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Picu Pocketbook
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Picu Pocketbook
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PICU POCKET CARD ETT size= (Age in years+16)/4 ETT depth from lip/teeth=3xETT size FORMULAE: ! inf"sions# mg dr"g/1$$ml %"id = 1 89A(m.)= 6 x desired dose(m&g/'g/min) x height ( cm ) ×weight ( kg ) ÷ 3600 √ height eight('g) esired rate (m*/hr) w eight× height÷ height÷ 60 or √ weight× VASOPRESSORS: . :5; = ' < hei height ght(&m (&m)/ )/ edi&atio edi&atio ose(m&g/' ! 9&reat(mg/d*) = x n g/min) inf"sion ml/min/13m . rate a = $33 $33 iin n *80> *80> t?1 t?1 opamine ,-.$ 1ml/hr 'g o"tami ,-.$ 1ml/hr $4, $4, in ter term m A:A A:A ? 1 ne year Adrenaline $1-1 1ml/hr= & $, $,, in (0arm $1m&g/ &hildren/adoles&ent sho&') 'g/min females 2or$$,-. 1ml/hr= d $$ $$ in adol adoles& es&en entt adrenaline $1m&g/ males (old 'g/min 3 7odera 7oderall index index = eight/le eight/length ngth3 sho&') < 1$$ ilrinone ,$-, 4 :; = @ of dextro dextrose se < inf"si inf"sion on mg/'g rate(ml/'g/day) rate(ml/'g /day) /144 loading , 8i&ar 8i&ar &orre& &orre&tion tion## dose a 2eona 2eo nate= te=$6 $6 x $.,-1 eight(98E-) mg/'g/min 2on-n 2on-neon eonate ate=$ =$3 3x SEDATION by infusion: eight(98E-) idazolam 1-3 m&g/'g/min & :iBe :iBe half half dose dose stat stat and 5entanyl 1-, m&g/'g/hr(1$$"g/ml ine&tion) remaining in diBided 7ropofol 1-. mg/'g/hr doses in !5 orphine $1-$. mg/'g/hr after a ol"s of $1 mg/'g d 9tat dose as 1-. mEC/'g mEC/'g (1$mg/ml ine&tion) Atra&"ri"m $, mg/'g $3-$, mg/'g/min
6 9odi"m 9odi"m &orr &orre&tio e&tion n = $6 < eight < sodi"m deD&it ANTIBIOTICS: 1 AA AA2# 2# 1,-.$m 1,-.$mg/'g g/'g/d /d 1. hr> neonates till days F . :E2TA :E2TA2# 2# ,$mg/ ,$mg/'g/d 'g/d 1hr 3 E5F7E; E5F7E;AGF2 AGF2E/9H E/9H*8A *8ATH TH( ( A:2E<)# 1$$mg/'g/d Ch 4 E5FT E5FTA<E# A<E# 1$$-1,$mg/' 1$$-1,$mg/'g/d g/d C6-h> meningitis# .$$mg/'g/d C6h , E5T E5TAGE( AGE(5F; 5F;TH TH)#1$ )#1$$$1,$mg/'g/d Ch 6 E5T; E5T;A< A
eningitis# 1$$mg/'g/d C1.h E5H;F E5H;F< <E# E# ,$-1$$mg/' ,$-1$$mg/'g/d g/d C6-h 7*F< 7*F<## 1$-.$mg/' 1$-.$mg/'g/d g/d C1.h C1.h I F5*F< F5*F<## ,-1$mg/ ,-1$mg/'g/d 'g/d C1.h 1$*2AJ2# .$-4$mg/'g/d C6-h 11AF
$$>$$$ "nits/'g/d C6h 1477TAG# 3$$-4$$mg/'g/d C6-h 1,7E2E/*A9TAT2# 6$-1$$ mg/'g/d C6h 16E;F7E2E# 6$mg/'g/d Ch> neonates.$mg/'g/dose C1.h> meningitis 4$mg/'g/dose Ch
1AGT;EF2A# I$-3$$mg/'g/d C6-h 1K*F;A7KE2F*# 1$$mg/'g/d C6h 1I*2EGF*# neo? days -1$mg/'g/dose C1.h> Ldays11yr M Ch .$TEF7*A22# 1$mg/'g C1.h x 3 doses 1$mg/'g/d F .1!A2FJ2# 1$mg/'g/dose C6h> meningitis M 1,mg/'g/dose C6h ..7F*J<2 8# .,>$$$ "nits/'g C1.h ANTICONVULSANTS: 1 AGE7A# $.-$, mg/'g/dose L1 month of age> max ,mg for ?, yrs> 1$mg for L,yrs . *F;AGE7A# $$,-$1 mg/'g/dose > max 4 mg 3 7KE2F8A;8TF2E# *oading 1,-.$ mg/'g at 1mg/'g/min> &an giBe ,mg/'g till max 3$ mg/'g aintenan&e 3-, mg/'g/d C1.h or K9 F 4 7KE2JTF2# loading dose1,-.$ mg/'g/d at 1mg/'g/min maintianen&e dose ,N mg/'g/d C-1.h , !A*7;FATE# loading .$ mg/'g ,-1$ mg/'g/dose Ch SEDATION FOR PROCEDURES:
1 AGF*A# $. mg/'g/dose> max 6mg> in&rements of .,@ of initial dose . 5F;T02# 1 mg/'g/dose 3 7KE2A;:A2# 1 mg/'g/dose OTHERS: 1 ;A2TA# 1 mg/'g/dose K !> C1.K 7F . *A9<# 1 mg/'g/dose 3 7;8# 1$ ml/'g oBer 4 ho"rs ith *asix miday> in 5 M ,ml/'g 4 557# 1$ ml/'g oBer . ho"rs , ;7# 1, ml/'g oBer 3$ mins 6 E
Basic P!ia"#ic Mc$anica% Vn"i%a"ion S""in&s fo# &""in& s"a#"!: Vo%u' Vn"i%a"ion Mo! SIMV(VC 1 5iF. - ,$@> if si&' 1$$@ 0ean rapidly to 5iF. ? ,$@ if possile
. nspiratory time ( time)- minim"m $, se&onds> ranging "p to 1 se&ond in older 'ids 3 ;ate (!)- age appropriate 3$ (infants) don to 1,( ad"lt sized patients) to start 4 Tidal Bol"me (!t) - 1$ml/'g ro"nding don then loo' at &hest rise> listen for reath so"nds and &he&' 7ea' nspiratory 7ress"re (77) , e&rease !t 5 exam reBeals ex&essiBe &hest rise> large air entry and higher than expe&ted 77s (?3$3, &m K.$) EleBated 77s may res"lt from ; main stem ET t"e pla&ement> m"&o"s pl"gging> ex&essiBe !t or poor l"ng &omplian&e> ie 1O p"lmonary disease 9trongly &onsider sit&hing to press"re &ontrol style reath for seBere l"ng disease 6 n&rease !t 5 exam reBeals poor &hest rise> minimal air entry and loer than expe&ted 77s (?1, &m K.$) 8e aare that ad"lt size Bentilator &ir&"its may gole large amo"nts of Bol"me ea&h reath (.-3 &&/ eBery &m K.F press"re diPeren&e eteen 77 and 7EE7) f this o&&"rs in&rease !t or &hange to a press"re &ontrol style reath 7EE7 - 4&m> higher if 5; &ompromised y atele&tasis> adominal distension or seBere l"ng disease n&rease in .&m K.F
aliC"ots !ol"me re&r"itment ith 7EE7 ta'es ho"rs "t &an e lost in min"tes 7ress"re 9"pport (79)- (f aBailale) for spontaneo"s reathing patients 79 starts at 1$ &m K.F I A8: to a&&"rately a&&ess Bentilation stat"s 1$ <; to &onDrm adeC"a&y of ET t"e pla&ement and &hest expansion 11 End Tidal F. monitors if aBailale S""in&s fo# &""in& s"a#"!: P#ssu# Vn"i%a"ion Mo! SIMV(PC 1 9ame initial settings as !ol"me &ontrol for 5iF. > t> ;ate> 7EE7> and 79 . Altho"gh not int"itiBe 7ress"re style Bentilation oPers adBantages y alloing ePe&tiBe !t at loer 77> and improBes oxygenation for any giBen !t 9trongly &onsider press"re Bentilation (if aBailale) for large air lea's d"e to small ET t"e size> inePe&tiBe Bentilation .O ad"lt Bent &ir&"it on small infant/&hild> or poor l"ng &omplian&e 3 9et 7ress"re &ontrol to giBe ePe&tiBe &hest rise and aCed"ate air entry Expe&t 77s 1-.. &m K.F in patients ith healthy l"ngs> .3-. &m K.F for moderate l"ng disease>
.-3, &m K.F in more seBere disease 4 Fn&e 7 is estalished> loo' at ma&hine meas"red inspiratory and expiratory Bol"mes as an estimate of patients l"ng &omplian&e !ol"mes sho"ld e ?1$ml/'g to aBoid oBerstret&h Si')% P#ob%' so%*in&: 0hen a Bentilated patient a&"tely deteriorates donQt e aR D islodged ET T"e- &he&' for eC"al reath so"nds> EtF. S> O str"&ted M "&o"s pl"g> s"&tion P ne"mothorax- &he&' for eC"al reath so"nds> needle &ompression Bs <; ased on relatiBe "rgen&y E C"ipment fail"re- dis&onne&t from &ir&"it> hand ag> &onDrm 1$$@ F. is %oing S"#a"&is fo# 'o# Co')%+ )#ob%'s: Kypoxemia# goal is to ean 5F. ? ,$@ 1 inimize airlea' y pla&ing larger Et t"e> y repositioning head or &hanging to press"re mode . n&rease 7EE7 in .&m K.F in&rements to in&rease f"n&tional resid"al &apa&ity (Aerated l"ng Bol"me) onsider paralyti&s for 7EE7 L 1$
3 n&rease time to in&rease ean Airay press"re 4 n&rease ;ate espe&ially if 7F. is eleBated as ell and there is need to in&rease min"te Bentilation , hanging to 7ress"re &ontrol ill res"lt in improBed oxygenation for the same Bol"me deliBered 6 Fn&e the appropriate !t is estalished> re&ommend against &hanging Bol"mes n A;9 Bentilator ind"&ed l"ng in"ry is asso&iated ith TB L -1$ ml/'g Hi&$ Pa, P#ssu#s: (L3, &mK.F or platea" press"re L 3$ &m K.F) 1 9"&tion Et t"e . he&' t"e position ith <; 3 onsider inhaled ron&hodilators espe&ially if patient ith prolonged expiratory phase and deBeloping a"topeep 4 hanging to 7ress"re &ontrol ill res"lt in loer pea' press"re for the same !t , onsider adopting a 7ermissiBe hyper&apnia strategy if l"ng &omplian&e and oxygenation is poor if the fa&e of high pea' press"res This entails limiting deliBered TB to ro"ghly 6ml/'g of ideal ody eight> liBing ith m"&h higher 7F. and loer sat"rations (,@)> "sing Kigher 7EE7 and longer t for re&r"itment and oxygenation
Consi!#a"ions fo# E+"uba"ion: I')#o*! %un& !isasS e&retions / 9edation / 9pontaneo"s !t (L,ml/'g) M minimal s"&tion freC"en&yS 7atient aa'e eno"gh to reath and prote&t airayS O xygenation 5iF. ?3,@ A iray - aintainaleS *ea'S> onsider steroids 1. ho"rs prior if me&hani&al Bentilation L4O or after m"ltiple airay int"ations P ress"res - 77 ?.,> 7EE7 ? , P#!ic"o#s of E+"uba"ion Fai%u# !ariale *o ris' ?1$@ Kigh ;is' L.,@ TB spontaneo"s L6, ml/'g ?3, ml/'g
5F. ?$3$ L$4$ 77 ?.,&mK.$ L3$&mK.$
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