EMERGENCY DRUGS Epinephrine 0.01 mkd Atropine 0.02-0.03 mkd Adenocard 6 mg initially; 12mg nxt Adenosine 6mg/2mL Ca Gluc 10% 0.1-0.2 mkd Captopril 0.3-1.0 mkD q 12 Capoten 25mg/tab Hydralazine 0.1-0.5 mkd Apresoline PO: 10mg; 25 IV: 20mg/amp L-Carnitine 30-40 mkd Carnicor PO: 1/10; 330 IV: 1/5 Lidocaine 1.0 mkd bolus 10-50 ugKm Mannitol 20% 1-2 mkd Prep 1.2% soln (1 med/mL) NaHCO3 1.5-2.0 mkd Naloxone 0.1 mkd Plain 0.4mg/1mL Neonatal 0.02mg/1mL Nifedipine 0.2-1.0 mkd Nipride 0.5-1.5 ugkm Urecholine 2.9mg/m2/d q8 PO CEPHALOSPORINS 1st Generation Cephalexin 50-100 mkD q6 Cefadroxil 25-50 mkD BID Cefalothin 50-100 mkD QID Cefazolin 50-100 mkD QID Cephradine 25-50 mkD q6 2nd Generation Cefamandole 50-100 QID Cefaclor 20-40 mkD q12 Ceclor 125/5; 250/5 DS Cefuroxime IV: 50-100 mkD q8 PO: 20-40 mkD BID Zinnat 125/5,250/5 Zinacef IV 3rd Generation Cefotaxime 50-100 mkD BID-QID NB: 50 mkd q 12H 1g bid for > 12yo & adults Claforan 500mg; 1g; 2g Ceftriaxone Child: 20-80 mkD OD Adult: 1-2 g OD Rocephin AMINOGLYCOSIDES Amikacin 10-15 mkD Amikacide 100/2; 250/2 Kanamycin 30-50 mkD Netilmycin 6-8 mkD Nettomycin 50/2 Tobramycin 6-8 mkD (Nebcin) Gentamycin 5-8 mkD IV Garamycin 20mg; 40mg; 80 ANTI-AMOEBIC Metronidazole 40-50 mkD (7.5 mkd) < 7 or > 2q = 7 mkD > 7 or > 2 g = 30 mkD Flagyl PO: 125/5; 250 IV: 500/100 Metroxyn 500mg Servizole 200mg/5mL
Tinidazole 50-60 mg OD x 3 days (AGE) 50-60 mg x 5 days (liver) Etofamide 15-20 mkD Kitnos 40/5; 250; 500 Furazolidone 5-7 MKD q6 Cotrimoxazole 8-10 mkD bid (TMP) Kindoprim 40/5 Bacidal 80/5 Trizole 80/5 Triglobe 45/5 Bactrim 160/5; 40; 80 Lidaprim 40/5 Macrobid 40/5 Clindamycin >1mo – 20-40 mkD q 6-8 <1mo- 15-20 mkD q6-8h Dalacin C 75/5ml Chloramphenicol 50-100 mkD Chloromycetin (Men: 100 mkd Chloramol q 6H) Tetracycline 40-60 mkD MACROLIDES Erythromycin 30-50 mkD Erythrocin 200/5; 400/5 ds; 100/2.5gtts Azithromycin 10 mkD ODx3 d Clarithromycin 15 mkD q12 or 7.5 mkd Klaricid 125/5 (don’t ref)
ANTI-STAPH Nafcillin 100-200 mkD q6 Vigopen 250/5 Co-Amoxiclav 40-60 mkD Augmentin 156/5; 312/5 Stafloxin 100-200 mkD Vancomycin 40-60 mkD Cloxacillin 50-100 mkD q6 Prostaphlin-A 125/5 Orbenin 250; 500 Oxacillin 100-200 mkD IV (Prostaphlin) OTHER B-LACTAMS Imepenem 60 mkD q6 NB: 20 mk q 12 Piperacillin (Cypercil) Less Serious: 100-200 MKD q6 Serious: 200-300 MKD Vancomycin 40-60 MKD (give in 2h) Ceftazidime 50-100 mkD (Fortum) < 2mo: 25-50 mkD BID
> 2mo: 30-100 mkD TID Adult: 1-6 g/day TID Cefoperazone 100-150 mkD Child: 50-200 mkD BID Adult: 2-4 gkD q12 Cefobis Cefoxitin 50-100 mkD q6-12 Mefoxin 1 g/vial
Ceftizoxime Child: 40-80 mkD bid-qid Adult: 0.5-2 g/d 2-4 doses IV/IM Cefixime 3-6 mkD BID Tergicef 100/5 (50mg/ml) Cefdinir 9-18 mkD q8 Omnicef 50mg/sachet; 100mg/cap Cedax 9 mkD OD (180/5) Cefetamet 20 mkD OD q12 Globocef 250/5 4th Generation Cefepime
for severe infection, q8
2mo old, BW <40kg = 50 mkq12x10d ANTI-TB INH Tx: 15-20 mkD liver Px: 10-15 mkD peri. neuritis Trisovit 50/5 Nicetal 100/5 Primafort 100/5 Odinah 150/5 Trisofort 200/5 Pyrobin H 150/5 Comprilex 200/5
Ethambutol 15-25 mkD optic neuritis Myambutol 200/5 Ethambin 125/5 Isoetham 150/5 Ethambin/INH 150/5; 125 Rifampicin 10-20 mkD (liver) Rimactane 100/5; 200/5 150; 300; 450; 600 Meningo Px: Adult: 600 q12 x 4 doses 1-12yo: 10 mk q12 x 4 doses 3mo-1y: 5 mk q12 x 4 doses Streptomycin 20-30 mkD OD IM ototoxic PZA 30-50 mkD q8 ANTI-FUNGAL
Nystatin 0.5-1mL tid-qid x 7d (thrush) NB: 400 TU/day Inf/child: 1-2 MU/d Mycostatin 100 TU/mL 500 TU/tab Amphotericin B 0.3-0.7 MKD 500mg + 10mL dist H2O Griseofulvin 10 mk SD
Adult: 500-1000mg/day but not <10mkd single or div. doses Child: 10 mkD in div. doses Grisovin 125 mg/tab Fluconazole LD: 6 MKD MD: 3 mkD x 1 week Diflucan 50mg/cap Ketoconazole Nizoral 200mg/tab Terbutafine HCl 1 tab OD Lamisil 250mg/tab;
ANALGESICS Fentanyl Low: 2 mkD
Mod: 2-20 mkD High: 2-50 mkD Sublimaze (Janssen): 50ug/2mL Ibuprofen 5-10 mkd q6-8 Dolan FP 100/5 Mefenamic acid 3-5 mkD Ponstan 50/5 Midazolam 0.1 mkD Dormicum IV: 5/1;5/5;15/3 PO: 5mg/tab Morphine 0.1-0.2 mkD Morphine 10/mL Nalbuphine 0.1 mkD Nubain 10/mL Pancuronium 0.04-0.1 mkD Promethazine Phenergan IV: 50/2 PO: 1/1; 10mg PENICILLINS PCN: 50-100TUKD or 25-30 mkD 625mg = 1 MU 250/5 = 400 TU 312.5/5= 500 TU 500mg = 800 TU Oral PCN 100-200 TUKD Pentacillin 50/5; 500mg Sumapen 25/5; 250; 500 Megapen 50 TU/mL gtts 312.5/5; 625mg Amoxicillin 40-60 mkD q8 Nafcillin 100-200 mkDq6 Stafloxin 100-200 mkD Ampicillin 100-200 mkD (NB: 50-100 BID; men: 300-400 mkd q6) Ampicin/Pentrexyl/Aldribid Bacampicillin 25-50 mkD Penglobe 200/5 ANTI-HELMINTHIC Oxantel pamoate 10-20 mkd Quantrel 100/5; 100 Tetramizole 2.5-5 mkd SD TMZ 25mg/10mL Mebendazole 100 mkd BID x 3 days
Antiox: 100; 500mg/tab; 20mg susp Combantrin 125mg; 250mg/tab 125mg/5mL susp >15yo = 500 mg 10-14yo = 375 mg 5-9 yo = 250 mg 5 yo = 125 mg ANTI-VIRAL Methisoprinol 50-100 mkD Isoprinosine 250/1; 500 Inosiplex 50 mkD Immunosine 250/5 Amantadine 5-8 mkD Symmetrel 50/5 Virazole 10 mkD Acyclovir 10-15 mkD q6 x 5D Zovirax 250/5; 200 ANTACIDS Cimetidine 10-20 mkD q12 Tagamet Syr: 200/1; 100/5 Tab: 200; 400; 800 IV: 200/2 Ranitidine 4-5 mkD q8 Zantac IV: 50/2 PO: 150; 300; 15/1 Cisapride 0.2 mkd q8 Prepulsid 1/1; 0.2 mkD TID Omeprazole Losec 20mg; 40mg Famotidine 0.7 md q 12 H2 Bloc 20/2 Lanzoprazole 25 mg OD PO Prevacid FDT ANTI-SPASMODIC Relestal 1 mkd (5/1; 10/5) Bentyl 10/5; 10 mg
Buscopan 1-3 tab TID; 1-2 tsp TID PO: 5/5; 10mg IV: 25mg/amp Metoclopromide 0.1 mkd q8H (0.1-0.2 mkd up to 4x/D) ANTI-ASTHMA Aminophylline LD: 8-10 mk MD: 3-5 Drip: 0.4-0.9 mkH Noenate: 1 mkd q8 or 2 mkd q12 Apnea: LD: 5-6 mkd MD: 2 mk 12h post-LD Prep: 250/10
Drip: eg: 5kg at 0.4 mkH in 8h drip: 5 x 0.4 x 8 = 16mg in 8h if IVF rate is 5cc/h, fill soluset with 40cc IVF+ 16mg Amino (0.64mL) Theophylline 3-5 mkd Nuellin 80/15; 50; 125; 250 Terbutaline SQ: 0.005 mkd PO: 0.075 mkd Drip: 0.003 mkH Bricanyl IV: 0.5/1 PO: 1.5/5; 2.5 Salbutamol 0.12-0.15 mkd Ventolin 2/5 sy; 1.2/5 exp; 2 Librentin 2/5; 2mg Prox-S 2/5; 2mg Atrovent 4-8gtts/mL NSS ANTI-DERMATOSES Hydrocortisone 1% TID x 2 wks Hytone/Hydrotpic/Eczacort Betamethasone BID-TID Betnovate/Diprolene/Diprosone Fluocinolone acetonide BID-TID Aplosyn 10; 25; HP Synalar 10; 25; HP Mometasone furoate OD Elica/Momate Clobetasole propionate Dermovate
Diflucortolone valerate BID-TID Nensona
Desoximetasone BID-TID Esperson
Triamcinolone acetonide BID-TID Kenacort A/Ladercort A COUGH Ambroxol 1.2-1.6 mkD q12 Mucosulvan 15/5; 7.5/1.5 Zobrixol 15/5; 7.5/1.25 Salvotran 15/5; 30/5 Bromhexine 7-12y = 1 tsp TID
2-6y = ½ tsp TID Bromulex 4mg/5mL; 8mg SCMC 20-30 mkD Loviscol 50/1; 100/5 Solmux 40/1; 200/5 Cemetol 200/5 DIAZEPAM DRIP 0.3 mkH dilute in NSS makes 0.1mg/mL conc = mg/total vol (mL
ANTI-CONVULSANTS Carbamazepine 10-20 mkD Tegretol 100/5; 200mg Clonazepam 0.01-0.03 mkD For Dr. Bael: LD: 0.03 MK MD: 0.08 mkD q12 Rivotril 2mg/tab Diazepam 0.2-0.4 mkd (max:2-5mg) Valium 10mg/2mL Lorazepam 0.05-0.1 mkd (max: 0.4 MK) Midazolam 0.1-0.2 mkd (Domicum) Phenobarbital LD: 15-20 mk MD: 5 mkD Luminal IV: 130mg/1mL PO: 20mg/5mL Gr 1: 65 mg (Gr 1, ½, ¼) Phenytoin LD: 15-20 mk MD: 5-8 mkD Dilantin IV: 100mg/2mL PO: 30/5; 125/5; 30; 100 Valproic acid 15 mkD Depakene 250mg/5mL Epival 250mg/tab
ANTI-HISTAMINES
Diphenhydramine 3-5 mkD TID-QID Benadryl IV: 50/1x3 dose PO: 12.5; 25; 50 Methdilazine 0.3 mkD q12-q6 Tacaryl 4/5; 4; 8 Clemastine 0.05 mkD q12 Tavegyl 0.5/5; 1mg Hydroxyzine 1 mkD Iterax 2mg/ml; 10; 25 Cetirizine 0.25 mkD Virlix 10mg/1mL Loratadine 2-12yo, < 30k: 1 tsp OD >30k: 2 tsp OD Claritin 5mg/5mL Ketotifen 0.025 mkd q12 Zadec 1mg/5mL; 1mg Zaditen 0.2mg/1mL; 1 ATROPINE SULFATE Pedia 1-2 mg SQ q 20min 0.2 Mkd q 3-5min Adult 2mg q 10 min IV/IM 0.5mg (5mL) q 3-5min Mkd PRN after 24h DIURETICS Furosemide 1.0-2.0 mkd Lasix 20/2; 40mg Frusema 20/2; 20mg; 40 Diazoxide 5-10 mkd Diazoxide 300/2 Acetazolamide 20-30 mkD Diamox 250mg/tab Spironolactone 1.5-3.0 mkD Aldactone 25mg/tab Hydrochlorothiazide 1-2 mkD Dichlotride 25mg; 50mg/tab Mannitol 20% 1.5-2 gkD or 5cckd 200g/1L; (1gm = 5 cc; 0.5-1gkd) DOPAMINE DRIP 1-5 ug/k/min = VD, inc renal & splan circ 5-10ug/k/min = inotropic; no effect on HR 10-20 ug/k/min = inc BP Prep: Dopamine: 200/5 Conc Dopa D5W S 800 1 cc 49 cc DS 1600 2 cc 48 cc QS 3200 4 cc 46 cc Prep: Dobutamine: 250/2 Conc Dobu D5W S 1000 4cc 46 cc DS 2000 8 cc 42 cc QS 4000 16 cc 34 cc Computation for concentration: 1. D5W 250 + 200 mg/amp 200/250 = 0.8 mg/cc = 800 ug/cc 1 cc = 60 ugtts conc = 600/60 = 13.33 ug/ugtts 2. Lidocaine 2% 2 g/100 mL = 20 mg/mL
AD = rate x conc Rate = RD x Wt x 60 Wt x 60 Conc
Heparin LD: 50 UK IV bolus MD: 10-20 Ukh Heparin Lock 0.5-1 U/mL NSS or
0.02mL/50mL NSS HepB IgG 0.5mL/K w/n 12h of birth
then at 3 & 6 mos if vaccine not given Hep B Vaccine 0.5 mL IM Indomethacin IV (12-24h interval) Initial: 0.2 mk 2nd Dose: < 48h: 0.1 mk 2-7dy: 0.2 mk > 8 dy: 0.25 mk 3rd Dose: < 48h: 0.1 mk 2-7 dy: 0.2 mk > 8 dy: 0.25 mk Methyldopa 5-40 mkD q6-8 Aldomet 125; 250 STEROIDS Dexamethasone 0.2-0.4 mkd Decadron 4/1 Hydrocortisone LD: 10 mk MD: 5 mkD Solu-cortef 100/2; 250/2 Act-o-vial 100 Prednisolone 0.7 mkD Solumedrol 125/2 Prednisone 0.5 mkD 1 mkD (BA) ALBUMIN Albumin: 1 g/K/dose Alburein 12.5g/50mL (25%) Formula: Desired-Actual x 1.2 x Wt Albumin 0.5-1.0 g/K (max 6 gKD) Albumer/Albutein 50/1 (5%) 250/1 (25%) ELECTROLYTES
Vitamin K 0.3 Mkd (max 5 mg) x 3 dys Calcium gluconate 10% 1 cc/k/shift IV MD: 200-500MKD q6 or drip (Max 200 Mkd in 10 min) IV: 100/1 (9 el. Ca/ml or 0.45mg
Ca/ml)
PO: 500 mg (45 mg Ca) 650 mg (58.5 mg Ca) Iron Tx: 4-6 MKD
Px: 1-2 MKD
Iberet 500 mg (26.25 elem Fe) Odiron 50mg/10mL; 25mg/5mL Fer-in-sol 15mg/0.6ml; 18mg/5mL Propan 25mg/5mL Ferlin 30mg/5mL; 15mg/1mL Incremin 30mg/5mL Polyvifer 10mg/1mL Glucagon 0.25-0.3 mkd 0.3 mkd-1mg in IDM 1 mg (1 “U”) vial PARACETAMOL 10-15 mkd Aeknil 300mg/2mL Afebrin 120mg/5mL; 325mg; 500 Biogesic 100mg/1ml; 250/5; 500 Calpol 120mg/5mL; 250mg/5mL Crocin 125mg/5mL; 500mg Defebrol 60mg/0.6mL; 120mg/5mL Naprex 250mg/5m; 500mg Opigesic 125mg; 250mg Rexidol 150mg/5mL; 60/0.06; 600 Tempra 120mg/5mL; 60mg/0.06mL Tylenol 120mg/5mL Winadol 120mg/5mL; 500mg SALICYLATES Anti-rheumatic 65-130 mkD Asaped 81mg Ascriptin 325mg Aspirin Gr V Gr 1 = 65 mg Neo-Novaldin 325mg Superin 180mg/5mL; 3g INTRALIPID 10% = 10 g/100 mL 20% = 20 g/100 mL (180cal/100ml) eg: Wt = 2k at intra dose=0.5 gkD (10%) 2 kg x 0.5 x 100 = 10 mL (of 10% IL) 10
VAMIN/AMINOSTERIL CHON: 2.5-4 Gkd Amino 6% Glucose: 5-9 MK
Prep. per liter: CHON : 60 g Calories : 650 cal Glucose : 100 g start dose at CHON = 0.5 gKD eg: wt = 1kg
1 kg x 0.5 x 1000 60
LUMBAR TAP Pressure (in cmH2O) G 22 (1 ½) = gtts in 21 sec G 22 (3 ½) = gtta in 39 sec G 20 (3 ½) = gtts in 12 sec WBC correction in traumatic tap: Periph WBC x 1000 = WBC 5,000,000 1000 RBC C/I: increased ICP
severe CP depression infected skin
decreased platelet count or blood d/o brain abscess PHOTOTHERAPY Indication: PT: 10 mg% bilirubin FT: 15 mg% bilirubin Complications: osmotic diarrhea rashes
bronze baby syndrome dehydration
HS METHOD for IVF Infusion 2.5-10kg 100cc/k/day 10-20kg 1000cc+50cc/k over 10k >20kg 1500cc+20cc/k over 20k TF/4 = cc/hr or ugtt/min Phototx +20% Tachypnea +25-50% Fever +12% q 1oC > 37.5oC Hypermetabolic +25-50%
Burns +14% for 1st Degree Sweating +10-25%
KVO: ugtt = 3.5 gtt = 10
BALLARD’S MATURITY TESTING Score AOG (wks) 5 26 10 28 15 30 20 32 25 34 30 36 35 38 40 40 45 42 50 44 CHARACTERISTICS OF PROXIMAL & DISTAL SBO
HIGH SBO LOW SBO
Acute onset less acute Prominent vomiting less prominent Vomit not feculent often feculent Pain frequent less frequent minimal distension prominent
DIGITALIZATION Digitalis 0.04-0.06 mk (TDD) Pedia Elxr 0.05/ml; 0.25/ml PO: 0.25mg/tab IV: 0.5mg/2mL amp TDD = 0.04-0.06 Mk 1st dose = ½ TDD 2nd dose = ¼ TDD (8hrs) 3rd dose = ¼ TDD (6 hrs) 12H after, start MD = 1/5 of TDD OD = 1/10 of TDD BID Adult: TDD: 0.5-1.5 Mkd MD: 0.125-0.25 Md Cafeine Na benzoate 0.1-0.2 cc IM Prep 5mg/ml; 10mg/mL Nelson’s: ½ TDD – immediately ¼ TDD – 12H after ¼ TDD – 12H after ¼ TDD in 2 doses (q 12H) as MD SA = Wt x 4 + 7 x 400 (renal) Wt + 90 Men SA x 1500 Preterm SA x 1200 CHF SA x 800 Cardiac SA x 200 Renal SA x 400 + 24h UO MF < 2yo = SA x 1500 > 2yo = SA x 1200 0-5 kg wt x 0.05 + 0.05 6-10 kg wt x 0.04 + 0.1 10-15k wt x 0.03 + 0.2 15-20k wt x 0.02 + 0.3
CRITERIA FOR RHEUMATIC FEVER Major: carditis, polyarthritis, chorea,
subcutaneous nodules, erythema marginatum Minor: hx of RF/RHD, arthralgia, fever, elevated ASO, CRP & ESR, prolonged PR interval, (+) culture of Grp. A strep
RANSON’S CRITERIA for ACUTE PANCREATITIS On Admission: 1. age > 55 yrs 2. leukocytosis > 16,000 3. hyperglycemia > 200mg/dL (11mmol/L) 4. serum LDH > 400 IU/L 5. serum AST > 250 IU/L During the initial 48hrs: 1. hematocrit fall > 10% 2. fluid sequestration > 4000 mL 3. hypocalcemia < 8mg/dL (1.9mmol/L) 4. hypoxemia (PO2 <60mmHg) 5. BUN rise >1.85mg/dL (>1.8mmol/L) post IVF
6. hypoalbuminemia < 3.2g/dL (32g/L)
CRITERIA FOR AMI
1.typical pain: retrosternal, severe, pain lasting >30min, unrelieved by nitrates, cold, clammy perspiration
2. evolutionary ST elevation followed by Q wave formation and ST segment inversion
3. elevation of serum CPK-MB Labs:
Onset Peak Duration CPK-MB 4-6h 12-24h 24-48h SGOT 8-12h 36-48h 3-5days LDH 12-24h 2-4days 7-10days
GLUCOSE INFUSION RATE GIR = Rate x Dextrosity
Wt x 60 Dextrosity: D5 50 D7.5 75 D10 100 D50 500 Conversion:
conc desired-actual x 2 x total vol 100 eg: D10 – D5 x 2 = 0.1 100 if total vol = 100 cc: 100 x 0.1 = 10cc D50W + 90cc D5 IVF = 100cc of D10 IVF thus: 100cc/k/day divided by 3 shifts
= x 10% = D50 in sol To convert to: D7.5 = x 0.055 D10 = x 0.11 D12.5= x 0.16 Calorie in IVF: D5 = x 0.2 D7.5 = x 0.3 D10 = x 0.4 D12 = x 0.5
H = 24 x pCO2 HCO3 Chronicity: H – 40 ; if < 0.3 = chronic pCO2 0.3-0.7 = ac/chr > 0.8 = acute Oxygenation: 80-100 adequate 60-80 mild hypoxemia 50-60 moderate < 50 severe CPAP TFR = wt x TV(10-15) x RR x IE ratio(2) + 2000 (2L) FiO2 = CA (0.2) + 02 (1) x 100 TFR CA = 100 – FiO2 x TFR 79 O2 = FR – CA ET Size: > 2 yo = age(yrs) + 16 4 HR RR 2-12 mo = <160 < 2 mo = up to 60 1-2 yo = <120 2mo-2yr = 50 2-8 yo = <110 1-5 yo = 40 IE: 60/RR - IT IT PEFR Ht= x – 100 x 5 + 170 (F)/175 (M) % PEFR = actual x 100 expected ABG pH 7.35-7.45 = 7.4 pCO2 35-45 = 40 HCO3 22-26 = 24 O2 80-100 Metabolic Acidosis: pCO2 = 1.5 (HCO3) + 8.4 2 Metabolic Alkalosis:
0.6-0.7mmHg inc pCO2 q 1meq/L inc
HCO3
Respiratory Acidosis:
Acute: 1meq/L inc HCO3 q 10mmHg inc
pCO2
Chron: 3-3.5meq inc HCO3 q 10mmHg
inc pCO2
Respiratory Alkalosis:
Ac: 2-2.5meq dec HCO3 q 10mmHg dec
pCO2
Chr: 4-5meq dec HCO3 q 10mmHg dec
pCO2
def: 0.3 x ABE x wt
HYPERBIL MGT
HEALTHY TERM NEONATE age(h) considr photo ex ex & photo transif foto foto fails <24 25-48 >12 >15 >20 >25 49-72 >15 >18 >25 >30 >72 >17 >20 >25 >25 LBW BW phototx exchange <1500 5-8 13-16 1500-1999 8-12 16-18 2000-2499 11-14 18-20 KRAMER'S CLASSIFICATION: Zone Jaundice Est. Levels I Head/neck 6-8 mg/dl II Upper trunk 9-12 III Lower trunk 12-14 to thigh IV Arms/Legs/ 15-18 Elbows/Knees V Hands/Feet > 18 JAUNDICE Clinical Jaundice
manifestation of color starting at serum bilirubin levels 5-7 mg% Criteria to rule out physiologic jaundice:
1. Clinical jaundice in the 1st 24 hrs of life.
2. Increase in total serum bilirubin at > 5 mg/dL/day (85 umol/L). 3. Total serum bilirubin > 12 mg/dL in full term, and > 15 mg/dL in preterm.
4. Direct bilirubin > 1.5-2 mg/dL (26-34 umol/L).
5. Jaundice lasting for more than 1 week for term, 2 weeks for preterm. VITAL SIGNS I. HEART RATE <2 mo 140-160 2-12 mo 120-140 1-2 yo 100-120 2-8 yo 90-110 II. RR <2 mo up to 60 2mo-1yr 50 1y-5y 40 III. BP syst upper :yrs x 2 + 90 lower: yrs x 2 + 70 diast 30 mm Hg lower INTUBATION/EXTUBATION INTUBATION ET SIZE
> 2yo: age (yrs) + 16
--- 4 PT: 2 or 2.5 FT: 3 or 3.5 ET LENGTH age/2 + 12 kg cm 1 7 2 8 3 9 EXTUBATION CRITERIA FiO2 < 50 P/F no electrolyte imbalance control of infection good muscle mass racemic epi (0.3 mL + 4.7 PNSS)
2.5 mL x 3 d (q4-6) Dexamethasone 6 hrs prior then 24 hrs
Initial Vent settings in neonate
Settings low moderate high PIP <18 18-24 >24 PEEP <4 5-6 >7 I Time 0.4 0.4-0.8 >0.8 Rate <20 20-40 >40 Flow <8 8-10 >10 MAP <8 8-12 >12
CARI 2mo-2 yo: Mild Pneumonia: send home, TMP-SMX, Tx fever, ff-up in 2-4 days Severe Pneumonia:
Admit, give IV/IM Benzyl PCN, Tx fever, tx wheezing, supportive care, reassess daily Very Severe Pneumonia: Admit, give O2, Chloramphenicol, tx fever and wheezing,
reassess BID (q 15min if possible) < 2 mos:
Severe Pneumonia: Hospitalize, keep warm,
give 1st dose antibiotic Benzyl PCN/ Garamycin/Gentamycin
MALCOLM HOLIDAY (1/4 1st hr; ¾ 7 hrs)
Mild Moderate Severe < 2 yo 50 100 150 > 2 yo 30 60 90
Hydrite 1 tab in 100cc water = 8h Glucost 1 sachet in 100cc water = 8h Oresol 1 sachet in 1L water = 24h Glucolyte 1 sachet in 200cc water
FLUIDS AND ELECTROLYTES 1. Hypotonic: D5W; D5NM; D5 0.3NaCl; D5 IMB; Isolyte; D5 Maintresol 2. Isotonic: D5LR; D5 NSS; PLR; PNSS 3. Hypertonic: D50W; D10W STAGES OF DHF 1. Febrile 2. Afebrile 3. Convalescent GRADING OF DHF 1. Fever + non-specific ssx; (+) tourniquet test 2. Gr. 1 + spontaneous bleeding 3. Gr.2 + manifestations of circulatory failure: rapid, weak pulse; narrow pulse pressure; HPOT; cold, clammy extremities
4. Profound Shock with undetectable BP & pulse
Days 1-5: petecchiae, fever Days 5-7: bleeding > Day 6 : shock
CLASSICAL DENGUE FEVER 1. Thrombocytopenia not < 100T 2. Hemoconcentration not > 20% of baseline STAGES OF DHF 1. Febrile 2. Afebrile 3. Convalescent GRADING OF DHF 1. Fever + non-specific ssx; (+) tourniquet test 2. Gr. 1 + spontaneous bleeding 3. Gr.2 + manifestations of circulatory failure: rapid, weak pulse; narrow pulse pressure; HPOT; cold, clammy extremities
4. Profound Shock with undetectable BP & pulse
Days 1-5: petecchiae, fever Days 5-7: bleeding > Day 6 : shock
CLASSICAL DENGUE FEVER 1. Thrombocytopenia not < 100T 2. Hemoconcentration not > 20% of baseline
PULMONARY VOLUMES 1. Total Volume (TV) = 500 mL = volume inspired or expired with each normal breath
2. Insp. Reserve Volume (IRV) = 3.0 L = volume that can be inspired over and above the TV
3. Exp. Reserve Volume (ERV) = 1.1L 4. Residual Volume (RV) = 1.2 L = volume that remains in the lungs after maximal expiration 5. Dead Space = 150 mL
a. Anatomical: volume of the conducting airways
b. Physiological functional measurement; volume of the lungs that does not eliminate CO2
(usually greater in lung diseases with V/Q inequalities)
BLOOD TRANSFUSION FWB 20 cc/k (max)
Vol = desired – actual Hb x 6 x Wt = desired – actual Hct x Wt rate = vol x 12 gtts/mL = gtts/min 60 min x 4h
PRBC 10-15 cc/k
15 cc/K in neonates Vol = desired – actual Hb x 2 x Wt = desired – actual Hct x Wt Desired Hct = volume/wt + Actual Hct Sedimented RBC 15 cc/k
Platelet Conc: 1 U / 6 KBW
1U = 30-50 cc (raises platelet ct by 10T) FFP = Fluid rate (5-20 cc/k/h in 4h)
ACTUAL RETIC COUNT (ARC) Actual Hct x reticulocyte ct Desired Hct
RETICULOCYTE INDEX = Arc / 2 = Hct / ret ct x 2 > 2 = hemolysis
< 2 = BM suppression
DOUBLE VOLUME EXCHANGE TRANSFUSION
= KBW x estim body vol x 2
PARTIAL EXCHANGE TRANSFUSION = KBW x estim vol x Hct A-D
Actual Hct
1 u = increases Hgb by 2; Hct by 3
GLASGOW COMA SCALE MOTOR None 1 Extension 2 Flexion 3 Withdraws to pain 4 Localizes pain 5 Obeys command 6 VERBAL None 1 Incomprehensible 2 Inappropriate 3 Confused 4 Oriented 5 EYE OPENING None 1 To PAIN 2 To COMMAND 3 Spontaneous 4 Score: < 7 = poor prognosis
IV FLUIDS Na K Cl HCO3 Ca PO4 IMB 25 20 22 23 3 3 NM 40 13 40 16 3 3 NSS 154 154 LR 130 4 109 28 3 3 NMR 40 30 IsolyteM 40 35 40 IsolyteP 25 20 20 PLP48 25 20 22 0.3% 51 51 0.6% 102 102 0.45 77 77 0.9% 154 154 ORS 90 20 80 30 (20 gluc) P-lyte90 90 20 80 P-lyte Pl 45 20 35 Na = 1 meq = 23 mg K = 1 meq = 39.1 mg IVF OF CHOICE LBM PLR Vomiting D5 NSS Maintenance D5 NM BA D5 0.3% NaCl Fever & Sweating D5 0.3% NaCl; Drowning D5W Ascitis D5W; D10W CHF D5 NSS HPN D5W/D5LR(BP) CHF (NPO) D5 NSS 2o to HPN D5W Heat Stroke D5 NSS Burns PLR Azotemia D5W Inc BUN D10W Bleeding D5 LR UTI D5 NSS Profuse Bleeding D5 LR Dengue Fever D5 0.3% NaCl DM PNSS ELECTROLYTES Na = 135-145 meq (RV= 136 meq) K = 4-5.6 meq (RV= 4 meq) Ca = 8-10 meq Cl = 98-106 meq Deficit = (desired-actual) x Wt x 0.6 Adult = desired-actual x 350 3 Maintenance: Na = 3 meq/kg K = 2 meq/kg Na/K deficit is given in 3 days Na/K delivery = 0.1-0.4 meq/kg Full incorporation = 40 meq/L APGAR ACTIVITY (muscle tone) 0 no activity 1 some flexion 2 very active PULSE (HR) 0 none 1 < 100 beats/mi 2 > 100 beats/min GRIMACE 0 no response 1 grimace 2 good cry APPEARANCE (color) 0 blue 1 pink, bluish extremities 2 pink all over RESPIRATION 0 none 1 slow, irregular 2 regular 2-3 severely depressed 4-6 moderately depressed 7-10 vigorous IBW 2-12 mo = age in mo x 10 = wt in lbs < 6 mo = age in mo x 600 + BW = wt in gms 6-12 mo = age in mo x 500 + BW = wt in gms < 1 yo = Age (mo) + 9 2 > 2 yo = age in yrs x 2 + 8 = wt in kg = age in yrs x 5 + 17 = wt in lbs 4-5 = 2 x BW 1 yo = 3 x BW 2 yo = 4 xBW 3 yo = 5 x BW 5 yo = 6 x BW 7 yo = 7 x BW 10 yo = 10 x BW MOTOR GRADING 0 no movement 1 flicker of contraction with no associated movement at a joint 2 movement present but can’t sustain against gravity 3 movement against gravity but not with resistance 4 movement against some resistance 5 movement against full resistance COMPOSITION OF BODY FLUIDS Na K Cl HCO3 Gastric 50 10-15 150 0 Panc 140 5 50-100 100 Bile 130 5 100 40 Ileosto 130 15-20 120 25-30 Diarrh 50 35 40 50 Sweat 50 5 55 0 Blood 140 4-5 100 25 Urine 0-100 20-100 70-100 0 Osm = 2 (Na meq/L + K meq/L) + Urine mg/dL – glucose mg/dL 2.8 18 DEVELOPMENTAL MILESTONES 1mo regards 2 smile 3 turns head 4 holds head 5 rolls over 6 transfers objects 7 sits briefly 8 creeps 9 pulls up 10 cruises
11 walks with support 12 stands / walks alone
BCE NB 45-50 cal/kg 3-10kg 60-80 10-15 45-65 15-25 40-45 25-35 35-40 35-60 30-35 > 60 25-30 MF = BCE x Wt x 1.5 = cc/hr 24 or ugtt/min Fever = +12% for every oC rise > 37.5oC Hyperventilation/dyspnea = + 25% Bronchial asthma = + 50% Bililight therapy = + 20% CALORIC REQUIREMENTS < 1 mo 110-140 cal/k/day 1-11 mos 110-115 1-2 yrs 100-110 3-6 yrs 90-100 7-9 yrs 80-90 10-12 yrs 70-80 13-15 yrs 55-65 16-19 yrs 45-50 PROTEINS RDA 0-5 mos 2.5 g/kg/day 6-11 mos 2.5-3.0 1-6 yo 2.0-2.5 7-12 yo 1.5-2.0 13-15 yo 1.5 16-19 yo 1.0-1.5 Milk Formula CHON Similac 20 cal 1.5/100 NAN 20 1.5/100 S-26 20 2.25/100 Pre-NAN 21 2/100 BM 22 1.1/100 Enfalac 21 2.25/100
K infusion rate = IV rate x amt of K (mEq) Vol of IVF x wt Normal KIR: 0.1 – 0.3
Vit K = 0.3 mg/kg for IV antibiotics >7 D Ca gluconate - 1 cc/kg/shift Ca deficit - 53-75 mEq/k/day Ca requirement - 27-32 mEq/day Wt x dose 9.8 in 24H Eg. 75 mEq x 3 kg in 24 H
In q shift = 75 mEq x 3 kg = 75 mEq 3 shifts
= 75 mEq = 8.3 cc = 72 mEq 9 (1 cc = 9 mEq) Ideal tracheal aspirate: EC <25
PMN’s >10 Max steroids for NS : 2 mkD or 60
Mkm ≈ 4-6 wks Normal values: Crea (NB): 0.3-1.0 pH (premature 48H): 7.35-7.5 (Birth term): 7.11-7.36 (5-10’) (30’) (>1 H) 7.26-7.49 (1 day) 7.29-7.45 (thereafter) 7.35-7.45 pCO2 (NB): 27-40 BUN (NB): 3-12 Na (NB): 134-146 K (<2 mos): 3.0-7.0 (2-12 mos): 3.5-6.0
ALL HIGH RISK PROTOCOL PHASE induction consolidation maintenance Vincristine 15 mg/m2 on D0,7,14,21 Doxorubicin 25 mg/m2 on D0,7,14,21 Prednisone 40 mg/m2 on D21-25- L aspariginase 6mg/m2 for 9 doses (3 doses per week; mwf/mtw)
Anaphylaxis epinephrine. 1:1000 0.01 mkd max of .5 ml IM diphenhydramine 1-2 mkd IM/IV up to 50 mg q 4-6 Ranitidine 1-2 mkD up to 50 mg IV q 6H Hydrocortisone 5-10 mkd up to 100-500 mg IV q 4-6H ANTHROPOMETRY 1. Body Weight A. Ideal Body Weight At birth 3000 gms < 6 mo (g) age in mo x 600 + BW 6-12 mo (g) age in mo x 500 + BW Nelson's: 3-12 mos (age in mo + 9)/2 1-6 yr (kg) age in yr x 2 + 8 7-12 (kg) (age in y x 7- 5) / 2 B. Expected Body Weight (up to 1 mo) Term EBW=(age in days-10) x 20 + BW
Preterm EBW=(age in days-14) x 15 + BW
Where: 10=time to recover over physiologic wt loss 20=g/day gained C. Estim wt 4-5mo 2 x BW 5 yo 6 x BW 1 yo 3 x BW 7 yo 7 x BW 2 yo 4 x BW 10 yo 10 x BW 3 yo 5 x BW 2. Length A. Ave. Nelson's:
Birth Length: 50 cm (20 in) 1yo: 75 cm 2-12 yo: yr x 6 + 77 Height in cm: age inyrs x5 + 80 Height in in: age (yrs) x 2 + 32 3. Head Circumference (Del mundo) At birth 35 cm < 4 mo 1/2 in/mo (1.3 cm/mo) 5-12 mo 1/4 in/mo (0.6 cm/mo) 1-2 yr 1 in/ yr (2.5 cm/yr) 3-5 yr 1/2 in/ yr (1.3 cm/yr) 5-20 yrs 1/2 in/5 yrs (1.3 cm/5yr) (Nelsons)) 0-3 mo 2 cm/mo 3-6 mo 1 cm/mo 6-12 m 0.5 cm/mo 1-3 y 0.25 cm/mo 4-6 y 1 cm/yr
ASTHMA CLASSIFICATION BASED ON SEVERITY
intrmtnt persistent mild mod severe
day sx <1/w >1/w daily daily night sx «2/mo >2/mo >1/w >1/w PEFR exp »80 »80 60-79 <60 PEFR var <20 20-30 >30 >30 FEV1 »80 »80 60-79 <60 ATHMA SCORING WOOD'S SCORE 0 1 2 p02 or 50-100 «70 in «70 in cyanosis rm air 40fio2 Breath snds N unequal absent Acc muscles N mod max Exp wheeze N mod extrem Cerebal fxn N depresd/coma agitated 1-3 mild asthma attack
4-6 moderate, bedside 7 up severe, intubate
SILVERMAN'S SCORE 0 1 2 Flaring - min marked Lower chest
Retractions - visible marked Upper chest
Retractions - synch in- seesaw drawing Xyphoid
retractions - visible marked Grunting - steth ears (audible)
3-4 give 02 »7 intubate
Personal best Predictive Value of PEF females: ht(cm) - 100 x 5 + 175 males:ht(cm) - 100 x 5 + 170 actual PEF >80%, normal
CHF CLASSIFICATION *Anatomic
I acquired
II congenital *Physiologic (disturbance in) A heart rhythm and conduction B myocardial contraction C clinical syndrome (HPN,DM) *Functional
I asymptomatic
II symptomatic w >ordinary act III symptomatic w minimal activity IV symptomatic at rest
*Therapeutics A no restriction of act B restriction of severe act C restriction of moderate act D sharp restriction of ordinary act] E complete rest in a chair or bed
CONVULSION SCORING factor 0 1 2 occurence none upon spont
stimulation duration fleeting 10-60s >1min severity mild mod severe twitch clonus
frequency >60mi 60s- >10mi apart 10 mi
ventilation adeq impair impair cyanosis
MILK
Abbot,wyeth = 1:2 MJ & Nestle = 1:1 MILK CAL CHON g FAT CHO alfare 72/dL 2.5 3.6 7.8 bm(t) 699/L 9.09 41.96 72.7 75/dl 1.1 4.5 20/oz bm (pt) 671/L 14.09 38.93 66.4 bonna 22/oz 1.1/dl
caro syr 120/oz 31 corn oil 813/dL 82 enfalac 67.6/dL 2 3.5 7.4 21/oz 2.25/dl gain 22/oz 2.8g/dL lactum 21.4/oz 3.42g/dL nan1 67/dL 1.2 3.6 7.5 20/oz 1.5/dl nan ha 67/dL 1.51 neosure 22/oz nutren jr 100/dL 3 3.9 13.3 prenan 80/dL 2.3 4.2 8.6 21/oz 2/dl promil 81/dL 2.4 4.1 8.9 s26 20/oz 2.25/dl s26lbw 100/ 2.4/dL 125ml 24/oz CPAP GUIDELINES
1. Initially CPAP is set @ 6cm water. If there is no inc in PO2 in 15 min pressure must be increased in 2cm increments to a maximum of 10cm. (If by ETT) or by 12cm (in other method).
2. If there is an increase in PaO2, reduce pressure.
3. If 10-12cm water pressure is attained and if PaO2 reamins under50, FiO2 must be increased by 5-10% increments.
4. CPAP failure is evident if PaO2 remains less than 50 in 100% FiO2 with 10-12cm water.
*If CPAP fails under non invasive method, an ETT must be inserted. *If CPAP fails w/ ETT, mechanical ventilation is indicated.
Parameters To Be Met B4 Weaning 1. Improvement in CXR
2. AABG showing PO2 >/= 50 mmHg 3. Blood PH >/= 7.3
4. PCO2 </= 55 mmHg 5. Hgb 12-15g% or Hct 36-45 Weaning from CPAP
1. Decrease FiO2 by 3-5% every time PaO2 > 70
2. With FiO2 of 40%, reduce pressure by increments of 2 cm water every 2-4H until pressure of 2-3cm is achieved.
3. transfer ptient to oxygen hood with FiO2 of 15-50%
CREATININE CLEARANCE I. based on height
* 0.33 = preterm,lbw,<1yo 0.45=term, infant, <1yo 0.55=children, adolescent fem 0.7 =adolescent male * x ht (cm) --- serum crea (mg/dl) II. adult * male=72 female=85 140-age x wt --- * x crea (mg/dl) VALUES 80-120 normal 50-80 renal impairment 20-50 renal insufficiency 5-20 renal failure <5 uremia GFR=125 ml/min (75-150) 24 urinary crea: M=15-20 ug/k
CSF Normal Values OPENING P Newborn 80-110 mm H2O Infant <200 mm H2O GLUCOSE Premature 24-63 mg/dl (csf-bld ratio 55-105%) Term 44-128 mg/dl (csf-bld ratio 44-158%) PROTEIN Premature 65-150 mg/dl Term 20-170 mg/dl WBC ct Premature 0-25 /cumm (57 % PMNs) Term 0-22 /cumm (61% PMNs) ELECTROLYTE COMPUTATION I. POTASSIUM normal =4-5.6 meq (4) N K deliverance = 0.1 - 0.4 meq/kg Deficit = (KD-KA) x wt x 0.6 Maintenance K= 2 x wt
Total K def = deficit + maintenance Full incorporation: 40meq/L or 20meq/500cc K INFUSION RATE
K delivery = ivf rate x K in ivf / vol/ wt normal=0.2-0.4meq/kg
II.SODIUM
maintenance Na=3 x wt maximum target/day=10 meq Na = 1 mEq = 2.3 mg/dl K = 1 mEq = 3.91 mg/dl NaHC03= gr x=650 mg=7.7 meq
gr v=325 III. CALCIUM normal = 8-10 meq IV. CHLORIDE normal = 98-106 meq V. CO2 normal = 15 meq
ET Tube Sizes and Distances According to Infant Weight Weight (gms) l.D. (mm) Depth (cm) 500-1000 2.5 N 7.0 1000-1400 3.0 7.5 1400-1900 3.0 8.0 1900-2200 3.5 8.5 2200-2600 3.5 9.0 2600-3000 3.5 9.5 3000-3400 3.5 10.0 3400-3700 3.5 10.5 3700-4100 4.0 11.0 4100-4500 4.0 11.5 >4500 4.0 12.0
MODIFIED GLASGOW SCORE FOR INFANTS MOTOR 6 spontaneous 5 withdraws to touch 4 withdraws to pain 3 abnormal flexion 2 abnormal extension 1 none VERBAL 5 coos, babbles 4 irritable, cries 3 cries to pain 2 moans to pain 1 none EYE 4 spontaneous 3 to speech 2 to pain 1 none
DOUBLE VOLUME EXCHANGE TRANSFUSION
= KBW x EST. Blood vol. x 2 materials:
1. NGT fr. 5 #1 (umbilical cath.) 2. Three way stop cock 3. FWB 4. suture 5. 50cc syringe 6. Ca gluconate 7. HGT strip EFW station fundic ht (in) - 13 x 155 - 12 0 11 +
normal wt for term: 2500-3800 g Naloxone
Narcan cc=0.1 x efw --- 0.4 given to bb whose mothers were given Demerol with in 4 hrs PTD LBW 2000-2499
VLBW 1500-1999 ELBW 1000-1499
GROWTH I. WT GAIN
age wt gain length hc (g/day) (cm/mo) cm/mo
0-3 mo 30 3.5 2
3-6 mo 20 2 1
6-9 mo 15 1.5 0.5
9-12mo 12 1.2 0.5
1-3y 8 1 0.25
4-6y 6 3/y 1/y
II. Nails 1cm/3mo
III. Hair 1cm/mo
IV. Liver span 1 w : 4.5 5 cm 12 yo : M 7-8 cm F 6-6.5 >12 yo: M: 0.032 x wt(lbs) + 0.18 x ht (in) - 7.86 F: 0.027 x wt + 0.22 x ht - 10.75 V. Gallbladder length infants: 1.5-5.5 cm adolesc: 4-8 cm width neonates: 0.8 cm all ages : 0.5-2.5
GROWTH AND DEVELOPMENT 1. Fontanelle Closure
Anterior : 12-18 mos Posterior : 3-4 mos 2. Reflexes of Neonates
appears disappears Moro Birth 8 mos Stepping Birth 6 wks Placing Birth 6 wks Sucking & Birth 4 mos,awake Rooting 7 mos, sleep Palmar Grasp Birth 6 mos Plantar Grasp Birth 10 mos Adductor Birth 7 mos Spread of knee jerk
Tonic Neck 2 mos 6 mos Neck Righting 4-6 mos 24 mos Landau 3 mos 24 mos Parachute 9 mos Persists
