Picu Pocketbook

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PICU POCKET CARD PICU POCKET CARD ETT size= (Age in years+16)/4 ETT size= (Age in years+16)/4 ETT depth from lip/teeth=3xETT size ETT depth from lip/teeth=3xETT size ! inf"sions# mg dr"g/1$$ml %"id = ! inf"sions# mg dr"g/1$$ml %"id = 6 x desired dose(m&g/'g/min) x 6 x desired dose(m&g/'g/min) x eight('g) eight('g) esired rate (m*/hr) esired rate (m*/hr) VASOPRESSORS: VASOPRESSORS: e edi&atiodi&atio n n ose(m&g/' ose(m&g/' g/min) g/min) ! ! inf"sion inf"sion rate rate  ooppaammiinnee ,,--..$$ 11mmll//hhrr o"tami o"tami ne ne , ,--..$$ 11mmll//hhrr Adrenaline Adrenaline (0arm (0arm sho&') sho&') $ $11--11 11mmll//hhrr== $1m&g/ $1m&g/ 'g/min 'g/min 2or-adrenaline adrenaline (old (old sho&') sho&') $ $$$,,--.. 11mmll//hhrr== $1m&g/ $1m&g/ 'g/min 'g/min  iillrriinnoonnee ,,$$--,, mg/'g mg/'g loading loading dose dose $.,-1 $.,-1 mg/'g/min mg/'g/min SEDATION by infusion: SEDATION by infusion: 

iiddaazzoollaamm 1--3 13 mm&&gg//''gg//mmiinn 5

5eennttaannyyll 11--, , mm&&gg//''gg//hhrr((11$$$$""gg//mml l iinnee&&ttiioonn)) 7

7rrooppooffooll 11--. . mmgg//''gg//hhrr 

oorrpphhiinnee $$11--$$. . mmgg//''gg//hhr r aafftteer r a a ooll""s s oof f $$1 1 mmgg//''gg (1$mg/ml ine&tion)

(1$mg/ml ine&tion) A

Attrraa&&""rrii""mm $$, , mmgg//''g g $$33--$$, , mmgg//''gg//mmiinn FORMULAE: FORMULAE:

1

1 8899AA((mm..₎₌₎₌

√

height height

((

cmcm

))

×weight ×weight

((

kgkg

))

÷÷36003600

or

or √ √ weiweight×ght× heiheight÷ght÷6060 .

. :5; :5; = ' < h= ' < heieightght(&m(&m)/)/ 9&reat(mg/d*) = x 9&reat(mg/d*) = x ml/min/13m ml/min/13m.. a a  = $ = $33 i33 in *8n *80> 0> t?1t?1 'g 'g 

 $4$4, in t, in tererm A:m A:A ? 1A ? 1 year year & & $$,,, , inin &hildren/adoles&ent &hildren/adoles&ent females females d

d $$$ in ad$ in adololes&es&enentt males

males 3

3 7o7oderaderal indel index = eighx = eight/let/lengthngth33

< 1$$ < 1$$ 4

4 :; = @ :; = @ of deof dextroxtrose < inse < inf"sif"sionon rate(ml/'g

rate(ml/'g/day) /day) /144/144 ,

, 8i&a8i&ar r &or&orre&re&tiontion## a

a 2eo2eonanate=te=$6 $6 xx eight(98E-) eight(98E-) 

 2o2on-nn-neoneonateate=$=$3 x3 x eight(98E-) eight(98E-) &

& :iB:iBe hale half dosf dose stae stat andt and remaining in diBided remaining in diBided doses in !5

doses in !5 d

d 9tat 9tat dose dose as as 1-. 1-. mEC/mEC/'g'g

6

6 9od9odi"m &i"m &orrorre&tioe&tion = $6 n = $6 << eight < sodi"m deD&it eight < sodi"m deD&it ANTIBIOTICS:

ANTIBIOTICS: 1

1 AAAA2# 1,2# 1,-.$m-.$mg/'gg/'g/d -/d -1. hr> neonates till  days F 1. hr> neonates till  days F .

. :E2T:E2TAA2# ,$2# ,$mg/mg/'g/d 'g/d --1hr

1hr 3

3 E5FE5F7E;7E;AGF2AGF2E/9HE/9H*8A*8ATHTH(( A:2E<)# 1$$mg/'g/d Ch A:2E<)# 1$$mg/'g/d Ch 4

4 E5FE5FTTA<A<E# 1$$-1,$E# 1$$-1,$mg/'mg/'g/dg/d C6-h> meningitis# .$$mg/'g/d C6-h> meningitis# .$$mg/'g/d C6h

C6h ,

, E5E5TTAGAGE(E(5F;5F;THTH)#1$)#1$$- $-1,$mg/'g/d Ch

1,$mg/'g/d Ch 6

6 E5E5T;T;A<A<F2E# ,$-F2E# ,$-, mg/', mg/'g/dg/d C1.h> eningitis# 1$$mg/'g/d C1.h> eningitis# 1$$mg/'g/d C1.h

C1.h 

 E5HE5H;F;F<<E# ,$-1$$E# ,$-1$$mg/'mg/'g/dg/d C6-h C6-h   7*7*F<F<# 1$-.$# 1$-.$mg/'mg/'g/d C1g/d C1.h.h I I F5*F5*F<F<# ,-1# ,-1$mg/$mg/'g/d 'g/d C1.hC1.h 1$*2AJ2# .$-4$mg/'g/d 1$*2AJ2# .$-4$mg/'g/d C6-h C6-h 11AF<J**2# 1$$mg/'g/d C6h 11AF<J**2# 1$$mg/'g/d C6h 1.AH:E2T2# ,$-1$$mg/'g/d 1.AH:E2T2# ,$-1$$mg/'g/d C6-h C6-h 13-7E2# 1>$$>$$$ "nits/'g/d C6h 13-7E2# 1>$$>$$$ "nits/'g/d C6h 1477TAG# 3$$-4$$mg/'g/d C6-h 1477TAG# 3$$-4$$mg/'g/d C6-h 1,7E2E/*A9TAT2# 6$-1$$ 1,7E2E/*A9TAT2# 6$-1$$ mg/'g/d C6h mg/'g/d C6h 16E;F7E2E# 6$mg/'g/d Ch> 16E;F7E2E# 6$mg/'g/d Ch> neonates.$mg/'g/dose C1.h> neonates.$mg/'g/dose C1.h> meningitis 4$mg/'g/dose Ch meningitis 4$mg/'g/dose Ch

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1AGT;EF2A# I$-3$$mg/'g/d C6-h

1K*F;A7KE2F*# 1$$mg/'g/d C6h

1I*2EGF*# neo? days -1$mg/'g/dose C1.h> Ldays-11yr M Ch .$TEF7*A22# 1$mg/'g C1.h x 3 doses 1$mg/'g/d F .1!A2FJ2# 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;8TF2E# *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 7KE2JTF2# 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 Ch SEDATION FOR PROCEDURES: 1 AGF*A# $. mg/'g/dose> max 6mg> in&rements of .,@ of initial dose . 5F;T02# 1 mg/'g/dose 3 7KE2A;:A2# 1 mg/'g/dose OTHERS: 1 ;A2TA# 1 mg/'g/dose K !> C1.K 7F . *A9<# 1 mg/'g/dose 3 7;8# 1$ ml/'g oBer 4 ho"rs ith *asix miday> in 5 M ,ml/'g

4 557# 1$ ml/'g oBer . ho"rs , ;7# 1, ml/'g oBer 3$ mins 6 E<A# peri-ext"ation- $,-.

mg/'g/day x 3 doses

Basic P!ia"#ic Mc$anica% Vn"i%a"ion

S""in&s fo# &""in& s"a#"!: Vo%u' Vn"i%a"ion Mo! SIMV(VC

1 5iF. - ,$@> if si&' 1$$@ 0ean rapidly to 5iF. ? ,$@ if possile

. nspiratory time ( time)- minim"m $, se&onds> ranging "p to 1 se&ond in older 'ids

3 ;ate (!)- age appropriate 3$ (infants) don to 1,( ad"lt sized patients) to start

4 Tidal Bol"me (!t) - 1$ml/'g ro"nding don then loo' at &hest rise> listen for reath so"nds and &he&' 7ea' nspiratory 7ress"re (77) , e&rease !t 5 exam reBeals ex&essiBe &hest rise> large air entry and higher than expe&ted 77s (?3$-3, &m K.$) EleBated 77s 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 sit&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 loer than expe&ted 77s (?1, &m K.$) 8e aare that ad"lt size Bentilator &ir&"its may gole large amo"nts of Bol"me ea&h reath (.-3 &&/ eBery &m K.F press"re diPeren&e eteen 77 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>

adominal distension or seBere l"ng disease n&rease in .&m K.F

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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

aBailale) 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

aBailale

S""in&s fo# &""in& s"a#"!: P#ssu# Vn"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 alloing ePe&tiBe !t at loer 77> and improBes oxygenation for any giBen !t 9trongly &onsider press"re Bentilation (if aBailale) 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 77s 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 estalished> 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> EtF. 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 %oing

S"#a"&is fo# 'o# Co')%+ )#ob%'s:

Kypoxemia# goal is to ean 5F. ? ,$@

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 Airay press"re

4 n&rease ;ate espe&ially if 7F. 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 estalished> 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&$ Pa, 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 loer 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 7F. and loer sat"rations (,@)> "sing Kigher 7EE7 and longer t for re&r"itment and oxygenation

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Consi!#a"ions fo# E+"uba"ion: I')#o*! %un&

!isas-S e&retions / 9edation / 9pontaneo"s !t (L,ml/'g) M minimal s"&tion freC"en&yS 7atient aa'e eno"gh to reath and prote&t airayS

O xygenation 5iF. ?3,@ A iray - aintainaleS *ea'S> onsider steroids 1. ho"rs prior if me&hani&al Bentilation L4O or after m"ltiple airay int"ations

P ress"res - 77 ?.,> 7EE7 ? , P#!ic"o#s of E+"uba"ion Fai%u# !ariale *o ris' ?1$@ Kigh ;is' L.,@

TB spontaneo"s L6, ml/'g ?3, ml/'g

5F. ?$3$ L$4$

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