Pedia Handy Notes

MIME-Version: 1.0 Content-type: multipart/mixed; boundary="simple boundary" --simple boundary Content-Type: Text/plain; charset=ISO-8859-1 ABG (chang/obra) neonate x ph 7.3-7.4 pCO2 30-40 35 HCO3 20-22 22 O2 50-80

7.35

older 7.35-7.45 7.4 35-45 40 22-26 24 >95

HCO3/CO2 MET ACID pCO2:1.5 x HCO3 + 8.4 +- 2 {limit of 10} MET ALK chang: CO2: inc by 0.5-1 per HCO3 inc 1 35 or 40 + {limit of 55} obra: pCO2: 0.9 x HCO3 + 9 +- 2 RESP ACID obra: HCO3(24+):^ pCO2/10 x 2.5 chang: acute= HCO3(24+):0.1 x ^pCO2 +-3 {max 27-28} chronic= HCO3(24+):0.4 x ^pCO2 +-3 {>30} RESP ALK obra: HCO3 (24-):^ pCO2/10 x 4 chang: acute= HCO3(24-):0.1-0.3 x ^ pCO2 {20-22} chronic= HCO3(24-):0.5 x ^ pCO2 {12-15} ACUTE VS CHRONIC RESPI ACID ^H: 24 x pCO2 : ^H -40 --------------HCO3 ^pCO2 if = 0.8:acute RESPI ALK

x

pH=7.41-7.45 : chronic >7.45 : acute HCO3 DEFICIT ABE x wt x 0.3 (1/2 correction) half bolus, half drip hco3 + dist water ABE HCO3 (desired-actual) x 0.6 desired=22 --simple boundary ABG INTERPRETATION Rule #1: An acute change in PaCO2 of 1mmHg is asso w/ an inc or a dec in pH of 0.008 units thus, when the PaCO2 increases by 10mmHg will dec by 0.08 units (inversely proportional). > determine the resp component of acid-base balance To asses the resp component of aid-base balance: 1. calculate the amt by which the reported PaCO2 either falls below or exceeds 4 0mmHg. Subtract the patient's PaCO2 from 40mmHg. 2. Predict the pH based on the measured PaCO2 accdg to rule #1. 3. Compare the measured pH w/ the predicted pH. *If the predicted pH is equal to the measured pH, all change in the oH are resp in origin. *If the measured pH is > than the predicted pH, an asso. metabolic alkalosis is present. *If the measured pH is < than that predicted from PaCO2 an asso. metabolic acidosis is present. Rule #2: A pH change w/ 0.01 units is the result of a base change of 0.67 mEq/L, therefore, pH inc or dec by 0.15 units, corresponding inc or dec in base by 10 mEq/L (directly proportional). > the diff bet calc pH & measured pH (ABG result) x 2/3 (0.66)meq/L is equal to base excess > if BE is > 4 either +/- AbN + 4: met alkalosis - 4: met. acidosis

BD/BE calculated by multiplying the difference between the actual pH and predict ed pH from the PaCO2 by 67. The predited pH is always subtracted from the actual pH before multiplying the difference by 67. If the actual pH is lower than the predicted pH, the difference will be anumber indicating a base deficit & the pre sence of metabolic acidosis. Rule #3: The total body HCO3 deficit = base deficit x pt's wt (kg) x 0.3 --simple boundary ABG READING METABOLIC ACIDOSIS Expected pCO2 = HCO3 x 1.5 + 8.4+-2 Limit = 10mmHg METABOLIC ALKALOSIS Expected pCO2 = each mEq inc in HCO3 will inc pCO3 by 0.5 - 1mmHg Limit = 55mmHg RESPIRATORY ACIDOSIS Acute = HCO3 inc by 3-4mEq/L every10 Limit = 30mmHg Chronic = each mmHg inc in pCO2 will inc HCO3 by 0.4mEq/L RESPIRATORY ALKALOSIS Acute = HCO3 dec by 2-4mEq/L every 10 Limit = 18mmHg Chronic = each mmHg dec in pCO2 will dec HCO3 by 0.5mEq/L Limit = 12 - 15mmHg --simple boundary ABG VALUES pH NV ACID ALK

pCO2

7.35-7.45 < 7.35 > 7.45

35-45 >45 1 mo: >80 60-80 40-60 50 paO2/FiO2 (dec) < 200 ALVEOLAR TO ARTERIAL O2 GRADIENT AaDO2= - PaO2 Pb:760 (barometric pressure at sea level) R:1 (respiratory quotient) 47: water vapor pressure if > 500; 80% mortality AO2= 713 x FiO2%(dec) - (pCO2/0.8) a/AO2= pO2/AO2 if . 500, 80% mortality in OR CALCULATED PAO2 (partial alveolar O2) (pb - PH20) (FiO2) - PaCO2 pb=760 PH20=47 if diff bet PAO2 and PAO2 is 30 min, unrelieved by nitrates, asso with cold cl ammy perspiration 2. Evolutionary ECG abn St elevation ff by Q wave formation and t wave inversion 3. Elevated serum CPK-MB

Labs for AMI Onset Peak CK-MB 4-6h SGOT 8-12h LDH 12-24h

Duration 12-24h 36-48h 2-4D

--simple boundary

24-48h 3-5D 7-10D

ALEC GODCHILDREN NAME MA/PA 1 2 3 4 5 6 tisay 7 --simple boundary

BIRTHDAY rachel ryan nefer al nenet anthea

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 D21-25L aspariginase 6mg/m2 for 9 doses (3 doses per week; mwf/mtw) --simple boundary ALLOPURINOL 10 mkD --simple boundary AMINOGLYCOSIDES Amikacin 10-15 MKD OD in NB & infants q 12 in older children 34wks: q24H Amikacide 100/2; 250/2 Kanamycin 30-50 MKD Netilmycin 30-50 MKD Netromycin 50/2 Tobramycin 6-8 MKD Gentamycin 4-8 MKD 38wks: 4 MKd q24H Garamycin 20; 40; 80/2 --simple boundary AMIODARONE 5 mkd q 8 for 1 week q 12 for 1 week od for 1 week --simple boundary ANALGESICS Mefenamic Acid 3-5 MKd Ponstan 50/5 Nalbuphine 0.1-0.15 MKd Nubain 10/ml Midazolam 0.1 mkd iv: 5/1; 5/5; 15/3 po:5 mg/tab Pancuronium 0.04-0.15 MKd q1-2h Fentanyl low: 2ug/k/d mod: 2-20 ug/k/d high: 20-50 ug/k/d Infusion rate: 1-5 ug/k/H Anesthesia: 5-50 ug/k/d Sublimaze (Janssen) 50 ug/2 50/1 Promethazine Phenergan

IV: 50/2 PO: 1/1;10

Morphine 0.1-0.2 mkd 10/mL Meperidine 0.5-1.5 MKd Max 2 MKd IV: 4MKd PO Demerol Ibuprofen 5-10 MKd q6-8 Dolan 100/5 --simple boundary ANEMIA DEFINITION neonate: > 34 weeks venous hgb= 6 mo 5 ml tid 60mkD q8 Ercefuryl 220/5 --simple boundary ANTIBIOTICS PCN G NB: 50-100 T U q12 beyond NB: 100-200 T U q6H Meningitis: 200-400 T U q6h Congenital Syhillis: 50 T U cc = 5 ---------TU IM 625 mg = 1 M U 250/5 = 400 TU/5ml 312.5/5 = 500 TU/5 ml 500 mg = 800 TU/5 ml Oral PCN 50-100 MKD Pentacillin 50/5; 500 Sumapen 25/5; 250; 500 Megapen 50/ml drops 312/5; 625 Amoxicillin 40-60 MKD q8H Pediamox Glamox Himox Moxillin prep 250/5 at er.. 25mkdose bid x 3days Amox/Clavulanic Acid 40-60 MKD Augmentin 312.5/5 (250)BID 156/5 (125) TID, 457/5 (400) Amoclav 228.5/5 (200), 312.5/5 (250) tid, 457/5 (400) bid Co-Amoxiclav 156/5, 312/5 Naficillin 100-200 MKD q6H 25-50 MKd Vigopen 250/5 28days): q8H 30-36wks (0-14days): q12H (>14days): q8H 37-44wks (0-7days): q12H (>7days): q8H >45wks: q6H Stafloxin 100-200 MKD Ampicillin NB:50-100 mkD 100-200 MKD mening: 300-400 mkD

Ampicillin + Sulbactam 25-50 mkD Unasyn 375 mg (250) 750 mg (500) Bacampicillin 25-50 MKD Penglobe 200/5 Vancomycin 40-60 MKD give in 2 hrs 10 mkd q12 in neonates q 6 in children 45wks: 10 MKd q6H *reconstitute 500mg vial with 10cc sterile water for injection (or D5W, PNSS) then ck sol with D5W, D5IMB, PNSS) inal conc of 5mg/ml. Solution is stable for 14 days.

make a sol total 100cc (sto to make a f

Oxacillin 50-100 MKD 25-50 MKd Prostaphlin IV = 100-200 MKD NB: 35-50 mkd q 12 28days): q8H 30-36wks (0-14days): q12H (>14days): q8H 37-44wks (0-7days): q12H (>7days): q8H >45wks: q6H *reconstitute 1g vial with 5.7 cc sterile water to make a final 7cc conc of 167mg/ml. Solution is stable for 3 days at room temperature, 7 days ref IV drip over 30 min Prostaphlin 125/5 Orbenin 125/5; 250; 500 Cloxacillin 50-100 mkD q6 Prostaphlin A 125/5 Pharex 250/5 Flucloxacillin 100-200 mkD Stafloxin Ciprofloxacin 15-30 mkD q 12 (iv,po) for px older than 6mos --simple boundary ANTICONVULSANT

Diazepam 0.2-0.4 MKd Max 2-5 mg or wt x 0.04=ml Valium 10/2 Trazepam 10/2 DRIP 0.3 mkh dilute in NSS makes conc: mg/total vol(ml) Rate: RD x wt x 60 ------------------conc AD: rate x conc ------------wt x 60

0.1mg/mL

Phenobarbital LD 15-20 MKd MD 3-5 MKD q8-12 Luminal IV 130/ml PO 20/5 Gr I(65mg) 1/2(30mg) 1/4(15 mg) Phenytoin LD 15-30 MKd MD 5-8 MKD q8 or 3-9 mkd q12 Dilantin IV 100/2 PO 30/5; 125/5; 30; 100 *to be diluted w/ equal amt of dist water, to be given very slow IVTT while monitoring the heart rate. Hold if with arrythmias. Flush dist. water prior to & after giving dilantin. not added to glucose containing * with ECG monitoring

solution

Carbamazepine 10-20 MKD Tegretol 100/5; 200 Clonazepam 0.01-0.03 MKD For Bael: LD 0.03 MKd MD 0.08 MKD q12H Rivotril 2/tab Valproic Acid 10-15 MKD Depakene 250/5 po, 400/4 iv Epival 250/tab Lorazepam 0.05-0.1 MKd Max 0.4 MK Midazolam IV: 0.15-0.3 MKd q2-4H IV Infusion: 0.01-0.06 m/k/H (10-60ug/k/H) Intranasal: 0.2-0.3 MKd; 5mg/ml Sublingual: 0.2-0.3 MKd;

5mg/1ml

Oral: 0.3-0.5 MKd Prep: 5/1, 15/3 Midazolam drip Rate: RD x wt x60 -----------conc AD: rate x conc -----------wt x 60 Dormicum drip 1-5 ugkmin (* x 60) 0.06-0.12 mkhr ex: 5mg/ml + 9 ml NSS = 0.5 mg/ml Rate: wt x dose *x 60 ----------------0.5 AD: rate x conc ---------------wt x *60 Morphine 0.05-0.2 MKd q4H or 0.1-0.3 mkd 16mg/ml diluted to make 1:1 IV infusion: LD 100 ug/k x 1H MD 10-15 ug/k/H Thiopental LD: 5 mkd (2-4) Drip: 0.5 - 2 mkh (1) Prep: 1g/50cc (20%) --simple boundary ANTIDERMATOSIS Hydrocortisone 1% TID x 2 wks Hytone Hydrotpic Eczacort Bethamethasone BID-TID Betnovate Fluccinolone acetonide bid-tid Aplosyn 10,25 HP Synalar 10,25,HP Mometasone furoate od Elica Clobetasole propionate Dermovate Diflucortolone valerate bid-tid --simple boundary ANTIHELMINTHICS

Oxantel pyrantel pamoate RD: 10-20 MKd SD @ HS 11 mk once Max 1g prep: Quantrel 20mg/ml; 100/5 100mg/tab Combantrin 125/5 125, 250/tab RD: >15 yo : 500mg 10-14 yo : 375mg 5-9 yo : 250mg 5 yo : 125mg Tetramizole 2.5-5 MKd SD TMZ 12.5/2.5; 50; 100/tab Albendazole 400 mg po once 200/5 10mL one dose Mebendazole 100mg BIDx 3D or 500 mg once Antiox 20mg/ml; 100; 500mg/tab Combantrin 125mg,250mg/tab 125/5ml susp >15yo =500 mg 10-14 yo=375 mg 5-9 yo=250mg 5yo=125 mg Piperazine ascaris bolus 150 mk po then 65 mk q 12 x 6 doses --simple boundary ANTIHISTASMINES Diphenhydramine 3-5 mkD tid-qid IV/IM: 1 MKD 50/1 x 3 d PO: 3-5 MKD TID 12.5/5, 25, 50 Methdilazine 0.3 MKD q12H-6H Tacaryl 4/5; 4; 8 Clemastine 0.05 MKD q12H Tavegyl 0.5/5; 1mg/tab Hydroxyzine 1 MKD Iterax 2mg/ml; 10; 25 mg/tab Ceterizine 0.25 mkD od Atopic derm=0.25 mkd bid Virlix 10mg/ml; 10mg/tab Zyrtec 1mg/ml sol 10mg/ml drops 20 gtts=10mg

10 gtts=5 mg 5 gtts=2.5 mg 1drop=0.5mg Loratadine 2-12yo 30kg: 2tsp OD Claritin 5mg/5ml; 10mg/tab Ketotifen 0.025 Mkd q12 Zadec 1mg/ml Zaditen 0.2 mg/ml. --simple boundary ANTISPASMODIC Dicycloverine 1 MKd Relestal 5mg/ml gtts 10mg/5 ml syr Bentyl 10/5, 10 mg Hyoscine-N-butly bromide Buscopan 1-3 tab TID 1-2 tsp TID PO: 5mg/5ml; 10mg/tab IV: 25mg/amp Metoclopramide 0.1 MKd q8 Plasil 10mg/tab; 5mg/ml susp 10mg/2ml amp Motilium 0.4-0.6 mkd 1mg/ml qid 15 min ac 10 mg tab tid 15 min ac --simple boundary ANTIVIRAL Methisoprinosine 50-100 MKD Isoprinosine 250/ml; 500mg/tab Inosinoplex 50 MKD Immunosine 250/5 Amantadine 5-8 MKD Symmetrel 50/5 Acyclovir 10-15 MKD q4H Zovirax 200/5; 200mg/tab zoster: 30 mkD Virazole 10 MKD --simple boundary APGAR A activity 0 no activity 1 some flexion

2 very active P pulse 0 none 1 100 G grimace 0 no response 1 grimace 2 good cry A appearance 0 blue 1 pink body, bluish ext 2 pink allover R respiration 0 none 1 slow, irregular 2 regular 2-3 severely depressed 4-6 mod. depressed 7-10 vigorous --simple boundary Content-Type: Text/plain; charset=ISO-8859-1 ASTHMA CLASSIFICATION BASED ON SEVERITY intrmtnt

persistent mod

mild

severe

day sx 1/w

daily

daily

night sx «2/mo

>2/mo

>1/w

>1/w

PEFR exp »80

»80

30

FEV1 »80 »80 60-79 --simple boundary Content-Type: Text/plain; charset=ISO-8859-1

80%, normal --simple boundary BETA-LACTAM Imipenem 60 MKD q6H Neonate: 20-25 MKd q12H Tienam 48 hrs: PNSS 24 hrs: DW reconstitute with 100cc pnss,

keep ref, iv drip 30 min

Meropenem 20-40 MKd q8-12H 10-20 mkd q8 60 mkD q8 Sepsis: 20 Mkd q12H Meningitis & Psuedomomas infections: 40 MKd q8H *decrease in platelet ct Piperacillin less serious:100-200 mkD q6 serious:200-300 mkD Tazocin (+Tazobactam) 2.25 g t 48-96 hrs storage Aztreonam 30 mkd slow iv 5-10 min --simple boundary BLOOD FLOWS CO= 5 lpm coronary bld flow cerebral muscle skin renal puolmonary

5% of CO 15 20 5 25 100

difference bet arms is 5-10 mmHg postural hypotension: fall of systolic >20 mmHg

vial + 10cc DW, slow ivt

big heart, clear lungs:pericardial eff big heart, pul congestion: LV failure, cardiomyopathy --simple boundary Content-Type: Text/plain; charset=ISO-8859-1 BLOOD TRANSFUSION Blood volume neonate 85cc/k infants 80cc/k children 75cc/k I. FWB 20 cc/k (max) vol=desired-actual hb x 6 x wt desired-actual hct x wt rate=vol x 12gtts/ml ----------------- = gts/min 60 min x 4 hrs time=4-6 hrs II. PRBC 10cc/k neonates=10-15 cc/k vol=desired-actual hb x 3 x wt desired-actual hct x wt time=3hrs cardiac= hgb x wt ÷ 2( 2 aliqs) III. SEDIMENTED RBC 15 cc/k IV. PLT CON 5-10 cc/k 1u /6 k bw mfd (2hrs) 1u=30-50 cc; raises plt by 10t V. CRYPPT 20cc/k soluble (fv,viii) CRYOSUPERNATE insoluble viii, xiii , fibrinogen if inc aptt, normal pt VI. FFP fluid rate 5-20 cc/k/h 4 hrs 10 cc/k allowable blood loss:12-15% of blood volume --simple boundary BRAIN DEATH CRITERIA Harvard absence of response negative EEG response

(-) reflex and respiration (-) cerebral perfusion --simple boundary BRONCHOPULMONARY DYSPLASIA (BPD) Treatment dexamethasone 0.5 mkd x 3 d learning disability not routine pulse course-6 doses in pt not weaned fr mv aminophylline furosemide 1 mkd limit fluids to 130 cckD nebulize vit a: 5000 u/k q other day 1st month of life to prevent --simple boundary

bpd

BURNS I. LUND & BREWER CLASSIFICATION Age(y) 0-1 1-4 5-9 10-14 Head 21 19 15 Trunk 15.5 (for all) UE 9.5 (for all) LE 14 15 17 Genitalia 1 (for all) II. AMERICAN BURN ASSN PEDIA head 18 UE / 9 trunk / 18 LE / 14 genitalia 0

15 13

11 18

19

ADULT 9 9 18 18 1

m2=(kg x 4 + 9) / 100 m2 burned=(% burn x m2) / 100 if > 50% SA burn, compute up to dangerous if >15% involved if >10% fliud loss, severe fluid do not exceed 4-5 L of fluid III. PARKLAND PEDIA % BSA x 2ml/k + 1500ml/m2 1/2 : 1st 8 hrs 1/2 : next 16 hrs ADULT cc/D= 4 ml x % burn x kg 1st 8h = 1/2 of computed 2nd 8h= 1/4 3rd 8h= 1/4 UO: 30-70 cc/h 1st hrs: LR

50% only loss

per 24 hrs

2nd hrs: D5W - to replace evaporative serum na of 140 Colloid sol (plasma) - to maintain h > 40% 2nd & 3rd degree UO : 30-100 cc/h IV. CINCINNATI UNIT 4ml/k/% burns + 1500 ml/m2 BSA 1st 8h = LR + 50 mg NaHCO3 2nd 8h= LR 3rd 8h= LR + 12.5g albumin V. GALVESTONE UNIT (SBI) 5000 ml/m2 % burn + 2000 ml/ m2 BSA *INDICATIONS FOR HOSPITALIZATION >15% BSA high tension wire electrical burn inhalational injury inadequate home situation *SUSPECT ABUSE/NEGLECT: burns to hands feet genitalia 2nd-3rd degree burns > 20 TBSA chemical burns

--simple boundary Content-Type: Text/plain; charset=ISO-8859-1 CALCIUM CALCIUM GLUCONATE IV MD 200-500 MKD max 200 IV 100/ml (9 elem

10% q6H as drip; MKd in 10 min Ca/ml or 0.45 mEq elem Ca/ml) PO 500 (45 mg Ca); 650; 58.5 Ca sandoz=110mg/5ml * 1-2cc k/dose q8H * 1cc = 9mg elem Ca DR. GO maintenance=30-40 mg/k/D correction=50-70 ml of 10% ca gluc= wt x dose÷9.4=cc in 24 hrs --simple boundary

water loss, maintaining plasma volume in pts wit burns

CALORIC REQUIREMENT < 1 mo ----------1-11 mo --------1-2 yo ----------3-8 yo ----------7-9 yo ----------10-12 -----------13-15 yo --------18-19 yo ---------

110-140 cal/day 110-115 100-110 90-100 80-90 70-80 55-85 45-50

0-6 mo ----------6-12 mo ---------1-3 yo -----------4-6 yo -----------7-10 yo ----------11-14 yo (M) ----11-14 yo (F) -----15-18 yo (M) ----15-18 yo (F) ------

117 kcal/k 108 kcal/k 100 kcal/k 90 kcal/k 80 kcal/k 65 kcal/k 55 kcal/k 50 kcal/k 40 kcal/k

up to 10 kg= 11-20 kg >20

100cal/k 1000 + 50 cal/k >10 1500+20 >20

preterm 110-140 kcal/k/D term 100-120 cho chon fats

50% 20 30

4cal/g 4 9

1T sugar=60 cal --simple boundary CATCH UP CALORIES kcal/k/day= kcal/k req wt age x ibw(wt for age) -------------------------------------actual wt chon=1g/k/D cho =60% fats=rest p50 (wt-age) 0-6 mo 117 6-12 mo 108 1-3y 100 4-6y 90 7-10y 80 adolescent male 11-14 65 15-18 50 female 11-14 55 15-18 40 --simple boundary

energy (kcal/k)

chon g/k 2.2 2 1.8 1.5 1.2 1 0.8 1 0.8

CBC VALUES WBC

Neutro Bands Lymph Mono Eos Baso Platelets

Birth 9-30 24 h 9.4-34 1 mo 5-19.5 1-3 yrs 6-17.5 4-7 yrs 5-15.5 8-13 yrs 4.5-13.5 Adult 4.5-11 3-5 Seg

54-62 25-33 3-7

1-3 0-0.75 NB 84-478T after 1week = adults Adults 150-400T

Hgb

1-3 days 14.5-22.5 g/dl 2 mos 9-14 6-12 yrs 11.5-15.5 12-18 M 13-16 F 12-16 18-49 M 13.5-17.5 F 12-16

Hct

1 day 48-69 2 days 48-75 3 days 44-72 2 mos 28-42 6-12 yrs 12-18 M 37-49 F 18-49 M 41-53 F

35-45 36-46 36-46

Band : Neutrophil ratio if > 0.2, neonatal sepsis MCV=yrs + 70 adults:80-92 MCHC increase in spherocytosis Mentzer value: MCV / RBC count 11 : IDA --simple boundary CEPHALOSPHORINS FIRST GEN Cephalexin 50-100 MKD Ceporex (125/5; 250/5) Selzef; Keflex Cefradoxil 25-50 MKD BID

Cefazolin 50-100 MKD q6-8H Stancef 500mg; 1g vial Cefradine 25-50 MKD q6H SECOND GEN Cefuroxime 50-100 MKD q8H IV 20-40 MkD q12H PO Zinacef 250; 750; 1.5g Zinnat 125/5; 250/5 Cefamandole 50-100 MKD QID Mandol 500mg; 1g vial Cefaclor 20-40 MKD q12H Ceclor 50mg/ml drops 125/5 susp 250; 500mg pulvule THIRD GEN Ceftazidime 50-100 MKD >3mos-1yo: 80 MKD BID >2yo: 160 MKD TID/QID Adults: 1-6g/day BID/TID Neo-2mos: 90-100 MKD TID 30 MKd 28days): q8H 30-36wks (0-14days): q12H (>14days): q8H 37-44wks (0-7days): q12H (>7days): q8H >45wks: q8H Fortum 250; 500mg; 1g, 2g 2mo 30-100 MKD TID Adult 1-6gm/day TID Ceftriaxone 50-100 MKD OD, iv drip child:20-80 mkD od adult:1-2 g od Sepsis & Disseminated GC: 50 MK q24H Meningitis: 100 MK LD, then 80 MKq24H Uncomplicated GC opthalmia: 50 MK (max 125mg)SD Rocephin 250; 500mg; 1g vial Cefotaxime 50-100 MKD bid-qid GC Infection: 25 MKd GC opthalmia: 100 MK SD >12yo: 1g BID 28): q8H 30-36 (0-14days): q12H (>14days): q8H 37-44wks (0-7days): q12H

(>7days): q8H >45wks: q6H Claforan 250;500mg, 1; 2g vial 2kg 7D:15 q 12 Cefoperazone 100-150 MKD BID Cefobis 0.5g & 1g vial child: 50-200 MKD BID adult: 2-4gm KD q12H Ceftizoxime 40-80 MKD BID/QID:C 500mg-2g/day BID/QID: adult Tergecin 500mg; 1g vial Ceftibuten 9 MKD BID/OD Cedax 200;400 mg cap 38mg/ml susp; 180/5 Cefixime 3-6 MKD q12H Tergecef 100/5; 20/ml 100mg/cap Zefral 100/5 50mg/1g sachet Cefprozil 20 MKD OD or 15 MKD BID Procef 250/5 Cefoxitin 50-100 MKD Mefoxin 1g vial Cefdinir 9-18 MKD q8H Omnicef 50mg/sachet 100mg/cap Cefetamet 20 MKD q12H Globocef 250/5 CEDAX 9 MKD OD 180/5 FOURTH GEN Cefepime 100 mkD q12 for severe infection 50 mkq 8 2mos: 50 MKd q12 x 10 D (w/o ref: 24H, with ref: 7days) decrease platelet count Cepimax 1g vial --simple boundary CEREBRAL EDEMA seizure : cytotoxic edema

increased icp tx: mannitol meningitis : vasogenic edema tx: dexamethasone --simple boundary CHEMOTHERAPY CYCLOPHOSPHAMIDE D5W 250 x 2 h or Dr. cabral: cyclo 500 + D5W = 100cc, pb to mainline (closed) in 1 hr materials: gloves d5w 250cc dw vial soluset 5cc syringe #2 adverse rxn: acute hemorrhagic cystitis order: hydrate (sa x 1500) in 8h cyclo 1hr drip metoclopramide 1 tab 30 or, then ivtt q8 prn pred q other day (to leucocyte count & alopecia CYTARABINE 50-100 mg/m2 24 hr infusion may not protect fr light DOXORUBICIN 30 ml PNSS x 1 hr infusion protect fr light METHOTREXATE CNS prophy age 0-1 1-3 3-6 >6 adult 15

dose 6mg 8 10 12

jra 5-30 mg/m2 or 0.15-1 m/k once a week monitor cbc, esr 3 weeks VINCRISTINE 1.5 mg/m2 dilute w 9ml 0.9NaCl --simple boundary

(D5.3) min pri decrease

COMPOSITION OF BODY FLUIDS FLUID Na K Cl HCO3 Gastric 50 10-15 150 0 Pancreas 140 5 50-100 100 Bile 130 5 100 40 Ileostomy 130 15-20 120 25-30 Diarrhea 50 35 40 50 Blood 140 4-5 100 25 Urine 0-100 20-100 70-100 0 --simple boundary COMPOSITION,MILK et al Abbot,wyeth = 1:2 MJ & Nestle = 1:1 MILK CAL alfare 72/dL bm(t) 699/L bm (pt) bonna d5 d7.5 d10 d12.5 d50 enfalac

671/L 22/oz

CHON g FAT CHO 2.5 3.6 7.8 9.09 41.96 72.7 75/dl 1.1 20/oz 14.09 38.93 66.4 1.1/dl cc x .2 cc x .3 cc x.4

4.5

cc x .5

cc x 2 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 similac pm Nepro 14% chon 60% carbohydrate 26% fats cal fat mct 7.7/ml veg oil 9/ml caro syr 120/oz 31 corn oil 813/dL 82 --simple boundary 67.6/dL

CONVERSION Celsius = (F - 32) x 5/9 F = (C x 9/5) + 32

cho

1cc 1gtt 1cc

= 15 gtts = 4 ugtts = 60 ugtts

--simple boundary CONVULSION SCORING factor occurence duration severity

0 none fleeting mild

frequency >60mi ventilation adeq

1 upon 10-60s mod twitch 60sapart impair

2 spont stimulation >1min severe clonus >10mi 10 mi impair cyanosis

--simple boundary COUGH MEDS Ambroxol 1.2-1.6 MKD q12H Mucosolvan 15/5; 7.5/5 Zobrixol 15/5; 6/1; 7.5/1.5 Ambrolex 15/5 Bromhexine 7-12 yo: 1 tsp TID 2-6 yo: 1/2 tsp TID Bromulex 4/5; 8mg/tab Bisolvan 0.8 mg/ml elixir 2mg/ml soln 4mg amp SCMC 20-30 MKD Loviscol 50/ml drops 100/5 250/5 Solmux 40/ml drops 200/5 susp Diphenhydramine 3-5 MKD Benadryl 12.5/5 syr 50/ml amp 25mg; 50mg Phenylpropanolamine Disudrin 6.25g/ml drops 12.5/5 syr q6 RD: 1-3mo: 1/4 ml 4-6mo: 1/2 ml 7-12mo: 3/4 ml 1-2yo: 1 ml 2-6yo: 1/2 tsp 7-12yo: 1 tsp Nafarin A 12.5/ml

RD: 2-6yo: 1/2 tsp 7-12yo: 1 tsp Brompheneramine Dimetapp 4/5ml syr 2/ml drops RD: 0.1 ml/k/dose TID-QID 1-6mo: 0.5 ml 7-24mo: 1 tsp 3-12yo: 1-2 tsp --simple boundary 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 mechanical ventilation is indicated. O2: CA Flow Rate (cm H2O) Fio2 4cm 40 1:3 50 1.5:2.5 60 2.2 70 2.5:1.5 80 3:1 90 3.5:0.5

6cm 8cm 10cm 12cm 1.5:4.5 2:6 2.5:7.5 3:9 2:4 3:5 4:6 4.5:7.5 3:3 4:4 5:5 6:6 4:2 5:3 6:4 7.5:4.5 4:1.5 6:2 7:2.5 4.3 5:1 7:1 9:1 10.5:1.5

ARRANGEMENT OF CPAP Compressed air \ / I O2 Patient

\ Bottle

Trouble Shooting: 1. Poor entry - increase flow rate 2. Retaining CO2 - cannot tolerate CPAP - ambubag to blow excess O2 - always suction before CPAP, ABG Parameters To Be Met B4 Weaning

1. 2. 3. 4. 5.

Improvement in CXR AABG showing PO2 >/= 50 mmHg Blood PH >/= 7.3 PCO2 70 2. With FiO2 of 40%, reduce pressure by increments of 2 cm water every 2-4H until pressure of 2-3cm is achieved. 3. transfer ptient to oxygen hood with FiO2 of 15-50% --simple boundary CPAP TECHNIQUE 1. Kink CA tube - adjust O2 guage, read @ puf botle until 2.5L (even if guage reads 6L). 2. Open CA, adjust CA to make puff bottle reach 3L Normal PaO2: FT: 60-80% Monitor 1. ABGs after every change in setting if feasible 2. patient's condition * with PaO2 > 100: dec FiO2 gradually while checking patien repeat ABG after 15-30 mins. --simple boundary CPAP TFR = WT X TV (10-15) X RR X I:E Ratio (2) + 2000 (2L) FiO2 = CA (0.2) + O2 (I) x 100 -----------------------------TFR or (CA+PA) CA = 100 - FiO2 --------------79

x TFR

O2 = FR - CA Materials Needed: Cardence y-tubing rubber tubing glass tubings 1L bottle w/ calibration w/ glass tubing inserted into the cover Compressed air Pulse Oximeter FORMULA:

F.R. = TV x wt x RR x I:E + 2000 1000 where: FR = flow rate TD = tidaL volume NB: 6-10cc/kg Child: 10-15cc/kg Adult: 15cc/kg I:E = 2 Dead space = 2000 RR = 40-60 normal e.g. NB, PT, BW = 1.2kg FR = 6 x 1.2 x 40 x 2 + 2000 1000 = 3 CA + O2: determine FiO2 by assessing patient plus CXR. If septic, showing white out on CXR --> increase FiO2 to 100% If 90%: CA = 100 - FiO2 x FR 79 = 100 - 90 x 3 = 0.4 L 79 O2 = FR - CA = 3 - 0.4 = 2.6 L/min if CA=PA, FiO2 is 60 --simple boundary CREATININE CLEARANCE FORMULA I. based on height * 0.33 = preterm,lbw, 0.03 m/k/min.

--simple boundary DIGITALIS 0.04-0.06 m/k TDD not given if HR < 100/min Lanoxin 0.05/ml, 0.25/ml elixir 0.25mg tab 0.5mg/2cc amp IV e.g. wt= 2.65 kg = 0.04 x 2.65 kg ---------------------4 = given 4x in 24H ( q6H, 1/4 of TDD) = after 4 doses, give 1/10 of TDD q12H ++: 1st 2nd 3rd 12H

dose: 1/2 TDD dose: 1/4 TDD (8H after) dose: 1/4 TDD (8H after) after; start MD: 1/5 TDD OD 1/10 TDD BID

--simple boundary DIURETICS Furosemide 1-2 MKD Lasix 20/2; 20; 40/tab Frusema 20/2; 20; 40/tab Diaxozide 5-10 MKd 300mg/2ml Acetazolamide 20-30 MKD Diamox 250mg/tab Spironolactone 1.5-3.0 MKD RD: edema: 100mg/day Essen. HPN: 50-100mg/day My. Gravis: 100-400mg/day Aldactone 25mg/tab Hydrochlorotiazide 1-2 MKD Dichlotride 25, 50mg/tab Mannitol 20% 1.5-2 gkd or 5 cc/kg/d 200 g/L; 1g = 5cc --simple boundary DOBUTAMINE DRIP Prep: 250/2 Factor

Conc

Dobu

D5W

S 16.6 DS 33.2 QS 66.4

1000 2000 4000

8.3 4.15

4cc 8cc 16cc 500 250

46cc 42cc 34cc 2

48 49

1

AD = rate x conc ----------Wt x 60 AD = rate x factor -----------wt Rate = RD x wt x 60 ----------conc Rate = Rd x wt --------factor NOREPINEPHRINE 4mg (4ml) + 1 L D5=4ug/ml pedia: 2ug/min CPR: 0.1 ugkmin --simple boundary DOMPERIDONE Motilium mins before meals TID --simple boundary

0.4 mg/k/dose 15

DOPAMINE DRIP 1-5 ug/k/min: VD; inc renal & splanchnic circulation 5-10 ug/k/min: inotropic,Inc heart contraction, no effect on HR 10-20 ug/k/min: inc BP Prep: Dopa 200/5 S DS QS

Factor 13.3 26.6

Docard: 40/ml

Conc 800 1600 3200 3.33 200 6.65 400

Dopa 1cc 2cc 4cc 0.25 0.5

D5W 49cc 48cc 46cc 49.75 49.5

NB: mg dopa = 6 x wt x RD Rate Concentration: 200 = 0.25cc dopa + 49.75cc D5W 400 = 0.5cc dopa + 49.5cc D5W 800 = 1.0cc dopa + 49cc D5W Rate = RD x wt x 60 ---------------conc Rate= RD x wt ---------

factor AD=rate x conc ----------wt x 60 AD= rate x factor -------------wt --simple boundary dope displaced ett obstructed ett pneumothorax equipment failure --simple boundary Dosing dose = rd x wt ml/mg aminogly amikacin 10-15mkD -od / q12 if oldr prep 100/2 genta 5-8mkD skintest >/=6mos mef 50/5 nabuphine 0.1mkd famotidine 0.7mkd q12 --simple boundary DOUBLE VOLUME EXCHANGE TRANSFUSION dvet = KBW x EST. Blood vol. x 2 neonate bld vol: 80-85 cc/k exchanges: total volume/10 materials: 1. NGT fr. 5 or 8 #1 (umbi cath.) 2. Three way stop cock 3. FWB 4. needle wd suture 5. 10cc syringe 6. 5 cc syring 7. forceps 8. blood set 9. microset 10. sterile bottle 11.gloves 12. PNSS 13. excision set 14. eye sheet 15. betadine others: Ca gluconate HGT strip

newborn screening test tube for specimen --simple boundary EFW station fundic ht (in) - 13 x 155 12 11

0 +

normal wt for term: 2500-3800 g Naloxone Narcan cc=0.1 x efw ----------------0.4 given to bb whose mothers were given Demerol with in 4 hrsPTD LBW 2000-2499 VLBW 1500-1999 ELBW 1000-1499 --simple boundary Electrolyte Balance (desired-actual) x wt. x 0.6 for ex, K: 2 Na:130 K def (4-2) x 10kg x 0.6 = 12mEq Km: wt x 2 =10 x 2 =20 Total= 32meq Nad=60 Nam=wt x 3 =30 Total=90 step1 1000 PLR 130 4 step2 333 D5IMB 12 yo M: 0.032 x wt(lbs) + 0.18 x ht 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 --simple boundary HEPARIN LD: 50 uk iv bolus MD: 10-20 ukh Heparin lock 0.5-1 u/ml NSS or 0.02 ml/50 ml NSS --simple boundary HEPATIC ENCEPHALOPATHY STAGE I euphoria mild confusion slurred speech disoriented sleep asterixis + / EEG usu normal

(in) - 7.86

STAGE II lethargic mod confusion asterixis + EEG abnormal STAGE III marked confusion incoherent speech sleepy but arousable asterixis + EEG abnormal STAGE IV coma + / - reponse to noxious stimuli asterixis EEG abnormal --simple boundary HYPERBIL MGT HEALTHY TERM NEONATE age(h) considr photo photo 72

>12 >15 >17

ex

ex trans & if foto fails

>15 >18 >20

>20 >25 >25

>25 >30 >25

LBW BW PM 2500

15-18

20-25

>2500 12-15 --simple boundary

18-20

sick

HYPERNATREMIA TBW=kg x 0.6 vol of d5w (L)=TBW x actual Na

-1 ---------desired Na

hrs infusion=A Na - D Na ------0.5 meq/hr ***** TBW x wt x Actual serum Na - 1

foto

-----------------Desired serum Na e.g. wt = 6.3 TBW = 50% ; 60%

ASNa = 164mEq DSNa = 140mEq 0.5 x 6.3

=

x 164 - 1 ---140

=

(3.15) (1.18 - 1) = 0.567L = 567cc

No. of Hours: @ least 0.5mEq dec in Na/hr or 12mEq dec in na/24H 164 - 140 = 24mEq

= 48

0.5mEq/hr --> 567 = 11.8cc/hr + (I H2O loss) 48 20cc = 31.8cc/hr --simple boundary Ideal bodywt 3-12 = mo+9/2 1-6y = yr x 2 + 8 7-12y = yr x 7 - 5 / 2 waterlow's clas wasting: act wt kg --------- x 100 wt for ht >90 80-90mild 70-80mod 95 90-95mild 80-90mod motor loss eye sign forced downwrd gaze dificlty n upward gaze deviated away fr the lesion PONTINE early coma pinpoint pupils in midposition bilateral decerebrate posturing caloric testing (impaired/-) CEREBELLAR sudden diziness & vomiting marked truncal ataxia ipsilateral CN V (corneal), VI, VIII weakness

--simple boundary intraventricular hemorrhage grade 1 bleeding confined to subependymal region or 50% bleed with dilatec ventricles grade 4 gr 3 with intraparenchymal hemorrhage --simple boundary 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 1

cm 7

germinal matrix-

vent

ricle

2 3

8 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 --simple boundary IVIG Kawasaki= 2g/kg Loading dose = 0.018 cc/k/min (30 min) Maintenance = 0.05 cc/k/min (6H) 0.5 cc/k/h for 30 min increments max 8cc/k/h adults 15 cc/k/H --simple boundary JAUNDICE Clinical Jaundice - manifestation of color starting 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. KRAMER'S CLASSIFICATION: Zone I II III IV

Jaundice Head/neck Upper trunk Lower trunk to thigh Arms/Legs/ Elbows/Knees

Est. Levels 6-8 mg/dl 9-12 12-14 15-18

at serum bilirubin levels 5-7

V

Hands/Feet

> 18

--simple boundary K+ adults - 40-100meq/da' pedia - 2-5meq/day --simple boundary LAB VALUES ALBUMIN

3.7-5 g/dL

ASOT < 200 iu/ml significant if > 320 CALCIUM ionized (mg/dL) cord 3-24h 5-6 4.3-5.1 CALCIUM total cord 3-24h 24-48h 4-7 D child after

24-48h 4-4.7

9-11.5 9-10.6 7-12 9-10.9 8.8-10.8 8.4-10.2

CRP < 6 mg/L PHOSPHORUS nb 4.8-9 mg/dL PROTIME

INR 30 None None None None None No ne None

PNEUMONIA DANGER SIGNS < 2 mos poor suck wheezing fever convulsions drowsy stridor 2mos-5yrs unabl to drink convulsions drowsy stridor --simple boundary Content-Type: Text/plain; charset=ISO-8859-1 Peds Hx n°bp Pre -Aje -PNC -Alc smoke -Dses -Hpn DM Asth -efw -lmp -Bldtype of mother Na -hrs ptd contractions / hypo pain -Labor Hours -Term -NSD -PROM -Meconium -Cyanosis -Cord -Penatal comp. -BW -BRank Post -Immunizations receivd- number/wer -Milestones -Feeding -illness -Vit. -rooting other reflex -FDA

-Previous hosp. WARM AIRWAY INFXN NUTRITION >1yo= Yrs * 2 + 70 // +90 = dia lower 30. --simple boundary Pedsnutrition formulas #weight 95 no 90-95 mild 80-90 moderate