pedia idiot notes

WATERLOW CLASSIFICATION

WASTING = Actual weight (kg) x 100

p50 weight for height

STUNTING = actual height (cm) x 100

p50 height for age

WASTING: >90 normal 81-90 mild 70-80 moderate 95 normal 90-95 mild 85-89 moderate /= 60 2-12 mos: >/= 50

BLOOD PRESSURE COMPUTATION

SYSTOLIC DIASTOLIC

0-12 mos 110-90 mmHg 75-55 mmHg

1-2 yrs 110-90 mmHg 75-55 mmHg

3 yrs = age x 2 + 70

FONTANELS

At Birth: 2 x 2 cm (anterior)

Closes at: 9-18 mos (anterior)

6-8 mos (posterior)

HEART RATE

Premature 120-170

0-3 mos 100-150

3-6 mos 90-120

6-12 mos 80-120

1-3 yrs 70-110

3-6 yrs 65-110

6-12 yrs 60-95

12 yrs 55-85

ACID BASE BALANCE (ABG)

Normal (N): normal acid base balance

pH PaCO2 HCO3 BE

Respiratory Acidosis

Uncompensated N N Partly

Compensated N Respiratory Alkalosis

Uncompensated N N Partly Compensated N Met Acidosis

Uncompensated N

Partly Compensated N Met Alkalosis

Uncompensated N Partly Compensated N

GUIDELINES FOR BLOOD TRANSFUSION

Cryopecipitate is administered using blood set/ macroset and

transfused fast drip unless otherwise indicated

Platelet Concentrate administered using platelet set and transfused

fast drip unless otherwise indicated

Pheresed Platelet I U is equivalent to six to fourteen (6-14) U of randomly collected platelet concentrate transfuse using platelet

set

PRBC/FWB is administered using blood set and transfused within 6-

8 hrs

FFP is administered using blood set/macroset and transfused for two

hours unless otherwise indicated

COMPUTATION FOR PRBC

For:

(Desired Hct Actual Hct) x weight

Desired Hct = 40% for full correction

30% for WBC w/c are Content of PRBC

RBC = 200 cc

Anticoagulant = 50 cc

1 pack RBC= 250 cc (to be transfused in 4 hrs)

Evidence Based Study

Give diphenhydramine 30 min 1 hr pre-BT

BLOOD GLUCOSE

Normal: 70-110 mg/dl

> 120 mg/dl: hyperglycemia

Term infants: > 140 mg/dl normally

Preterm: > 30 mg/dl normally

CLINICAL PRACTICE GUIDELINES IN THE

EVALUATION OF PEDIATRIC COMMUNITY ACQUIRED

PNEMONIA 2004

Predictors of CAP in a patient with cough

1. 3 mos to 5 yrs with tachypnea &/or chest retractions 2. 5-12 yrs with fever, tachypnea and crackles 3. > 12 yrs with the presence of the ff:

a. Fever, tachypnea, tachycardia b. At least 1 abnormal chest findings

(rales, wheezes, ronchi, dim BS)

WHO age specific criteria for tachypnea

2-12 mos 50 1-5 yrs 40 >5 yrs 30

RISK CLASSIFICATION FOR PNEUMONIA RELATED

MORTALITY

Variables PCAP

A

Min.

Risk

PCAP B

Low

Risk

PCAP C

Mod

Risk

PCAP D

High Risk

1.Comorbid

illness

None (+) (+) (+)

2.Compliant

caregiver

Yes Yes No No

3.Abilityto

follow up

Possible Possible Not

Possible

Not

Possible

4.Presence of

DHN

None Mild Mod Severe

5.Ability to feed Able Able Unable Unable

6.Age >11

mos

>11

mos

50/min

>40/min

>30min

>60/min

>50/min

>35/min

>70/min

>50/min

>35/min

8.Signs of resp

distress

a.Retraction

b.Head bobbing

c.Cyanosis

d.Grunting

e.Apnea

f.Sensorium

None

None

None

None

None

Awake

None

None

None

None

None

Awake

Inter/

Subcostal

Present

Present

None

None

Irritable

Supraclav/

Int/subcoatal

Present

Present

Present

Present

Lethargic/

Stuporous/

comatose

9.Complications None None Present Present

ACTION

PLAN

OPD

Ff up at

end of

tx

OPD

Ff up

after 3

days

Admit to

regular

ward

Admit to

PICU &

Refer to

specialist

PCAP A or PCAP B

No diagnostic aids are initially requested

PCAP C or PCAP D

1. The ff should be routinely requested: a. CXR APL b. WBC c. Culture & sensitivity of

i. blood for PCAP D

ii. Pleural fluid

iii. Tracheal aspirate upon initial intubation

d. Blood gas &/or pulse oximetry 2. The ff may be requested:

Culture and sensitivity of sputum for older children

3. The ff should not be requested a. ESR b. CRP

An Antibiotic is recommended

1. For a px classified as either PCAP A or B and is a. Beyond 2 yrs b. Having high grade fever w/o wheeze

2. For a px classified as PCAP C and is a. Beyond 2 yrs of age b. Having high grade fever w/o wheeze c. Having alveolar consolidation in the CXR d. Having WBC > 15,000

3. For a px as PCAP D

Empiric Treatment

1. For PCAP A or B w/o previous antibiotic = Amoxicillin (40-50 mkD) oral TID

2. For PCAP C who completed Hib immunization = Pen G IV (100,000 U/k/D) QID

PCAP C not completed Hib immunization

= Ampicillin IV (100 mkD) QID

3. For PCAP D consult specialist

When can a px be considered as responding to current antibx?

1. Decrease in respiratory signs and defervescence w/in 72 hrs after initiation

2. Reevaluate if ssx persists beyond 72 hrs after antibiotics 3. End of tx, CXR, WBC, ESR, or CRP should not be done to

assess therapeutic response to antibx

What should be done if px is not responding to current antibx?

1. If PCAP A or PCAP B is not responding w/in 72 H a. Change initial antibx b. Start oral macrolide c. Reevaluate dx

2. If PCAP C is not responding w/in 72 H, consult w/ a specialist because of the ff possibilities

a. PCN resistant Strep pneumonia b. Complications (pulmonary or extrapulmonary c. Other dx

3. If PCAP D is not responding w/in 72 H, consider immediate consult with a specialist

Switch from IV antibx to oral 2-3 days after initiation of antibx is

recommended in a px who:

a. Is responding to the initial antibx b. Is able to feed with intact GIT absorption c. Does not have any pulmo or extrapulmo complications

Ancillary treatment

1. O2 and hydration 2. Bronchodilators, CPT, steam inhalation, NSS nebulization

Prevention

1. Vaccines 2. Zinc supplementation for 4-6 months

a. 10 mg for infants b. 20 mg for children > 2yrs

OPD MEDS

Amoxicillin 30-50 mkd (50 mkd) q 8h

Suspension 125 mg / 5 ml

250 mg / 5 ml

Drops 100 mg/ml

Capsules 250 mg; 500 mg

Amoxicillin + clavulanic acid (amox 30-50 mkd)

Suspension 125 mg/156.25mg/5 ml TID

200 mg/228.5 mg/5 ml BID

250 mg/312.5 mg/5 ml TID

400 mg/457 mg/5 ml BID

Tablet 250mg/375 mg; 500 mg/625 mg

Cloxacillin 50-100 mkd q 6h

Suspension 125 mg/5 ml

250 mg/5 ml


Chloramphenicol 50-75 mkd q 6h



CEPHALOSPHORINS

Cefalexin (1st gen) 25-100 mkd q 6-8h

Suspension 125mg/5ml

250 mg/5 ml

Drops 100 mg/5 ml


Cefaclor (2nd gen) 20-40 mkd q 8-12 h


187 mg/5 ml

250 mg/5 ml

375 mg/5ml

Drops 50 mg/ml

CD exten rel tab 375 mg; 750 mg

Cefuroxime (2nd gen) 20-40 mkd q 12 h


250 mg/5 ml

Sachet 125 mg/ sachet

250 mg/ sachet

Tablet 125 mg; 500 mg

Cefixime (3rd gen) 6-12 mkd q 12h


Drops 20 mg/ml

Cefipime 100 mkd q 12h

Vial 500 mg; 1 gram

Cotrimoxazole (TM 5-8 mkd q 12h)

Suspension 200 mg/40 mg/5 ml

400 mg/80 mg/5 ml

Tablet 400 mg/80 mg/tab

800 mg/160 mg/tab

MACROLIDES

Erythromycin 30-50 mld q 6h


400 mg/5 ml

Drops 100 mg/2.5 ml

100 mg/ml

Clarithromycin 7.5 mkdose q 12h


Tablet 250 mg; 500 mg

Roxithromycin 6-12 yrs: 100 mg/tab BID

Albendazole 2 yo 400 mg SD


Tablet 400 mg

Acyclovir 20 mkdose diven q 6h

Max 800 mg/day

Suspension 200 mg/5ml

Blue 400 mg

Pink 800 mg

Diphenhydramine 1-2 mkdose IM/IV/PO

5 mkd q 6h

Syrup 12.5 mg/5 ml

Capsule 25 mg; 50 mg

Ampoule 50 mg/ml

Hydroxizine 1 mkd BID

Syrup 2 mg/ml

Tablet 10 mg; 25 mg

Adult 10 mg BID or 25 mg OD @ HS

Desloratadine

Syrup 2.5 mg/5 ml

6-11 mos 2 ml (1 mg) OD

1-5 yrs 2.5 ml (1.25 mg) OD

6-11 yrs 5 ml (2.5 mg) OD

Ceterizine

Oral drops 10 mg/ml

6-12 yo 10 drops BID

2-6 yo 5 drops BID

Tablet 10 mg

Adult & >12 yo 1 tab OD

6-12 yo tab BID or 1 tab OD

Loaratadine

Syrup 5 mg/5ml

Adult & 12 yo 10 ml OD

2-12 yo (>30 kg) 10 ml OD

(

SEX MATURITY RATING IN GIRLS

STAGE PUBIC HAIR

1 Preadolescent

2 Sparse, lightly pigmented, straight, medical border of

labia

3 Darker, beginning to curl, increased amount

4 Coarse, curly, abundant, but amount less

5 Adult feminine triangle medical surface of thigh

NEWBORN SCREENING

What is newborn screening?

Newborn screening is a simple procedure to find out if your

baby has a congenital metabolic disorder that may lead to

mental retardation and even death if left untreated.

Why is it important to have newborn screening?

Most babies with metabolic disorders look normal at birth.

One will never know that the baby has the disorder until the

onset of signs and symptoms and more often ill effects are

already irreversible.

When is newborn screening done?

Newborn screening is ideally done on the 48th hour or at

least 24 hours from birth. Some disorders are not detected if the

test is done earlier than 24 hours. The baby must be screened

again after 2 weeks for more accurate results.

How is newborn screening done?

Newborn screening is a simple procedure. Using the heel

prick method, a few drops of blood are taken from the babys heel and blotted on a special absorbent filter card. The blood is

dried for 4 hours and sent to the newborn screening laboratory

(NBS lab).

Who will collect the sample for newborn screening?

Newborn screening can be done by a physician, nurse,

midwife, or medical technologist.

Where is newborn screening available?

Newborn screening is available in participating health

institutions (Hospitals, lying-in, rural health units and health

centers). If babies are delivered at home, babies may be brought

to the nearest institution offering newborn screening.

When are newborn screening results available?

Newborn screening results are available within three weeks

after the NBS lab receives and tests the samples sent by the

institutions. Results are released by the NBS lab to the

institutions and are released to your attending birth attendants

or physicians. Parents may seek the results from institutions

where samples are collected.

What are the disorders included in the newborn screening

package?

The Philippine Newborn Screening program is currently

screening for five disorders and the following are:

1. Congenital Hypothyroidism (CH) CH is the most common inborn metabolic disorder. CH

results from lack or absence of thyroid hormone which is

essential to growth of the brain and the body. If the disorder is

not detected and hormone replacement is not initiated within 4

weeks, the babys physical growth will be stunted and will start losing IQ points and may become severely mentally retarded.

2. Congenital Adrenal Hyperplasia (CAH) CAH is a rare but dangerous inborn metabolic disorder. This

causes severe salt loss, dehydration and abnormally high levels

of male sex hormones in both boys and girls. If not detected

and treated early, babies may die within 9-13 days.

3. Galactosemia (Gal) GAL is a condition in which babies are unable to process

certain part of the milk called galactose. Accumulation of

excessive galactose in the body can cause many problems

including liver damage, brain damage, and cataracts.

4. Phenylketonuria (PKU) PKU is a rare condition in which the baby cannot properly

use one the building blocks of protein called phenylalanine.

Excessive accumulation of phenylalanine in the blood causes

brain damage.

5. Glucose 6 Phosphate Dehydrogenase Deficiency (G6PD Def) G6PD deficiency is a condition where the body lacks the

enzyme called G6PD. Babies with this deficiency are prone to

hemolytic anemia resulting from exposure to oxidative

substances found in drugs, foods and chemicals.

EXPANDED PROGRAM OF IMMUNIZATION (EPI)

Vaccine 1st dose # of dose Interval Dose

BCG Birth-up 1 0.05 ml ID

DPT 6 wks 3 4 wks 0.5 ml IM

OPV 6 wks 3 4 wks 0.5 ml oral

Hep B 6 wks 3 4 wks 0.5 ml IM

Measles 9 mos 1 0.5 SQ

TT 2 mos 2 6 wks 0.5 IM

Rubella 1 yr 1 1 ml SQ

Mumps 1 yr 1 0.5 ml IM

Hemophilus

influenza

2 mos 5 yrs

3 2 mos

Varicella

zoster

9 mos - up 1 0.5 ml SQ

FLUID COMPUTATION (FLUID HYDRATION)

10 kg = 30 cc/kg run @ 8h (D5 0.3 NaCl) -MILD

= 60 cc/kg run @ 1h - MODERATE

run @ 6-8h

= 90 cc/kg run 1/3 @ 1h -SEVERE

run 2/3 @ 6-7 h

eg.: IV Fluids given ______ run @ 8h w/ 30cc/kg computed as

mild dehydration

*started w/ IVF ___ regulated at ______ computed as _____

dehydration in _____ hrs

Micro- cc/hr to macro cc/hr 4

FACTORS MODIFYING WATER REQUIREMENT

EXTRA REQUIRED:

Fever (add 12% for each oC above 37.5)

Hypermetabolic States (thermal injury, thyrotoxicosis, resp.

distress) 25-75%

Abnormal H2O/electrolyte losses (diarrhea,/vomiting) depend

on degree of hydration

Sweating (10-35%)

LESS REQUIRED:

Hypothermia (subtract 12% for each oC < 37.5)

Very high humidity

Oliguria/anuria

Sedated/paralyzed patient (subtract 40%)

Edematous/ antidiuretic states (cardiac failure)

HALLIDAY-SEGAR METHOD

(Maintenance Fluid)

(Nelson 16th ed)

0-10 kg 100 ml/kg/day

11-20 kg 1000 + 50 ml/kg for each kg > 10 kg

>20 kg 1500 + 20ml/kg for each >20 kg

LUDANS METHOD (del Mundo 2000)

0-3 kg 75 ml/kg/day




31 kg 50 ml/kg/day

DOPAMINE DRIP

Prep: 200 mg/5ml (40 mg/ml)

Dose: 3-30 mcg/kg/min

Formula:

Amt/dose = wt x dose x K (6) prep 2(to make 50 ml prep)

to incorporate running dose

eg: 10 kg child, dopamine @ 5 mcg/kg/min @ 5 cc/hr

=10 kg (5mcg/kg/min) 6 40 mg/ml 2

5 cc/hr

= 0.75 ml of dopamine

To order:

Dopamine drip 0.75 ml plus

49.25 D5W @ 5 cc/hr

DOBUTAMINE DRIP

Prep: 250 mg/20 ml (12.5 mg/ml)

Dose: 3-30 mcg/kg/min

Formula:

Amt/dose to = wt (dose) (K) prep 2 (to make 50 ml prep)

incorporate running dose

eg: 10 kg child, dobutamine @ 5 mcg/kg/min @ 5 cc/hr

=10 kg (5mcg/kg/min) (6) 12.5 mg/ml 2

5 cc/hr

= 2.4 ml of dobutamine

To order:

Dobutamine 2.4 ml plus 47.6 ml D5W @ 5 cc/hr

To check:

(dose) X = prep x running rate x amt/dose incorporated x 2

Weight x 6

ACTUAL DOSE = dose/wt

= dose x preparation

Wt

PEFR COMPUTATION

*for 100-170 cm (ht) only

Predicted PEFR

Females: ht (cm) 100 x 5 + 170 Males: ht (cm) 100 x 5 + 175 Actual PEFR:

% = actual PEFR x 100

Predicted PEFR

RDA (RECOMMENDED DAILY ALLOWANCE)

AGE Wt(kg) Cal/kg P F

VLBW < 1500 - 2.25 -

0-6 mos 3-6 110-115 2.5 -

7-12 mos 7-9 110-115 2.3 2

1-3 yrs 10-12 110 1.5-2.5 -

4-6 yrs 14-18 90-100 1.5-2.25 4

7-9 yrs 22-24 80-90 1.5-2.0 -

10-12 yrs 28-32 70-80 1.5-2.0 2.5

CCU = IBW x ABW x caloric for age

ABW

= IBW x caloric for age

TCR = CCU x (50% - 60%)

CHON = ABW x RDA chon x 4

NPC TCR CHON CHO = NPC x 60%

FATS = NPC CHO TCR every other day starting day 3 (+ 10%) To orders:

>start feeding based on the ff computation

Total caloric req. = 792 cal

Protein = 64 cal

Carbohydrate = 436 cal

Fats= 292 cal

-divided into 3 meals and 2 snacks

-pls provide sterile water after each feeding

*after 3 days

>Revise OTF/feeding based on the ff computation

Total caloric req = 871

Protein = 64

Carbohydrates = 464

Fats = 343

>Osteorized Feeding

- start osteorized feeding based on the ff computation (same)

- divided into 6 equal feeding

- please provide sterile H2O after each feeding

Eg: Px 8 y, 24.1 kg (ABW)

IBW 24 kg Caloric req 7-9 yo = 80-90 cal/kg

CCU = 24 kg x 85 cal/kg = 2040 cal

3rd day = 2040 cal x 0.75 = 1530 ~ 1500

LYMPHADENOPATHY

1 cm cervical & axillary LN

1.5 cm inguinal LN

SPECIFIC GRAVITY

1.005- 1.020

rehydration is not enough

Adolescence 10-18 females 12-20 males

Childhood 2-12 years old Infant to 2 years old

URINE OUTPUT

(1 cc/kg/hr)

Pedia: 1-3 cc/kg

Adult: 3 cc/kg/hr

ANEMIA

Hgb 10-12 g/dl = mild

8-10 g/dl = moderate

SYSTOLIC DIASTOLIC

Inflate for 5 minutes

+ volar area 1 inch distal to antecubital fossa of about 1 inch

+ petichial rashes of >20

DHF STAGING

I Febrile stage (1-7 days)

II Afebrile stage (3-4 days)

III Convolescent Stage

DHF GRADING

I Anorexia, vomiting, convulsion, restless

Flushes skin, + tourniquet test, abdominal pain, hepatomegaly

Pleural effusion (unilateral/bilateral), constipation, abdominal

distention

II Gum bleeding, epistaxis, petechiae on palate & axillae, rashes on

extremities

III Chest pain, cough, lethargy, violaceous skin, flushed face

Purpura, hematemesis, hemoptysis, melena

Cold clammy extremity, shock, ecchymosis

IV Profound shock

APGAR

(1953 Invented by Virginia Apgar) 10 assess for the need for resuscitation 50 assessment of resuscitation/prognosis of patient *APGAR does not predict neurological damage

0 1 2

Appearance Blue, pale

ext & trunk

Blue ext,

pink trunk

Completely

pink

Pulse Absent < 100 > 100

Grimace (-) response Grimace Cry, cough,

sneeze

Activity Limp Some

flexion of

extremity

Active motor

Respiration absent Slow,

irregular

Good strong

cry

Score: 7-10 = vigorous infant

4-6 = mild-mod asphyxia 100% O2 face mask 5 min heart stops 50% chance survival >10 min heart stops 0% chance survival

ECG

V3R Right, 5th ICS MCL

V4R - Right, 5th ICS, AAL

V7 Left, 5th ICS AL

PICCU INSTRUMENTS

1. Suction unit 2. Mechanical vent 3. Syringe pump 4. Pulse oximeter 5. Infusion pump 6. Soluset w/ microset 7. Macroset 8. Platelet set 9. Blood set 10. Billy light ( 20 W x 10 bulb x 20 inches) 11. Neovent/ infant ventilator 12. Cardiac monitor 13. IV stand

FEBRILE SEIZURE

Age: between 9 mos 5 yrs Temp: 39 C above

Seizure: generalized, tonic-clonic

Duration: few seconds 10 min Others: followed by postictal period of drowsiness

Rule out: meningitis by lumbar tap

Treatment: oral diazepam, 0.3 mg/kg q 8h

(1mg/kg/24hr) for 2-3 days

AMOEBIASIS

>Entamoeba histolytica (protozoan parasite)

Transmission: fecal contamination of food or hands, may also be

transmitted by anal intercourse

Pathologic feature: flask-shape ulcers in submucosa due to lytic

digestion

Diagnosis: E. histolytica in stool, tissues or aspirate, etc

Treatment: metronidazole

H. PYLORI INFECTION

- human, H2O, domestic cats & house flies (reservoir)

- ideal test:

Non invasive

Highly accurate

Inexpensive

Readily available

Endoscopy invasive 1.Biopsy & histopath

Definitive dx

Turns yellow +

Areas: antrum, body, transition zone

Drawbacks: invasive, risk of sedation

Anesthesia: absence of specialist 2.rapid urase testing for biopsy tissue

3.Bacterial culture

4. Polymerase Chain Reaction

-Non invasive

1.Immunoessay

2.Saliva & urine test

3. Stool test (monitoring eradication)

Immunoassay (ELISA)

- sensi: 60-70%

4. urea breath testing

- specificity & sensi: >95%

- difficult in smaller children

- primary goal of treatment: to dx the cause of clinical sx & not

presence of H. Pylori

- Eradication therapy

Both active H. pylori & symptomatic GI dse

Treated are:

Duodenal/gastric ulcer at endoscopy

Prior hx of duodenal or gastric ulcer

Noninvasive & invasive test +

Pathologic evidence of MALT lymphoma

Pathologically proven atrophic gastritis w/intestinal metaplasia

OPTION 1

Amoxicillin 30 mkday up to 1 g BID for 2 wks

Clarithromycin 15 mkday 500 mg BID for 2 wks

PPI 1 mkday up to 2 mg BID for 4 wks

OPTION 2

Amoxicillin (same)

Metronidazole 20 mkday to 500 mg BID

PPI 1 mkday up to 20 mg BID

OPTION 3

Clarithromycin 2 wks Metronidazole 2 wks PPI 4 wks

OPTION 4

Bismuth Subsalicylate 1 tab (262 mg) QID or 15 ml (17.6

mg/ml QID)

Metronidazole

PPI

Plus add

Amox

Tetracycline (>12 yo) 50 mkday up to 1 gm BID

Clarithromycin

OPTION 5

Ranitidine 1 tab QID for 2 wks

Bismuth 1 tab QID for 2 wks

Citrate 1 tab QID for 2 wks

Clarithromycin same Metronidazole same

Tazobactam NA + Piperacillin NA (vigocid)

Zdorixol 6mg/ml syrup

Mucolvan 15 mg/3 ml susp

Ambroxol (expel) 15 mg/5 ml

1-2 yrs tsp BID

2-6 yrs tsp TID

7-12 yrs 1 tsp TID/BID

Multivitamins (Lugraplex Syrup)

2-6 yrs 1tsp

7-12 yrs 2 tsp

>12 yrs 1 tbsp

Cherifer forte Syrup

2-6 yrs 2.5 5 ml OD 6-12 yrs 1-2 tsp OD

Ascorbic acid (Geturs) 100 mg/5 ml

1 tsp OD

MFA (Medismon) 50 mg/5 ml

6 mos 1 yr 1 tsp 2-4 yrs 2 tsp

5-8 yrs 3 tsp

9-12 yrs 4 tsp

COMPLICATIONS OF PHOTOTHERAPY

(20 watts, 20 inches, 5 bulbs)

1. DEHYDRATION 2. BLINDNESS 3. BRONZE BABY sun burn

BLOOD TRANSFUSION

PRBC - blood set Desired Hct (40 or 30) actual Hct x Wt (kg)

Platelet Transfusion platelet set 1 unit platelet conc / 10 kg

PRBC - 20 cc q unit in 4 hrs (200 cc RBC; 50 cc anticoagulants)

Platelet - 50 cc

Whole blood - 500 cc

Leukemia Pxs ANC (Absolute Neutrophil Count) WBC x segmenters (%) x total diff ct (%)

Eg: WBC = 5000; segmenters = 50%

TDC (50%) = 1250

ADMITTING ORDERS

A admit D diet or diagnostics M meds I IV T therapeutics

Eg;

>admit under the service of. >consent to care

>TPR w/ BP q 2

>Diet

>Problem: fever, pallor, SOB

>labs & diagnostics

>meds

Nursing orders: I & O

A. MAINTENANCE FLUIDS

Infants and children require adequate fluid

and electrolyte intake to maintain fluid

balance. Calculation of maintenance fluids

based on the child's weight is required to

prevent under hydration or over hydration. To

weigh the child, use the same scale, at the

same time of day, before feeding, without

clothes.

First: Obtain an accurate weight in

kilograms.

Second: Apply the following table:

Child Weight: Normal

Maintenance Fluid Requirements:

0 - 10 kg 100cc/kg/day (100cc per kg divided by 24 hours)

10.1 - 20 kg

50cc/kg/day (1000cc for first

10 kg plus 50cc per kg for each kg over

10 kg, total divided by 24 hours)

20.1 kg and up

20cc/kg/day (1500cc for first

20 kg plus 20cc per kg for each kg over

20 kg, total divided by 24 hours)

Examples:

1. An 8.5 kg infant requires

maintenance fluids. The infant should receive

8.5 kg x 100cc = 850cc total over 24 hours.

Divide 850cc by 24 hours to calculate the

amount of fluids the infant should receive

each hour:

OR cc = 8.5kg x 100cc x 1 = 850cc = 35cc/hr

hr

kg 24 hrs. 24 hr

2. A 15 kg child requires maintenance

fluids. The child should receive

[10 kg x 100cc = 1000cc] [5 kg x

50cc = 250cc] = 1250cc total over 24

hours

Divide 1250cc by 24 hours to calculate the

amount of fluids the child should receive each

hour: 1250cc = 52cc/hr

24 hr.

OR

cc = (10kg x 100cc) (5kg x 50cc)=1000cc

250cc=1250cc x 1_ = 52cc/hr

hr kg kg

24

3. A 25 kg child requires maintenance

fluids. The child should receive:

10 kg x 100cc = 1000cc

10 kg x 50cc = 500cc

5 kg x 20cc = 100cc

1600cc total over 24 hours

Divide 1600 cc by 24 hours to calculate the

amount of fluids the child should receive each

hour:

1600cc = 67 cc/hr

24 hr.

OR

cc = (10kg x 100cc) (10kg x 50cc) (5kg x

20cc) = 1000cc 500cc 100cc = 1600cc x

1 = 67 cc/hr

hr kg

kg kg 24

B. URINE OUTPUT

Normal urine output is:

A. Infant: 2-3 ml/kg/hr

B. Toddler/preschooler: 2 ml/kg/hr

C. School-age child: 1 - 2cc/kg/hr

D. Adolescent: 0.5-1 ml/kg/hr

First: Obtain accurate wt. in kg

Second: Measure urine output accurately.

Third: Compute number of hours that patient

voided the above amount of urine.

Fourth: Use formula: Amt. of urine

divided by wt. in kg

divided by number of hours

Example:

At the end of your 8 hours shift, your 10 kg

infant voided 300cc. Is this sufficient urine

output for this patient?

cc = 300cc x 1 x 1 =

300 = 3.75 cc/kg/hr

kg/hr 10kg 8hr 80

This is sufficient urine output for this

patient.

HR RR 2 12 mos = < 160 < 2 mos = up to 60 1 2 yo = < 120 2 mos 1yo = 50 2 8 yo = < 110 1 5 yo = 40

FORMULA FOR IDEAL BODY WEIGHT (NELSON)

AGE KILOGRAMS(Kg) POUNDS(lbs) At birth 3.25 7 3-12 months Age in months + 9 Age in months + 11 2 1-6 yrs. Age in yrs. x 2 + 8 Age in yrs. x 5 + 17 7-12 yrs. Age in yrs. x 7 5 Age in yrs. x 7 +5 2 (ABW / IBW) x 100 HEIGHT cm inches N = 91 100 % at birth 50 20 1st degree = 75 90 % at 1 yo 75 30 2nd degree = < 60 2-12yo age(yr)x6+77 age(yr)x2.5=30 WATERLOW CLASSIFICATION WASTING:

____ABW_____ _ X 100 = % IBW for actual L.

Normal = > 90 % Mild = 75 90 % Moderate = 60 74 % Severe = < 60 % STUNTING:

___Actual height___ X 100 = % Ideal Ht. for age Normal = > 95 % Mild = 90 95 % Moderate = 85 89 % Severe = < 85 % IMMUNIZATIONS BCG .05 cc ID R deltoid @ birth; .10 cc L deltoid for school entrant A/R : subcutaneous abscess; LAD Ostcitis, dessiminated dse. (rare) DPT 5 cc IM upper outer thigh A/R : (w/in 48 hrs.) high fever, hypotonic Collapse or shock-like state,

inconsolable Crying for 3 hrs., convulsion with or Without fever within 3 days; erythema Induration, palpable nodule, sterile

abscess OPV 2 drops A/F : paralysis (rare) MEASLES .5 cc SQ outer part upper arm A/F : (w/in 713 days) fever for 12 days, Transient thrombocytopenia Encephalopathy, encephalitis Allergic rxn. , anaphylaxis, convulsions TT .5 cc IM, 2 doses @ least 4wks. Apart HIB .5 cc SC/IM A/F : pain, redness, swelling, > 24 hrs. fever HEP. B IM A/F : pain, fever, allergic rxn., anaphylaxis VARICELLA .5 ml SC A/F : fever, rashes

A P G A R ACTIVITY (muscle tone)

0 no activity 1 some flexion 2 very active

PULSE (HR) 0 none 1 100 bpm

GRIMACE 0 no response 1 grimace 2 good cry

APPEARANCE (color) 0 blue 1 pink, bluish extremity 2 pink all over

RESPIRATION

0 none 1 slow, irregular 2 regular

2-3 = severely depressed 4-6 = slow, irregular 7-10= vigorous

CROUP SCORING 0 1 2 Insp. Breath normal harsh w/ rhonchi delayed Stridor none inspiratory inspiratory w/ exp. Cough none hoarse cry bark Retractions none flaring, supra- (1) + subc. Sternal retracn interc. Retracn Cyanosis none none in 40%O2 > 6 intubate

PENICILLIN A. Aqueous PNC (PCN G Na) RD: 100 200 T U/k/D in 3-4 divided doses or 50 100 mg/k/D (IV) B. Benzathine (Penadur) RD: 600 T 1.2M U IM q 28 days Prep: 600 T, 1.2M, 2.4M U/vial C. Phenoxymethyl PCN RD: q 6-8 H po 25 T 50 T U/k/D; or 15 30 mg/k/D 625 mg = 1 M U 250 mg/5 ml = 400 T U 312.5 mg/5 ml = 500 T U 500 mg = 800 T U Prep: Centrapen 625 mg cap 312.5 mg/5ml susp Megapen 625 mg cap 312.5 mg/5 ml, 50 T U/ml drops Pentacillin 500 mg cap 250 mg/5 ml susp Sumapen 250, 500 mg cap 125, 250 mg/5 ml susp D. Isoxazole PCN RD: q 6H IV/PO 100 200 mg/k/D except * Prep: Oxacillin Na (IV) Prostaphlin 250, 500 mg vial *Cloxacillin Na (PO) (Prostaphlin A) (50 100) 250, 500 mg cap 125 mg/5 ml susp 250, 500 mg vial *Nafcillin Na (Vigopen) (25 mg/k/D) 250 mg cap 500 mg cap 250 mg/5 ml soln Fluocloxacillin Na (Stafloxin) 250, 500 mg cap 250, 500 mg, 1 g vial E. Ampicillin RD: 100 200 mg/k/D q 6H/8H IVTT (meningitic : 200 400 mg/k/D) Prep: 100 mg/ml drops 125, 250 mg/5 ml susp 250, 500 mg vial/cap Ampicillin, Pensyn Pentrexyl (with 125 mg vial) Ampedia (with 100 mg vial) Ampicillin/Cloxacillin (Amplicox) Adult cap/inj 500 mg (250/250)

Ped cap/inj 250 mg (125/125) 5 ml drops (60/30) Neonatal vial (50/25) Ampicillin/Cloxacillin (Pensyclox) 500 mg cap/inj (250/250) 250 mg/5 ml susp (125/125) 100 500 mg/5 ml drops Sultamicillin (Unasyn) > 375 mg vial Sulbactam Na 125 mg Ampicillin 250 mg > 750 mg vial S = 250 mg A = 500 mg Sultamicillin (PO) > 375 mg tab < 30 kg : 50 mg/k/D q 12H > 30 kg : 375 750 mg q 12H

(adult dose) *Combination of drugs computed on the

basis of Ampicillin F. Amoxicillin RD: 40 -60 mg/k/D q 8H Prep: 100 mg/ml drops 125, 250 mg/5 ml susp 250, 500 mg cap/vial* Amoxil, Clearamox, Glamox, Himox* Moxillin*, Pediamox* (250 mg vial) Sumoxil*, Wyamox Amoxicillin/Bromhexine (Bisolvomox, Mucomox) Cap: Amox = 500 mg Brom HCl = 8 mg Co-Amoxiclav (Augmentin*, Amoclav) RD: < 12 y.o. 25 mg/k/D q 8H po (for severe infxn. Up to 50 mg) Prep: 375 mg tab 9250/125) 625 mg tab (500/125) * 1 g tab (875/125) * 156.25 mg/5 ml susp TID (125/31.25) 228.5 mg/5 ml susp * BID (200/28.5) 457 mg/5 ml susp * BID (400/57) 312.5 mg/5 ml susp TID (250/62.5) 300 mg vial (250/50) * 600 mg vial (500/100) 1.2 g vial (1g/200) *po BID dosing prep. G. Bacampicillin RD: 25 50 mg/k/D q 8 12 H Prep: Bacacil, Bacamcillin 400 mg tab Penglobe 400, 800 mg tab H. Sulbenicillin RD: 20 80 mg/k/D up to 80 180 mg/k/D q 4 6 H Prep: Kedacillin 1-2 g vial I. Piperacillin RD: 100 200 mg/k/D q 6 H Severe infxn: 200 300 mg/k/D Prep: Cypercil 2 g vial Tazocin * 2.25, 4.5 g vial (2, 4 g Piperacillin/ .25 , .5 g Tazobactam) * usual dose : 2.25 to 4.5 g/D q 6 12 H

CEPHALOSPHORIN FIRST GENERATION 1. Cephalexin RD: q 6 H 50 100 mg/k/D (IV) * / PO 40 60 mg/k/D (po) Prep: Cefalexin, Ceporex Forexine, Keflex Lexum, Selzef Selvispor 250, 500 mg cap 125, 250 mg/5 ml susp 100 mg/ml drops 125 mg/1.25 ml drops * 500 mg, 1 g vial Cefalin 500mg q6H 2. Cefadroxil RD: 25 50 mg/k/D q 12 H Prep: Duracef *, Kefidrox 500 mg cap 250 mg/5 ml susp * 50 mg/ml drops * 3. Cephalothin RD: 80 160 mg/k/D q 4 6 H Prep: Keflin 1 g vial 4. Cefradine RD: 25 50 mg/k/D q 6 8 H po 50 100 mg/k/D q 6 H * IV Prep: Duphratex *, Sedinef * Velosef 250, 500 mg cap 125, 250 mg/5 ml susp 500 mg vial 5. Cefatrizine RD: < 12 y.o. 20 14 mg/k/d q 8 12 H For OM: 50 75 mg/k/D Prep: Zanitrin 250, 500 mg cap 250 mg/5 ml susp 6. Cefazolin RD: 20 40 mg/k/D q 12 H Severe infxn: 50 100 mg/k/D q 8 H Prep: Stancef, Lupex, zolival Zolfef, Megacef 500 mg, 1 g vial SECOND GENERATION 1. Cefuroxime RD: 20 40 mg/k/D BID (po) 20 40 mg/k/D 50 100 mg/k/D q 6 8 H (IV) Prep: PCAP 75 150 Zinacef, Lifurox * 250, 750 mg vial * Zinnat 125, 250 mg/5 ml susp 125, 250, 500 mg tab 2. Cefamandole RD: 50 100 mg/k/d q 4 8 H Prep: Mandol 1 g vial 3. Cefaclor RD: 20 40 mg/k//d q 8 H Prep: Ceclor 250, 500 mg pulvules 125, 187, 250 (DS) 375 mg/5 ml susp 50 mg/ml drops 375, 750 mg CD extended

release tab (BID) 4. Cefoxitin RD: 40 160 mg/k/D q 6 12 H Prep:

Mefoxin 1 g vial 5. Ceradolan RD: 40 80 mg/k/D q 6 8 H Severe infxn: Up to 160 mg/k/D Prep: Cefotiam 200 mg tab 500 mg, 1 g vial THIRD GENERATION 1. Cefotaxime RD: < 12 y.o. 50 100 mg/k/D q 6 12 H 150 200 mg/k/D severe infxn >12yo/adults

1gm BID Prep: Claforan, Clavacef * 250, 500 mg, 1 g vial 2. Cefoperazone RD: 50 200 mg/k/D q 12 H Prep: Cefobis 500 mg, 1 g vial 3. Ceftazidime RD: 50 -100 mg/k/D q 8 H < 2 mos. 25 60 mg/k/D q 12 H > 2 mos. 30 100 mg/k/D q 8 12 H Prep: Fortum 250, 500 mg, 1g, 2 q vial 50 100 mg/k/D q 12 H 4. Ceftrixone RD: 20 80 mg/k/D OD 50 100 mg/k/D q 12 H Prep: Rocephin 250, 500 mg, 1 g vial 5. Ceftizoxime RD: 40 80 mg/k/D q 6 12 H Up to 120 mg/k/D for severe infxn. Prep: Tergecin 500 mg, 1 g vial 6. Cefixime RD: 8 10 mg/k/D q 12 H Up to 12 mg/k/D for severe infxn. Prep: Tergecef 100, 200 mg cap 50 mg sachet 100 mg/5 ml susp Zefral 120 mg/5 ml 7. Ceftibuten RD: 9 mg/k/D OD Prep: Cedax 200, 400 mg cap 36 mg/ml susp 8. Cefdinir RD: 14 mg/k/D OD or BID Prep: Omnicef 100 mg cap 50 mg/500 mg granules 125/5 syrup 250/5 (USA) 9. Cefetamet RD: BID < 12 y.o. 20 mg/k/D > 12 y.o. 500 mg Prep: Globocef 500 mg tab 250 mg/5 ml susp 10. Cefprozil RD: 20 30 mg/k/D BID Prep: Procef 250, 500 mg tab 125, 250 mg/5 ml susp FOURTH GENERATION 1. Cefepime RD: 50 mg/k/D q 12 H IV drip > 2 mos. , < 40 kg 100 mg/k/D q 12 H

Inc. to q 8 H severe infxn. Prep: Cepimax 500 mg, 1, 2 g 2. Cefpirome RD: not for < 12 y.o. 1 2 g q 12 H Prep: Cefrom 1, 2 g AMINOGLYCOSIDES 1. Amikacin RD: 10 15 mg/k/D q 12 H (IV) Prep: Amikacide, Amikin, Pediakin, Bilkin 100, 250, 500 mg 2. Kanamycin RD: 15 mg/k/D q 12 H (IV) Prep: Kanamycin Meiji 1 g 3. Gentamycin RD: 5 8 mg/k/D q 8 H (IV) Prep: Garamycin 20 mg/ml, 60 mg/1.5 ml 80 mg/2 ml Servigenta 80 mg/2 ml 4. Tobramycin RD: 6 8 mg/k/D q 6-8 H (IV) Prep: Nebcin 20, 80 mg/2 ml 5. Netilmycin RD: 6 8 mg/k/D q 8 H (IV) Prep: Netromycin 50, 100 mg/2 ml 150 mg/1.5 ml 6. Streptomycin (Anti-TB) RD: 20 mg/k/D q 12 H (IV) Prep: 1 g vial 7. Neomycin RD: 50 mg/k/D q 6 H PO (ETEC) MACROLIDES 1. Erythromycin RD: q 6 H 30 50 mg/k/D po 20 mg/k/D (IV) Prep: Erymax 250 mg cap 40 mg/ml susp Erycin 250, 500 mg tab 200 mg/5 ml susp 100 mg/2.5 ml drops Erythrocin 400 mg/5 ml DS 500 mg vial Ethiocin, Macrocin Ilosone / DS 500 mg tab 250 mg pulvules 125 mg/5 ml liq 250 mg/5 ml DS 100 mg/ml drops Servitrocin (no drops) 2. Spiramycin RD: 2 3 tabs daily (adults only) Prep: Rova 3 3 MIU tab 3. Roxithromycin RD: 5 8 mg/k/D * or > 40 kg 150 mg tab BID 24 40 kg 100 mg tab BID Prep: Macrol / Macrol Kiddie 150 mg tab/100 mg tab Rulid 100, 150 mg tab 4. Clarithromycin RD: 15 mg/k/D BID (max 500 BID) Prep: Klaricid

125 mg/5 ml susp 250, 500 mg tab 5. Dirithromycin RD: 500 mg OD (adults only) Prep: Dynabac, Onzayt 250 mgtab 6. Azithromycin RD: 10 mg/k/D (for 3 D); or 10 mg/k/D in D1, 5 mg/K in D2-4 Prep: Zithromax 250 mg cap 200 mg/5 ml susp TETRACYCLINE C/I : < 8 y.o. 1. Doxycycline RD: 5 mg/k/D BID/QID Prep: Atrax, Biocolyn, Doryx, Doxin, Servidoxyne, Vibramycin *, Doxicon 50 *, 100 mg cap 2. Oxytetracycline RD: 25 50 mg/k/D q 6 H po Prep: Leydoxycycline *, Terramycin 250, 500 mg cap 125 mg/5 ml susp * 3. Tetracycline RD: 25 50 mg/k/D q 6 H po Prep: Hostacycline, Unimycin * 250 *, 500 mg cap QUINOLONE 1. Nalidixic acid RD: 33 55 mg/k/D q 6H Prep: Wintomylon 500 mg tab 250 mg/5 ml susp 2. Ciprofloxacin RD: 10 mg/k/D q 12 H (IV) 12 mg/k/D q 8 12 H po Prep: Ciprobay 250, 500 mg tab 100 mg/50 ml, 100 mg/100 ml 400 mg/200 ml infusion 3. Ofloxacin RD: q 12 H 5 mg/k/D IV 10 mg/k/D po Prep: Inoflox Qinolon 200, 400 mg tab 200 mg/100 ml inj. SULFONAMIDE RD: BID TMP 8 10 mg/k/D * SMZ 40 50 mg/D (or 1 cc/k/D; prep = 40/200) Prep: Cotrimoxazole Bacidal Forte tab 160/180 5 ml susp 80/400 Bactrim tab 80/400, 160/800 5 ml susp 40/200 40/5 Cotrimazine Forte tab 180/820 5 ml susp 45/205 Globec tab 80/820 5 ml susp 45/205 Globaxol cap 80/400 5 ml susp 40/200 Lipadrim Forte tab 160/800 5 ml susp 40/200

Microbid tab 160/800 Cap 80/400 5 ml susp 40/200 Septrin Forte tab 160/800 Cap 80/400 5 ml susp 40/200 Triglobe Forte tab 180/820 Tab 90/410 5 ml susp 45/180 CHLORAMPHENICOL RD: 500 100 mg/k/D q 6 H IV/po Meningitis : 100 200 mg/k/D q 6 H Prep: Biomycetin (no 250 cap) Chloramol, Chloramycetin Pediachlor (no cap) *, Plivacol (no susp) * Kimicetine * 250, 500 mg cap 125 mg/5 ml susp 1 g vial CLINDAMYCIN RD: 20 40 mg/k/D q 6 8 H (IV/IM) 10 25 mg/k/D TID/QID po Prep: Dalacin C 150, 300 mg cap 75 mg/5 ml granules 150 mg/ml amp. LINCOMYCIN (For PCN allergy) RD: 30 60 mg/k/D TID po 10 mg/k/D q 24 H IV Prep: Lincocin 250, 500 mg cap 250 mg/5 ml susp 600 mg/2 ml inj NITROFURANTOIN RD: 5 7 mg/k/D q 6 H Prep: Macrodantin 50, 150 mg cap LORACARBEF RD: 15 30 mg/k/D q 12 H Prep: Lorabid 100, 200 mg/5 ml susp 200 mg pulvule IMEPENEM / CILASTIN RD: 60 mg/k/D q 6 H Prep: Tienam (500/500) 1 g vial VANCOMYCIN RD: 40 60 mg/k/D q 6 -12 H Prep: 500 mg vial MEROPENEM RD: 60 120 mg/k/D q 8 H Prep: Meronem 500 mg, 1 g vial ANTI - TUBERCULOSIS 1. INH RD: OD/BID Px : 10 mg/k/D Tx : 10 20 mg/k/D Adults : 5 mg/k/D max 300 mg Prep: Nicetal Forte tab 400 mg 100 mg/5 ml susp

Odinah tab 400 mg 150 mg/5 ml susp * Comprilex 200 mg/5 ml susp Trisofort tab 400 mg 200 mg/5 ml liq Trisovit tab 100 mg 50 mg/5 ml liq 2 kit : Curazid 200/5 2. Ethambutol RD: OD < 12 y.o. : 10 15 mg/k/D > 12 y.o. : 15 25 mg/k/D Max 2500 mg/D Prep: Ebutol 400 mg E-200 mg INH tab 125 mg 100 mg/5 ml syr Ethambin INH 200 mg 100 mg tab 125 mg 150 mg tab Ethamizid 400 mg 200 mg tab 3. Rifampicin RD: 10 20 mg/k/D OD Adults : 10 20 mg/k/D OD (max 600 mg/D) Meningo px. < 1 mo. 10 mg/k/D OD for 4 days Others : 20 mg/k/D OD up to 600 mg/D for 4 days Prep: * Natricin 300, 450 mg cap 100, 200 mg/5ml susp Rimaped 100 mg/5ml syr * Rimactane Forte 150, 300 mg cap 450, 600 mg tab 100, 200 mg/5 ml syr Rifadin 150, 300, 450, 600 mg cap 100 mg/5 ml susp 4. PZA RD: 15 40 mg/k/D OD/BID (max 2 g/D) 2 cure = kidz kit 250/5 Prep: PZA-Ciba 500 mg tab 250 mg/5 ml susp 5. Streptomycin RD: 20 30 mg/K/D OD IM - ototoxic ANTI AMOEBICS 1. Metronidazole RD: 40 50 mg/k/D TID or q 8 H (IV/PO) IV drip = 7.5 mg/k/D q 8 H Prep: Anaerobia 250, 500 mg tab 125 mg/5 ml susp 500 mg inj

Flagyl, Triconex, Rodazid 500 mg forte tab 125 mg/5 ml susp 500 mg inj

Metroxyn 500 mg tab Servizole 250, 500 mg tab 200 mg/5 ml susp 500 mg inj 2. Secnidazole RD: 30 mg/k SD or in 2 divided doses w/in 4 hrs. 3D treatment 1 tab TID (adult) 25 mg/k/D (child) Prep: Flagentyl 500 mg tab 500 mg/15 ml susp 25 mg/20 ml susp 3. Etofamide RD: 15 20 mg/k/D TID for 3D Prep: Kinox 200, 500 mg tab

100 mg/5 ml susp 4. Diloxanirde furoate RD: 20 mg/k/D TID x 10 days Prep: Furamide 500 mg tab, 125 mg/5 ml susp 5. Tinidazole RD: 50 60 mg/k/D OD x 3 days Prep: Fasigyn 300, 500 mg tab FOR AGE 1. Furazolidone RD: 5 7 mg/k/D QID Prep: Furoxone 100 mg tab 16.7 mg/5 ml liq Diafuran, F-Zolidone 100 mg tab 50 mg/5 ml susp 2. Nifuroxazide RD: < 6 mos. 1 tsp BID > 6 mos. 1 tsp TID Adult - cap QID Prep: Ercefuryl 200 mg cap 220 mg/5 ml susp 3. Infloran Berna 1 cap TID ANTI HELMINTHICS 1. Piperazine citrate RD: 75 100 mg/k OD x 2 days Prep: Tabeel 1.25 g/5 ml syr 2. Pyrantel pamoate RD: 10 20 mg/k SD (q 3 mos) Prep: Combantrin 125, 250 mg tab 125 mg/5 ml susp Quantrel 100 mg tab, 20 mg/ml susp 3. Mebendazole (not for < 2 y.o.) RD: 100 mg/D BID for 3 days Prep: Antiox 100, 500 mg tab 20, 50 mg/ml susp 4. Tetramisole RD: 2.5 mg/k SD Prep: TMZ 50, 100 mg tab 12.5 mg/5 ml syr ANTI - FUNGAL 1. Nystatin RD: infant : 2 ml QID Adult / children : 4 6 ml QID 1 2 tab TID Prep: Mycostatin 500 T U tab 100 T U/ml susp 2. Amphotericin B RD: 250 ug/k with grad. inc. to total 1 1.5 mg/k/D Prep: Fungizone 50 mg/10 ml vial 3. Griseofulvin RD: 10 mg/k/D 4. Fluconazole RD: Px : 3 mg/k/D OD x 1 wk. Tx : 6 mg/k/D OD Prep: Diflucan 50, 150, 200 mg cap 2 mg/ml vial 5. Terbinafine

RD: OD > 40 kg 250 mg 20 40 mg 125 mg < 20 mg 62.5 mg Prep: Lamisil 250 mg tab 6. Ketoconazole RD: OD > 30 kg 200 mg 15 30 mg 100 mg < 15 mg 5 mg/day Prep: Nizoral 200 mg tab ANTI VIRAL 1. Methisoprinol RD: 50 100 mg/k/D TID or QID Prep: Isopronosine 500 mg tab 250 mg/5 ml syr 2. Amantadine RD: 5 8 mg/k/D BID (max 150 mg/D) Adult 200 mg/D Prep: Symmetrel 100 mg tab 50 mg/5 ml syr 3. Acyclovir RD: 20 mg/k/D q 4 H (5x/D, miss mn dose) Prep: Zovirax 200, 400, 800 mg tab

250 mg vial 4. Inosiplex RD: 50 mg/k/D q 6 H Prep: Immunosin 500 mg tab 250 mg/5ml syr MUCOLYTICS 1. Carbicisteine RD: 20 30 mg/k/D TID/QID Prep: Loviscol 500 mg cap 100, 250 mg/5 ml syr 50 mg/ml drops 2. Ambroxol RD: 1.2 1.6 mg/k/D q 12 H Prep: Ambrolex *, Salvotran Mucosolvan ** 30 mg tab 15, 30 mg/5 ml syr 7.5 mg/ml drops *

6 mg/ml drops ** Inhalation soln 15 mg/2 ml **

15 mg/2 ml amp ** DECONGESTANT 1. Loratadine / Pseudoephedrine RD: BID > 12 y.o. 1 tab > 30 kg 5 ml < 30 kg 2.5 ml Prep: Clarinase tab 5/120 Syr 5 60/5 ml 2. Brompheniramine / Phenylephrine Phenylpropanolamine Prep: Dimetapp TID/QID Syrup 4 12 y.o. 1 tsp 2 3 y.o tsp Drops 7 24 mos. 1 ml 1 6 mos. .5 ml

ANTI HISTAMINE 1. Diphenhydramine RD: 5 mg/k/D q 6 H 1 2 mg/k/D q 6 H Prep: Benadryl 25.5 mg cap 125 mg/5 ml syr 50 mg/ml amp 2. Chlorpheniramine RD: 0.35 mg/k/D q 6 H Prep: Cohistan 4 mg tab 2 mg/5 ml syr Histacort (2 mg C - 2mg Prednisone) Naafarin A, Tuseran, Myracof AF/F, Sinutab, Neozep > 12 y.o. 1 2 tab or 2 tsp 7 12 y.o tab or 1 tsp 2 6 y.o. tsp TID/QID 3. Loratadine RD: 0.16 mg/k/D OD or 1 2 y.o. 2.5 ml 2 12 y.o., < 30 kg 5 ml > 30 kg 10 ml

Adult 1 tab or 10 ml Prep: Claitin, Loradex 10 mg tab 5 mg/5 ml syr 4. Astemizole RD: OD < 6 y.o. 2 mg/10 kg 6 12 y.o. tab, 5 ml > 12 y.o. 1 tab Prep: Hismanal 10 mg tab 1 mg/ml susp 5. Clemastine RD: 0.05 mg/k/D q 12 H Prep: Tavegyl 1 mg tab .5 mg/5 ml syr Tavist 1 mg tab .5 mg/5 ml syr 6. Cetirizine RD: 0.25 mg/k/D OD or Adult, > 12 y.o. 1 tab OD 6 12 y.o. tab BID or 1 tab OD or 10 drops BID or 10 ml

OD or 5 ml BID Prep: Virlix, Zyrtec * 10 mg/ml drops 10 mg tab 1 mg/ml soln * Anerkid 2.5 mg/ml Atnix 2.5 mg/ml 7. Hydroxyzine RD: 1 mg/k/D OD or 1 5 y.o. 5 10 mg 6 10 y.o. 20 30 mg Adults 25 50 mg Prep: Iterax 10, 25 mg tab 2 mg/ml syr ANTI ASTHMATICS 1. Epinephrine RD: 0.1 0.2 cc/kg/D 1 : 10,000 - 1 cc/k/D SQ/IVTT 1 : 1,00 - 0.01 cc/k/D SQ 2. Terbutaline RD: .005 mg/k/D rpt prn after 20 min. SQ (onset 30 min) .075 * - .1 mg/k/D TID po (onset 2 3 min) (wt x .25 = cc) Prep: Bricanyl / expectorant * (with Guaifenesin), Pulmoxel * 2.5 mg tab, 5 mg ER tab .3 mg/ml syr .25 mg/D misthaler, inhaler

500 ug/D turbuhaler 5 mg/2 ml neb soln .5 mg/ml amp 1.5 mg/5 ml syr * 3. Salbutamol RD: 0.12 0.15 mg/k/D q 6 H (wt x .375 = cc) Prep: Ventolin, Librentin, Asmalin 2 mg tab 2 mg/5 ml syr 2.5 mg/2.5 ml, 5 mg/2.5 ml neb 4. Aminophylline RD: children LD 5 10 mg/k MD 3 5 mg/k/D q 8 H Slow IVTT in 20 min Apnea of prematurity: LD 5 6 mg/k MD 2 mg/k/D Drip : .4 - .9 mg/k/H Eg: 5kg @ .4 mg/k/H in 8 H If IVF rate is 5cc/H, fill Soluset w/ 40cc IVF + Amino 16 mg (.64 ml) Prep: 25 mg/ml amp 5. Bambuterol RD: not for < 2 y.o. , OD A : 10 mg B : 5 mg Prep: Bambec 10 mg tab, 1 mg/ml soln 6. Theophylline RD: 3 5 mg/k/D q 6 H po Prep: Brondil 130 mg tab 25 mg/5 ml elixir Nuelin 125 mg tab 175 mg SR tab 80 mg/15 ml syr 7. Ketotifen RD: BID > 3 y.o. / A 1 mg 6 mos 3 y.o. 1 drop or .1 mg/k/D Prep: Zadec / SRO, Zaditen / SRO 1 mg tab 2 mg SRO tab 1 mg/5 ml syr 1 mg/ml drops ANTIPYRETICS / ANALGESICS 1. Paracetamol RD: 10 15 mg/k/D q 4 H Prep: 100mg/ml (drops) 120mg/5ml or 250mg/5ml (syr) 500mg tab Calpol ,Tempra, Biogesic 2. Ibuprofen / Paracetamol RD: 5 10 mg/k/D q 6-8 H Prep: Dolan FR 100mg/5ml, 200/5 (syr) 3. Aspirin RD: 10 20 mg/k/D (Gr 1 = 65 mg) Prep: Aspilet 80 mg tab Cor 30 30 mg tab Ascriptin 325 mg tab (w/ Al(OH)3, Mg(OH)2) For: RF : 65 130 mg/k/D Arthritis : 40 60 mg/k/D KD : 80 100 mg/k/D (febrile stage) 3 5 mg/k/D (afebrile stage) 4. Indomethacin RD: fever : 1 mg/k/D TID anti - inflam. : 2 4 mg/k/D TID PDA closure : .2 - .3 mg/k/D q12 24 H x 3 doses Prep: Indocid 25 mg cap Infree 100 mg cap 5. Mefenamic Acid RD: 3 5 mg/k/D

5 8 mg/k/D q 6 8 H PDA closure : 2 mg/k/D q 8 H x 3 doses Prep: Ponstan / SF 250 mg, 500 mg cap 50 mg / 5 ml susp NARCOTIC ANALGESIC 1. Meperidine RD: I/C .8 1.3 mg/k/D q 3 4 H (IM / SC) 1 2 mg/k/D q 2 H (IV) adult : 50 -150 mg q 3 4 H Prep: Demerol 50 mg vial 100 mg/2 ml 2. Nalbuphine RD: SC, IM, IV q 3 6 H prn C : .1 - .2 mg/k/D A : .15 - .2 mg/k/D Max : 10 mg Prep: Nubain 10 mg/ml amp 3. Morphine RD: .1 - .2 mg/k/D q 2 4 H (IM / SC / IV) .01 - .1 mg/k/H cont. infu. Prep: 16 mg/ml amp (add 15 ml dose H2O to make 1 mg/ml prep.) 4. Fentanyl RD: for analgesia .5 2 ug/k/dose q 1 2 H IV for anesthesia N 10 ug/k/D I 15 50 ug/k/D C 50 100 ug/k/D Prep: Sublimaze .05 mg/2 ml 10 ml amp Other drugs for Sedation 1. Midazolam RD: 0.1 mg/k/D Prep: Dormicum 15 mg tab 5 mg/ml, 5 mg/5 ml 15 mg/3 ml amp 2. Ketamine RD: 1 2 mg/k/D (IM) 0.5 1.5 mg/k/D (IV) 6 10 mg/k/D (po) Prep: Ketalar 50 mg/ml inj ANTACIDS 1. Cimetidine RD: q 4 6 H (pc meals) N 10 15 mg/k/D < 1 y.o. 20 mg/k/D 1 12 y.o. 20 40 mg/k/D A 200 mg BID po (max 800 mg q HS) 200 mg q 4 6 H IV Prep: Tagamet 200 , 400, 800 mg tsb 100 mg/5 ml liq 200, 300 mg/2 ml amp 2. Famotidine RD: q 12 H C .7 mg/k/D A 20 40 mg Prep: H2Bloc, Pepcidine 20, 40 mg tab 20 mg/2 ml amp 3. Sucralfate RD: QID (1 H ac meals, HS) C : < 6 y.o. .5 g/D > 6 y.o. 1 g/D A : 1 g/D Prep: Iselpin 500 mg, 1 g

4. Omeprazole RD: OD C : .5 mg/k/D A : 20 40 mg Prep: Losec 10, 20 mg cap 40 mg/10 ml inj 5. Ranitidine RD: C : 1.5 mg/k/D q 6 H (IV) 2 mg/k/D q 6 8 H (po) A : 50 mg q 6 8 H (IV) 150 mg q 8 12 H (po) Prep: Pylorid 400 mg tab Ranix, Zantac */FR 150, 300 mg tab 150 mg/10 ml syr * 50 mg/2 ml amp 6. Al (OH)3 / Mg (OH)2 RD: QID (pc meals & at HS) 2 4 tabs, 1 2 tsp Prep: Mucaine, Novaluzid Simeco, Mylanta Tab, susp ANTISPASMODICS 1. Hyosine RD: PO A / > 6 y.o. 1 2 tabs 3 5x / D 10 20 ml 3 5x / D < 5 y.o. 5 10 ml TID Infant 5 ml TID IV / IM / SC A : 1 2 amp (max 100 mg/D) C : amp TID Prep: Buscopan (plus w/ para) 10 mg tab 5 mg/5 ml liq 20 mg amp Spasmolysin 10 mg tab 20 mg/ml amp 2. Dicycloverine / Dicyclomine RD: 15 min. ac meals : TID / QID Not for 6 mos. C : 2 12 y.o. 10 mg 6 mos 2 y.o. 5 10 mg or .5 1 ml drops < 6 mos. 3 mg/k/D Prep: Bentyl *, Relestal ** 10 mg tab * 10 mg/5 ml syr 5 mg/ml drops ** OTHER GIT REGULATOR 1. Cisapride RD: ac meals, TID C .6 - .9 mg/k/D or 5 mg/D A 15 40 mg/D Prep: Prepulsid 5 mg tab 1 mg/ml susp 2. Metoclopramide RD: q 8 H C .1 - .5 mg/k/D A 1 tab Prep: Plasil 10 mg tab 5 mg/5 ml syr 10 mg/2 ml amp 3. Domperidone RD: TID / QID Dyspepsia A : 1 tab or 2 tsp C : 7.5 mg/k/D Nausea / Vomiting A : 2 tabs or 4 tsp

C : 15 20 ml/10 kg/ Prep: Molitium 10 mg tab 1 mg/ml susp EMERGENCY MEDICINES Atropine 0.02 0.03 Mkd Naloxone 0.1 Mkd Plain 0.4 / 1 Neonatal 0.02 / 1 Captopril 0.3 1 Mkd q 12 H Capoten 25 mg tab L-Carnitine 30 40 Mkd Carnicor po 1 g / 10; 330 IV 1 g / 5 Hydralazine 0.1 0.5 Mkd Apresoline IV 20 / amp; Tab 10, 25 Lidocaine 1 Mkd bolus 10 50 ugKm Adenocard initial 6 mg then 12 mg Adenosine 6/2 10% Ca Gluconate 0.1 0.2 Mkd Mannitol 20% 0.25 0.5 Mkd NaHCO3 1.5 2 Mkd Prep 1.2% soln (1 med/ml) DOPAMINE RD: 1 5 ug/k/min = VD, inc renal and splanchic circ. 5 10 ug/k/min = inc cardiac contractions w/o effect on HR 10 20 ug/k/min = inc BP

Rule of 6 (Docard 40 mg/ml) Wt. x 6 = mg of Dopa to make 100cc

Mg div. 40 = ml of Docard + D5W Rate = dose (1cc/H = 1 ug/k/min)

Pre mixed (200 mg/250 ml) Rate (cc/H) = wt. x dose

13.3

3 mg/k + 50 ml D5W or 15 mg/k + 250 ml D5W Ug/k/min = cc/hr

15 mg/k + 50 ml Ug/k/min = 5 x cc/hr

DOBUTAMINE RD: 2 20 ug/k/min Prep: 250 mg/20 ml inj > to make soln for desired rate and Conc. same with Dopa DIURETICS Furosemide 1 2 MKD Lasix 20/2; 40 Frusema 20/2; 20; 40 Diazoxide 5 10 MKD 300/2 Acerazolamide 20 30 MKD Diamox 250/tab Spironolactone 1.5 3 MKD Aldactone 25/tab Hydrochlorothiazide 1 2 MKD Dichlotride 25, 50/tab Mannitol 20% 1.5 2g/k/D or 5 cc/k/D 200 g/L 1 g = 5 cc 0.5 1 g/k/D ANTICONVULSANTS Diazepam 0.2 0.4 Mkd (max 2 5 mg) Valium 10/2 ; Trazopam 10/2 Phenobarbital LD 15 20 Mk MD 5 MkD q 8 H Luminal IV 130/1 Po 20/5 (Gr 1 = 65 mg) Gr 1, , Carbamazepine 10 20 MKD Tegretol 100/5; 200 Phenytoin LD 15 20 MK MD 5 8 MkD Dilantin IV 100/2 Po 30/5, 125/5, 30, 100 Clonazepam 0.01 0.03 MKD For Bael LD 0.03 MK MD 0.08 MKD q 12 H Rivotril 2/tab Valproic acid 15 MKD Depakene 250/5 Epival 250/ta

Lorazepam 0.05 0.1 MKD (max 0.4 MK) Midazolam (Dormicum)

0.1 0.2 MKD DIAZEPAM DRIP 0.3 MKH dilute in NSS to make 0.1 mg/ml Conc. = mg/ total vol (ml) Rate = RD x wt x 60 Conc. AD = rate x conc. Wt. x 60 LUMBAR TAP Pressure (in cm H2O) G 22 (1 & ) = gtts in 21 sec G22 (3 & ) = gtss in 39 sec G20 (3 & ) = gtss in 12 sec WBC correction in Hemorrhagic tap : Periph WBC x 1000 = WBC 5,000,000 1000 RBC C/I : 1. Increase ICP 2. severe Cp compression 3. infected skin (absolute) 4. decrease plt or bld d/o 5. brain abscess ANTIDERMATOSIS Hydrocortisone 1% TID 2 wks. Hytone, Eczacort Betamethasone BID TID Betnovate, Diprolene, Diprosone Fluocinolone Acetonide BID TID Aplosyn 10, 25, HP Synalar 10, 25, HP Mometasone Furoate OD Elica Clobetasole Propionate Dermovate Triamcinolone Acetonide BID TID Kenacort A, Ladecort A BLOOD TRANSFUSION FWB in 6 H = (des act Hct) x wt. = (des act Hb) x wt. x 2 x 3 = 20 cc/kg pRBC in 4-6 H = (des act Hct) x ractions = (des act Hct) x P (VC) = (des act Hb) x 2 X wt. = 10 cc/kg Plt conc in MFD = 1 U / 6 KBW 1 U = 30 50 cc will raise plt by 10T Plt rich plasma in 4 H Actual Retic ct. (ARC) : Actual Hct x retic ct. Desired HCt Retic Index : ARC or Hct x 2 2 retic > 2 hemolysis < 2 RBC suppression Double Vol. Exchange transfusion : = KBW x est. body vol. x 2 Partial Exchange Transfusion = KBW x est. vol. x (A-D Hct) Actual Hct A B G NORMAL VALUES pH = 7.35 - 7.45 = 7.4 pCO2 = 35 45 = 40 HCO3 = 22 26 = 24 O2 = 80 100 % METABOLIC ACIDOSIS (HCO3) pCO2 = 1.5 (HCO3) + 8 + 2 METABOLIC ALKALOSIS 0.6 0.7 mmHg inc. pCO2 for

every 1 mEq/L inc. HCO3 RESPIRATORY ACIDOSIS Acute : 1 mEq/L inc. HCO3 for every 10 mmHg inc pCO2 Chronic : 3 5 mEq/L inc. HCO3 for Every 10 mmHg inc. pCO2 RESPIRATORY ALKALOSIS Acute : 2 2.5 mEq/L dec HCO3 for Every 10 mmHg dec pCO2 Chronic : 4 5 mmHg dec HCO3 for Every 10 mmHg dec pCO2 FLUIDS AND ELECTROLYTES 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 .3 Na 51 - 51 - - - .45Na 77 - 77 Types of IV Fluids : 1. HYPO - D5W, D5NM, D50, .3 NaCl, D5 IMB Isolyte, D5 maintesol 2. ISO - D5LR, D5NSS, D5NK, LR, NSS 3. HYPER D50W, D10W IVF OF CHOICE : LBM D5LR Vomiting D5 NSS Maintenance D5 NM BA D50 .3 NaCl fever & Sweating D50 .3 NaCl / D5W Drowning D5W Ascitis D5W / D10W CHF D5 NSS HPN D5W / D5LR watch BP Heart stroke D5NSS Burns D5LR Azotemia D5W Inc Burn D10W Bleeding D5LR UTI D5NSS Profuse Bleeding D5LR DF D5 0.3% NaCl DM PNSS MAINTENANCE FLUID =(BCE) (wt.) (1.5 ml/k) NB 45 50 cal/k/D 3 10 m 60 80 10 15 m 45 65 15 25 m 40 45 25 35 m 35 40 34 60 m 30 35 > 60 m 25 30 < 10 kg : 100 cc/k/D > 10 kg : 50 cc/k in excess of 10 k + 1000 > 20 kg : 20 cc/k in excess of 20 k + 1500 = + 12% for q degree rise in temp (fever) = + 15% for hyperventilation/dyspnea = + 50% for BA = + 20% for photo tx Renal px : SA x 400 + UO in 24 H Cardiac px : SA x 800 Surface area : 0 5 kg = wt. x .05 + .05 6 10 kg = wt. x .04 + .10 10 15 kg = wt. x .03 + .20 15 20 kg = wt. x .02 + .40 FLUID PLAN > w/o electrolytes Deficit : Na K Cl/k Mild 4 3 3 Mod 8 6 6 Severe 12 9 9 Maintenance : 3 2 2 > w/ electrolytes Deficit : (desired actual) x wt. x .6

Maintenance : 3 mEq/k for Na 2 m Eq/k for K Deficit + Maintenance = total reqt. Na reqt given in 2 days K reqt given in 3 days * full K incorporation = 40 mEq/L Na : 1 mEq = 23 mg K : 1 mEq = 39.1 mg FLUID REQT FOR NBS Day 1 term 65 cc/k/D Preterm 75 85 2 80 3 80 100 4 110 -120 5 130 140 6 150 7 120 8 100 CALORIC REQT < 1 m 110 140 cal/k/D 1 11 m 110 115 1 2 y.o. 100 110 3 6 y.o. 90 100 7 9 y.o. 80 90 10 -12 y.o 70 80 13 15 y.o. 55 65 16 19 y.o. 45 50 Total Caloric reqt div into 50% CHO div 4 = gm 15 % fats div 9 = gm 35% CHON div 4 = gm Nestle (1:1) Nan / HA 1 & 2 Prenan, Neslac (> 1 y.o.), Nestogen 1 & 2 Lactogen 2, Primolac (> 6 m), Al 110 (lac intol) Alfare (sev diar) Wyeth (1:2) Bonna, Bonamil, S 26 / LBW Promil, Nursoy (lac intol) Abott (1:2) Similac Avd / PM 60/40 Gain, Grow (> 1 y.o.), Pediasure (1-10 y.o.) Isomil (allergy) VAMIN RD: SD .5 g/k/D CHON (up to max 2.5 3 g/k/D) 5 9 mg/k/D gluc Prep: (per liter) CHON 60 gm Gluc 100 gm Cal 650 cal E.g: wt 1 kg 1 kg x .5 g/k/D x 100 = cc of Vamin 6 Cc o Vamin x .65 = cal/Day AMINOSTERIL Prep: (per liter) Infant 6% 240 kcal, 60 gm CHON 100% 400 kcal, 100 gm CHON Wt. x RD x 100 = cc of Amino 6% 6 cc of Amino x .24 = cal/D INTRALIPID RD: .5 2 g/k/D Prep: 10% = 100 gm/L = 1100 cal/L 20% = 200 gm/L Wt. x RD x 100 = cc of Intra 10% 10 Cc of Intra x 1.1 = cal/D LIPOVENOUS Prep: 10% = 100 gm/L = 1080 cal/L GLUOSE DELIVERY RATE N = 5- 8 mg/k/min. IV rate x conc. x 24 H

60 x 24 x wt. OR IV rate x conc. wt. x 60 Concentration (Dextrosity) D5 = 50 mg D10 = 100 mg D7.7 = 75 mg D50 = 500 mg Preparation of desired Dextrosity: Desired conc. present conc. x 2 100 = product X total volume needed Eg. D10 D5 x 2 = 1 100 If total vol. needed is 100cc : 100 cc x .1 = 10 cc D50 W + 90 cc D5 IVF to make a 100 cc of D10 IVF DEHYDRTION (CDD) Pediatrics None vol/vol replacement < 1 y.o. 50 100 cc/LBM > 2 y.o. 100 200 cc/LBM Some : 75 ml x wt(kg) for 4 H Assess q 4 H; IV = 8 H Severe : < 1 y.o. > 1 y.o. Kg x 30 1 hr. 30 min. Kg x 70 5 hrs. 2.5 hrs. Adults: Mild Moderate Severe Kg x 30 (50) kg x 60 (100) kg x 90 (150) In 8 hrs. in 1st hr. 1/3 in 1st hr. in 7 H 2/3 in 7 H Computed deficit / 4 = gtts/min 1 macrodrop = 4 udrop MALCOLM HOLIDAY Mild Moderate Severe < 2 y.o. 50 100 150 > 2 y.o. 30 60 90 (1/4 tab in 1st H, in 7 H) Hydrite - 1 tab in 100 cc water - 8 H Glucost - 1 sachet in 100 cc water - 8 H Oresol - 1 sachet in 1 L water - 24 H Glucolyte - 1 sachet in 200 cc water ORS 90 20 80 30 (gluc 20) Pedialyte (citrate 30) 90 90 20 80 dext 25 Pedialyte (citrate 30) 45 45 20 35 dext 20 Hydrite 90 20 80 30 gluc 111 TREATMENT OF PNEUMONIA CARI 2 mos 5 y.o. MILD PNEUMONIA Send home, Cotrimoxazole, tx fever, Check child back 2 4 days after 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 prn, reassess 2x daily (q 15 min. if possible) < 2 mos. SEVERE PNEUMONIA Hospitalize Keep warm Give first dose of Antibiotic Benzyl PCN Garamycin Gentamycin C P A P TFR = wt. x TV (10 15) x RR x IE ratio (2) = 2000 (2L) FIO2 = CA (0.2) + O2 (1) x 100 TFR

CA = 100 FIO2 x TFR 79 O2 = FR CA ET size > 2 y.o. = age(yrs) + 16 4 STAGES OF DHF I. Febrile II. Afebrile III. Convalescent Grading of Fever I. fever w/ no specific constitutional s/sx (+) Tourniquet test II. (+) Spont. Bleeding of skin III. Circulatory failure manifestations: - rapid & weak pulse, narrow pulse pressure/ hypotension w/ presence of cold clammy extremities IV. Profound Shock w/ undetectable blood pressure and pulse DAY 1 5 = PETECHIAE, FEVER DAY 5 7 = BLEEDING DAY 8 = SHOCK CLASSICAL FEVER - Thrombocytopenia not < 100T - Hemoconcentration not > 20% of baseline DIGITALIZATION TDD : 0.04 = 0.06 Mk 1st dose : of TDD 2nd dose : of TDD (8 H) 3rd dose : of TDD (6 H) 2 H after, start MD of TDD OD of TDD BID Adult : TDD 0.5 1.5 MkD MD 0.125 0.25 Md Caffeine Na Benzoate 0.1 0.2 cc IM Prep: 5/ml; 10/ml Furosemide 1 -2 MKD Lasix 40/tab; 20/2 inj Atropine Sulfate Pedia : 1 2 mEq SQ q 20 min 0.2 MKD q 3 5 min Adult : 2 mg q 10 min IV/IM 0.5 mg (5ml) 3 5 min 0.01 MKD prn after 24 H Digitalis 0.04 0.06 Mk (TDD) Pedia Elixer .05/ml; 0.25/ml Tab 0.25 mg/tab Inj 0.50 mg/2 amp DOPAMINE DRIP 1 5 ug/k/min = VD, inc. renal & splanchnic circulation 5 10 ug/k/min = inc. heart contraction w/o 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 3 cc 46 cc Prep: DOBUTAMINE 250/2 Conc Dobu D5W S 1000 4 cc 46 cc DS 2000 8 cc 42 cc QS 4000 16 cc 34 cc AD = rate x conc. Wt. x 60 Rate = RD x wt. x 60 Conc. KVO = ugtt = 3.5 gtt = 10

DEVELOPMENTAL MILESTONES Gross Motor : Mos Head steady in sitting 2 Pull to sit, no head lag 3 Hands together in midline 3 Asymmetric tonic neck Neck reflex gone 4 Sits w/o support 6 Rolls back to stomach 6.5 Walks alone 12 Runs 16 Fine Motor : Mos Grasps rattle 3.5 Reaches for object 4 Palmar grasp gone 4 Transfers obj. hand to hand 5.5 Thumb finger grasp 8 Turn pages of a book 12 Scribbles 13 Builds tower of 2 cubes 15 Builds tower of 6 cubes 22 Communication & Language : Smiles in response to face, voice 1.5 Monosyllabic babble 6 Inhibits to no 7 Follows 1 step command w/ gesture 7 follows 1 step command w/o gesture 10 Speaks 1st real word 12 Speaks 4 6 words 15 Speaks 10 15 words 18 Speaks 2 word sentences 19 Cognitive : Stares momentarily at spot where object disapperead 2 Stares at own hand 4 Bangs 2 cubes 8 Uncovers toys 8 Egocentric pretend play 12 Uses stict to reach toy 17 Pretend play w/ doll 17

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