w tx
DX OF MOM TB Infxn TB Dse
Current Dse w/o tx
TB Dse
Hematogenous Spread
TB Dse w/ spread
MGT OF BABY BCG PPD at 4 wks of age PPD, CXR at once PPD, CXR, AFB of gastric aspirate
PTB Relapse
INITIAL TX
RIU D/C > May go home with mother > PJIIC to do fundoscopy and provide DS prior to discharge > Home instructions given (burp, bath, cord care, feeding) > Ff up at Pedia OPD on next Tuesday for BCG & Hep B > Milk feeding Q3 hours or per demand, preferably breast feeding > Daily bath : T 36.5-37.2 > Daily cord care with 70 % isopropyl alcohol 3x/day > Burping every end- feeding for 20 minutes S/P BMA >Please send specimen for the ff: BMA slides = for staining BMA C/S = >Maintain patient on prone position x 4 hours >May have milk feedings/ DAT once fully awake >Monitor VS q15 min for the 1st hour q30 min for the 2nd hour q1 hour thereafter until stable >watch out for bleeding on BMA site and refer to PROD stat for LP >Secure consent for LP >Prepare the ff materials: LP set Gloves size 7 ½ #2 Needle, gauge 23 OS, 4x4 Sterile cotton balls Betadine solution >NPO now S/P Lumbar tap >Hgt now >Please send specimen as ff: bottle #1 : WBC, diff count bottle #2 : CSF C/S bottle #3 : protein, sugar >Flat on bed for 4 hours > NPO temporarily >Montior VS q15 min x 1 hour q30 min x next hour q1 hour thereafter until stable
None INH
INH or RIF
HRZS
2HREZS or 1HREZ, 5 HRE
LIVER FXN TESTS 0 – 5 days 1 – 19 years 10 – 19 years
SGPT / ALT 6 – 50 5 – 45
SGOT / AST 35 – 140 15 – 55 5 - 45
TOTAL BILIRUBIN ( ACTUAL/17.1) Preterm Full term Cord Blood 0 – 1 day 1 – 2 days 2 – 5 days > 5 days
<2.0 <8.0 <12.0 <16.0 <20.0
<2.0 <6.0 <8.0 <12.0 <10.0
ALBUMIN
Premature Full term, <6days < 5 years 5 – 19 years 18
1.8 – 3.0 2.5 – 3.4 3.9 – 5.0 4.0 – 5.3 55
GLUCOSE (mg/dL) (0.0555) = mmol/L
WATERLOW CLASSIFICATION WASTING
>90 80-90 70-79 <70 STUNTING
: normal : mild : moderate : severe
Height in centimeters ideal height (P50) for age >95 90-95 80-90 <80
mmol/L
Cord blood
45 – 96
2.5 – 5.3
Premature
20 – 60
1.1 – 3.3
Neonate
30 – 60
1.7 – 3.3
1 day
40 – 60
2.2 – 3.3
>1 day
50 – 90
2.8 – 5.0
Child
60 – 100
3.3 – 5.5
Adult
70 - 105
3.9 – 5.3
Oral Dose
Adult
75g
Child
1.75gm/kg (max: 75gm)
OGTT
Normal
Diabetic
Fasting
70 – 105
> 126
60min
120 – 170
> 200
90min
100 – 140
> 200
120min
70 - 120
> 200
x 100%
: normal : mild : moderate : severe
IDEAL WEIGHT At birth 3000 g <6 months: weight in g = Age in months x 600 + BW 6-12 months: weight in g = age in months x 500 + BW 1-6 years: 2n + 8 6-12 years = n x 7-5 (7n-5/2) 2 4-5 mos 1 year 2 years 3 years 5 years 7 years 10 years
Mg/dl
Actual weight in kilograms x 100% ideal weight (P50) for actual height
2 x BW ~ 6 kg 3 x BW ~ 9 kg 4 x BW ~ 12 kg 5 x BW ~ 15 kg 6 x BW 7 x BW 10 x BW
54
19
GLUCOSE (mg/dL) (0.0555) = mmol/L
WATERLOW CLASSIFICATION WASTING
>90 80-90 70-79 <70 STUNTING
: normal : mild : moderate : severe
Height in centimeters ideal height (P50) for age >95 90-95 80-90 <80
54
mmol/L
Cord blood
45 – 96
2.5 – 5.3
Premature
20 – 60
1.1 – 3.3
Neonate
30 – 60
1.7 – 3.3
1 day
40 – 60
2.2 – 3.3
>1 day
50 – 90
2.8 – 5.0
Child
60 – 100
3.3 – 5.5
Adult
70 - 105
3.9 – 5.3
Oral Dose
Adult
75g
Child
1.75gm/kg (max: 75gm)
OGTT
Normal
Diabetic
Fasting
70 – 105
> 126
60min
120 – 170
> 200
90min
100 – 140
> 200
120min
70 - 120
> 200
x 100%
: normal : mild : moderate : severe
IDEAL WEIGHT At birth 3000 g <6 months: weight in g = Age in months x 600 + BW 6-12 months: weight in g = age in months x 500 + BW 1-6 years: 2n + 8 6-12 years = n x 7-5 (7n-5/2) 2 4-5 mos 1 year 2 years 3 years 5 years 7 years 10 years
Mg/dl
Actual weight in kilograms x 100% ideal weight (P50) for actual height
2 x BW ~ 6 kg 3 x BW ~ 9 kg 4 x BW ~ 12 kg 5 x BW ~ 15 kg 6 x BW 7 x BW 10 x BW
19
s r a e y + 3 1
; - e c n r i n t u t a a e c t n s c ; d u o m u c r o e n o t x t a b c e s i l d g a a i p e u k a r t s s g a t e t m c s p e n e i o n r s b p e u l a s w a e C t c
x e n l o k r s - g s l n p i t o e s s e i d a r a , e h w s w u n u m l t t ; a i a t o r e s a c r t t c c l r s a e s e r ; d u e , a ; r r i c c s i c i e t s i s t r p t n t d h p u c a i c a p h a d n r l n a a f U a p s s m a m m o
s r a e y 2 1 0 1
e t o l l r r o y e a e l r d d t n s g e n a e a p p ) s a v ( a l r i e t s l e u c ) a s x a e i g g n t t n i e m m n n f n r r a p t a l p e e r f r o t h f o n o n i o f s a s C o t c ( i l v p
t s t e o a h i g u s r i p - l g a g d n o r b i 3 n o i f n e d a n c s i o i a g o c ; x g t e t o s k e p s s , o l b r e r g v ; p o m n e p w s e s d , p e d y r a r m e t m t i h t o r n a h o A d s a c u u m p w
s r a e y 9 7
l ) ; a r d s s l r e n e a e o s d t p n a s - v e n o f a t n h a i d t m e e t , s s e i e s e a t i v r e n t t r c p e a e n e s o o s r f r p e m e p u r e e t o s o r b r u p u a s U p ( i f n p q o
f o s s l e ; y a r i r s s e p p d r a e l o r e o d u s c v ; w b a e d r a e s t n t h c r o a i s i g o c n N b s r v i
s r a e y 6 5
; h t g , s n d s a t c . s 6 l e n n e h e f e f e u v c c e i n o a i e e v s i - n n g s n l s e t e e e a t a a u r d s s s r n e r e r r u q u s e v o s l o a a e S a w u p p n c s
, i t r s n o i e s e p t e l y d i s o a t h t e n c g n s p ; i i e e a s m r t s h h i s i e r c r v s t l u c t s a a g i s f n e o M c i f d l c
E G A
e v e i s g s a u s e r g l l p n i x a k E L S
mg/dL
mmol/L
Cord Blood
21 – 40
7.5 – 14.3
Premature
3 – 25
1.1 – 9.0
Newborn
3 – 12
1.1 – 4.3
Infant/ Child
5 – 18
1.8 – 6.4
Thereafter
7 - 18
2.5 – 6.4
CSF
Cell count (cells/mm3)
PT
0 – 25MN
0 – 25
0 – 10 PMNs
0 – 10
0 – 1000RBC
0 - 1000
NB
l a u l t a p i t e a c p r s e o P l s l u d i s n k i V a S
52
Neonate
X 106 cells /L
0 – 20 MNs
0 – 20
0 – 10 PMNs
0 – 10
0 – 800 RBC
0 - 800
0 – 5 MN
0 – 5
0 – 10 PMNs
0 – 10
0 – 50 RBC
0 - 50
21
s r a e y + 3 1
; e i - r c t n n t a a t n e u c s u m c ; d u o c r o e n o t x t a b c e s i l d g a i a a s p e u k r s g a t t e t m c s p e n e i o n r s b p e a C t u l s w a e c
x e n g o k r s s l l i n o e s s a p t d r e i a , e h w s w u n u m l t t ; a e t c o r a t c c r a s e s a r t i s e , l ; e d u r ; r t s i a s r c c e i r u c s p i t i n t d h p t c i c l a d a a n r n a a f p h U a p s s m a m m o
s r a e y 2 1 0 1
r e t o l l d r o y e a r t l n e e s g e d a a n p v p ) ( i s a e s a l e u s t c ) l r a g g n t a m e i t x e n n i r n n f t r m a p n r o t a l p e e r h f o o f o f a s n l i s C o t c ( i v p
s o - t h e t a i g u s r p - l g i r b g i d n o i 3 a n n c f g n o a d s i o i ; x e t a e o c t g o k s r l e o p s s b , e o p ; r s g v m n e e p d , s p e m a t w m d a y r t t i r n h o h r o e A d s a c u u m p w
s r a e y 9 7
l a r d ; r s ) s l e d e n s o n t e a p o f a s h - v e n a t n e i , s e e s d a m t t i e a t i e v t s r p t r e n e c e s o a o s e r n p f r p e u r e o e o t s r b e u a r u m s f n p q p U p ( i o
f o s l r s e ; y a e i r s s d r p p r l a e d o o u e s v c w a b ; d e e r n t a s t r h c a o s i g c n N b i s r o v i
s r a e y 6 5
; h t g , s n d s a t c . s 6 l e n n e h f e e e u v e f c e i n o a i e c v n s n g s n l i s t e e e r a d s a e a t s s u r n e r e r r q u s e v o s l o a u a e S a w u p p n c s
, i t s n r e s i o e e t l y t d s p i o a h t n c i g n s e i p e r t e a ; s i m s h h s i e r c r v s c s t l t n a a u s f g i e o M c i f d l c
E G A
52
BUN (mg/dl) ÷ (0.357) = mmol/L
e v e i s g s a u s e r g l p n l i x a k E L S
BUN (mg/dl) ÷ (0.357) = mmol/L mg/dL
mmol/L
Cord Blood
21 – 40
7.5 – 14.3
Premature
3 – 25
1.1 – 9.0
Newborn
3 – 12
1.1 – 4.3
Infant/ Child
5 – 18
1.8 – 6.4
Thereafter
7 - 18
2.5 – 6.4
CSF
Cell count (cells/mm3)
PT
0 – 25MN
0 – 25
0 – 10 PMNs
0 – 10
0 – 1000RBC
0 - 1000
NB
l a u l t a i p t a e c r p s e o P l s u d l s n i k i V a S
Neonate
21
X 106 cells /L
0 – 20 MNs
0 – 20
0 – 10 PMNs
0 – 10
0 – 800 RBC
0 - 800
0 – 5 MN
0 – 5
0 – 10 PMNs
0 – 10
0 – 50 RBC
0 - 50
CSF (Leukocyte Diff. Count %) Lymphocytes
62 + 34
Monocytes
36 + 20
Neutrophils
2+5
Histiocytes
0 (rare)
Ependymal cells
0 (rare)
Eosinophils
0 (rare) 70 – 180 mmH2O
CSF Pressure CSF Volume
Child 60 – 100 Adult 100 - 160
CSF Glucose
Adult 40 – 70mg/dL
Traumatic Tap 1 mg CHON = 80 – 1000 RBC 1 WBC = 60 – 1000 RBC Correction Factor 700 RBC = 1 WBC 500 – 700 RBC = 1 mg% CHON
i a l c s p e d x n r p ” n e f o c p a i p e c o t t e e r a d t c s s u r r i ; “ t n a r s e s o t t s c o i d u u m t s p g e r n n a b e t t u i n a c a s h U l
s d s , 6 t c ; h , r y e e t l k a s l r j n e n o a e o c , e z i e b c i c l b y n o a t b o t e r u r e m c , e a t a , m o u s r g e e n e s q a b o m a l o n s e t e w i o i h a m t y p t u o c t g s o e i n f l u o h i a n k R d i o a a t p d c
y - g g n n i o s a ; l n s d e d a e a ) , v n r n m r e t i e a o t e o m a g a , h w s r l r p f s u a l e p e i a t o w i g u i t d l o f g m i n n u g n f a s e n U m i k o l ( m
s - s - e s 0 5 t c ; r - t k m e e e e e o n 2 y s j a c i t t r b u u c r s d a s u e o n o c p g l d b i l b r e f r o s r k e n l o e e c t ; a w e t m a m o u b f o ; e s q a l w e n y k n e d h s t e i s e d t m c k w r t a g s n c e i a ; f a o n n u a e R d i r b 1 o w t o
t i h s b s ) d r a i n n e w a v a t r t e a r s r i e c h e v d s e t n s h a y U p t ( b
- s d ; ; 4 t c ; n r a s e e t e 0 a f d s e r j h 2 b c o s s e n a n l p s r o > b o r e p t e a y o n m o u s s a i t e s q e d k t r w w t e , e n i s o t m t u g n u o e i n e e o u n R d i k f k b w c
s y d h n “ w a ” , , s n t s e ” o r n i t e r e e d h h s n w w e u “ q U “
l a s i t t n p e e u c q n e o S C
22
”
n s a l L l i c k i t S p e e g c a e u R g
51
CSF (Leukocyte Diff. Count %) Lymphocytes
62 + 34
Monocytes
36 + 20
Neutrophils
2+5
Histiocytes
0 (rare)
Ependymal cells
0 (rare)
Eosinophils
0 (rare)
CSF Pressure CSF Volume
70 – 180 mmH2O Child 60 – 100 Adult 100 - 160
CSF Glucose
Adult 40 – 70mg/dL
Traumatic Tap 1 mg CHON = 80 – 1000 RBC 1 WBC = 60 – 1000 RBC Correction Factor 700 RBC = 1 WBC 500 – 700 RBC = 1 mg% CHON
22
- e i t t 6 i l r , t u r s n o w r e n t m h e r n ; o e s ; d t i e a s i t b o i c s k e i c m s m p z w r m s s n r u l a l o e i i t e m t e t y p n o d c o g e u f p b a a r o e i m j r p q s r o g d e r r s p t v e b e e t e n d R 7 o s p s p o e a i
- t e i t 6 l r i r , t u s n o r e n e m s w ; d t h t e r n ; o i e a t m b o i c s k s e i i r c s w z p u p m s n m m s t a l o r t e i i l e t n y c e o r d g u e a o f b i j o p o a e m r p q s r g s p t v e r r e d b e e t e n R 7 o s p s p o e a i d
i a l c s p n d x o e r n e f c p p e ” a i c o t p t e e r a d t s s s c u r r ; a “ t n i r s e u i c o o t t d g t s p s u m e t n i t a b u e n n a c a r s h U l
s d s , 6 t c ; h , r y a e e t l k s j l c r n e c n a e o , z i e b a i o o c l o n b r e m c t t e b y r e u e , t a a , m o u s r g e e n e s q a b m a l o o n i e t e w o s i h t a m t y u o o s t g n f l p o h i c a e i n k o a u R d i a t p d c
y - g g n n i o s a ; l s n d e d e a ) a , v n r n m r e i t e a o a o m t a g e , h w s l r e r p f s u a l p i e i a t o w i g u t g i d l f o u e n m n g f n s m n k o l a ( U m i
s - s - e s 0 5 t c ; t k i m e e e e e r n 2 y s j t a c o r u u u c r c p s d a t e b s g o n o l d b r i b r e f e o r s l n l e m o e t c k a w t m o u b f e ; o ; e s q a l w n e e a y k d n t e s d t i m k w r h t a s e c g e i n s n e c a ; f a o n R d i u a r b 1 o w t o
t i h s b s ) d r a i n n e a a v w r t r t e s r i v a e e s c t d s e h n a h y U p t ( b
- s d ; 4 t c ; n r a ; s e e t e 0 a f d s e r j h c s s p o r 2 e b n a n l s o > b o r e t e a y i o m o u p a n t s d t e s q s r e k w w t e o u o t , e n i m u g s n t e i n e e o u n R d i k f k b w c
s y d h n “ w a ” , , s t n ” s o e i r r n t e e e s d h h e n w w u “ q U “
l a s i t t n p e e u c q n e o S C
51
”
n s a l L l i c k i t S p e e g c a e u R g
s r a e y + 3 1
) 9 1 5 ( T N E M N I A T T A L A T N E M P O L E V E D
r a n u i d d n r e - d , o n e h o i c , h s t e c a n e n u e r c n i r t o M c s a t
s r a e y 2 1 0 1
, - s s r n d r r e g o l o f i t n t o i o d t o o s o t o u a l s o - n r n o c m i r a k a r t e - g d e a c i c t w c o s l ; ; x n j n s n n h m e e w h p c t e t i ; e e i e a i l a o ; o v s g s m m v i w r s h i t l t t c p h n i r a - a e r s o l d n m c p o l c t e t v o e a e e n r u e e n o r p r y i t n I s c e d s C b m w a m c m a
s r a e y 9 7
l y i l e d e c d c e t x s ; l n s r n s o l y e , a a l a a s s p s i t c t p e a l w a s k n k a e p r r i s m e e d u b t a a s g o t ; w c w n e l e e c v a r g b r t s s l o s o o r r r s u n t o r t ; n r t e p t c i n d t i o i t n l o a e r r u a e p n e m o o o S d g l m s P a l i c t
s r a e y 6 5
; t o o f 1 n o s p o H
n s o e o k l t a r o w l s n e a e C h
r o t o M s s l l i o r k G S
E G A
Hct
2 days
48 – 69 48 – 75
14.5 - 22.5
3 days 2 months 6-12 years
44 – 72 9.0 - 14.0 11.5 - 15.5
28 – 72 35 – 45
Male
13.0 – 16.0
37 – 49
Female
13.5 – 17.5
36 – 46
12-18 years
18-49 years Male Female
41 – 53 12.0 – 16.0
36 - 46
Hemoconcentration: 3Hgb – Hct / 3Hgb x 100
WBC COUNT (x1000 cells/mm3 ) Birth
l l i k S r o t o M e n i F
24 hours
9.0 – 30.0 9.4 – 34.0
1 month
5.0 – 19.5
1-3 years
6.0 – 17.5
4-7 years
5.5 – 15.5
8-13 years
4.5 – 13.5
Adult
4.5 – 11.0
ANC: WBC x Neutrophils = X N>1,500 <1000 signifies predisposition to infection 23
s r a e y + 3 1
r a n u i d d n r o - e , o n d h i e t c , h s n e c a e c n u r e t r n i o M c s a t
s r a e y 2 1 0 1
s r a e y 9 7
l l y e e i c d c d o x , l s ; n s r t n e s y e a a t l a e a a s s l s t l i c p s w n p k r a a e r i s p m e d u k e b t a g a s o n e ; w t c w e e v l r g b c r t s s l o o s r o r a u i n t o r t r t ; r s l e t c n n r i d p o t i o a t e u a e p r n e m n o o o S d g l m s P a l i c t
s r a e y 6 5
; t o o f 1 n o s p o H
n s o e o k l t a r o w l s n e a e C h
r o t o M s s l l i o r k G S
BLOOD
l ; - , s n l s e s e a a l o t n t p i l m c o f y ; s t u - e f a t n c i i ; r r r e h d f c t f s d f o s i n i e o k r w a d l s a e e s t o e k s d t t d n a l i r w r i r h t o a u o r e e t i r W w w p b m c m a
, g s o t s r n d r e o l i r i n t o d f t o o s o o t o u a l s i o o n c m r a k n r a r t e - g d c e a c t w o c ; h s h l c x i n ; m e n e p n j i s n w t e t i ; e e s e a i l a o ; v s p h o g i m c w i m v t r h t l n s i r s - t o l p t n c a a o r c a l d e m e t e v o e e n r u e y i e n p r t o n s c e d s C b m w a m c m r I a
E G A
50
Hgb
1 day
; e y r p r t s e s ; l n s u s t a c a n i r s t e o y e t o g e l n i l t a a r l i m s a a m t o r c c o i o n c p m h t l t e e a r o i o u P b c f a c w
50
) 9 1 5 ( T N E M N I A T T A L A T N E M P O L E V E D
BLOOD
l ; - , s n l s e s e a a l o t t n f p l - i c m o f y a t ; s t u r n e c i r i r e h d c f t ; i n f o s f d i s a l o k e r w d s a e s t o e e k s l d t t d a r i h r i o e n r t t e i o a u r w r W w w p b m c m a
Hgb
Hct
1 day 2 days
48 – 69 48 – 75
14.5 - 22.5
3 days 2 months 6-12 years
44 – 72 9.0 - 14.0 11.5 - 15.5
28 – 72 35 – 45
Male
13.0 – 16.0
37 – 49
Female
13.5 – 17.5
36 – 46
12-18 years
18-49 years Male Female
41 – 53 12.0 – 16.0
36 - 46
Hemoconcentration: 3Hgb – Hct / 3Hgb x 100
; e y r p r t s e s ; l s u t a n o a s c n i r s t y e o t e g e l n a i a l t l m a a s r i t m r c c o i o l o n c p m h t t e e a r o i o u P b c f a c w
WBC COUNT (x1000 cells/mm3 ) Birth
l l i k S r o t o M e n i F
24 hours
9.0 – 30.0 9.4 – 34.0
1 month
5.0 – 19.5
1-3 years
6.0 – 17.5
4-7 years
5.5 – 15.5
8-13 years
4.5 – 13.5
Adult
4.5 – 11.0
ANC: WBC x Neutrophils = X N>1,500 <1000 signifies predisposition to infection 23
LEUKOCYTE DIFFERENTIALS % 0
Myelocytes Neutrophils - bands
3 – 5
Neutrophils – segmenters
54 – 62
Lymphocytes
25 – 33
Monocytes
3 – 4
Eosinophils
1 – 3
Basophils
0 – 0.75
h t n i w i o s s i e v r s s e e r p D u s
m y o l r i f s s e a e t a r r e a t p h e o S m
, e m a n l l u f s e x v e i G s
r o , 3 o t s t n e u r o o C m
84 – 478
Adult
150 - 400
2 t o t ; o f o n o w 1 f o p e t n s 1 d s o c s ; p r e r s e i e d s t a t p n 5 s s t r a r p e e t o e S f U p f
CRP < 6 Band to Neutro: Stabs + Mono Neutro Normal: < 0.02 IT: Stabs + Mono N<0.2 Total WBC ANC: WBC x Segs
s r y ½ 3
24
e f i n k a e s u n a C
s e i r o t s s l l e T
r d , o d l s n a ) a 3 d s o y s s s n n c r e e r e o e g o z z l n i h i . i t i u n e i ( n o r s h g g s p o , o r o c d r m p r d c l o c e e o e r o i r e o e o C p w t R c R m
0 1 o t s t n u o C
e m a n t s r i f s t n i r P
3 h t i w n a m s s w t a r r a D p
e r a u q s s e i p o C
t t t e h o e e l b l c a p h h m t p o i l a c w s s n e w o t i r g a s r r e n W D p i
l l e w l l a b s e h c t a C
k l a w e o t o t l e e H
t e e f h t o b , s p i k S
p u s n o t t u B
s s o r c s e t a t i m I
PLATELET COUNT Newborn
t u o h t n i w i o s s i e v r s s e e r p D u s
” s e l a t l l a t “ s l l e T
t o o f 1 , s r i a p t s t e n s w r o e D p
t o o f 1 n o s p o H
s r y ½ 4
s r y 4
b u s d n a s s d t d c a r A t
s e h s u g n i t s i D
t f e L & t h g i R l l e w y l r i a f s e t i r W
o t l e e h d r k a l w a k w c e a o B t
s r y 5
s r y 6
49
LEUKOCYTE DIFFERENTIALS % 0
Myelocytes Neutrophils - bands
3 – 5
Neutrophils – segmenters
54 – 62
Lymphocytes
25 – 33
Monocytes
3 – 4
Eosinophils
1 – 3
Basophils
0 – 0.75
h t i n w i o s s i e v s r s e e r p u D s
m y o r l i f s s e a e t a r r e a h p t e o S m
, e m a n l l u f s e x v e i G s
r o , 3 o t s t n r u e o o C m
Newborn Adult
CRP < 6 Band to Neutro: Stabs + Mono Neutro Normal: < 0.02
t u o h t i n w i o s s i e v s r s e e r p u D s
e f i n k a e s u n a C
s e i r o t s s l l e T
r d , o l ) a s n d 3 o y d a c r s s s n s g e e r e n o o e z z l n i h t i . i i u i e ( n n o r s s h g g p o , o r o c e d d c o c r m p e r e e l o r o i r o e o C p w t R c R m
0 1 o t s t n u o C
e m a n t s r i f s t n i r P
3 h t i w n a m s s w t a r r a D p
e r a u q s s e i p o C
t t t e h e e l o b l c a p h h m i p o t l a c w s s n e w o t s i r a r r e g n W D p i
l l e w l l a b s e h c t a C
k l a w e o t o t l e e H
t e e f h t o b , s p i k S
p u s n o t t u B
” s e l a t l l a t “ s l l e T
s s o r c s e t a t i m I
PLATELET COUNT 84 – 478 150 - 400
2 t o t ; o o n f o w 1 f o p e t n s 1 d s o c s ; p r e r s e i s t d t a e p n 5 s s t a r t o p r e e e S f U p f
IT: Stabs + Mono N<0.2 Total WBC ANC: WBC x Segs
24
f l e l s y e s t e e l s s p e r m D o c
s r y ½ 3
49
t o o f 1 , s r i a p t s t n e w s o r e D p
s r y 4
t o o f 1 n o s p o H
s r y ½ 4
s r y 5
f l e l s y e s t e e l s p s e r m o D c
b u s d n a s s d t d c a r A t
s e h s u g n i t s i D
t f e L & t h g i R l l e w y l r i a f s e t i r W
o t l e e h d r k a l w a k c w a e o B t
s r y 6
L A N L O A S I R C E O P S
s e r u t c i p s t a P
E G A U G N A L
a d a r D e , h t a o m s a d r M o n w a 3 h t
R O T O M E N I F
p u c m o r f s k n i r D
R O T O M S S O R G
e n o l a l l e w s k l a W
E G A
s m 5 1
r , o - g e i 2 s n p u e s e e o h e g a i m s w p t s e , t s a a k t r n r t i a o u m w T 3 I
d e e n s e t a c i d n I
s d r o w 0 1
l a c i t r e v a s e e t a k t i o r t m I s d r a w k c a b s k l a W
s r i a t n r i i s f a p l u e h s c s s p ‟ s t d l e a i r e h e S c C s m 8 1
y h i l e b t r p t d d w a e n m s h n s g g i o n n s k g a d i s i s o i l l a a n s n e i p i n t a r v t s p e y e h o t t s s b h s s s l e p s m n l e u y a i y e t e e i e o r e r o a s l i H R m T d U t l h D W d 3 r o n 2 e s e n n i i b s d m r o o C w
s n y o c d t i o c i b e p e r 1 i n o o d t s s s w ) e t 3 o f m e n t l i l r o o a o a r u P p F 2 ( N t
r a l u c r i c a s e e t a k t i o r t m I s s r i a t s l l e n w w o s d e n , n o u p l R U a
s r y 2
s l a r u l p s e s U
Child Adult male <50 Adult female <50
0 – 10 0 – 15 0 - 20 ASO TITER (Todd Limits)
2 – 5 years 6 – 9 years 10 – 12 years
s e i r o t s e l t t i l
120 – 160 240 320
BLEEDING TIME (minutes) Normal Borderline
e l c r i c a s e t a t i m I
Newborn
s p m u J
y l i r e a l t l l c n a y c e b i r m s t w s o m o e r d t f h i T R 1
s r y ½ 2
s r a e y 3
48
Infants
0-6 mos 3yrs 5 yrs 10 yrs 15 yrs
2 – 7 7 - 11 PROTHROMBIN TIME 11 – 19 11 - 15 APTT (sec) 20 – 35 <90 SYSTOLIC
DIASTOLIC
p50-p95 80-100 95-112 97-115 116-138 116-138
p50-p95 45-60 64-80 65-84 70-92 70-95
25
L A N L O A S I R C E O P S
s e r u t c i p s t a P
E G A U G N A L
a d a r D e , h t a o m s a d r M o n w a h 3 t
R O T O M E N I F
p u c m o r f s k n i r D
R O T O M S S O R G
e n o l a l l e w s k l a W
E G A
s m 5 1
48
ESR
s e m a g e v i t c a r e t n i
r , o - g e 2 n s i s u p o e e e h e g a i m s w p t e s t , s a a k t r n r t i a o u m w T 3 I
d e e n s e t a c i d n I
s d r o w 0 1
l a c i t r e v a s e e t a k t i o r t m I s d r a w k c a b s k l a W
s r i a t n r s i i a f l h p u e s c s s s ‟ p t d e a l e e i h r S c C s m 8 1
y h t e b i r w l p t d d a s h n s n e o g i m g n n g a d s k i s i i s o l l a a n s n e p i i n t a r v t p s y e h o t t s s e b h s s s e p s n m e l e l i y e y e e t e u o r a i r o a s l i H h R m T d U t l D W d
3 r o n 2 e s e n n i i b s d m r o o C w
s n y o i c d i o t p b c e e r 1 i n d o s o t s s ) w 3 e t o f m e n t l i l r o o a o 2 a r u P p F ( N t
r a l u c r i c a s e e t a k t i o r t m I s s r i a t s l l e n w w o s d e n , n o u p l R U a
s r y 2
s l a r u l p s e s U
ESR
s e m a g e v i t c a r e t n i
Child Adult male <50 Adult female <50
0 – 10 0 – 15 0 - 20 ASO TITER (Todd Limits)
2 – 5 years 6 – 9 years 10 – 12 years
s e i r o t s e l t t i l
120 – 160 240 320
BLEEDING TIME (minutes) Normal Borderline
e l c r i c a s e t a t i m I
Newborn
s p m u J
y l i r e t l l c a l n a y c e b i r m s t w s o m o e t r d f h i T R 1
s r y ½ 2
s r a e y 3
Infants
0-6 mos 3yrs 5 yrs 10 yrs 15 yrs 25
2 – 7 7 - 11 PROTHROMBIN TIME 11 – 19 11 - 15 APTT (sec) 20 – 35 <90 SYSTOLIC
DIASTOLIC
p50-p95 80-100 95-112 97-115 116-138 116-138
p50-p95 45-60 64-80 65-84 70-92 70-95
SODIUM (mmol/L) Newborn Infant Child Thereafter <2months 2-12 months >12 months
134 – 146 139 – 146 138 – 145 136 – 146 POTASSIUM (mmol/L)
g n a r t s h t i w y h s r S e d n u o s s e t a t i m I
3.0 – 7.0 3.5 – 6.0 3.5 – 5.0 CHLORIDE (mmol/L)
Cord Blood Newborn Thereafter
96 – 104 97 – 110 98 - 106
e l t t o b s d l o H
ER DRUGS Atropine Asystole, Bradycardia CaCl2 hypoten, bradyc Ca ChB ovrds Ca Gluconate hypocal, tetany
0.01-0.03 mkds 10 – 20 ug/kg min dose:100ug 10 – 120 mk
Dobutamine
Infusion rate: 2.515 ug/k/min
Inotropic support Dopamine
1/1 amp
clear line of drugs that will ppt HCO3
Wt x 200 100
100/1x10 amp
250/250 premx 500/250 premx 250x20ml vial wt x 5 x desired dose à 1 cc/h 2.5-5 ug/k/min inc in 5-10 ug increments
g n i d l o h s d n a n t S o
200/250 premx 400/250 premx
wt x 5 x desired dose à 1 cc/h
<2months 2-12 months >12 months
134 – 146 139 – 146 138 – 145 136 – 146 POTASSIUM (mmol/L)
g n a r t s h t i w y s h r S e
96 – 104 97 – 110 98 - 106
e l t t o b s d l o H
ER DRUGS Atropine Asystole, Bradycardia CaCl2 hypoten, bradyc Ca ChB ovrds Ca Gluconate hypocal, tetany
0.01-0.03 mkds 10 – 20 ug/kg min dose:100ug 10 – 120 mk
Dobutamine
Infusion rate: 2.515 ug/k/min
Dopamine
Wt x 200 100
1/1 amp
clear line of drugs that will ppt HCO3 100/1x10 amp
250/250 premx 500/250 premx 250x20ml vial wt x 5 x desired dose à 1 cc/h 2.5-5 ug/k/min inc in 5-10 ug increments
g n i d l o h s d n a n t S o
200/250 premx 400/250 premx
n i s e t a r g n e i p s o s o e r C d
- e m r r o c o s t s s y d s e n b a e u O m q
r , e h a t o m a d r M a o n d w a a 1 h t D
r e g h n i f c a o x r e p d p n I a
r e g n i f b m p u s h a r T g
s t c e j b r o e s h g t n e a g o B t
s y o t s w o r h T
s p e e r C
o t f l e s s d l n l u a P t s
g n i d l o h s k l a n W o
e n o l a s d n a t S
s h t n o m 0 1
s h t n o m 1 1
s h t n o m 2 1
e y b e y b s e v a W
wt x 5 x desired dose à 1 cc/h 47
y r e s r u n s s e e m o a D g
r , o ) s e s m k e r a r a t c - d g n u a s i o - l p l t t d a e o o p H h f o (
e s u o t s n t p o m o e p t s t A a
n i s e t a g r n e i p s o s e o r C d
- e m r o r c o s t s s y d e n s b a e u O m q
r , e a h t m o a d r M a o n d w a a 1 h t D
s d n a s t s r r e e u d t n s e U g
h t i w s g n d r i o n a w e 2 m
r e g h n c i f a x o e r d p n p I a
r e g n i f b m p u s h a r T g
s t c e j b r o e s h g t n e a g o B t
s y o t s w o r h T
s p e e r C
o t f l e s s d l n l a u t P s
g n i d l o h s k l a n W o
e n o l a s d n a t S
s h t n o m 0 1
s h t n o m 1 1
s h t n o m 2 1
s h t n o m 9
shock, renal perf
26
e s u o t s n t p o m o e p t t s A a
h t i w g s n d r i o n a w e 2 m
d n u o s s e t a t i m I
3.0 – 7.0 3.5 – 6.0 3.5 – 5.0 CHLORIDE (mmol/L)
Cord Blood Newborn Thereafter
Inotropic support
r , o ) s e m r k s e a r a t c d g u n o a s i - l p l t t a e d o o p H h o ( f
47
SODIUM (mmol/L) Newborn Infant Child Thereafter
y r e s r u n s s e e m o a D g
s d n a s t e s r r e u d t n s e U g
s h t n o m 9
shock, renal perf
26
e y b e y b s e v a W
L A N L O A S I R C E O P S
d n u o s o t s n r u T
, e k i l s e s t e a k c i i d l s n i I d
E G A U G N A L R O T O M E N I F
S R S O O T R O G M
h t i w f l e s s r s e d k e c e a r F c
s s e e c a z f i n r g i a l o i c m e a R f
a k e e p s y o a o l P b
d a e h l o d t r o n o o G c
s w e h C
g a l d a e h o N
l l a m s t a s s t e c e k j a b R o p u s h t i w s t r t i o S p
s g e l e m n o o s t s r h g a i e e B w
ER DRUGS CONT. Epinephrine Bradycardia, asystole, hypotension, anaphylaxis
Asthma: 0.3-0.5 ml of 1:1000 dil 10-100ug/k, then drip 0.05-2 ug/k/ min
E G A
s h t n o m 6
250 – 500 mk 1 – 2 ml/kg of D25W
crenation: infusion
Hydralazine Art sm ms dilator
0.1 – 2 mg/k
20/2 amp
Insulin
0.1 „u‟/kg hgt > 300 mg/dl
Humulin R
KCl hypokalemia
s h t n o m 7
Lidocaine
s e c n u o B
s h t n o m 8
46
rapid
2 meqs/mlx20 1 meq/mg 1g/250ml Inj
Ven dysrhythmias
1 mg/k load, then drip at 20-50 ug/k/min
Midazolam
0.04 – 0.1 mk
1/1,5/1,5/5, 15/3 amp 15 tab
NaHCO 3 metab acidosis
0.5-1.0 meq/kg 625 mg – 7.7 meq 325 mg – 3.9 meq
Naloxone opiate poisoning
10 – 25 ug/k
8.4% amp x10
0.4/1 inj 0.02/1 neon inj
27
L A N L O A S I R C E O P S
d n u o s o t s n r u T
, e k i l s e s t e a k c i i d l s n i I d
h t i w f l e s s r s e d k e c e a r F c
s s e e c a z i f n r g l a i o c i e m a R f
a k e e p s y o a o l P b
t n n e e m p e o v o – m e d s n o a l C h
n e h w ‟ g m n a i y M r „ c
a d a D , a m a M
R O T O M E N I F
l l a m s t a s s t e c e k j a b R o
d - n a b h o s m r o e f r d f s s n a n t h a c r o e T j t
r o f s e s h t c c e a j e b R o
d a e h l o d t r o n o o G c
s w e h C
g a l d a e h o N
p u s h t i w s t r t i o S p
s g e l e m n o o s t s r h g a i e e B w
ER DRUGS CONT. Epinephrine Bradycardia, asystole, hypotension, anaphylaxis
Asthma: 0.3-0.5 ml of 1:1000 dil 10-100ug/k, then drip 0.05-2 ug/k/ min
E G A
s h t n o m 6
s h t n o m 7
0.1+ 0.9ml 1+ 9ml
Glucose Hypoglycemia, stupor, seizures
250 – 500 mk 1 – 2 ml/kg of D25W
crenation: infusion
Hydralazine Art sm ms dilator
0.1 – 2 mg/k
20/2 amp
Insulin
0.1 „u‟/kg hgt > 300 mg/dl
Humulin R
Lidocaine
s e c n u o B
s h t n o m 8
27
rapid
2 meqs/mlx20 1 meq/mg 1g/250ml Inj
Ven dysrhythmias
1 mg/k load, then drip at 20-50 ug/k/min
Midazolam
0.04 – 0.1 mk
1/1,5/1,5/5, 15/3 amp 15 tab
seizures, sedation s h t n o m 5
1:1T 1:10T
1 cc/hr = 0.1ug/kg/hr 2 cc/hr = 0.5ug/kg/hr 10cc/h = 1ug/kg/hr
KCl hypokalemia
t u o h t t r i w o p s t p i S u s
1/1 amp
wt x 0.6 + 100cc D5W
E G A U G N A L
S R S O O T R O G M
46
0.1+ 0.9ml 1+ 9ml
Glucose Hypoglycemia, stupor, seizures
seizures, sedation s h t n o m 5
1:1T 1:10T
1 cc/hr = 0.1ug/kg/hr 2 cc/hr = 0.5ug/kg/hr 10cc/h = 1ug/kg/hr
d - n a b h o s r m o e f r d f s s n a n t h a r c o e t T j
t u o h t t i r w o s p p t i u S s
1/1 amp
wt x 0.6 + 100cc D5W
a d a D , a m a M
n e h w ‟ g m n a i y r M „ c
r o f s e s h t c c e a j e b R o
t n n e e m p e o v o – m e d s n o a l C h
NaHCO 3 metab acidosis
0.5-1.0 meq/kg 625 mg – 7.7 meq 325 mg – 3.9 meq
Naloxone opiate poisoning
10 – 25 ug/k
8.4% amp x10
0.4/1 inj 0.02/1 neon inj
ANTIHYPERTENSIVES / CARDIAC DRUGS Acetazolamide (Diamox)
5 – 10 mkdose
250 tab
Captopril (Capoten) ACE Inhibitor Digoxin (Lanoxin)
0.5 – 1 mkdose max: 6 mkd
25 tab
0.25 tab/amp 0.05 mg/ml elixir IV dose is 75% of oral dose Doses taken in 24h
Furosemide (Lasix, Frusema) Loop Diuretic Mannitol
LD 0.02 - 0.04 MD 0.0035 - 0.0075 q12 IV MD 0.004 x wt mkdose Rapid LD: >10y: 750-1500 ug, single dose Slow LD: >10y250-750 ug daily x 1wk Oral LD: 5-10y 25ug/kg 2- 5y 35ug/kg FT neon - 2y 45ug/kg PT neon 1.5-2.5 kg 30ug/kg <1.5 kg 25ug/kg Oral MD: 125-750 ug/day IV LD: 5-10y 25 ug/kg 2- 5y 35 ug/kg FT – 2y 35 ug/kg PT 1.5-2.5kg 30ug/kg <1.5 20ug/kg 0.5 – 1 mkdose 20, 40 tab 20/2 amp
Osmotic Diuretic
LD 1g/kg MD 0.25 – 0.5 mkdose q6h
Nifedipine (Calcibloc)
mkd x 5 = cc of 20% mannitol 0.05 – 0.1 mkdose SL
Spironolactone (Aldactone) K Sparing Diuretic
1 – 3 mkday LD 3 MD 1 – 2
Y R O T N E V N I R O I V A H E B G N I N E E R C S
20/100ml (20% vol) cerebral edema; max of 2 weeks than use K+ sparing
L A N L O A S I R C E O P S
s e l i m S
E G A U G N A L
g n i l g r u g y s t a d o r n h u o T s
R O T O M E N I F
e n i l d s i w m o t o l l o t f c e e y j b E o
o r o k M c ( S R e s ) e x S O n l c x t O T i r l e e l n a f f R O o e t e G M T r S r
d a m e o r h f y s l t e s h i g a i R l s
d e t s i f s d n a H
d , n n e s e a v e h h i s h w t o s n i y d d r o s i n t p i v e a i s t l g m c k e i e a R R d a t
e l t t a r h t i w d n s a y h a l n P i
s h g u a L
s l a e u q S
d n d u a o e s h s s d e r v a o w o M t
s t w s o a l p e l o t n f c i e l e d y j b i E o m
r e h t e g o t s d n a H
t d c n e a j b h o i n s d p e s c a r l a G p
l l o d o r e r e e t n t n t n o o n o s r i o p n f o r c s r c p n d n e d i d i a ° n g a e 5 a n e ° 0 o H 9 H 4 H l
m r a , p t u r t s o e p h p C u s
5, 10 cap
25, 50, 100 tab BID
28
n r o b w e N
h t n o m 1
s h t n o m 2
s h t n o m 3
s h t n o m 4
L A N L O A S I R C E O P S
s e l i m S
, n e s e v h i e w o s h n i y t o s t d n i p i v e i s m k e i t c l a R d a t
d n a h s d r a g e R
e l t t a r h t i w d n s a y h a l n P i
E G A U G N A L
g n i l g r u g y s t a d o r n h u o T s
s h g u a L
s l a e u q S
d n d u a o e s h s s d e r v a o w o M t
R O T O M E N I F
e n i l d i s w m o t o l l o t f c e e y j b E o
s t w s o a l p e l o t n f c i e l e d y j b i E o m
r e h t e g o t s d n a H
t d c n e a j b h o i n s d p e s c a r l a G p
E G A
45
ANTIHYPERTENSIVES / CARDIAC DRUGS Acetazolamide (Diamox)
5 – 10 mkdose
Captopril (Capoten) ACE Inhibitor Digoxin (Lanoxin)
0.5 – 1 mkdose 25 tab max: 6 mkd LD 0.02 - 0.04 MD 0.0035 - 0.0075 q12 IV MD 0.004 x wt mkdose Rapid LD: >10y: 750-1500 ug, single dose Slow LD: >10y250-750 ug daily x 1wk Oral LD: 5-10y 25ug/kg 2- 5y 35ug/kg FT neon - 2y 45ug/kg PT neon 1.5-2.5 kg 30ug/kg <1.5 kg 25ug/kg Oral MD: 125-750 ug/day IV LD: 5-10y 25 ug/kg 2- 5y 35 ug/kg FT – 2y 35 ug/kg PT 1.5-2.5kg 30ug/kg <1.5 20ug/kg 0.5 – 1 mkdose 20, 40 tab 20/2 amp
0.25 tab/amp 0.05 mg/ml elixir IV dose is 75% of oral dose Doses taken in 24h
Furosemide (Lasix, Frusema) Loop Diuretic Mannitol Osmotic Diuretic
LD 1g/kg MD 0.25 – 0.5 mkdose q6h
Nifedipine (Calcibloc)
mkd x 5 = cc of 20% mannitol 0.05 – 0.1 mkdose SL
Spironolactone (Aldactone) K Sparing Diuretic
1 – 3 mkday LD 3 MD 1 – 2
28
r e v o s l l o R
250 tab
Y R O T N E V N I R O I V A H E B G N I N E E R C S
20/100ml (20% vol) cerebral edema; max of 2 weeks than use K+ sparing
o r o k M c ( S R e s ) e x S O n l c x t O T i e r e l l f R O n t o a f G M T e r S e r
d m a e o r h f y s l e t s h i g a i l R s
d e t s i f s d n a H
l l o d o r e r e e t n t n t n r o o i n o s o p n f o r p c c r s n d e d n d i a ° n g a i ° e 5 a n e 0 o H 9 H 4 H l
r e v o s l l o R
m r a , p t u r t s o e p h p u C s
5, 10 cap
25, 50, 100 tab BID
E G A
45
n r o b w e N
h t n o m 1
s h t n o m 2
s h t n o m 3
s h t n o m 4
EENT/Derma Preparations Fluocinolone + Neomycin + Polymyxin (Aplosyn Otic) Docusate Na (Otosol)
3 – 4 gtts BID – QID
H2O2
otitis externa, acute/chronic w or w/o otitis media fill ear canal x 4 – 5 mins, plug, x 2 nights, suction – impacted cerumen CI: perforated TM 2 – 3 gtts x 3 days – impacted ceru
Ofloxacin (Inoflox Otic)
3 – 5 gtts BID otitis media
JBS lid scrub
cotton swab BID chalazion, hordeolum
Fucidic Acid (Fucithalmic)
1 gtt BID x 2 days (1% eye drops) conjunctivitis, removal of forgn body
Solcoseryl Paste
apply 3 – 5 times daily gingivitis, stomatitis
Dental
Amoxicillin (Amoxil, Pediamox)
Orofar – L
1 – 2 lozenges q3 – 4 15 ml soln gargle x 30 – 60 mins
Hexetidine (Bactidol)
½ mouthful gargle x 30 secs sorethroat, halitosis
Silver Sulfadiazine
1% cream for burns (Flammazine)
Mupirocin (Bactroban)
2% cream / ointment TID x 10d
Kwell Lotion
Apply all over the body nmt 24, t hen rinse x 3d for scabies
44
Sultamicillin (Unasyn Oral) Ticarcillin-Clavulanic Acid (Timentin)
250, 500 cap 125/5 syr, 250/5 forte 100/1; 125/1.25 drops 500 vial 50 – 100 q6 250, 500 cap 125, 250/5 susp < 2wks old, 100/1 drops give q12 250, 500 vial 375 mg (250/125) vial 750 mg (500/250), 1.5 g (1g/500) 50 – 100T 50T tab 100 – 200 1.2, 2.4 MU inj (high dose) 30 – 50 (Clavulanic Acid) 375, 625, 1g tab 156.25 (125) ,228.5 (200), 312.5 (250), 457/5 (400) susp A (bid 228/457) 125, 250/5 susp N 300, 600, 1.2 vial 50 – 100 QID 125, 250/5 susp 250, 500 cap 50 – 100 QID 250, 500 vial drip 200 – 400 (Piperacillin) q6 – q8 50 – 100 (preterms) 2.25g (2g/250mg) vial 4.5g (4g/500mg) vial, IV Infusion ( )ANST; 50 – 100 PO 125/5 - 200T „u‟ QID 250/5 - 400T „u‟ 625/5 -1.2M „u‟ 50 – 100 BID 375, 750 tab 250/5 susp 75 – 100 q8 – 1.6g vial: 1.5/100 q12 mkdose 3.2g vial: 5/2
Amoxicillin (Amoxil, Pediamox)
PENICILLINS 50 – 100 IV 30 – 50 PO
Ampicillin
Ampicillin-Sulbactam (Unasyn) BID Benzathin Pen G q6 Co-Amoxiclav (Augmentin, Natravox)
Cloxacillin Na (Prostaphlin A) Oxacillin Na (Prostaphlin) PiperacillinTazobactam (Tazocin) PhenoxymethylPen (Sumapen)
29
EENT/Derma Preparations Fluocinolone + Neomycin + Polymyxin (Aplosyn Otic) Docusate Na (Otosol)
3 – 4 gtts BID – QID
H2O2
otitis externa, acute/chronic w or w/o otitis media fill ear canal x 4 – 5 mins, plug, x 2 nights, suction – impacted cerumen CI: perforated TM 2 – 3 gtts x 3 days – impacted ceru
Ofloxacin (Inoflox Otic)
3 – 5 gtts BID otitis media
JBS lid scrub
cotton swab BID chalazion, hordeolum
Fucidic Acid (Fucithalmic)
1 gtt BID x 2 days (1% eye drops) conjunctivitis, removal of forgn body
Solcoseryl Paste
apply 3 – 5 times daily gingivitis, stomatitis
Dental
Orofar – L
1 – 2 lozenges q3 – 4 15 ml soln gargle x 30 – 60 mins
Hexetidine (Bactidol)
½ mouthful gargle x 30 secs sorethroat, halitosis
Silver Sulfadiazine
1% cream for burns (Flammazine)
Mupirocin (Bactroban)
2% cream / ointment TID x 10d
Kwell Lotion
Apply all over the body nmt 24, t hen rinse x 3d for scabies
44
PENICILLINS 50 – 100 IV 30 – 50 PO
Ampicillin
Ampicillin-Sulbactam (Unasyn) BID Benzathin Pen G q6 Co-Amoxiclav (Augmentin, Natravox)
Cloxacillin Na (Prostaphlin A) Oxacillin Na (Prostaphlin) PiperacillinTazobactam (Tazocin) PhenoxymethylPen (Sumapen) Sultamicillin (Unasyn Oral) Ticarcillin-Clavulanic Acid (Timentin) 29
250, 500 cap 125/5 syr, 250/5 forte 100/1; 125/1.25 drops 500 vial 50 – 100 q6 250, 500 cap 125, 250/5 susp < 2wks old, 100/1 drops give q12 250, 500 vial 375 mg (250/125) vial 750 mg (500/250), 1.5 g (1g/500) 50 – 100T 50T tab 100 – 200 1.2, 2.4 MU inj (high dose) 30 – 50 (Clavulanic Acid) 375, 625, 1g tab 156.25 (125) ,228.5 (200), 312.5 (250), 457/5 (400) susp A (bid 228/457) 125, 250/5 susp N 300, 600, 1.2 vial 50 – 100 QID 125, 250/5 susp 250, 500 cap 50 – 100 QID 250, 500 vial drip 200 – 400 (Piperacillin) q6 – q8 50 – 100 (preterms) 2.25g (2g/250mg) vial 4.5g (4g/500mg) vial, IV Infusion ( )ANST; 50 – 100 PO 125/5 - 200T „u‟ QID 250/5 - 400T „u‟ 625/5 -1.2M „u‟ 50 – 100 BID 375, 750 tab 250/5 susp 75 – 100 q8 – 1.6g vial: 1.5/100 q12 mkdose 3.2g vial: 5/2
CEPHALOSPORINS Cefalexin 1 (Ceporex) 1
25 – 50
Cefoxitin (Panafox)
80 – 160 q6 slow IV
Cefaclor 2 (Ceclor, Xelent) Cefuroxime 2 (Zinacef, Zinnat, Panaxim) Cefixime 3 (Tergecef, Ultraxime)
20 – 40 TID
Ceftazidime 3 (Fortum, Zeptrigen) Ceftriaxone 3 (Forgram, Rocephin) Cefotaxime 3
30 – 50 q8
50 – 100 q8
5 – 10 mkdose BID
50 – 100 q24 100 meningitic q12 – 24 50 – 100 q6
MVT / ASCORBIC ACID
250, 500, 1g cap 125, 250/5 susp 125/1.25, 100/1 d 1g vial IV
Ceelin
2 tsp 1 tsp
1 – 2y 3 – 12m <3m > 15y 4 – 15y
1.2 ml 0.6 ml 0.3 ml 2 tsp 1 tsp
1 – 2y 3 – 12m <3m 6 – 12y 2 – 6y
1.2 ml 0.6 ml 0.3 ml 2 tsp 1 tsp
6 – 24m <6m YA – children Ychild – infants
0.6 ml 0.3 ml 2.5 – 5 ml 0.5 – 1 ml
Vitamin A
<2y >2y
100T „u‟ 200T „u‟
Tiki-Tiki Plus
<1 y
Tiki-Tiki Star
Adults 4 – 12y 1 – 3y 6 – 12y 1 – 6y
2 tsp 1 tsp ½ tsp 1 tsp ½ tsp
<1y
0.3 ml
100/5 syr 100/1 drops
250 X, 500 cap 125, 250/5 susp 50/1 drops 250, 500 tab 125, 250/5 susp 250, 750, 1.5 inj 750 monovial 100, 200 cap 50mg/gx6g sach 100/5 susp 20/1 drops 250, 500, 1g IV 250, 500, 1g IM (pseudomonas) 250, 500, 1g, 2g vial 1, 2g monovial F
Pedcee 500/5 syr 100/1 drops
Cherifer with Taurine, CGF syrup / drops Prozinc syrup / drops
1, 2g vial
Cefepime 4 (Cepimax)
150 mkd q8 500, 1g, 2g vial mkdose: <2m 30 q8-12 >2m 40 q12 1st-Gram (+) esp Pnemococci, Strep, Staph, Kleb, E coli, Proteus; Poor activity vs MRSA, Pseudomonas, Enterobacter, Acinetobacter and B fragilis (PEAB) 2nd- 1st gen plus Kleb and B. Fragilis; less active on gram (+) Poor activity pseudomonas & enterobacter 3rd- Expanded gram (-) coverage; cross BBB; Active vs. Citrobacter, H. Flu & Neisseria; Poor activity vsEnterobacter 4th – More resistant to beta-lactamase; Activity vs PEAB 30
7 – 12y 2 – 6y
Clusivol syrup / drops
43
CEPHALOSPORINS 1
Cefalexin (Ceporex)
25 – 50
Cefoxitin 1 (Panafox) Cefaclor 2 (Ceclor, Xelent) Cefuroxime 2 (Zinacef, Zinnat, Panaxim) Cefixime 3 (Tergecef, Ultraxime)
80 – 160 q6 slow IV
Ceftazidime 3 (Fortum, Zeptrigen) Ceftriaxone 3 (Forgram, Rocephin) Cefotaxime 3
30 – 50 q8
20 – 40 TID
50 – 100 q8
5 – 10 mkdose BID
50 – 100 q24 100 meningitic q12 – 24 50 – 100 q6
MVT / ASCORBIC ACID
250, 500, 1g cap 125, 250/5 susp 125/1.25, 100/1 d 1g vial IV
Ceelin
2 tsp 1 tsp
1 – 2y 3 – 12m <3m > 15y 4 – 15y
1.2 ml 0.6 ml 0.3 ml 2 tsp 1 tsp
1 – 2y 3 – 12m <3m 6 – 12y 2 – 6y
1.2 ml 0.6 ml 0.3 ml 2 tsp 1 tsp
6 – 24m <6m YA – children Ychild – infants
0.6 ml 0.3 ml 2.5 – 5 ml 0.5 – 1 ml
Vitamin A
<2y >2y
100T „u‟ 200T „u‟
Tiki-Tiki Plus
<1 y
Tiki-Tiki Star
Adults 4 – 12y 1 – 3y 6 – 12y 1 – 6y
2 tsp 1 tsp ½ tsp 1 tsp ½ tsp
<1y
0.3 ml
100/5 syr 100/1 drops
250 X, 500 cap 125, 250/5 susp 50/1 drops 250, 500 tab 125, 250/5 susp 250, 750, 1.5 inj 750 monovial 100, 200 cap 50mg/gx6g sach 100/5 susp 20/1 drops 250, 500, 1g IV 250, 500, 1g IM (pseudomonas) 250, 500, 1g, 2g vial 1, 2g monovial F
Pedcee 500/5 syr 100/1 drops
Cherifer with Taurine, CGF syrup / drops Prozinc syrup / drops
1, 2g vial
Cefepime 4 (Cepimax)
150 mkd q8 500, 1g, 2g vial mkdose: <2m 30 q8-12 >2m 40 q12 1st-Gram (+) esp Pnemococci, Strep, Staph, Kleb, E coli, Proteus; Poor activity vs MRSA, Pseudomonas, Enterobacter, Acinetobacter and B fragilis (PEAB) nd 2 - 1st gen plus Kleb and B. Fragilis; less active on gram (+) Poor activity pseudomonas & enterobacter 3rd- Expanded gram (-) coverage; cross BBB; Active vs. Citrobacter, H. Flu & Neisseria; Poor activity vsEnterobacter 4th – More resistant to beta-lactamase; Activity vs PEAB 30
7 – 12y 2 – 6y
Clusivol syrup / drops
43
COUGH AND COLDS PREPARATION Ambroxol (Mucosolvan, Ambrolex, Zobrixol) 30,75 cap 30/5 syr 15/5 ped syr 7.5/1 drops Carbocisteine (Solmux, Loviscol) 500 cap 100/5 ped syr 50/1 drops
Codeine (Codipront) 30 cap 11/5 syr Phenylpropanolamine (Disudrin) – q6h 12.5/5 syr 6.25/1 drops Brompheniramine + Phenylephrine (Dimetapp Reformulated) 0.15mkd Syrup Drops TID - QID
>12y 6 – 12 y 2 – 6y 1 – 2y 12 – 24m 7 – 12m <6m Adult 5 – 12y <5y 9 – 12m 6 – 8m 3 – 5 m <3m Adult >14y 6 – 14y 4 – 6y 2 – 4 7 – 12y 2 – 6y 1 –2y 7 –12m 4 – 6m 1 – 3m 7 –12y 5 – 6y 2 – 4y
1 – 2 tsp TID 1 tsp ½ tsp ½ tsp BID 1 ml BID 0.75ml 0.5ml 1 cap TID 5 – 10ml 5 ml BID 1 ml QID 0.75 ml 0.5 ml 0.25 ml 1 cap BID 1 tbsp BID 2 tsp 1 tsp ½ tsp 1 tsp ½ tsp 1 ml ¾ ml ½ ml ¼ ml 7.5 ml 5 ml 4 ml
4 – 6y 2 – 4y 1 – 2y 6 – 12m 3 – 6m 1 – 3m
2.5 – ml 2 – 2.5 ml 1.5 – 2 ml 1.25 – 1.5 1 – 1.25 0.75 - 1
42
OTHER ANTIBIOTICS Amikacin q12 No skin test Aminoglycoside Azithromycin (Zithromax) Macrolide Ciprofloxacin (Ciprobay) Fluoroquinolone Chloramphenicol (Chloromycetin, Pediachlor) Clarithromycin (Klaricid) Macrolide Clindamycin (Dalacin C)
Codeine (Codipront) 30 cap 11/5 syr Phenylpropanolamine (Disudrin) – q6h 12.5/5 syr 6.25/1 drops Brompheniramine + Phenylephrine (Dimetapp Reformulated) 0.15mkd
42
10 mkd OD x 5d
200/5 susp 250 cap 500 tab/vial 250, 500 tab 100/50, 200/100, 400/200 IV infu 125/5 susp 250, 500 cap 1g vial 250, 500 tab 500 mg OD tab 50 vial 150, 300 cap 75/5 granules 150 amp 80/400 T sus 40/200 B sus 80/400 tab 160/800 forte 500 + 500 vial
20 mkdose q8
50 – 100 QID
7.5 mkdose BID 20 – 30 q6 – 8
5 – 8 BID (Trimethoprim)
Imipenem + Cilastatin (Tienam) B-Lactam Gentamycin Aminoglycoside
10 – 20 mkdose q8 max: 2g 5 – 8 6 – 7.5 q8
Meropenem (Meronem) B-Lactam
30 mkd 40 meningitic q8
Vancomycin (Vancocin)
10 – 15 mkdose q6
20/1; 80/2 amp 500, 1g vial (HAP, Sepsis, Neutropenic pxs) 500 vial (MRSA)
31
Ambroxol (Mucosolvan, Ambrolex, Zobrixol) 30,75 cap 30/5 syr 15/5 ped syr 7.5/1 drops Carbocisteine (Solmux, Loviscol) 500 cap 100/5 ped syr 50/1 drops
TID - QID
100, 250, 500 50, 125, 250/1
Co-Trimoxazole (Bactrim, Trizole)
COUGH AND COLDS PREPARATION
Syrup Drops
FT 10 PT 15
>12y 6 – 12 y 2 – 6y 1 – 2y 12 – 24m 7 – 12m <6m Adult 5 – 12y <5y 9 – 12m 6 – 8m 3 – 5 m <3m Adult >14y 6 – 14y 4 – 6y 2 – 4 7 – 12y 2 – 6y 1 –2y 7 –12m 4 – 6m 1 – 3m 7 –12y 5 – 6y 2 – 4y
1 – 2 tsp TID 1 tsp ½ tsp ½ tsp BID 1 ml BID 0.75ml 0.5ml 1 cap TID 5 – 10ml 5 ml BID 1 ml QID 0.75 ml 0.5 ml 0.25 ml 1 cap BID 1 tbsp BID 2 tsp 1 tsp ½ tsp 1 tsp ½ tsp 1 ml ¾ ml ½ ml ¼ ml 7.5 ml 5 ml 4 ml
4 – 6y 2 – 4y 1 – 2y 6 – 12m 3 – 6m 1 – 3m
2.5 – ml 2 – 2.5 ml 1.5 – 2 ml 1.25 – 1.5 1 – 1.25 0.75 - 1
OTHER ANTIBIOTICS Amikacin q12 No skin test Aminoglycoside Azithromycin (Zithromax) Macrolide Ciprofloxacin (Ciprobay) Fluoroquinolone Chloramphenicol (Chloromycetin, Pediachlor) Clarithromycin (Klaricid) Macrolide Clindamycin (Dalacin C)
31
FT 10 PT 15
100, 250, 500 50, 125, 250/1
10 mkd OD x 5d
200/5 susp 250 cap 500 tab/vial 250, 500 tab 100/50, 200/100, 400/200 IV infu 125/5 susp 250, 500 cap 1g vial 250, 500 tab 500 mg OD tab 50 vial 150, 300 cap 75/5 granules 150 amp 80/400 T sus 40/200 B sus 80/400 tab 160/800 forte 500 + 500 vial
20 mkdose q8
50 – 100 QID
7.5 mkdose BID 20 – 30 q6 – 8
Co-Trimoxazole (Bactrim, Trizole)
5 – 8 BID (Trimethoprim)
Imipenem + Cilastatin (Tienam) B-Lactam Gentamycin Aminoglycoside
10 – 20 mkdose q8 max: 2g 5 – 8 6 – 7.5 q8
Meropenem (Meronem) B-Lactam
30 mkd 40 meningitic q8
Vancomycin (Vancocin)
10 – 15 mkdose q6
20/1; 80/2 amp 500, 1g vial (HAP, Sepsis, Neutropenic pxs) 500 vial (MRSA)
ANTIPYRETICS AND ANALGESICS Aspirin (Aspilets) 80 6.5 mkday Ibuprofen (Dolan) 100/5
Anti-inflam Kawasaki RHD 10 mkdose 7 – 12y 2 – 6y 0.2 mkdose x 3 doses
60 – 90 mkdose 100 mkd q6 80 – 100 mkdq6
Morphine Nalbuphine Paracetamol (Tempra, Calpol)
0.05 – 0.1 mkdo 0.15 x wt mkdo 10 – 15 mkdose
Tramadol (Tradonal)
0.5 mkdose
10/1 amp 10/1 amp 120/5 syr 250/5 forte syr 100/ml drops 50 mg cap 100/2 syr 100/1 drops
Indomethacin (Indocid)
ANTIMICROBIAL SPECTRA OF SELECTED ANTIMICROBIALS (from UMED)
LEGEND: + = usually effective clinically or >60% susceptible + = clinical trials lacking or 30-60% susceptible 0 = not effective clinically or <30% effective S = synergistic w/ Ampicillin NT = not tested
32
10 ml q6 5 – 10 25mg/tab + 25 cc VODKA
GIT PREPARATIONS Dicycloverine (Relestal) colic Domperidone (Motilium) Glycerin Suppository
5/1 drops 6m – 2y 0.5 -1ml q4-6h 0.5 mkd AC TID - QID 1.9g pediatric supp 2.5g adult supp
2/1 syrup 6 – 12y 5ml 2 – 5y 2.5-5ml 1/1 susp 10 tab
Maalox Antacids Omeprazole (Losec)
2 – 4 chewtabs 15 ml PC, qHS
chew tabs 225/200 susp 10, 20 cap 40 IV
Ranitidine (Zantac) H 2 Blocker
2 – 4 BID
75,150, 300 tab 150, 300 FR tab 50/2 amp
41
ANTIPYRETICS AND ANALGESICS Aspirin (Aspilets) 80 6.5 mkday Ibuprofen (Dolan) 100/5 Indomethacin (Indocid) Morphine Nalbuphine Paracetamol (Tempra, Calpol)
ANTIMICROBIAL SPECTRA OF SELECTED ANTIMICROBIALS (from UMED)
Anti-inflam Kawasaki RHD 10 mkdose 7 – 12y 2 – 6y 0.2 mkdose x 3 doses 0.05 – 0.1 mkdo 0.15 x wt mkdo 10 – 15 mkdose
LEGEND: Tramadol (Tradonal)
+ = usually effective clinically or >60% susceptible + = clinical trials lacking or 30-60% susceptible 0 = not effective clinically or <30% effective S = synergistic w/ Ampicillin NT = not tested
32
0.5 mkdose
60 – 90 mkdose 100 mkd q6 80 – 100 mkdq6 10 ml q6 5 – 10 25mg/tab + 25 cc VODKA 10/1 amp 10/1 amp 120/5 syr 250/5 forte syr 100/ml drops 50 mg cap 100/2 syr 100/1 drops
GIT PREPARATIONS
41
Dicycloverine (Relestal) colic Domperidone (Motilium)
5/1 drops 6m – 2y 0.5 -1ml q4-6h 0.5 mkd AC TID - QID
Glycerin Suppository Maalox Antacids Omeprazole (Losec)
1.9g pediatric supp 2.5g adult supp 2 – 4 chewtabs 15 ml PC, qHS
Ranitidine (Zantac) H 2 Blocker
2 – 4 BID
2/1 syrup 6 – 12y 5ml 2 – 5y 2.5-5ml 1/1 susp 10 tab
chew tabs 225/200 susp 10, 20 cap 40 IV 75,150, 300 tab 150, 300 FR tab 50/2 amp
ANTIHISTAMINES
Betamethasone + Dexchlorpheniramine (Celestamine) Cetirizine (Virlix)
6 – 12y 2 – 6y
Diphenhydramine (Benadryl)
1 mkdose TID
Hydroxyzine (Iterax) Loratadine (Claritin)
0.5 mkdose BID
½ tab/tsp ¼ - ½ tsp TID 10/1 drops 10 tab OD 1/1 soln 12.5/5 syr 50/1 amp 25, 50 cap 10, 25 tab 2/1 syr
0.5 –1 mkdo BID - TID
5/5 syr 10tab
0.25 – 0.5 mkdo BID
STEROIDS Dexamethasone
0.08-0.3 mkd q6 – q12 LD 7; MD 7 q8 5 – 25 mg daily
Hydrocortisone (Solu – Cortef) Prednisone (Pred 5, Pred 30, Liquipred)
5/1 inj 100/2, 250/2, 500/4 vial 5, 30 tab 15/5 syr
APPETITE STIMULANTS Appebon
7 – 14y 2 – 6y adults child/ adole PT / infants 6 – 12y 2 – 6y
Heraclene 2 – 6 wks 1mg/cap Pediafortan AS
2 – 4 tsp OD 1 – 2 tsp 3 caps OD 2 – 3 caps 1 cap 1 – 2 tsp 1 tsp
40
33
ANTIHISTAMINES
Betamethasone + Dexchlorpheniramine (Celestamine) Cetirizine (Virlix)
6 – 12y 2 – 6y
Diphenhydramine (Benadryl)
1 mkdose TID
Hydroxyzine (Iterax) Loratadine (Claritin)
0.5 mkdose BID
½ tab/tsp ¼ - ½ tsp TID 10/1 drops 10 tab OD 1/1 soln 12.5/5 syr 50/1 amp 25, 50 cap 10, 25 tab 2/1 syr
0.5 –1 mkdo BID - TID
5/5 syr 10tab
0.25 – 0.5 mkdo BID
STEROIDS Dexamethasone
0.08-0.3 mkd q6 – q12
5/1 inj
Hydrocortisone (Solu – Cortef)
LD 7; MD 7 q8
100/2, 250/2, 500/4 vial
Prednisone (Pred 5, Pred 30, Liquipred)
5 – 25 mg daily
5, 30 tab 15/5 syr
APPETITE STIMULANTS Appebon
7 – 14y 2 – 6y
2 – 4 tsp OD 1 – 2 tsp
Heraclene 2 – 6 wks 1mg/cap Pediafortan AS
adults child/ adole PT / infants 6 – 12y 2 – 6y
3 caps OD 2 – 3 caps 1 cap 1 – 2 tsp 1 tsp
40
33
DPT FOR SEDATION > 15y (50mg)
< 15y
Demerol
1ml
0.5ml (25mg)
Phenergan
0.5 ml (12.5mg)
0.25ml (0.25mg)
Thorazine
0.5ml (12.5mg)
0.25ml (0.25mg)
ANTI ASTHMA Aminophylline As drip + 15cc D5W
5 mkd LD 0.2 – 0.5 MD MD = [(0.2) x wt] x 3 q3h cycles
25mg/ml amp
34
Budesonide (Budecort)
Respules: 250, 500 ug/ml 500 – 1000 ug BID initial 250 – 500 ud BID MD
Doxophylline (Ansimar) 400 mg tab 100/5 syr
5 – 9 mkdose >12 y <12 y Adults
10 ml BID 6 – 9 ml BID 1 tab TID
Salbutamol (Ventolin) 2 mg tab, 2/5 syr 2.5/2.5 nebules 100 ug inhaler Terbutaline (Bricanyl) 2.5 mg tab 0.3 mg/ml syr
>12 7 – 12y 2 – 6y
1 – 2 tab / tsp 1 tab / tsp ½ tab / tsp
7 – 15y 3 – 7y <3y
5 – 10 ml BID 2.5 ml BID 0.075 mkd
39
DPT FOR SEDATION > 15y (50mg)
< 15y
Demerol
1ml
0.5ml (25mg)
Phenergan
0.5 ml (12.5mg)
0.25ml (0.25mg)
Thorazine
0.5ml (12.5mg)
0.25ml (0.25mg)
ANTI ASTHMA Aminophylline As drip + 15cc D5W
5 mkd LD 0.2 – 0.5 MD MD = [(0.2) x wt] x 3 q3h cycles
25mg/ml amp
34
39
Budesonide (Budecort)
Respules: 250, 500 ug/ml 500 – 1000 ug BID initial 250 – 500 ud BID MD
Doxophylline (Ansimar) 400 mg tab 100/5 syr
5 – 9 mkdose >12 y <12 y Adults
10 ml BID 6 – 9 ml BID 1 tab TID
Salbutamol (Ventolin) 2 mg tab, 2/5 syr 2.5/2.5 nebules 100 ug inhaler Terbutaline (Bricanyl) 2.5 mg tab 0.3 mg/ml syr
>12 7 – 12y 2 – 6y
1 – 2 tab / tsp 1 tab / tsp ½ tab / tsp
7 – 15y 3 – 7y <3y
5 – 10 ml BID 2.5 ml BID 0.075 mkd
ANTICONVULSANTS
Carbamazepine (Tegretol) Gen Tonic Clonic Clonazepam (Rivotril)
10 mkd; ↑ to 20/1 syr 20-30mkd TID 200 tab/SR tab (8-12 meq/mL) <30 kg à 0.05 mkd BID-TID max: 0.2mkd >30 kg à 1.5 mkd TID nmt 20mg/d
Absence, Myo, Partial Infantile Spasm Diazepam (Valium)
2mg/ tab
Ethosuximide (Zarontin) Absence Phenobarbital GTC Phenytoin (Dilantin)
Valproate (Epival, Depakene GTC, Absence
0.2 mkdo IV 0.3 mkdo IM 0.4 mkdo rect 20 mkd; ↑ to 40 mkd (40-100 meq/ml) 3 – 5 mkd BID LD:15 mg/kg (15-40 meq/ml) 3 – 9 mkd BID LD: 20mg/kg Max infu rate: 1mg/kg/min = cardiac standstill 10 mkd 30 – 60 mkd TID – QID (50 –100 meq/ml) SEDATION FOR EEG
10/2 amp 2, 5, 10 tab
15, 30, 60, 90 t
30, 125/5 susp 30, 100 tab 100/2 inj
250 tab E 250/5 syr D
Benadryl 1 mkdose Phenergan + Thorazine Benadryl + Thorazine NO DORMICUM, epileptiform focus
DIAZEPAM,
LUMINAL
– will
remove
38
35
ANTICONVULSANTS
Carbamazepine (Tegretol) Gen Tonic Clonic Clonazepam (Rivotril)
10 mkd; ↑ to 20/1 syr 20-30mkd TID 200 tab/SR tab (8-12 meq/mL) <30 kg à 0.05 mkd BID-TID max: 0.2mkd >30 kg à 1.5 mkd TID nmt 20mg/d
Absence, Myo, Partial Infantile Spasm Diazepam (Valium)
2mg/ tab
Ethosuximide (Zarontin) Absence Phenobarbital GTC Phenytoin (Dilantin)
Valproate (Epival, Depakene GTC, Absence
0.2 mkdo IV 0.3 mkdo IM 0.4 mkdo rect 20 mkd; ↑ to 40 mkd (40-100 meq/ml) 3 – 5 mkd BID LD:15 mg/kg (15-40 meq/ml) 3 – 9 mkd BID LD: 20mg/kg Max infu rate: 1mg/kg/min = cardiac standstill 10 mkd 30 – 60 mkd TID – QID (50 –100 meq/ml) SEDATION FOR EEG
10/2 amp 2, 5, 10 tab
15, 30, 60, 90 t
30, 125/5 susp 30, 100 tab 100/2 inj
250 tab E 250/5 syr D
Benadryl 1 mkdose Phenergan + Thorazine Benadryl + Thorazine NO DORMICUM, epileptiform focus 38
DIAZEPAM,
LUMINAL
– will
remove
35