Lesson Three

– In this lesson we will cover other methods of medication calculation.

– I will review some tips and tricks for easier, and faster calculation.

– We will apply all methods, and calculations learned thus far and practice some common drug doses.

Calculating Fluids

• When using a minidrip, the final gtts/min will be equal to the DD per hour.

Calculating Fluids

• When using a minidrip, the final gtts/min will be equal to the DD per hour.

Example: you are ordered to administer 1200ml over 3 hours using a 60gtts/ml solution set.

Calculating Fluids

• When using a minidrip, the final gtts/min will be equal to the DD per hour.

DD: 1200ml

SS: 60gtts/ml

T: 180 min

Calculating Fluids

• When using a minidrip, the final gtts/min will be equal to the DD per hour.

DD: 1200ml 1200ml x 60gtts/ml

SS: 60gtts/ml 180min

T: 180 min

Calculating Fluids

• When using a minidrip, the final gtts/min will be equal to the DD per hour.

DD: 1200ml 1200 x 1 gtts/min

SS: 60gtts/ml 3

T: 180 min

Calculating Fluids

• When using a minidrip, the final gtts/min will be equal to the DD per hour.

DD: 1200ml 400 gtts/min

SS: 60gtts/ml

T: 180 min

Calculating Fluids

• When using a minidrip, the final gtts/min will be equal to the DD per hour.

- You wanted to give 1200ml over 3 hours.- That is equal to 400ml per hour- The answer was 400gtts/min- THIS ONLY WORKS WITH A MINIDRIP

The Clock Method

The Clock Method

• Lidocaine Clock– 2gm/500ml or 1gm/250ml

The Dopamine Trick

• Take the patient’s weight in pounds.

• Drop the last digit.

• Subtract two

• The resulting number is your gtts/min for a starting dose of 5mcg/kg/min

The Dopamine Trick

• Take the patient’s weight in pounds.• Drop the last digit.• Subtract two• The resulting number is your gtts/min for a

starting dose of 5mcg/kg/min– 176 lb ----drop the last number– 17 ----subtract 2 from this number– 15gtts/min = 5mcg/kg/min

• This only works with a minidrip and 1600mcg/ml concentration

The Dopamine Trick

• 15gtts/min• Lets check it• 176 lb = 80kg

5mcg/kg/min x 80kg x 60gtts/ml400mg/250ml

The Dopamine Trick

• 15gtts/min• Lets check it• 176 lb = 80kg

5mcg/kg/min x 80kg x 60gtts/ml400,000mcg/250ml

The Dopamine Trick

• 15gtts/min• Lets check it• 176 lb = 80kg

5mcg/kg/min x 80kg x 60gtts/ml1600mcg/ml

The Dopamine Trick

• 15gtts/min• Lets check it• 176 lb = 80kg

5 x 8 x 6 gtts/min 16

The Dopamine Trick

• 15gtts/min• Lets check it• 176 lb = 80kg

5 x 1 x 6 gtts/min 2

The Dopamine Trick

• 15gtts/min• Lets check it• 176 lb = 80kg

5 x 1 x 3 gtts/min 1

The Dopamine Trick

• 15gtts/min• Lets check it• 176 lb = 80kg

5 x 3 gtts/min 1

The Dopamine Trick

• 15gtts/min• Lets check it• 176 lb = 80kg

15 gtts/min 1

The Dopamine Trick

• 15gtts/min• Lets check it• 176 lb = 80kg

15 gtts/min

The Dopamine Trick

• 15gtts/min• Lets check it• 176 lb = 80kg

15 gtts/min

IT WORKS!

Practice

• You have a patient who is in SVT.

• You are ordered to administer 6mg of Adenosine, rapid IV push.

• You have a 4cc pre-filled syringe with 12 mg of Adenosine.

• Your patient is 154 lbs

• You have a patent IV.

Practice

• DD - 6mg

• C - 12mg / 4ml

Practice

• DD - 6mg

• C - 12mg / 4ml

6mg

12mg/4ml

Practice

• DD - 6mg

• C - 12mg / 4ml

6mg

3mg/ml

Practice

• DD - 6mg

• C - 12mg / 4ml

6

3 ml

Practice

• DD - 6mg

• C - 12mg / 4ml

2ml

Practice

• You administer the Adenosine, and the SVT only breaks momentarily.

• You are ordered to administer 0.25 mg/kg of Cardizem slow IV push.

• You have a 5ml vial containing 25mg of Cardizem.

• Your patient weighs 154 lbs.

Practice

• DD - 0.25mg/kg

• Wt - 154 lbs

• C - 25mg / 5ml

Practice

• DD - 0.25mg/kg

• Wt - 154 lbs

• C - 25mg / 5ml

154 ÷ 2= 77

Practice

• DD - 0.25mg/kg

• Wt - 154 lbs

• C - 25mg / 5ml

154 ÷ 2= 77 - 7 = 70

Practice

• DD - 0.25mg/kg

• Wt - 70kg

• C - 25mg / 5ml

0.25mg/kg x 70kg

25mg/5ml

Practice

• DD - 0.25mg/kg

• Wt - 70kg

• C - 25mg / 5ml

0.25mg/kg x 70kg

5mg/ml

Practice

• DD - 0.25mg/kg

• Wt - 70kg

• C - 25mg / 5ml

0.25 x 70

5 ml

Practice

• DD - 0.25mg/kg

• Wt - 70kg

• C - 25mg / 5ml

17.5

5 ml

Practice

• DD - 0.25mg/kg

• Wt - 70kg

• C - 25mg / 5ml

3.5ml

Practice

• You are ordered to administer 0.1mg/kg of Ativan to a patient for seizures.

• You have a 1cc vial with 2mg of Ativan in it.

• Your patient weighs 121 lbs.

Practice

• DD - 0.1mg/kg

• Wt - 121 lbs

• C - 2mg / ml

Practice

• DD - 0.1mg/kg

• Wt - 121 lbs

• C - 2mg / ml

121 ÷ 2

Practice

• DD - 0.1mg/kg

• Wt - 121 lbs

• C - 2mg / ml

121 ÷ 2 = 60.5

Practice

• DD - 0.1mg/kg

• Wt - 121 lbs

• C - 2mg / ml

121 ÷ 2 = 61 - 6

Practice

• DD - 0.1mg/kg

• Wt - 121 lbs

• C - 2mg / ml

121 ÷ 2 = 61 - 6 = 55

Practice

• DD - 0.1mg/kg

• Wt - 55kg

• C - 2mg / ml

0.1mg/kg x 55kg

2mg/ml

Practice

• DD - 0.1mg/kg

• Wt - 55kg

• C - 2mg / ml

0.1 x 55

2 ml

Practice

• DD - 0.1mg/kg

• Wt - 55kg

• C - 2mg / ml

5.5

2 ml

Practice

• DD - 0.1mg/kg

• Wt - 55kg

• C - 2mg / ml

2.75ml

Practice

• You are preparing to perform rapid sequence induction, to intubate your patient.

• Your orders are to begin with 0.3mg/kg of Etomidate/Amidate.

• Your Patient weighs 187 lbs.• You have a 20ml pre-filled syringe,

containing 40mg of Etomidate.

Practice

• DD - 0.3mg/kg

• Wt - 187 lbs

• C - 40mg/20ml

Practice

• DD - 0.3mg/kg

• Wt - 187 lbs

• C - 40mg/20ml

187 ÷ 2

Practice

• DD - 0.3mg/kg

• Wt - 187 lbs

• C - 40mg/20ml

187 ÷ 2 = 93.5

Practice

• DD - 0.3mg/kg

• Wt - 187 lbs

• C - 40mg/20ml

187 ÷ 2 = 94 - 9

Practice

• DD - 0.3mg/kg

• Wt - 187 lbs

• C - 40mg/20ml

187 ÷ 2 = 94 - 9 = 85

Practice

• DD - 0.3mg/kg

• Wt - 85kg

• C - 40mg/20ml

Practice

• DD - 0.3mg/kg

• Wt - 85kg

• C - 40mg/20ml

0.3mg/kg x 85kg

40mg/20ml

Practice

• DD - 0.3mg/kg

• Wt - 85kg

• C - 40mg/20ml

0.3mg/kg x 85kg

2mg/ml

Practice

• DD - 0.3mg/kg

• Wt - 85kg

• C - 40mg/20ml

25.5

2 ml

Practice

• DD - 0.3mg/kg

• Wt - 85kg

• C - 40mg/20ml

12.75ml

Practice

• Your RSI protocol also requires that you administer 2mg/kg of succinylcholine immediately after the Etomidate.

• You have a 10cc vial with 200mg of Succs.

• The patient weighs 85kg

Practice

• DD - 2mg/kg

• Wt - 85kg

• C - 200mg/10ml

Practice

• DD - 2mg/kg

• Wt - 85kg

• C - 200mg/10ml

2mg/kg x 85kg

200mg/10ml

Practice

• DD - 2mg/kg

• Wt - 85kg

• C - 200mg/10ml

2mg/kg x 85kg

20mg/ml

Practice

• DD - 2mg/kg

• Wt - 85kg

• C - 200mg/10ml

2 x 85

20 ml

Practice

• DD - 2mg/kg

• Wt - 85kg

• C - 200mg/10ml

170

20 ml

Practice

• DD - 2mg/kg

• Wt - 85kg

• C - 200mg/10ml

17

2 ml

Practice

• DD - 2mg/kg

• Wt - 85kg

• C - 200mg/10ml

8.5ml

Practice

• After you intubate your patient, you are ordered to administer 10mcg/kg/min of Propofol/Diprivan to keep the patient from becoming responsive.

• You have a 50ml vial, containing 500mg of Diprivan.

Practice

• DD - 10mcg/kg/min

• Wt - 85kg

• SS - 60gtts/ml

• C - 500mg/50ml

Practice

• DD - 10mcg/kg/min

• Wt - 85kg

• SS - 60gtts/ml

• C - 500mg/50ml

10mcg/kg/min x 85kg x 60gtts/ml

500mg/50ml

Practice

• DD - 10mcg/kg/min

• Wt - 85kg

• SS - 60gtts/ml

• C - 500mg/50ml

10mcg/kg/min x 85kg x 60gtts/ml

500,000mcg/50ml

Practice

• DD - 10mcg/kg/min

• Wt - 85kg

• SS - 60gtts/ml

• C - 500mg/50ml

10mcg/kg/min x 85kg x 60gtts/ml

10,000mcg/ml

Practice

• DD - 10mcg/kg/min

• Wt - 85kg

• SS - 60gtts/ml

• C - 500mg/50ml

10 x 85 x 60

10,000 gtts/min

Practice

• DD - 10mcg/kg/min

• Wt - 85kg

• SS - 60gtts/ml

• C - 500mg/50ml

1 x 85 x 6

100 gtts/min

Practice

• DD - 10mcg/kg/min

• Wt - 85kg

• SS - 60gtts/ml

• C - 500mg/50ml

85 x 6

100 gtts/min

Practice

• DD - 10mcg/kg/min

• Wt - 85kg

• SS - 60gtts/ml

• C - 500mg/50ml

510

100 gtts/min

Practice

• DD - 10mcg/kg/min

• Wt - 85kg

• SS - 60gtts/ml

• C - 500mg/50ml

5.1gtts/min

Conclusion