EMERGENCY DRUGS

Epinephrine 0.01-0.03 mkd q3-5minAtropine 0.02-0.03 mkd(max0.5mg)

Adenocard 6 mg initially; 12mg nxt Adenosine 6mg/2mLCa Gluc 10% 0.1-0.2 mkdCaptopril 0.3-0.5 mkd q6-12h Capoten 25mg/tabHydralazine 0.1-0.2 mkd Apresoline PO: 10mg; 25

IV: 20mg/ampL-Carnitine 50 mkd q4-6h(N) 30-40mkd?? Carnicor PO: 1/10; 330 IV: 1/5Lidocaine 1.0 mkd bolus 20-50 ugKminMannitol 20% 1-2 mkd Prep 1.2% soln (1 med/mL) NaHCO3 1.5-2.0 mkdNaloxone 0.1 mkd Plain 0.4mg/1mL Neonatal 0.02mg/1mLNifedipine 0.25-0.5 mkdq4-6hNipride 0.5-1.5 ugkm**Urecholine 2.9mg/m2/d q8 PO**

CEPHALOSPORINS 1st Generation

Cephalexin 25-100 mkD q6-8h/ 250-500Cefadroxil 30 mkD BID(max:2g)Cefalothin 50-100 mkD QIDCefazolin 50-100 mkD q8Cephradine 50-100 mkD q6-12

2nd GenerationCefamandole 50-100 QIDCefaclor 20-40 mkD q8-12 Ceclor 125/5; 250/5 DSCefuroxime IV: 200-240 mkD q8

PO: 20-30 mkD BID

3rd GenerationCefotaxime 150 mkD q6-8 (menin:200)

NB:<7 100mkd q 12H; 1g q8-12 for > 12yo & 2g-adults

Claforan 500mg; 1g; 2gCeftriaxone NB 50-75mkDOD Child: 50-75 mkD ODMeningitis LD:75mkd,80-100mkDq12-24

Adult: 1-2 g OD

AMINOGLYCOSIDES

Amikacin 10-15 mkD/15-25mkDq8-12 Prep: 100/2; 250/2Kanamycin 30-50 mkDTobramycin 6-8 mkD (Nebcin)Gentamycin 5-8 mkD IV

MACROLIDES

Erythromycin 30-50 mkDErythrocin 200/5; 400/5 ds; 100/2.5gtts

Azithromycin 10 mkD ODx1D,5mkDx4D Grp. A Strep 12mkDx5 D

Clarithromycin 15 mkD q12 or7.5 mkd

Klaricid 125/5 (don’t ref)

ANTI-STAPH

Nafcillin 100-200 mkD q6 Vigopen 250/5Co-Amoxiclav 40-60 mkD Augmentin 156/5; 312/5Stafloxin 100-200 mkDVancomycin 40-60 mkDCloxacillin 50-100 mkD q6 Prostaphlin-A 125/5 Orbenin 250; 500Oxacillin 100-200 mkD IV (Prostaphlin)

OTHER B-LACTAMS

Imepenem 60-100 mkD q 6 or 8 NB: 20 mk q 12

Piperacillin (Cypercil) Less Serious: 100-200 MKD q6 Serious: 200-300 MKDVancomycin 40-60 MKD (give in 2h) q 8 or 12Meropenem 20 mkd q 8 or 60 mkD q 8 hrs 40 mkd q 8 hrs newborn septic

Ceftazidime 150 mkD q 8 hrs(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

CefobisCefoxitin 50-100 mkD q6-12 Mefoxin 1 g/vialCeftizoxime 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/capCedax 9 mkD OD (180/5)Cefetamet 20 mkD OD q12 Globocef 250/54th GenerationCefepime for severe infection, 50 mkd q8 2mo old, BW <40kg = 50 mkq12x10d Newborns 30 mkd q 8 hrs

ANTI-TBINH Tx: 5 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 200/5Ethambutol 20mkD optic neuritis Myambutol 200/5 Ethambin 125/5 Isoetham 150/5 Ethambin/INH 150/5; 125Rifampicin 10 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 dosesStreptomycin 20-30 mkD OD IM ototoxicPZA 15 mkD

Give PO pre breakfast

ANALGESICS

Fentanyl Low: 2 mkD Mod: 2-20 mkD High: 2-50 mkD

Sublimaze (Janssen): 50ug/2mLIbuprofen 5-10 mkd q6-8 Dolan FP 100/5Mefenamic acid 3-5 mkD Ponstan 50/5Midazolam 0.1 mkD Dormicum IV: 5/1;5/5;15/3

PO: 5mg/tabMorphine 0.1-0.2 mkD Morphine 10/mLNalbuphine 0.1 mkD Nubain 10/mLPancuronium 0.04-0.1 mkDPromethazine Phenergan IV: 50/2

PO: 1/1; 10mgKetorolac 0.25 mkd q 6 hrs

PENICILLINS

PCN: 50-100TUKD or 25-30 mkD

625mg = 1 MU 250/5 = 400 TU 312.5/5= 500 TU 500mg = 800 TUOral PCN 100-200 TUKD Pentacillin 50/5; 500mg Sumapen 25/5; 250; 500 Megapen 50 TU/mL gtts

312.5/5; 625mgAmoxicillin 20-50 mkD q8

80-90mkD-OMNafcillin 100-200 mkDq6Stafloxin 100-200 mkDAmpicillin 100-200 mkD (NB: 50-100 BID; men: 300-400 mkd q6)Unasyn 25 mkD q 6 hrs Ampicin/Pentrexyl/Aldribid Bacampicillin 25-50 mkD Penglobe 200/5

ANTI-HELMINTHICOxantel pamoate 10-20 mkd Quantrel 100/5; 100Tetramizole 2.5-5 mkd SD TMZ 25mg/10mLMebendazole 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-VIRALMethisoprinol 50-100 mkD Isoprinosine 250/1; 500Inosiplex 50 mkD Immunosine 250/5Amantadine 5-8 mkD Symmetrel 50/5Virazole 10 mkDAcyclovir 10-15 mkD q6 x 5D Zovirax 250/5; 200

ANTI-ASTHMAAminophylline LD: 8-10 mk

MD: 3-5 Drip: 0.4-0.9 mkH Neonate: 1 mkd q8 or 2 mkd q12 Apnea: LD: 5-6 mkd (o.5-0.9 m/k/hr infusion) 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 8hif IVF rate is 5cc/h, fill soluset with 40cc IVF+ 16mg Amino (0.64mL)

Theophylline 3-5 mkd Nuellin 80/15; 50; 125; 250Terbutaline SQ: 0.005 mkd

PO: 0.075 mkd Drip: 0.003 mkH

Bricanyl IV: 0.5/1PO: 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; 2mgAtrovent 4-8gtts/mL NSS

ANTI-DERMATOSES

Hydrocortisone 1% TID x 2 wks Hytone/Hydrotpic/EczacortBetamethasone BID-TID Betnovate/Diprolene/DiprosoneFluocinolone acetonide BID-TID Aplosyn 10; 25; HP Synalar 10; 25; HPMometasone furoate OD Elica/MomateClobetasole propionate DermovateDiflucortolone valerate BID-TID NensonaDesoximetasone BID-TID EspersonTriamcinolone 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; 30/5Bromhexine 7-12y = 1 tsp TID

2-6y = ½ tsp TID Bromulex 4mg/5mL; 8mgSCMC 20-30 mkD Loviscol 50/1; 100/5 Solmux 40/1; 200/5 Cemetol 200/5

Erdosteine 10 m/dk/d BID 175mg/mL

DIAZEPAM DRIP

0.3 mkH dilute in NSS makes 0.1mg/mLconc = mg/total vol (mL

ANTI-HISTAMINESDiphenhydramine 3-5 mkD TID-QID Benadryl IV: 50/1x3 dose

PO: 12.5; 25; 50Methdilazine 0.3 mkD q12-q6 Tacaryl 4/5; 4; 8Clemastine 0.05 mkD q12 Tavegyl 0.5/5; 1mgHydroxyzine 1 mkD Iterax 2mg/ml; 10; 25Cetirizine 0.25 mkD Virlix 10mg/1mLLoratadine 2-12yo, < 30k: 1 tsp OD

>30k: 2 tsp OD Claritin 5mg/5mLKetotifen 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; 40Diazoxide 5-10 mkd Diazoxide 300/2Acetazolamide 20-30 mkD Diamox 250mg/tabSpironolactone 1.5-3.0 mkD Aldactone 25mg/tabHydrochlorothiazide 1-2 mkD Dichlotride 25mg; 50mg/tabMannitol 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 circ5-10ug/k/min = inotropic; no effect on HR10-20 ug/k/min = inc BP

Prep: Dopamine: 200/5 Conc Dopa D5WS 800 1 cc 49 ccDS 1600 2 cc 48 ccQS 3200 4 cc 46 cc

Prep: Dobutamine: 250/2 Conc Dobu D5WS 1000 4cc 46 ccDS 2000 8 cc 42 ccQS 4000 16 cc 34 cc

Computation for concentration:

1. D5W 250 + 200 mg/amp200/250 = 0.8 mg/cc = 800 ug/cc1 cc = 60 ugttsconc = 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

STEROIDS

Dexamethasone 0.2-0.4 mkd Decadron 4/1Hydrocortisone LD: 10 mk

MD: 5 mkD Solu-cortef 100/2; 250/2 Act-o-vial 100Prednisolone 0.7 mkD Solumedrol 125/2Prednisone 0.5 mkD 1 mkD (BA)Methylprednisolone 1.5 mkD q 6 hrs

ALBUMIN

Albumin: 1 g/K/doseAlburein 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 MKDPx: 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/2mLAfebrin 120mg/5mL; 325mg; 500Biogesic 100mg/1ml; 250/5; 500Calpol 120mg/5mL; 250mg/5mLCrocin 125mg/5mL; 500mgDefebrol 60mg/0.6mL; 120mg/5mLNaprex 250mg/5m; 500mgOpigesic 125mg; 250mgRexidol 150mg/5mL; 60/0.06; 600Tempra 120mg/5mL; 60mg/0.06mLTylenol 120mg/5mLWinadol 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

LUMBAR TAPPressure (in cmH2O)G 22 (1 ½) = gtts in 21 secG 22 (3 ½) = gtta in 39 secG 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

colorless, 50-80 mmH2o, WBC 5/mm3 CHON <45 Glucose 60-75% of blood glucose

PHOTOTHERAPYIndication: PT: 10 mg% bilirubin

FT: 15 mg% bilirubinComplications:

osmotic diarrhearashesbronze baby syndromedehydration

HS METHOD for IVF Infusion

2.5-10kg 100cc/k/day10-20kg 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 > 37.5oCHypermetabolic +25-50%Burns +14% for 1st DegreeSweating +10-25%

KVO: ugtt = 3.5 gtt = 10

BALLARD’S MATURITY TESTING

Score AOG (wks)

5 2610 2815 3020 3225 3430 3635 3840 4045 4250 44

CHARACTERISTICS OF PROXIMAL & DISTAL SBO

HIGH SBO LOW SBOAcute onset less acute Prominent vomiting less prominent Vomit not feculent often feculentPain frequent less frequent minimal distension prominent

SA = Wt x 4 + 7 x 400 (renal) Wt + 90

Men SA x 1500Preterm SA x 1200CHF SA x 800Cardiac SA x 200Renal SA x 400 + 24h UOMF < 2yo = SA x 1500

> 2yo = SA x 1200

0-5 kg wt x 0.05 + 0.056-10 kg wt x 0.04 + 0.110-15k wt x 0.03 + 0.215-20k 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 yrs2. leukocytosis > 16,0003. hyperglycemia > 200mg/dL (11mmol/L)4. serum LDH > 400 IU/L5. serum AST > 250 IU/L

During the initial 48hrs:

1. hematocrit fall > 10%2. fluid sequestration > 4000 mL3. hypocalcemia < 8mg/dL (1.9mmol/L)4. hypoxemia (PO2 <60mmHg)5. BUN rise >1.85mg/dL (>1.8mmol/L) post IVF6. hypoalbuminemia < 3.2g/dL (32g/L)

CRITERIA FOR AMI

1.typical pain: retrosternal, severe, pain lasting >30min, unrelieved by nitrates, cold, clammy perspiration2. evolutionary ST elevation followed by Q wave formation and ST segment inversion3. elevation of serum CPK-MB

Labs:Onset Peak Duration

CPK-MB 4-6h 12-24h 24-48hSGOT 8-12h 36-48h 3-5daysLDH 12-24h 2-4days 7-10days

H = 24 x pCO 2

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 40-60 moderate < 40 severe

CPAP

TFR = wt x TV(10-15) x RR x IE ratio(2) + 2000 (2L)

FiO2 = CA (0.2) + 02 (1) x 100 TFRCA = 100 – FiO2 x TFR

79

O2 = FR – CAET Size: > 2 yo = age(yrs) + 16

4HR RR2-12 mo = <160 < 2 mo = up to 601-2 yo = <120 2mo-2yr = 502-8 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 = 7.4pCO2 35-45 = 40HCO3 22-26 = 24O2 80-100Neonates: 7.3-7.4; 35-45; 24-26

Metabolic Acidosis:pCO2 = 1.5 (HCO3) + 8.4 2 limit 10 Metabolic Alkalosis:q 1meq/L inc HCO3 there is 0.5-1.0 increase in pCO2 limit 55Respiratory Acidosis:Acute: 3-4 meq/L inc HCO3 q 10mmHg inc

pCO2

Chron: 0.4 meq inc HCO3 q 10mmHg inc pCO2

Respiratory Alkalosis:Ac: 2-4meq dec HCO3 q 10mmHg dec

pCO2 limit 18Chr: 0.5meq dec HCO3 q 10mmHg dec

pCO2

def: 0.3 x ABE x wt (half correction)

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 140-1602-12 mo 120-1401-2 yo 100-1202-8 yo 90-110

II. RR<2 mo up to 602mo-1yr 501y-5y 40

III. BPsyst upper :yrs x 2 + 90 lower: yrs x 2 + 70

diast 30 mm Hg lower

INTUBATION/EXTUBATIONINTUBATIONET SIZE

> 2yo: age (yrs) + 16 -------------------------------------

4PT: 2 or 2.5FT: 3 or 3.5

ET LENGTHage/2 + 12kg cm1 72 83 9

EXTUBATION CRITERIAFiO2 < 50P/Fno electrolyte imbalancecontrol of infectiongood 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

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 = 8hGlucost 1 sachet in 100cc water = 8hOresol 1 sachet in 1L water = 24hGlucolyte 1 sachet in 200cc water

FLUIDS AND ELECTROLYTES

1. Hypotonic: D5W; D5NM; D5 0.3NaCl; D5 IMB; Isolyte; D5 Maintresol2. Isotonic: D5LR; D5 NSS; PLR; PNSS3. Hypertonic: D50W; D10W

STAGES OF DHF1. Febrile2. Afebrile3. Convalescent

GRADING OF DHF1. Fever + non-specific ssx; (+) tourniquet test2. Gr. 1 + spontaneous bleeding 3. Gr.2 + manifestations of circulatory failure: rapid, weak pulse; narrow pulse pressure; HPOT; cold, clammy extremities4. Profound Shock with undetectable BP & pulse

Days 1-5: petecchiae, feverDays 5-7: bleeding> Day 6 : shock

CLASSICAL DENGUE FEVER1. Thrombocytopenia not < 100T2. Hemoconcentration not > 20% of baseline

IV FLUIDS

Na K Cl HCO3 Ca PO4IMB 25 20 22 23 3 3NM 40 13 40 16 3 3NSS 154 154LR 130 4 109 28 3 3NMR 40 30IsolyteM 40 35 40IsolyteP 25 20 20PLP48 25 20 22 0.3% 51 510.6% 102 1020.45 77 770.9% 154 154ORS 90 20 80 30 (20 gluc)P-lyte90 90 20 80 P-lyte Pl 45 20 35

Na = 1 meq = 23 mgK = 1 meq = 39.1 mg

IVF OF CHOICE

LBM PLRVomiting D5 NSSMaintenance D5 NMBA D5 0.3% NaClFever & Sweating D5 0.3% NaCl;Drowning D5WAscitis D5W; D10WCHF D5 NSSHPN D5W/D5LR(BP)CHF (NPO) D5 NSS2o to HPN D5WHeat Stroke D5 NSSBurns PLRAzotemia D5WInc BUN D10WBleeding D5 LRUTI D5 NSSProfuse Bleeding D5 LRDengue Fever D5 0.3% NaClDM PNSS

ELECTROLYTES

Na = 135-145 meq (RV= 136 meq)K = 4-5.6 meq (RV= 4 meq)Ca = 8-10 meqCl = 98-106 meq

Deficit = (desired-actual) x Wt x 0.6

Adult = desired-actual x 350 3

Maintenance: Na = 3 meq/kgK = 2 meq/kg

Na/K deficit is given in 3 daysNa/K delivery = 0.1-0.4 meq/kgFull incorporation = 40 meq/L

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 BW1 yo = 3 x BW2 yo = 4 xBW3 yo = 5 x BW5 yo = 6 x BW7 yo = 7 x BW10 yo = 10 x BW

MOTOR GRADING

0 no movement 1 flicker of contraction with no associated movement at a joint2 movement present but can’t sustain against gravity2 movement against gravity but not with resistance3 movement against some resistance4 movement against full resistance

COMPOSITION OF BODY FLUIDS

Na K Cl HCO3Gastric 50 10-15 150 0Panc 140 5 50-100 100Bile 130 5 100 40Ileosto 130 15-20 120 25-30Diarrh 50 35 40 50Sweat 50 5 55 0Blood 140 4-5 100 25Urine 0-100 20-100 70-100 0

Osm = 2 (Na meq/L + K meq/L) + Urine mg/dL – glucose mg/dL 2.8 18

BCE

NB 45-50 cal/kg3-10kg 60-8010-15 45-6515-25 40-4525-35 35-4035-60 30-35> 60 25-30

MF = BCE x Wt x 1.5 = cc/hr 24 or ugtt/min

Fever = +12% for every oC rise > 37.5oCHyperventilation/dyspnea = + 25%Bronchial asthma = + 50%Bililight therapy = + 20%

CALORIC REQUIREMENTS< 1 mo 110-140 cal/k/day1-11 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 RDA0-5 mos 2.5 g/kg/day6-11 mos 2.5-3.01-6 yo 2.0-2.57-12 yo 1.5-2.013-15 yo 1.516-19 yo 1.0-1.5

Milk Formula CHONSimilac 20 cal 1.5/100NAN 20 1.5/100S-26 20 2.25/100Pre-NAN 21 2/100BM 22 1.1/100Enfalac 21 2.25/100

K infusion rate = IV rate x amt of K (mEq) Vol of IVF x wt

Normal KIR: 0.1 – 0.3Vit K = 0.3 mg/kg for IV antibiotics >7 D

Ca gluconate - 1 cc/kg/shift

Maintenance/ DAY: 30X WT 9

Ca deficit - 53-75 mEq/k/dayCa 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

ALL HIGH RISK PROTOCOL

PHASE induction consolidation maintenance

Vincristine 15 mg/m2 on D0,7,14,21Doxorubicin 25 mg/m2 on D0,7,14,21Prednisone 40 mg/m2 on D21-25-L aspariginase 6mg/m2 for 9 doses (3 doses per week; mwf/mtw)

Anaphylaxis

epinephrine.1:10000.01 mkd max of .5 ml IM

diphenhydramine1-2 mkd IM/IV up to 50 mg q 4-6

Ranitidine1-2 mkD up to 50 mg IV q 6H

Hydrocortisone5-10 mkd up to 100-500 mg IV q 4-6H

ANTHROPOMETRY1. Body WeightA. 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 gainedC. 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

ASTHMA CLASSIFICATIONBASED ON SEVERITY intrmtnt persistent

mild mod severe day sx <1/w >1/w daily dailynight sx «2/mo >2/mo >1/w >1/wPEFR exp »80 »80 60-79 <60PEFR var <20 20-30 >30 >30FEV1 »80 »80 60-79 <60

ATHMA SCORINGWOOD'S SCORE

0 1 2p02 or 50-100 «70 in «70 in cyanosis rm air 40fio2Breath snds N unequal absentAcc muscles N mod maxExp wheeze N mod extremCerebal 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 markedLower chest Retractions - visible markedUpper chest Retractions - synch in- seesaw

drawingXyphoid retractions - visible markedGrunting - steth ears (audible)

3-4 give 02 »7 intubate

Personal best Predictive Value of PEFfemales: ht(cm) - 100 x 5 + 175males:ht(cm) - 100 x 5 + 170

actual PEF >80%, normal

CHF CLASSIFICATION

*AnatomicI acquiredII congenital

*Physiologic (disturbance in)A heart rhythm and conductionB myocardial contractionC clinical syndrome (HPN,DM)

*FunctionalI asymptomaticII symptomatic w >ordinary actIII symptomatic w minimal activityIV symptomatic at rest

*TherapeuticsA no restriction of actB restriction of severe actC restriction of moderate actD sharp restriction of ordinary act]E complete rest in a chair or bed

MILK Abbot,wyeth = 1:2 MJ & Nestle = 1:1

MILK CAL CHON g FAT CHOalfare 72/dL 2.5 3.6 7.8bm(t) 699/L 9.09 41.96 72.7 75/dl 1.1 4.5 20/ozbm (pt) 671/L 14.09 38.93 66.4bonna 22/oz 1.1/dlcaro syr 120/oz 31corn oil 813/dL 82enfalac 67.6/dL 2 3.5 7.4

21/oz 2.25/dlgain 22/oz 2.8g/dLlactum 21.4/oz 3.42g/dLnan1 67/dL 1.2 3.6 7.5

20/oz 1.5/dlnan ha 67/dL 1.51 neosure 22/oznutren jr 100/dL 3 3.9 13.3prenan 80/dL 2.3 4.2 8.6

21/oz 2/dlpromil 81/dL 2.4 4.1 8.9s26 20/oz 2.25/dls26lbw 100/ 2.4/dL

125ml24/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 Weaning1. Improvement in CXR2. AABG showing PO2 >/= 50 mmHg3. Blood PH >/= 7.34. PCO2 </= 55 mmHg5. Hgb 12-15g% or Hct 36-45

Weaning from CPAP1. Decrease FiO2 by 3-5% every time PaO2 > 702. 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%

CSF Normal Values

OPENING PressureNewborn 80-110 mm H2OInfant <200 mm H2O

GLUCOSEPremature 24-63 mg/dl

(csf-bld ratio 55-105%)Term 44-128 mg/dl (csf-bld ratio 44-158%)

PROTEINPremature 65-150 mg/dlTerm 20-170 mg/dl

WBC ctPremature 0-25 /cumm

(57 % PMNs)Term 0-22 /cumm

(61% PMNs)

ELECTROLYTE COMPUTATIONI. POTASSIUMnormal =4-5.6 meq (4)N K deliverance = 0.1 - 0.4 meq/kg

Deficit = (KD-KA) x wt x 0.6Maintenance K= 2 x wt Total K def = deficit + maintenanceFull incorporation: 40meq/L or 20meq/500ccK INFUSION RATEK delivery = ivf rate x K in ivf / vol/ wt normal=0.2-0.4meq/kgII.SODIUMmaintenance Na=3 x wt maximum target/day=10 meqNa = 1 mEq = 2.3 mg/dlK = 1 mEq = 3.91 mg/dlNaHC03= gr x=650 mg=7.7 meq

gr v=325III. CALCIUM normal = 8-10 meqIV. CHLORIDE normal = 98-106 meqV. 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 7.01000-1400 3.0 7.51400-1900 3.0 8.01900-2200 3.5 8.52200-2600 3.5 9.02600-3000 3.5 9.53000-3400 3.5 10.03400-3700 3.5 10.53700-4100 4.0 11.04100-4500 4.0 11.5>4500 4.0 12.0

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

stationfundic ht (in) - 13 x 155 -

12 0 11 +

normal wt for term: 2500-3800 g

NaloxoneNarcan cc=0.1 x efw

----------------- 0.4

given to bb whose mothers weregiven Demerol with in 4 hrs PTD

LBW 2000-2499VLBW 1500-1999ELBW 1000-1499

GROWTHI. WT GAINage wt gain length hc

(g/day) (cm/mo) cm/mo0-3 mo 30 3.5 23-6 mo 20 2 16-9 mo 15 1.5 0.59-12mo 12 1.2 0.51-3y 8 1 0.254-6y 6 3/y 1/y

II. Nails 1cm/3moIII. Hair 1cm/moIV. 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) - 7.86F: 0.027 x wt + 0.22 x ht - 10.75

V. Gallbladderlength infants: 1.5-5.5 cm

adolesc: 4-8 cmwidth neonates: 0.8 cm

all ages : 0.5-2.5

AGE GROUP

FREQUENT PATHOGENS (IN ORDER OF FREQUENCY)

Neonates (<1 mo)

Group B streptococcus, Escherichia coli, other gram-negative bacilli, Streptococcus pneumoniae, Haemophilus influenzae (type b,[*] nontypable)

1–3 mo  

Febrile pneumonia

Respiratory syncytial virus, other respiratory viruses (parainfluenza viruses, influenza viruses, adenoviruses), S. pneumoniae, H. influenzae (type b,[*] nontypable)

Afebrile pneumonia

Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealyticum, cytomegalovirus

3–12 mo Respiratory syncytial virus, other respiratory viruses (parainfluenza viruses, influenza viruses, adenoviruses), S. pneumoniae, H. influenzae (type b,[*] nontypable), C. trachomatis, Mycoplasma pneumoniae, group A streptococcus

2–5 yr Respiratory viruses (parainfluenza viruses, influenza viruses, adenoviruses), S. pneumoniae, H. influenzae (type b,[*] nontypable), M. pneumoniae, Chlamydophila pneumoniae, S. aureus, group A streptococcus

5–18 yr M. pneumoniae, S. pneumoniae, C. pneumoniae, H. influenzae (type b,[*] nontypable), influenza viruses, adenoviruses, other respiratory viruses

≥18 yr M. pneumoniae, S. pneumoniae, C. pneumoniae, H. influenzae (type b,[*] nontypable), influenza viruses, adenoviruses, Legionella pneumophila

ANTI-AMOEBIC

Metronidazole 35-50 mkD (7.5 mkd)q8 < 7 or <1.2kg = 7.5 mkDq12

> 7 or > 2 g = 30 mkD Flagyl PO: 125/5; 250 Servizole 200mg/5mLEtofamide 15-20 mkD Kitnos 40/5; 250; 500

Cotrimoxazole 6-20 mkD bid (TMP)Clindamycin <7d.o./<2kg:10mkD 10-40mkDq6-8 Dalacin C 75/5mlChloramphenicol 50-75 mkD Chloromycetin

Tetracycline 40-60 mkD

Other Antibiotics

ciprofloxacin 10 mkd q 12 hrs

Co-trimoxazole 8-10 mkD BID (based on TMP) Triglobe 45 mg/5mL Bactrim 160 mg/5mL; 40 mg/tab; 80 mg/tab Macrobid 40mg/5 mL

Clindamycin : 30 mkD for osteomyelitis 30-50 mkD q 8 or 6 Granules: 75mg/5mL 150/mL

Chloramphenicol 50-100 mkD Chloromycetin Chloramol

Tetracycline 40-60 mkD

Antacids

Cimetidine 10-20 mkD Tagamet syr 200mg/5ml; 100mg/5mL

Ranitidine 4-5 mkD q 8 Zantac IV 50 mg/2mL PO 150mg; 300 mg

Omeprazole 0.6-0.7 mk ODLosec 20 mg/tab; 40 mg/tab

Famotidine 0.7 mkd q 12 H2Bloc 20mg/2mL

Lanzoprazole 15-30 mg/24 hrs 25 mg OD PO Prevacid FDT

Anti emeticMetoclopramide 0.1 mkd q 8 hrs

GLUCOSE INFUSION RATE

GIR: RATE X DEXTROSITY WT X 60PERIPHERAL LINE: 5-6 CENTRAL LINE 9-12

Dextrosity d5 50 D 7.5 75 D10 100 D50 500

Converwsion:Conc desired-actual x 2 x total vol 1000

Eg: d10- d5x2= 0.1

Conversion: d7.5= 0.055 D10= 0.11

Calories: D5 0.2 kcal/cc D7.5 0.3 D10 0.4 D12 0.5

PULMONARY VOLUMES

1. Total Volume (TV) = 500 mL = volume inspired or expired with each normal breath2. Insp. Reserve Volume (IRV) = 3.0 L = volume that can be inspired over and above the TV3. Exp. Reserve Volume (ERV) = 1.1L4. Residual Volume (RV) = 1.2 L = volume that remains in the lungs after maximal expiration5. 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 neonatesVol = desired – actual Hb x 2 x Wt = desired – actual Hct x WtDesired Hct = volume/wt + Actual Hct

Sedimented RBC 15 cc/k

Platelet Conc: 1 U / 6 KBW1U = 30-50 cc (raises platelet ct by 10T)

FFP = Fluid rate (5-20 cc/k/h in 4h) 1O-15 CC/KGCRYOPPT: 1 UNIT/7 KG

ACTUAL RETIC COUNT (ARC)

Actual Hct x reticulocyte ctDesired 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-DActual Hct

1 u = increases Hgb by 2; Hct by 3

Insulin Drip

Secure regular insulin (100 iu/mL)

Prepare as follows:

1. aspirate 0.1 mL from vial + 0.9mL NSS to make 10 iu/mL2. aspirate 0.1mL from (1) + 0.9 NSS to make 1 iu/mL

Start dose at 0.05 iu/ k/ H

Ex. Weight 1.55 kg 1.55 x 0.05 = 0.08 mL/HCalculate for vol nedded in 8 hours 0.08mL x 8 = 0.6 mL

Instructions: aspirate 0.6 ml from (2) + 7.4mL to make 8 mL and run at 1 mL/ hour

DOPA- DOBU COCKTAIL

Get rate of dopa according to desired dose Get volume of dobu according to desired

dose using

Vol= __wt x RD x 60__ Dopa rate conc. of dobu

Eg.: wt 3kg , Dopa 15, Dobu 15

Dopa 1 ccDobu 0.8 ccD5Water 48.2 cc 50cc at 3.4 cc/hour