Pediatric

Acute
Care
Guide
1
PEDIATRIC INTUBATION
ET TUBE SIZES (ID=mm): After one year, then tube size can be estimated by
using the following formula: age in years/4 + 4
Term Newborn: 3.!3." mm
3 mo!# yr: 3."!4. mm
# yr $ % yr: 4. ! 4." mm
% yr ! #" yr: mm & 4 + 'age 'yr(/4(
Adult )emale: *. ! +. mm
Adult ,ale: +. ! -. mm
'Note!uncuffed tubes used until + yr.
of age, for children . + yr., use cuffed
/T tubes(
TUBE DEPTH: Age in years/% + #% or
0ize of the tube '12 in mm( 3 3
LARNGOSCOPE BLADES: Newborn: ,iller 45 # mo!#+ mo: ,iller 4#5 #+ mo!+ yr:
,iller/,A64%5 . + yr: ,iller/,A643
I!tu"ati#! Ti$%:
Thin7 of the 8neumonic &'S 'AID(
'onitors: 8ulse o3 'turn 9olume on(, 6: monitor
Suction
'achine: ma7e sure the 9entilator is in the room and ready to go
Airway: /TT with stylet, good to ha9e a size larger ; smaller a9ailable
I< access
Drugs: 9agolytic, lidocaine in 16=, sedation, 8aralytic
Pre#)*+e!ate with #> ?
%
and monitor with 8ulse o3imeter.
@a9e suction de9ice 'Aan7auer( 8resent.
=ro8er 8ositioning is mandatory 'su8ine, minimal re9erse Trendelenberg,
head e3tended ! nec7 fle3ed B%!i,,i!+ $#%iti#!C, Note ! 7ee8 head and nec7
immobilized with 8ossible s8inal inDury(.
?8en Daw with scissors motion using thumb and #
st
finger in o88osite
directions.
I!%ert ti8 of laryngosco8e "-ade into the 9allecula ad9ancing along right side
of tongue and swee8 to left to midline.
@a9e assistant a$$-* cric#id $re%%ure.
2
?bser9e cords ; insert /TT under direct 9isualization. 'Ese new stylet and
insert in /TT beforehand with ti8 not 8rotruding. Fend stylet at ada8ter
site to maintain 8osition.(
P#%t I!tu"ati#! C.ec/%
0ee /TT go 8ast 9ocal cords
6hec7 for bilateral breath sounds and abdominal gurgling
Gatch chest rise with 8ositi9e 8ressure
,onitor 8ulse o3imeter and /T6?
%

6hec7 8ost intubation 6H:.
I, t.e $#%iti#! #, t.e ET i% i! d#u"t #r t.e $atie!t i% !#t re%$#!di!+0 rem#1e
t.e ET a!d "a+ t.e $atie!t 2it. 3445 #)*+e!.
I!tu"ati#! 'edicati#!%
Sedati#!6Am!e%ia
,idazolam .# mg/7g
Ioraze8am .# mg/7g
Thio8ental " mg/7g 1< 'cardiac and res8iratory de8ressant, not with asthma(
/tomidate .%!.4 mg/7g 'good with low F=, can cause myoclonus, increased
res8iratory rate(
Jetamine #!% mg/7g 1<, K!# mg/7g =?, 3!* mg/7g 1, 'sedati9e and general
anesthetic, minimal cardiac and res8iratory de8ressant, increases 16=, releases
catecholamines(
)entanyl #!% mcg/7g
Para-*7i!+ A+e!t%
0uccinylcholine #!% mg/7g 1< 'com8lications ! hy8er7alemia, malignant
hy8erthermia ! contraindicated5 onset in 3 seconds ! # min., with " min. duration(,
needs concurrent defasiculating dose of other 8aralytic, not used in /gleston =16E
Atracurium ." mg/7g 1< 'histamine release leads to decreased F=, ta7es #!%
minutes for good 8aralysis(5 then .# mg/7g L #"!3 min
,i9acurium .#!.3 mg/7g 1< 'onset %!3 min, lasts #"!% min(
=ancuronium .#!.% mg/7g 1< 'onset - seconds, lasts 4" minutes to # hour,
9agolytic(
:ocuronium .K$#.% mg/7g 1< 'onset 3!- sec, lasts u8 to 3 min(
<ecuronium .# mg/7g 1< 'onset #!3 min, lasts u8 to 3 min(
Mi9e Atro8ine .#!.% mg/7g ' with neonate( with 0uccinylcholine to 8re9ent
bradycardia ! ,inimum dose .#" mg, ,a3 dose child ! ." mg/adolescent ! #. mg.
3
Ra$id Se8ue!ce I!ducti#!0 RSI 'es8. child with head inDury( GI9E RAPIDL::
Iidocaine #!% mg/7g 'if head inDury, should wait 3 minutes(
Atro8ine .#!.3 mg/7g 'minimum dose ! .# mg(
Thio8ental 4!K mg/7g 'consider ,idazolam .% mg/7g or /tomidate .3 mg/7g(
:ocuronium # mg/7g
PEDIATRIC E'ERGENC 'EDICATIONS
A!a-+e%ic%
2emerol: # mg/7g/dose 1,, 1< L % hr =:N
;e!ta!*-: #!% mcg/7g 1<, 1, L #!% hrs =:N 'Analgesia(
'#r$.i!e: .#!.% mg/7g 1<, 1,, 06 L %!4 hrs =:N
Iidocaine ."!#.> local ! ma3 dose 4 mg/7g or * mg/7g with /8ine8hrine 'a9oid /8i
with end arteries! fingers!toes!nose!ears!8enis(.
Sedati1e%
6hloral @ydrate: %!" mg/7g/dose =?/=: L 4!K hrs
2i8henhydramine 'Fenadryl(: " mg/7g/day ! L K hrs =?/1, 'ma3 total dose 4
mg/day( 'may gi9e #!% mg/7g/dose slow 1< for ana8hyla3is or =henothiazine
o9erdose L 4!K hrs(
'ida7#-am (9er%ed): .# mg/7g 1</1,5 .% mg/7g sublingual, .4!." mg/7g =?, ."
mg/7g =:
L#ra7e$am (Ati1a!): .# mg/7g 1<
Dia7e$am (9a-ium): .# mg/7g/dose 1<
Pe!t#"ar"ita-: %!4 mg/7g 1</1, '8otent sedati9e hy8notic, onset!# min, duration!
3 min(
'et.#.e)ita- (Bre1ita-): #!% mg/7g 1<, # mg/7g 1, 'ultra short acting, onset 3!
K sec, duration "!# min(
<etami!e 'really a dissociati9e anesthetic( ."!#." mg/7g 1<, 3!* mg/7g 1,, K!#
mg/7g =? 'causes increased secretions, laryngos8asm, increased F=, increased 16=(
A!ti.*$erte!%i1e%
2iazo3ide: 3.!". mg/7g ra8id 1< 8ush '# mg/7g ma3 total dose(
@ydralazine: .#!.% mg/7g 1,, 1< L 4!K hrs 8rn not greater than % mg5
Iabetolol 'not with asthma(: .%"!#. mg/7g 1< L #!% hrs, or .4 mg/7g/hr 1<
infusion
Nitro8russide: .%!+ mcg/7g/min 'light sensiti9e: bag ; tubing must be wra88ed,
can cause 6N to3icity, should be gi9en with sodium thiosulfate(.
,ino3idil: .%"!#. mg/7g/day =? gi9en N2 or F12, with ma3 dose " mg/day
4
Nitroglycerin #!K mcg/7g/min
Nicardi8ine: ." mcg/7g/min with range of ."!%. mcg/7g/min
/smolol: " mcg/7g load then "!%" mcg/7g/min
Cardiac (PALS)
Adenosine .# mg/7g 1<=, may double second dose with ma3 first dose of K mg and
ma3 %
nd
dose of #% mg
6alcium 6hloride '#>(: %" mg/7g or .%!.3 cc/7g 1<5 Ese caution in digitalized
8atients
6alcium Mluconate '#>(: K!#% mg/7g '.K!#.% ml/7g( 1< o9er "!# min
2igo3in: 2igitalizing: %!4 mcg/7g =? to be gi9en o9er %4 hrs & Total 2igitalizing
2ose 'Adult 2ose & # mg(5 Mi9e O T22 0tat, then P T22 L + hrs 3 %5 ,aintenance:
#!% mcg/7g/day =? F125 Note: 1< dose & %/3 =? dose ')or 0<T or 6@)(
@e8arin: "!# E/7g 1< Folus, then 1< 2ri8 at #!% E/7g/hr
Iidocaine # mg/7g 1<=, then %!" mcg/7g/min 8rone
=ro8ranolol: Arrhythmias! ."!.#" mg/7g 1< slow 8ush, may re8eat L K!+ hrs.
',a3 single dose & # mg/dose(5 Tet 08ells! .#"!.%" mg/7g/dose 1< slowly
0ynchronized cardio9ersion: ."!#. Q/7g
<era8amil .# mg/7g 1< '. # yr old(
Diuretic%
08ironolactone: #.!3." mg/7g/day + L K!+ hrs =?
6hlorothiazide: %!4 mg/7g/day t L #% hrs =?
@ydrochlorothiazide %!4 mg/7g/day =? + F12
)urosemide 'Iasi3(: #. mg/7g/dose 1< slow 8ush, =? '6@)/2iuresis(
,annitol: .%"!#. gm/7g/dose 1<
/thacrynic Acid 1< .K!%. mg/7g.
9a%#acti1e Dri$% (U%e %ta!dard c#!ce!trati#!% 2.e! a1ai-a"-e)
,ilrinone: 2ose: " mcg/7g 1< Ioad o9er #" min., ."!# mcg/7g/min5
2o8amine ; 2obutamine: 2ose: %!% mcg/7g/min
/8ine8hrine ; 1so8roterenol: 2ose: ." ! ." mcg/7g/min
=M/!1: 2ose: ."!.# mcg/7g/min
Re1er%a- = A!tid#te%
Nalo3one:
?8ioid induced res8iratory de8ression in 8atients with 8ain or to re9erse o8ioid
effects in conscious sedation: .# mg/7g 'ma3imum: ." mg( e9ery #!%
minutes until res8irations are adeLuate
5
:es8iratory arrest: children R" years or R% 7g: .# mg/7g5 children ." years or
% 7g: % mg/dose
?8iate into3ication: R" years or R% 7g: .# mg/7g5 re8eat e9ery %!3 minutes if
needed5 may need to re8eat doses e9ery %!K minutes5 ." years or % 7g: %
mg/dose5 if no res8onse, re8eat e9ery %!3 minutes5 may need to re8eat doses
e9ery %!K minutes
6ontinuous infusion: titrate dose to .4!.#K mg/7g/hour for %!" days in
children
)lumazenil:
6onscious sedation re9ersal: initial dose: .# mg/7g 'ma3 dose: .% mg( gi9e
o9er #" sec5 may re8eat .# mg/7g 'ma3 dose: .% mg( after 4" sec, then e9ery
min to ma3 total dose of ." mg/7g or # mg, whiche9er is lower
?9erdose: initial dose: .# mg/7g 'ma3 dose: .% mg( with re8eat dose of .#
mg/7g 'ma3 dose: .% mg( gi9en e9ery min to ma3 total dose of # mg
6ontinuous infusions: ."!.# mg/7g/hour
Neostigmine: ."!.* mg/7g/dose 1< 'with anticholinergic(
=hysostiomine: .# mg/7g slow 1< 'adult dose & % mg...consider anticholinergic(.
Acti9ated 6harcoal ! #!% g/7g/dose.
Pediatric Emer+e!cie%
H*$er/a-emia
6alcium Mluconate #>: ."!#. cc/7g 1< o9er "!# min with 6: monitor or
gi9e 6alcium 6hloride #>: % mg/7g 1< o9er "!# minutes '7e8t in code
cartSS(
Na@6?
3
, #!% m/L/7g o9er "!# min.
2e3trose '">(: #!% cc/7g 1< or 2e3trose '%">(: %!4 cc/7g o9er #" min
with .#"!.3 units/7g of :egular 1nsulin
0odium =olystyrene 0ulfonate 'Jaye3alate(: %"> in 0orbitol 0olution, #
g/7g/dose L K hrs =? or L %!K hrs =:
Albuterol nebs % unit doses '" mg neb( stat
2ialysis
H*$#+-*cemia
Neonates ! 2#, #!% cc/7g 1<
Toddlers ; 6hildren ! 2%" '.%" g/cc(, dose! %!4 cc/7g
?lder 6hildren ; Adolescents ! 2", dose! #!% cc/7g
Gor7 E8 'before 2e3trose gi9en if able( ! consider glucose, 1nsulin le9el,
Mlucagon, 6!8e8tide, 7etones, M@, 6ortisol, lytes 'TAM(, lactate, urine
7etones
6
Adre!a- Cri%i%
2"N0 % ml/7g 1< bolus
@ydrocortisone #!% mg/7g 1<F=, then B# mI 2"N0 + # mg
@ydrocortisoneC 1< at maintenance !or! @ydrocortisone " mg/m
%
1< L K
hours5 if in shoc7 gi9e " mg/7g L%4!4+ or as needed
6linical ! shoc7, altered mental status, wea7, nausea, 9omit, abdominal 8ain,
body aches, hy8onatremia, hy8er7alemia, metabolic acidosis, decreased
serum cortisol
7
Re%$irat#r* I%%ue%
A%t.ma 'edicati#!%
Albuterol '<entolin, =ro9entil, racemic albuterol(: continuous nebulizer ."
mg/7g/hr 'ma3 # mg/hr(
Ho8one3 'Ie9albuterol(: .K3!#.%" mg neb 8er treatment, continuous 3o8one3 not
well studied in =16E
/8ine8hrine .# mg/7g 06 'u8 to .3!." mg(L % min 3 3 doses 8rn
Terbutaline .# mg/7g 06 L % min 3 3 doses, then L %!K hours 8rn, may be gi9en
continuously if needed
18ratro8rium bromide nebulizer " mcg neb L4 hours, try to coordinate with
albuterol nebs
,ethyl8rednisolone '0olumedrol( % mg/7g load then # mg/7g 1< L K hours for 4+
hours
=rednisone #!% mg/7g/day =? 'ma3 K mg/day( for 3!# days
,agnesioum 0ulfate: 4 mg/7g/dose 'ma3 % grams( 3 one, gi9e o9er % min and
watch for hy8otension 'ha9e N0 bolus a9ailable and slow down dri8 rate if blood
8ressure changes(
Strid#r 'edicati#!%
:acemic /8ine8hrine nebulizer .%"!." cc in %." cc N0 L %!4 hrs
2e3amethasone '2ecadron( ." mg/7g 1< LK 3 K does
A!a$.*-a)i% T)
N0/ :I/ "> Albumin #!% ml/7g 1<
/8ine8hrine .# mg/7g 06 '.# ml/7g #:# soln( and re8eat in #" min 8rn. 1<
infusion: .#!#. mcg/7g/min.5
2i8henhydramine 'Fenadryl( #!% mg/7g 1< o9er "!# min.5
,ethyl8rednisolone % mg/7g 1< I2 followed by # mg/7g L K hours5
:anitidine 'Uantac( #!% mg/7g 1<F= L K!+ hours.
8
;-uid 'ai!te!a!ce0 De,icit%0 a!d De.*drati#!
B#-u%: % ml/7g :I or N0 for significant dehydration or 9olume deficit, re8eat if
no significant clinical im8ro9ement
'ai!te!a!ce ;-uid%: #
st
# 7g ! # ml/7g/%4 hrs 'or roughly 4 ml/7g/hr( + %
nd
# 7g
" ml/7g/%4 hrs 'or roughly % ml/7g/hr( + wt. . % 7g % ml/7g#%4 hrs 'or about #
ml/7g/hr(
De.*drati#! a!d De,icit%
'i-d 'R%!3 years old ! "> or " ml/7g deficit, .%!3 years old ! 3> or 3 ml/7g
deficit(
6linical ! thirsty, Tdry mucous membranes, tears 8resent, T tachycardia, normal
urine out8ut'.l ml/7g/hr(, normal F= and res8irations
'#derate 'R %!3 years old ! #> or # ml/7g deficit, .%!3 years old ! K> or K
ml/7g deficit(
6linical ! thirsty, irritable, dry mucous membranes, no tears, delayed ca8illary
refill '. % sec(, decreased turgor, s7in tenting, sun7en eyeballs and anterior
fontanel, oliguria, tachycardia, wea7 8ulse, normal F=
Se1ere 'R %!3 years old #"> or #" ml/7g deficit, . %!3 years old ! -> or -
ml/7g deficit(
6linical ! shoc7, cold mottled s7in, altered mental status, non!8al8able or 9ery
wea7 and thready 8ulse, significant oliguria or anuria, tachy8nea, 9ery sun7en
eyeballs and/or anterior fontanel, significant delayed ca8illary refill '.3!4 sec(,
no tears, 9ery dry mucous membranes
'a!a+eme!t #, ;-uid De,icit%
I%#!atremic6I%#t#!ic ! Folus with N0 or I:. :e8lace B2eficit ! FolusesC ! ">
o9er #
st
+ hours, then "> o9er ne3t #K hours. Add maintenance. Ese 2"PN0 or
2"ON0. :e8lace J with adeLuate urine out8ut
H*$#!atremic6H*$#t#!ic 'Na R #3 m/L/l( ! Folus with N0 or I:. Ese 2"N0 or
ON0 with maintenance and deficits. Ese 3> Na6l if Na R ##"!#% m/L/l or
sym8tomatic 'i.e. seizures...(. As7 the fellow or attendingSSS
H*$er!atremic6H*$ert#!ic 'Na . #" m/L/l( ! :e8lace fluid deficit e9enly
during a 4+!*% hour 8eriod. Folus with N0 8rn. Add maintenance. :e8lace J
with adeLuate urine out8ut. Ese 2"ON0 or 2"PN0. 0erum Na reduction should
be R #!#4 m/L/l/day. As7 the fellow or attendingSSS
9
E%timate% #, C#!ti!ui!+ L#%%e% (mE+6L)
0ource Na J 6l @6?
3
0ali9a K % #" "
Mastric K # - !
QeDunum # " # #
1leum #% " # %
File #" " # "
=ancreatic #" " + *
0weat " " 4 !
Erine K 3 4 !
2iarrhea #% #" + "
ELECTROLTE DISORDERS
H*$#!atremia 'Na+ R #3K m/L/l(
#( @y8o9olemic '/6), /3tra!renal ! E
Na
R % m/L/l, :enal $ E
Na
. % m/L/l( $ Iosses
from M1 '9omit, diarrhea(, s7in 'sweating(, lungs, third s8acing '8eritonitis...(,
bums5 :enal 'diuretics, :TA, diuretic 8hase of ATN, adrenal insufficiency !
AddisonVs disease, hy8oaldosteronism, 7etonuria(
a( T3
i( 0eizures, use 3> saline, " cc/7g will Na by 4 m/L/I
ii( Asym8tomatic5 see below
%( @y8er9olemic '/6)( ! 6@), cirrhosis, ne8hrosis, renal failure, li9er failure
a( T3 $ water restriction, consider diuresis, treat underlying cause
3( 1so9olemic $ @
%
? into3ication 'E
Na
R # m/L/l(, 01A2@ 'E
Na
. % m/L/l5
8ulmonary!TF, 8neumonia...5 6N0! trauma, infection, 6A5 ,eds! 6hlor8ro8amide,
<incristine, 6lofibrate, 6yto3an, Narcotics, N0A12Vs, Farbiturates, Tegretol,
Tricyclics(5 hy8othyroidism! my3edema, adrenal insufficiency5 0heehanVs, stress
'8ain, 8hysical, 8sychological(
a( T3 ! initially restrict water and consider re8lace losses with N0, consider
hy8ertonic saline if sym8tomatic.
4( ?thers ! =seudohy8onatremia 'hy8erli8idemia, hy8er8roteinemia! ,,,
hy8erglycemia B# mg/dl glucose #.K m/L/l Na
+
C(5 infusions 'Mlucose, ,annitol,
Mlycine(, /thanol, ,ethanol, /thylene glycol, 1so8ro8yl alcohol ! chec7 osmols
a( T3 ! if asym8tomatic, treat underlying cause
10
b( 23 ! wea7ness, anore3ia, nausea, 9omiting, confusion, lethargy, seizures,
coma
H*$er!atremia 'Na
+
. #4+ m/L/l(
#( /3cess )ree @
%
? Ioss ! :enal '21 ! central or ne8hrogenic, osmotic diuresis !
hy8erglycemia, ,annitol(5 M1, 07in, and :es8iratory losses5 fe9ers,
thyroto3icosis, significant burns
%( 1nadeLuate )ree @
%
? 1nta7e ! reset osmostat, 8oor =? inta7e, A,0, coma
3( /3cess Na
+
Main ! 1atrogenic 'Na@6?3, hy8ertonic saline, e3ogenous steroids(,
hy8eraldosteronism, 6ushingVs, congenital adrenal hy8er8lasia
a( 23 ! thirst, dehydration, confusion, muscle irritability, seizures, ras8.
8aralysis, coma
b( T3 ! 6orrect free @
%
? deficit slowly with one half of calculated amount and
reassess. 1f correction is too ra8id, 6N0 edema may result. 1sotonic fluids
for hemodynamic resuscitation.
4( 6alculated free @
%
? deficit & 'Na
+
! #4( 3 .K 'wt in 7g(/l4
,anaging @y8o/@y8ernatremia and 6haracteristics of 1nfusates
;#rmu-a C-i!ica- U%e
Na
+
&
'infusate Na
+
+ infusate J
+
( $ serum Na
+
/stimate the effect of # I
of infusate containing Na
+
and J
+
on serum Na
+
B .K 3 Gt '7g(C + #
I!,u%ate I!,u%ate Na
>
EC; Di%tri"uti#! 5
"> saline in water +"" #W
3> saline in water "#3 #W
.-> saline in water #"4 #
:ingerVs lactate #3 -*
.4"> saline ** *3
.%> saline in "> de3trose in water 34 ""
"> de3trose in water 4
W :emo9es 16) as a conseLuence
N /ngl Q ,ed %5 34%:#"+#!#"+-, ,ay %", %
N /ngl Q ,ed %5 34%:#4-3!#4--, ,ay #+, %
11
01A2@ 9s. 21
21
/3cessi9e water loss secondary to
decreased A2@
=olyuria and 8olydi8sia
Erine 0M R #."
0erum ?sm . %+K
2ehydration ensues with
hy8ernatrenmia
T3: 22A<= ; <aso8ressin
01A2@
/3cessi9e water retention
0erum ?sm R%+
1ncreased /6) 9olume
e3cessi9e water retention by 7idneys
and Na R #3
T3: )luid restriction, Iasi3
La" 1a-ue SIADH DI
UOP decreases increases
S$eci,ic Gra1it* increases decreases
Serum Na decreases increases
Serum OS' decreases increases
Uri!e Na increases decreases
Uri!e OS' incerases decreases
H*$#/a-emia
#( :edistribution 'al7alosis $ Na@6?
3
or contraction, 1nsulin ! Mlucose, anabolism,
F
#%
thera8y,
%
Agonists, =eriodic =aralysis(
%( :enal losses 'diuretics, low ,g
+%
, :TA ! ty8e 1, 9omiting, gluco/mineralocorticoid
e3cess, hy8eraldosteronism, FartterVs, IiddleVs(
3( M1 losses 'gastric ! 9omit, NM suction ! M1 obstruction, diarrhea, bile, fistula(
4( =? inta7e, lab error
a( 23 ! wea7ness, 8aresthesias, ileus5 /6M ! flat TVs, =<6Vs, E wa9e, 0T, wide
N:0, arrhythmias
b( T3 $ if J+ is X
3.!3.4

.3 m/L/7g 1< o9er # '% m/L ma3 all doses(
%."!%.-

." m/L/7g 1< o9er # ; maintainence rate
R%."

# m/L/7g 1< o9er % 'o9er # if sym8toms( ; maintainence rate
H*$er/a-emia
#( 6auses ! acidosis, tissue necrosis ! crush, hemolysis, blood transfusions, M1
bleed, renal failure, 8seudohy8er7alemia 'leu7ocytosis, thrombocytosis(,
mineralocorticoid acti9ity 'AddisonVs, hy8oaldosteronism(, 08ironolactone,
12
Triamterene, Amiloride, e3cess =? J
+
, high dose =6N, 0uccinylcholine, !
Floc7ers, 6a8to8ril, 2igo3in, @e8arin, catabolism, :TA 1<, lab error
%( 23 ! wea7ness, 8aresthesias, 8aralysis, confusion, arrhythmias5 /6M ! 8ea7ed T
wa9es, 0T de8ression, diminished = and : wa9es, 8rolonged =: and NT inter9als,
small = wa9es, wide N:0, sine wa9es 'fusion of N:0 and T wa9es( cardiac
arrest
3( T3 $ 'see emergency section(
a( /JM monitoring
b( 6orrect acidosis or hy8o9olemia
c( 6alcium Mluconate #>: ."!#. cc/7g 1< o9er "!# min with 6: monitor or
gi9e
d( 6a6l
%
#>: % mg/7g o9er #"!% min '7e8t in code cartSSS(
e( 2e3trose '">(: #!% cc/7g 1< or 2e3trose '%">(: %!4 cc/7g o9er #" min
with .#"!.3 units/7g of :egular 1nsulin
f( 0odium =olystyrene 0ulfonate 'Jaye3alate(: %"> in 0orbitol 0olution, #
g/7g/dose L K hrs =? or L %!K hrs =:
g( Na@6?
3
, #!% m/L/7g o9er "!# min.
h( Albuterol nebs % unit doses '" mg neb( stat
i( 2ialysis
H*$#ca-cemia BR +. mg/dl, ionized R %. m/L/l or R #. mmol/lC
#( 6auses ! hy8o8arathyroidism 's/8 8ara or thyroidectomy, :T, infiltration,
hungry bone syndrome, 8seudo!(, <it 2 def 'malabsor8tion, he8atic or renal
failure...(, 8ancreatitis, =?
4
, ,g
+%
, al7alosis, 6:), loo8 diuretics,
hy8oalbuminemia, rhabdomyolysis, tumor lysis syndrome, @e8arin, se8sis ! shoc7,
multi8le blood transfusion, osteoblastic mets
%( 23 ! hy8eracti9e tendon refle3es, 8aresthesias 'circumoral, fingerti8s(,
car8o8edal s8asm, laryngos8asm, tetany, seizures, 6he9oste7Vs or TrousseauVs
sign, wea7ness, confusion, irritability, hy8er8igmentation, card. failure5 /6M
!8rolonged ?T inter9als without E wa9es
3( T3
a(
6alcium Mluconate #> K!# mg/7g 1< o9er # hour '6a
+%
may 8otentiate
2igo3in(
b(
6a6l
%
#>: % mg/7g o9er #"!% min5 for ,g
+%
; J
+
c(
6alcium gluce8tate: %!" mg/7g/day 1< di9ided e9ery K hours
H*$erca-cemia
#( 6auses ! # hy8er8arathyroidism 'adenoma, hy8er8lasia, 6A(, cancer 'bone mets,
8araneo8lastic syndrome, =T@ li7e hormone(, thyroto3icosis, adrenal
insufficiency, immobility, 8heochromocytoma, meds 'Thiazides, <it A or 2
13
into3ication, Iithium(, granulomatous disease 'sarcoid, TF, fungal...(, 0/= A:),
=agetVs, 6:), =? calcium, mil7 al7ali syndrome, ,,, acromegaly
%( 23 ! anore3ia, nausea, 9omit, dehydration, abdominal 8ain, =E2, 8ancreatitis,
ne8hrolithiasis, restless, delirium, de8ression, lethargy, coma, hy8orefle3ia,
fractures5 /6M ! short NT, wide T
3( T3 ! if sym8tomatic
a( N0 #!% cc/7g 1< o9er # hour and 7ee8 urine out8ut Y %!3 cc/7g/hr 'Na
e3cretion causes 6a e3cretion(
b( Iasi3 ."!# mg/7g 1< L %!4 hrs for diuresis
c( @ydrocortisone #!% mg/7g 1< N2 and ta8er if sarcoidosis, <it A ; 2
into3ication, leu7emia
d( ,itramycin %" mcg/7g/day 1< o9er 3!4 days
e( 6alcitonin 'dosage not established in children( 4 units/7g 1,/0N L#%5 may
increase u8 to + units/7g L#% to ma3 of LK hrs
f( /tidronate *." mg/7g/day 1< o9er % hours for 3!* days
g( Mallium nitrate % mg/m
%
8er liter N0 o9er " days
h( 2ialysis
H*$#ma+!e%mia
#( 6auses ! Alcoholism, cirrhosis, diuretics, chronic diarrhea and fistulas,
8ancreatitis, malabsor8tion, malnutrition, NM drainage, 9omiting, Am8hoterecin
F, 6is8latin, Aminoglycosides, 0/= ATN, 2JA T3, se8sis, 8ost!
8arathyroidectomy, hy8eraldosteronism, with J and =?
4
, bums
%( 23 ! Gea7ness, muscle fasciculation, tremor, tetany, seizures, A,0, coma,
anore3ia, nausea, 9omiting, ileus, arrhythmias5 /6M ! =: and NT inter9al, 0T,
fli88ed TVs, wide N:0
3( T3 $
a( ,agnesium sulfate: %!" mg/7g/dose 1</1, L4!K for 3!4 doses5 ma3 single
dose: % mg '#K m/L( or for acute sym8toms "!# mg/7g 1< o9er % min
b( ,agnesium chloride: .%!.4 m/L/7g/dose 1</1, L4!K hours for 3!4 doses5
ma3 single dose #K m/L
c( ,agnesium chloride, gluconate, lactate, carbonate, o3ide, or sulfate salts:
#!% mg/7g/dose =? of elemental magnesium 4 times 8er day
H*$erma+!e%mia
#( 6auses ! :enal failure, rhabdomyolysis, tumor lysis, bums, tissue trauma, 2JA,
se9ere acidosis, hy8othyroidism, cathartic abuse, antacids, eclam8sia T3,
adrenal insufficiency.
14
%( 23 ! Iethargy, come, nausea, 9omiting, arefle3ia, muscle wea7ness, res8iratory
de8ression, F=, arrhythmias and conduction defects, 9asodilatation5 /6M ! li7e
hy8er7alemia
3( T3
a( <olume e38ansion with N0
b( Iasi3 1< if renal function adeLuate
c( 6a Mluconate #> ."!#. cc/7g 1< o9er "!# min with 6: monitor
d( T3 acidosis
e( 2ialysis if renal function se9erely im8aired
H*$#$.#%$.atemia
#( 6auses ! 2JA T3, alcoholism, T=N, glucose infusions, refeeding syndrome, bums,
al7alosis 'res8iratory or metabolic(, =?
4
! binding in gut, se8sis, malabsor8tion,
diarrhea, <it 2 def, hy8er8arathyroidism, ,g
+%
, J
+
, 6a
+%
, renal tubular
defects, anabolism, anabolic steroids
%( 23 ! 6N0 dysfunction 'irritability, wea7ness, 8aresthesias, confusion, seizures,
coma(, :F6 hemolysis, %,3 2=M, cardiomyo8athy, osteomalacia, 8latelet
dysfunction, res8iratory failure
3( T3 ! :e8lace either 1< 8hos8horus 'sodium 8hos8hate or 8otassium 8hos8hate(,
N/</: re8lace by 1, route. A9oid metastatic calcification. 6onsider =?
8hos8hate.
H*$er$.#%$.atemia
#( 6auses ! Ia3ati9e/enema abuse, =?
4
salts for hy8ercalcemia T3,
hy8o8arathyroidism, renal insufficiency, acidosis 'res8iratory, lactic(, se8sis,
rhabdomyolysis, tumor lysis, chemo, tissue necrosis, hemolysis, M@, <it 2
into3ication
%( 23 ! 0imilar features as seen with hy8ocalcemia. /cto8ic calcification may
occur.
3( T3
a( ,ay include 9olume e38ansion 'N0( if renal function normal
b( Aluminum @ydro3ide: "!#" mg/7g/day di9ided e9ery L4!K,
c( 2ialysis
ACID BASE DISORDERS
'eta"#-ic Acid#%i%
8@ R *.3", @6?3 'acute(
6om8ensation: a fall of # m/L @6?
3
will lead to a fall of #.% mm@g =a6?
%
3) /le9ated Anion Ma8 'Na
+
! 6l $ @6?
3
. #% m/L/l( 'UD PILES
15
a( 'ethanol, Uremia, Diabetic Jetoacidosis, Paraldehyde ; =henformin, Iron ;
1N@, Lactate, Ethanol ; /thylene Mlycol, Salicylates
?) Normal Anion Ma8 'hy8erchloremic, loosing bicarbonate( ! :TA, diarrhea,
8ancreatic or small bowel fistula, ileostomy, loss of small bowel fluid,
ureterosigmoidostomy, ileal loo8 bladder, drugs 'Acetazolamide ! carbonic
anhydrase inhibitor, 0ulfamylon, 6holestyramine, 08ironolactone(, T=N,
Arginine, Iysine, N@,61, 8osthy8oca8nia, adrenal insufficiency,
hy8oaldosteronism, dilutional
@) T3 ! re9iew current indications for bicarbonate re8lacement thera8y
A) @6?
3
deficit 'm/L(&'%4 $ @6?
3
( '.4( 'wt '7g((
'eta"#-ic A-/a-#%i%
8@ . *.4", @6?
3
'acute(
6om8ensation: a rise of # m/L @6?
3
will lead to a rise of .K mm@g =a6?
%
#( Na6l :es8onsi9e ! contraction al7alosis ! 9olume de8letion, 9omiting, NM suction,
diuretics 'loss of urine JZ(, 9illous adenoma, =6N and 6arbenicillin 'large doses(,
ra8id correction of chronic hy8erca8nia
a( T3 ! Na6l '.->(
%( Na6l :esistant ! e3cess mineralocorticoids '6ushingVs, hy8eraldosteronism,
FartterVs(, se9ere J
+
, al7ali administration 'lactate ! :I, citrate ! ban7ed blood,
acetate, Na@6?
3
(, mil7 al7ali syndrome, licorice e3cess
Re%$irat#r* Acid#%i%
8@ R *.3", =a6?
%
, 'acute(, @6?
3
'com8ensation(
Acute: a rise of # mm@g =a6?
%
will lead to a fall of .+ in 8@
a rise of # m/L/l @6?
3
will lead to a rise of # mm@g =a6?
%
6hronic: a rise of 3." m/L/l @6?
3
will lead to a rise of # mm@g =a6?
%
#( 23 ! acute airway obstruction 'asthma(, lung disease, hy8o9entilation 'narcotics
! ,0..., sedati9es, tranLuilizers, 6<A, 8aralysis, neuro8athy(, thoracic cage
abnormalities 'flail chest, rib fractures, 7y8hoscoliosis, scleroderma(, 8leural
effusions, =TH, hy8o7alemia, hy8o8hos8hatemia, hy8omagnesemia, muscular
dystro8hy
Re%$irat#r* A-/a-#%i%
8@ . *.4", =a6?
%
'acute(, @6?
3
'com8ensation(
Acute: a fall of # mm@g =a6?
%
will lead to a rise of .+ in 8@
a fall of % m/L/l @6?
3
will lead to a fall of # mm@g =a6?
%

16
6hronic: a fall of " m/L/l @6?
3
will lead to a fall of # mm@g =a6?
%
23 ! hy8er9entilation, an3iety, 8ain, 6N0 '6<A, head trauma, meningitis, 16=(,
early se8sis, fe9ers, =/, 6@), 8neumonia, A0A to3icity, interstitial lung disease,
he8atic insufficiency, 8regnancy, thyroto3icosis, hy8o3ia, 9entilator induced,
8ericardial effusion $ tam8onade
17
Sei7ure Di%#rder%
;e"ri-e Sei7ure%
0im8le 'R "!#" min., general, only # in %4 hours(
6om8le3 '. "!#" min., focal, multi8le(5 Associated with E:1Vs, ?,, ET1, 8neumonia,
8haryngitis, 9iral illness,X
223 ! hy8oglycemia, electrolyte abnormalities, 6N0 8athology 'head trauma,
meningitis, ence8halitis, tumor(, hy8o3ia, to3ins
Gor7!u8 ! 6F6, lytes, glucose, E/A and 6/0...5 0trongly consider I= with first
febrile seizure and R #% months. 1f . #+ months, do I= with meningeal signs or
8ossible 6N0 infection by @3 or =/. Gith 8rior antibiotics T3, strongly consider I=
with T mas7ed sym8toms. ,ay not need @ead 6T or //M with first sim8le febrile
seizure
1ncreased ris7 of ,eningitis: com8le3 febrile seizure, ,2 9isit within % days,
e3tended 8ost!ictal state, sus8icious Neuro e3am/=/, seizures in /:, first seizure
after 3 years old5 6onsider T3 '=henobarbital, 2iaze8am, <al8roic Acid( with
febrile seizure and abnormal baseline Neuro e3am, seizure . #" min., focal seizure
with Neuro deficit 'tem8orary or 8ermanent(, + family @3 of non!febrile seizures
Anti!8yretics: Acetamino8hen or 1bu8rofen.
A,e"ri-e Sei7ure%
DD)
Neonatal: ,etabolic 'hy8o3ic, hy8o/hy8erglycemia, hy8ocalcemia,
hy8o/hy8ernatremia, hy8omagnesemia, inborn error of metabolism, 8yrido3ine
deficiency or de8endency, 7ernicterus(, 1nfectious 'meningitis, ence8halitis, se8sis,
8ost!T?:6@ infections(, 6N0 'intracranial hemorrhage, cerebral!congenital
malformation, mass(, 2rug withdrawal 'o8iates...(, familial, hereditary 'tuberous
sclerosis(, idio8athic
#!K months: abo9e, 0ha7en Faby 0yndrome $ abuse
K months ! 3 years +: To3ins 'A0A, 6?, Theo8hyline, =b, Am8hetamine, 6ocaine...(,
Trauma 'abuse, 6N0 hemorrhage Bsubdural...C, 6N0 inDury...(, 1nfectious, ,etabolic
or degenerati9e disorder, 0ub!thera8eutic anticon9ulsant ! withdrawal, idio8athic
T)
'ai!tai! air2a* 'adeLuate o3ygenation, may need oral or nasal airway, suction oral
secretions, Tbag 9al9e mas7 9entilation, Tintubation!:01...(
C.ec/ 1ita- %i+!%
C.ec/ STAT +-uc#%e
?btain 1< access 'consider 1 if R K years and unstable(
'ed% = STOP THE SEIZURE:::
18
Ioraze8am 'may last u8 to %4!4+ hours( .# mg/7g 1< L #!#" min to ma3 of 4
mg/dose
2iaze8am .%!." mg/7g 1<. :e8eat L #!#" min. 8rn ,a3 total dose 'R "years ! "
mg, . " years $ # mg(.
:ectal 2iaze8am ." mg/7g 8r 'ma3 ! % mg, onset of acti9ity K!# min(. Y"#YaY
[" ! .% mg/7g 1<, ma3imum dose ! " mg
=henytoin #+!% mg/7g 1< I2 'ma3 ! # g( in N0 gi9en slowly at ."!#. mg/7g/min.
6om8lications ! hy8otension, arrhythmias, 6@). ,aintenance 2ose! 4!+ mg/7g/day
di9 N2 or F12 1< or =?, consider )os8henytoin if no access or small 9ein
)os8henytoin #+!% mg/7g 1< I2 'infuse #!#." mg/7g/min( or 1, '3!" min onset,
use # or % sites(, e38ensi9e, can use 8henytoin in gi9ing through 6<I
=henobarbital #!% mg/7g 1< I2 'ma3 dose ! # g(. 1nfuse Y # mg/min. 6an
re8eat "!# mg/7g 1< L % min 8rn 'total ma3imum dose ! 4 mg/7g(. ,aintenance
2ose & 3!" mg/7g day 1< or =? ! L #% hrs
=entobarbital for induced coma with refractory case. ,ay need 8ressors. 0am8le
dosing ! + mg/7g 1< bolus, then 3!4 mg/7g/hr
B#r/ U$
6F6 with diff., electrolytes, glucose, ,g, 6a, =hos, I=, To3 screen, I)TVs, N@
3
,
=T/=TT, anticon9ulsant le9els, @ead 6T, //M...(
19
Hemat#-#+ica- I%%ue%
DIC Treatme!t B)rom A =ractical Muide to =ediatric 1ntensi9e 6are, by Qeffrey I.
Flumer, 3rd edition 'Qanuary #--#(, 10FN: +#K%+"4*C
#. Treat underlying 8roblem
%. 1f @gb R * =:F6Vs '# cc/7g will @ct by 3>(
3. 1f =lt R % Mi9e =lt to K,
4. 1f =lt ." ; bleeding gi9e ))= '#cc/7g(
". 1f fibrinogen R *" g/dI5 gi9e cryo8reci8itate 'one bag 8er # 7g fibrinogen
by " g/dI or ." units/7g(
K. 1f after K!+ hours of aggressi9e treatment still bleeding double e3change
transfusion with he8arinized fresh blood or ))= ; =:F6Vs
*. ?nce stable, consider #!% units/7g/hr of he8arin with " units/7g load
+. ))= contains all clotting factors e3ce8t 8latelets
-. 6ryo8reci8itate is enriched for factor <11, 9G), and fibrinogen
B-##d Pr#duct%
=:F6Vs ! # ml/7g ' @ct by 3>(
Ieu7ode8leted: donor GF6 remo9ed to 8re9ent febrile, non!hemolytic
transfusion reactions ; delays formation of antibodies
1rradiated: inacti9ates GF6 that may sli8 by during leu7ode8letion, decreases
chance of M<@2 and transmission of 6,<
))=: #!#" ml/7g 1< o9er 3!#% min.
=latelets $ P 8heresis for infants, O 8heresis for R % 7g, # 8heresis for . % 7g
6ryo8reci8itate ! ." units/7g 1<
T*$e% #, B'T
'UD: matched, unrelated donor
Ha$-#: bone marrow with 3 out of K match, usually a 8arent
C#rd: cord blood with acti9e stem cells
Si"-i!+: marrow from a matched sibling
Aut#-#+#u%: 8atient recei9es his/her own har9ested stem cells
Ta!dem: autologous trans8lant 8erformed a %
nd
time after reco9ery from the r
#
st
autologous trans8lant5 ty8ically seen in neuroblastoma
T ce-- de$-eted: ,E2 trans8lant with s8ecial 8re8 to remo9e T cells, 8atients
at high ris7 for infections
20
;-uid A!a-*%i%
P-eura- E,,u%i#!%
;i!di!+%
Tra!%udate
(CH;0 Ne$.r#%i%0 Cirr.#%i%)
E)udate
(i!,ecti#!0 ca!cer)
A88earance
6lear/straw ++ +/!
Ghite/mil7y ++' chylothora3(
:eddish ++ 'see below(
Turbid ++ 'li8id/GF6s(
=urulent ++ 'em8yema(
)oul 0mell ++ 'anaerobic inf3n(
@emorrhagic/<iscous ++ 'mesothelioma(
Ancho9y =aste ++ 'amebiasis(
08ecific Mra9ity R #.#K . #.#K
Total =rotein 'g/dI( R 3. . 3.
=leural =rotein/0erum =rotein R ." . ."
I2@ '1E( R % . %
I2@ 8leural/I2@ 0erum R .K . .K
Mlucose R 3 mg/dI: rheumatoid
R !K mg/dI: cancer,
TF, em8yema
Amylase . %3 serum amylase:
acute 8ancreatitis
8ancreatic 8suedocyst
eso8hageal ru8ture lung
cancer
8@ Y *.4 R *.3
Ii8ids 0udan '+(, T:1M '+( &
chylous
0udan '!(, T:1M '+( &
chyliform
6ytology ++ malignancy
GF6s R #/mm
3
. #/mm
3
:F6s R #,/mm
3
. #,/mm
3
21
CS; ;-uid
2isease
=ressure
'cm @
%
?(
Total GF6
=redominate
6ell Ty8e
Mlucose
'mg/dI(
=rotein
'mg/dI(
Normal *!#+ !# mononuclear 4"!+ #"!4"
Acute
Facterial
,eningitis
/nl . " to #Vs =,Ns !4" "!#"
Frain
Abscess
/nl . " to #Vs
lym8hVs ;
=,Ns
nl/ high
Ase8tic
,eningitis
nl/occ ."!% lym8hVs nl/ %!%+
TF
,eningitis
/nl ."!" lym8hs #!4" 4"!"
)ungal
,eningitis
nl/ ."!+ lym8hs nl/ nl/
6ry8to ."!+ ly8mhs mod
u8 to " in
->
6occidio,
@isto,
Flasto
."!% lym8hs freL
0y8hilis nl/ ."!#" lym8hs nl/ %"!3
Amebic /nl .4!%,
=,Ns with
:F6
/nl
6arcino!
matous
,eningitis
nl/ ."!# mononuclear nl u8 to "
0olitary
Frain Tumor
/nl ."!#" mononuclear nl u8 to "
6hemical
,eningitis
nl/ ."!#Vs =,Ns nl
6erebral
Thrombosis
nl/ ."!" nl nl/u8 to #+
6erebral
@emorrhage
/nl
same as
blood
same as
blood
nl u8 to %
Ti8s for bloody ta8s
#( =&:F6
60)
3 'GF6
blood
/:F6
blood
( ; ?&GF6
60)
then ?:= . # is -3> sensiti9e ; -*> s8ecific
to detect meningitis 'Q 1nfect 2is #-- Qul5#K%'#(:%"#!4(
%( Allow # mg 8rotein 8er # :F65s in traumatic ta8, i.e. *4, :F6 ; =rotein #K
#K $ *4 & +K corrected
22
'i%ce--a!e#u% PICU Stu,,
G#-*te-* B#2e- C-ea!#ut Re+ime!
:egular brea7fast only on the day before the 8rocedure.
6lear liLuids only from brea7fast until midnight.
0tart Molytely around 4 8.m.
R # 7g 3 oz e9ery # $ % min to eLual # liter
#!% 7g 4 oz % min #." liter
%!3 7g " oz % min % liter
3!4 7g K oz % min %." liter
4!" 7g * oz % min 3 liter
. " 7g + oz % min 4 liter
Mi9e a dose metoclo8romide 3 minutes 8rior to starting Molytely and re8eat in
4 hours
,ost 7ids will not drin7 unless chilled or fla9ored
6an only gi9e NM, not 8ost 8yloric
M?AI is to ha9e clear F,Vs, may gi9e more if needed
23
Parameter% U%ed t# '#!it#r Acute Re%$irat#r* ;ai-ure
=arameter @ow to determine
Al9eolar ?
%
tension '=
A
?
%
(
Normal & #% torr
=
A
?
%
& =i?
%
$ '=
A
6?
%
/:(
Ghere =i?
%
& '=!=
@%?
(')i?
%
(
Assume =
A
?
%
& =a?
%
, : & .+,
; =
@%?
& 4*
Flood ?
%
6ontent
Arterial '6a?
%
(
Normal & % 9ol >
<enous '69?
%
(
Normal & #" 9ol >
6a?
%
& '#.34Z('@gb
\
('03?
%
( + .3#'=a?
%
(
Ghere 03?
%
is in fractions
Z#.3% for neonates, #.3K for adults in ml/g
\
in g/dI
Al9eolar!arterial ?
%
gradient 'A!a2?
%
(
Normal & 3 to " torr
A!a2?
%
& =
A
?
%
$ =a?
%
1ntra8ulmonary shunt 'Ns/Nt(
Normal & 3 to * 9ol >
Ns/Nt &
6
6?%
$ 6a?
%
6
6?%
!

69?
%
Arterio9enous ?
%
6ontent 2ifference
Normal & " 9ol >
a92?
%
& 6a?
%
! 69?
%
,i3ed 9enous ?
%
tension '=9?
%
(
Normal & 4 torr
,easured by means of 8ulmonary artery
catheter
,i3ed 9enous ?
%
saturation
Nomral *"> 'or %"> e3traction(
09?
%
& 0a?
%
!
=9?
%
'@gb 3 #3.+ 3 61(
6ardiac out8ut '6?(
Normal 'adult( & 4!+ I/min
)ic7: 6? &
<
?%
3 #
6'a!9(?
%
6ardiac 1nde3 '61(
Normal & 3." $ "." I/min/m
%
61 & 6?/Fody surface area
Ieft 6ardiac Gor7 1nde3
Normal & 4. .4 7g $ m/m
%
61 3 ,A= 3 .#3K
Ieft <entricular 0tro7e Gor7 1nde3
Normal & "K K gm $ m/m
%
01 3 ,A= 3 .#3K
:ight 6ardiac Gor7 1nde3
Normal & ." .K 7g $m/m
%
61 3 ,=A= 3 .#3K
:ight <entricular 0tro7e Gor7 1nde3
Normal & K .- gm $ m/m
%
01 3 ,=A= 3 .#3K
?3ygen deli9ery '2?
%
(
Normal & "% to *% mI/min/m
%
2?
%
& 6a?
%
3 61 3 # or
0< 3 @: 3 6a?
%
24
?3ygen consum8tion '<
?%
(
Normal & # to #+ mI/min/m
%
1nfants & K to + mI/7g/min
<?
%
& 61 3 a92?
%
3 #
?
%
e3traction ratio '?
%
/:(
Normal & %% > to 3 >
6a?
%
! 69?
%
3 #
or <?
%
/2?
%
6a?
%
=<:
Normal + $ %4 dyne!sec/cm
"
/m
%
*-.-% ',=A= $ =6G=(
61
0<:
Normal + $ #K dyne!sec/cm
"
/m
%
*-.-% 3 ',A= $ 6<=(
61
0tro7e 1nde3 '01(
Normal & 3 $ K ml/m
%
61/@:
0tatic com8liance of the res8iratory
system '6rs(
6rs &
/3haled tidal 9olume
]=lateau^ 8ressure ! =//=
Ot.er Parameter%
=a?
%
R % is A:20 and R 3 is AI1 'Normal is #/.%# & 4*K(
)i?
%
?% inde3 &
)i?
%
3 =aw 3 #
where . 3 would need /6,? inter9ention
=a?
%
6<= & 4 $ # mm @g
=A= & %"/# '#"( mm @g
=6G= & + $ #" mm @g
0erum ?sm & %BNaC +
Mlc
+
FEN
+
/t?@
+
,annitol
#+ %.+ 4.K #+
6orrected Na & ,easured Na +
#." 3 'Mlc $#"(
?r #.K mmol/I 8er # mg/dl of Mlc
#
6orrected retic & ?bser9ed retic 3 'obs @ct/nml @ct(
)/Na & # 3
Na urine 3 6r serum R # is 8rerenal failure
. 3 renal failure Na %"erum 3 6r urine
Mlucose Ioad
#. 4g Mlc/7g/day '2#G & #g / #cc ; 2#%."G & #%."g / #cc
4g / #cc & H / 'cc/7g/day(
%.2i9ide H by #44 to get A
3.,ulti8le A by # to get mg/7g/min
2ead s8ace 9entilation <
2
/<
T
& =
a
6?
%
$ /T6?
%
/ =
a
6?
%
25
26
TT
VIII
Prekallikrein
HMW-K Kallikrein
XII
XIIa
XI
XIa
IX
IXa
Ca
+2
Ca
+2
+ PL
I!tri!%ic
S*%tem
E)tri!%ic S*%tem
VII
[VIIa + i!!"e #a$%&r'
i!!"e
#a$%&r
[IXa + VIIIa + Ca
+2
+ PL'
X
Xa
VIIIa
IIa
V
(
V
IIa
Ca
+2
+ PL
Xa + Va + Ca
+2
+ PL
)r&*+in ,IIa-
Prothrombin (II)
#i+rin ,Ia- #i+rin&.en ,I-
XIII
XIIIa + Ca
+2
Cr&!!-linke/ #i+rin
Pla!*in&.en Pla!*in
0-M&n&*er 0-M&n&*er 0-0i*er
Pla!*in Pla!*in
FDPs
XII1 2%re3%&kina!e1
4r&kina!e1 %P(
12
11
9
8
10
5
2
1
P
T
T
7

10
5
2
1
P
T
Vit K dependent
Ina$%i5e
Protein C, S
(n%i%)r&*+in III
Ina$%i5e
(III ina$%i5e
H6P(7I8
6lotting 6ascade
IIa
2-Ma$r&.l&+"lin