EMERGENCY MANAGEMENT Intubation 3.

Ipratropium
- only for moderate to severe
Normal RR (PALS) Laryngoscope blade (straight or Miller) exacerbations
Age Breaths/min #00-1 – premie-2mos - decrease airway secretions
Infant <1yo 30-60 #1 – 3mos-1yo - give early but no benefit has been shown
Toddler (1-3) 24-40 #2 - >2yrs from repeated doses
Preschooler (4-5) 22-34 #3 - >8yrs 4. steroids
School age (6-12) 18-30 ETT 5. Epinephrine
Adolescent (13-18) 12-16 Size = (Age/4) + 4 - 0.01ml/kg SC or IM (1:1000; max 0.5ml)
Depth of insertion (cm) = ETT size x 3 every 15min up to 3 doses
Normal Heart Rate (PALS) Uncuffed ETT of rpxs<9yo
Age Awake Mean Asleep - attempts should not exceed 30secs Magnesium sulfate
Verify ETT placement - 25-75mkdose IV or IM (max 2g)
NB-3 mos 85-205 140 80-160
- observe chest wall movement infused over 20min, q4 or 6 up to 3-4 doses
3mo-2yr 100-190 130 75-160
- auscultation in both axillae and epigastrium - smooth muscle relaxant
2-10yrs 60-140 80 60-90
- end-tidal CO2 detection - CI – significant hypotension or with
>10yrs 60-100 75 50-90 - improvement in O2 sat renal insufficiency
- CXR
ABG - repeat direct laryngoscopy to visualize ETT * a normalizing PCO2 is a sign of impending respiratory failure
pH 7.35-7.45 - intubation of those with acute asthma is dangerous and should
pCO2 35-45 mmHg NGT be reserved for impending respiratory failure
pO2 80-100 mmHg - from nose to jaw angle to xiphoid - hypotension is the result of air trapping, hyperinflation –
HCO3 22-26 meq/L decpulmo venous return
O2 sat >85% Bag mask ventilation - tx – reduce lower airway obstruction
- 20 breaths/min (infants 30)
Initial MV set-up (PALS) PALS
Oxygen 100% * bradycardia requiring chest compression <60
Tidal Volume 6-15 ml/kg Tachycardia >240bpm suggests tachyarrythmia ET
Inspiratory Time 0.6-1 sec Cuffed
Peak Inspiratory 20-35 cm H2O Hypotension = systolic BP < [(age x2) + 70] Age (yrs)/ 4 + 3.5
pressure Uncuffed
Respiratory Rate Infants 10-30cpm Allergic emergencies Age (yrs)/ 4 + 4
Children 16-20cpm
Adolescents 8-12 1. Epinephrine Bag
PEEP 2-5 cm H2O - 0.01ml/kg (1:1000) IM One-one thousand two-one thousand three-
- max 0.5ml one thousand bag
- repeat every 5min as needed
Effects of Ventilator Setting Changes - site of choice – lateral aspect of thigh due Class I – high-quality CPR
to its vascularity IIa – shock
Ventilator Setting Changes Typical Effects on Blood Gases 2. Histamine-1 receptor antagonist IIb – medications
- diphenhydramine 1-2mg/kg IM, IV or PO
PaCO2 PaO2
3. Steroids to prevent late phase of allergic Defibrillation
↑ PIP ↓ ↑
response 1. 2 J/kg
↑ PEEP ↑ ↑
4. Racemic epinephrine 0.5ml inhaled for signs 2. 4 J/kg
↑ RATE (IMV) ↓ Minimal↑ of upper airway obstruction 3. 10 J/kg
↑ I:E Ratio No Change ↑
↑ FiO2 No Change ↑ Respiratory Emergencies
st
1 2 minutes
↑ Flow Minimal↓ Minimal↑ - HQ CPR
↑ Power (in HFOV) ↓ No change 1. O2 to keep saturation >95% - Shock 2 J/kg
↑ PAW (in HFOV) Minimal↓ ↑ 2. Inhaled B-agonists - No meds
After 2 minutes Needling – 2nd ICS, MCL Indications for Imaging in Closed Head Injury
- Stop, Analyze, Switch D - displacement Age <2 yrs GCS <14 or altered mental status Obtain Head CT
or palpable skull fracture
- HQ CPR O - obstruction
occipital, parietal, or temporal observation vs head CT
- Shock – 4 J/kg P - pneumothorax scalp hematoma or Hx of LOC
- HQ CPR E – equipment failure >5sec or severe mechanism of
injury or not acting normally per
- Meds
parent
1. Epi 0.1ml/kg (1:10,000 + 5ml NSS) Induced therapeutic hypothermia None of signs or symptoms listed No head CT
o
2. amiodarone 5mkd - PNSS 30cc/kg at 4 above
o > 2yrs GCS <14 or altered mental status obtain head CT
- Core body temp 32-34 C x 12-24h
or signs of basilar skull fracture
Hx of LOC or vomiting, or severe observation vs head CT
Cardioversion Glasgow Coma Scale mechanism of injury or severe
- for tachyarrhythmias Activity Best Response headache
Eye Opening None of signs or symptoms listed No head CT
Spontaneous 4 above
To speech 3
SVT – no P wave, narrow QRS, To pain 2 Burn
>220 bpm infant, >180 children None 1
Verbal Superficial - epidermis only
regular rhythm
Oriented 5 - erythema, pain
Confused 4 - sunburn or minor scalds
Stable Inappropriate Words 3
- not included in estimate of surface
1. physio – vagal maneuver Nonspecific sounds 2
None 1 area burned
ice on forehead – 10s
Motor Superficial partial - damages, but does not destroy
2. pharma Follows commands 6 thickness epidermis and dermis
adenosine 0.1mkd (max 6) Localizes pain 5
- intense pain, blisters, pink to
0.2mkd (max 12) Withdraws to pain 4
Abnormal flexion 3 cherry red skin, moist and weepy
Unstable
Abnormal extension 2 Deep partial thickness - epidermis and dermis
- synchronized cardioversion None 1
st - intense pain
1 – 0.5 J/kg Modified Coma Scale for Infants
nd - dry and white
2 – 1 J/kg Activity Best Response
Full thickness - all layers of skin
- sedate if conscious (midaz, diaz, eto) Eye Opening
Spontaneous 4 - charred black color
- press SYNC
To speech 3 - skin grafting required
Primary Assessment To pain 2
A – airway None 1
B – RR, O2 sat, effort, BS Verbal
C – HR, BP, central and peripheral pulses, CRT Coos, babbles 5
Irritable 4
D – alert, voice responsive, pain responsive, unresponsive Cries to pain 3
E – temp, rashes Moans to pain 2
None 1
Respiratory failure – inadequate Motor
Normal spontaneous 6
oxygenation and/or ventilation movement
Withdraws to touch 5
Respi failure – dec rate and effort Withdraws to pain 4
Respi distress – inc rate and effort Abnormal flexion 3
Abnormal extension 2
None 1
Shock

Severity
Compensated – poor perfusion
Hypotensive – poor perfusion, low BP
Irreversible
Burn assessment chart Drips
Dopa, Dobu, Epi Ludan’s
= wt x TFR / 24hrs = ___ cc/hr
3 x desired dose x wt x rate Weight (kg) TFR
12.5 dobu 0-3 75
40 dopa 3-10 100
1 epi 10-20 75
= ___ ml + d5W = 50 cc to run at rate ___ 20-30 60
30-40 50
>40 40
Albumin
>50 30
Wt x (1g/kg) x 100 / prep (5, 20, 25%)
= __ cc x 4hrs
Normal Urine Output
Infants and Young Children 1.5-2
FLUIDS and ELECTROLYTES
ml/kg/hr
Dehydration
No Dehydration Some Severe Older Children and 1 ml/kg/hr
Gen condition Well, alert Restless, irritable Lethargic, Adolescents
unconscious,
floppy
Eyes Normal Sunken Very sunken, dry
Sodium Correction
Tears Present Absent Absent Deficit = (desired – actual) x 0.6 x wt
Mouth and Moist Dry Very dry Maintenance = wt x 2-3mEqs
FLACC pain scale Tongue
Na req = D + M
Categories Scoring Thirst Drinks normally, Thirsty, Drinks Drinks porrly, not
0 1 2 not thirsty eagerly able to drink
FACE No particular Occasional Frequent to Skin Pinch Goes back quickly Goes back slowly Goes back very ___meqs= 50meqs
slowly X (cc) 20 ml
expression or grimace or constant
Body wt. loss <5 5-10 >10
smile frown, quivering Est. Fluid deficit Up to 50 50-100 >100
withdrawn, chin, clenched Potassium Correction
disinterested. jaw. 1. Deficit = (desired – actual) x 0.6 x wt
LEGS Normal Uneasy, Kicking, or
Intravenous Fluids
Maintenance = wt x 2mEqs
position or restless, tense. legs drawn up. Na K Cl lactose
K req = D + M
relaxed. IMB 25 20 22 23
ACTIVITY Lying quietly, Squirming, Arched, rigid NM 40 13 40 16
normal shifting back or jerking. ___meqs = 40 meqs
LR 130 4 109 28 X (cc) 20 ml
position and forth,
0.3 51 - 51 -
moves easily. tense.
CRY No cry, Moans or Crying 0.45 75 - 75 - 2. 40-60meqs/wt/24 = __ kir (0.1-0.3)
(awake or whimpers; steadily, 0.9 154 - 154 - TFR (Ludan’s)
asleep) occasional screams or NR 140 5 98 50
complaint sobs, frequent
X = K per L of IVF = ___ meqs
complaints. Holliday-Segar Tfr
CONSOLABILITY Content, Reassured by Difficulty to
relaxed. occasional console or
Weight ml/kg/day ml/kg/hr
st
touching comfort 1 10kg 100 4 40 or 60 – x = meqs to be added in IVF
nd
hugging or 2 10kg 50 2 Kcl = 2meqs/mlDurule = 10meqs/durule
being talked to, >20 20 1
distractable. Hypocalcemia
Calcium gluconate
100mg/ml (10%)
200-500mkD IV q6
HCO3 correction CARDIOLOGY IVIg
= wt x 0.3 + BE 2.5g/50ml
- ½ SIVP, ½ x 30min drip Murmur Test dose 1. __ml x 30min
Max – 50 meqs Grade Description 2. __ ml x 30 min
- metab acidosis – pH <7.25 1/6 Very faint Then remaining ____ x 11hrs to run at __.
pCO2 <15 2/6 Quiet, but heard immediately upon placing steth on Another line solely for Ig
BE >6 chest Main line on KVO
3/6 Moderately loud VS q15min x 1h then q30min x 2h then q1
Dextrosity 4/6 Loud
Di = DD – DA 5/6 Very loud, may be heard with steth partly off the chest 1. wt x 0.02 x 30 = __ ml
H-L 6/6 Heard even with steth entirely off the chest 2. wt x 0.04 x 30 = __ ml
D7.5 - 0.055
D10 – 0.11 Max = 0.06 cc/kg/,om
Abnormal Heart Sounds
D12.5 – 0.17
• Widely Split S1:Ebstein’s anomaly, RBBB
• Widely Split and Fixed S2:Right ventricular volume overload Phlebotomy
GIR
(e.g., ASD, PAPVR),pressure overload (e.g., PS), electrical delay in
= PT 8-10, FT 6-8 Polycythemia>0.65 Hematocrit
RV contraction (e.g., RBBB),early aortic closure (e.g., MR),
= dextrosity x 0.167 occasional normal child
Wt (kg) Est Blood Volume x (actual Hct – desired Hct)
• Narrowly Split S2:Pulmonary hypertension, AS, delay in LV
= dextrosity x (cc/hr) ActuaHct
contraction (e.g.,LBBB), occasional normal child
Wt (kg) x 6 • Single S2:Pulmonary hypertension, one semilunar valve (e.g., EBV x wt x 0.1-0.2
pulmonaryatresia, aortic atresia, truncusarteriosus), P2 not
Hyponatremia Jones Criteria (Rheumatic Fever)
audible (e.g., TGA, TOF,severe PS), severe AS, occasional normal
Major Minor
child Subcutaneous nodules Clinical
Deficit = (desired – actual) (0.6) (wt) • Paradoxically Split S2:Severe AS, LBBB, Wolff-Parkinson-White polyarthritis Arthralgia
Maintenance = wt x 2 Erythema marginatum Fever
syndrome(type B)
Na req = D + M Carditis Lab Findings
• Abnormal Intensity of P2:Increased P2 (e.g., pulmonary Chorea elevated ESR, CRP
hypertension),decreased P2 (e.g., severe PS, TOF, TS) Plus
1. Na req x 1000/Na in IVF in 1L = x supporting evidence of antecedent group A strep infection
• S3:Occasionally heard in healthy children or adults, or may
2. x/rate = __ hrs correction
indicate dilatedventricles (e.g., large VSD, CHF)
• S4:Always pathologic, decreased ventricular compliance DERMATOLOGY
Hypokalemia
Primary
Kawasaki Disease
1. Deficit = Wt x TBK (50 meq/kg) x K Criteria:
macule/ patch small flat lesion with altered color (<1cm)/ large macule
papule/ plaque elevated, well-circumscribed lesion (<1cm)/ large papule
K = < 3meq/L – 0.05
Fever persisting at least 5 days nodule/ tumor mass in dermis or subcutaneous fat/ large nodule
K = < 2.5meq/L – 0.10
Presence of at least 4 principal features vesicle/ bulla blister with transparent fluid/ large vesicle
K = < 2meq/L – 0.20 wheal erythematous, well-circumscribed, raised, erythematous
1. Changes in extremities lesion that appears and disappears quickly
Maintenance Acute – erythema of palms, soles; edema of hands and feet Secondary
= wt x 2-3meq/kg/day
Subacute – periungual peeling of fingers, toes in weeks 2-3 Scale small, thin plate of horny epithelium
K req = D + M Pustule well-circumscribed elevated lesions filled with pus
2. Polymorpous exanthema
Crust exudative mass consisting of blood, scale and pus
3. Bilateral bulbar conjunctival injection without exudates
2. rate of IVF x 24h x (6-8meqs) = X Ulcer erosion of dermis and cutis with clearly defined edges
4. Changes in lips and oral cavity Scar formation of new connective tissue after damage to
100ml
5. Cervical lymphadenopathy (>1.5cm), usually unilateral epidermis and cutis, leaving permanent change in skin
KIR = x/24/wt = _____ Excoriation surface marks often linear sec to scratching
Fissure linear skin crack with inflammation and pain
- 2d echo should be considered in any infant <6mos with fever of
3. x div 24 = ____ meqs/hr
>7 days’ duration, lab evidence of systemic inflammation, and
4. K req = hrs of correction no other explanation for the febrile illness
meqs/hr

* need to subtract K in IVF

DEVELOPMENTAL 2. Pervasive developmental disorder NOS – impaired social
PretermHead Growth interaction and communication skills and/or repetitive
st
Developmental Stage Theories 1 2 weeks 0.5cm stereotyped behaviors
Age Period Freud Erikson Piaget rd
3 week 0.75cm 3. Asperger syndrome – impairment in social interactions and
0-1 Infancy Oral Basic Truct Sensorimotor (I- th th
IV) 4 week until 40 week of devt 1 cm restrictive; repetitive patterns of behavior with no general delay
2-3 Toddlerhood Anal Autonomy vs Sensorimotor (V, in language, cognition , or attainment of self-help skills
Shame and VI)
doubt Tanner Staging
3-6 Preschool Oedipal Initiative vs Preoperational Waterlowe Classification
guilt Stunting Wasting
6-12 School Latency Industry vs Concrete Normal >95% >90%
Inferiority Operations
12-20 Adolescence Adolescence Identity vs Formal Operations Mild 87.5-95% 80-90%
identity Moderate 80-87.5% 70-80%
Diffusion
Severe <80% <70%
Thumb Sucking
Wasting = actual weight x 100
- normal in infancy but may persist up to 2-5yo
ideal weight
- interferes with normal teeth alignment – flaring of maxillary
incisor teeth
Stunting = actual height x 100
ideal height for age
Tantrums
- onset 6-12mos; - Peak – 2-4yo
-should not: persist beyond 5yo, last >15min, occur >3x/day
Disorders
Dentition
st Intellectual Disabillity
1 year of life
- significantly below-average intellectual functioning (IQ <70-75)
# of teeth = age in months - 6
existing concurrently with related limitation in 2 or more of the
3 yo – all 20 primary teeth have erupted
st st following adaptive skill areas:
6 yo – 1 molar, 1 permanent teeth to erupt
Communication, self-care, home living, social skills,
community use, self-direction, health and safety, functional
Ideal Body Weight academics, leisure, and work
<6 months = age x 600 + BW
6-12 months = age x 500 + BW
2-6 years = (age x 2) + 8 Communication Disorders
6-12 years = (age x 7) - 5
- expressive, mixed receptive-expressive, pragmatic, speech
2 production disorders
>12 yo = (ht in cm – 100) – 10% of the difference
Ideal Height (in cm) Learning Disabilities
= Age (yrs) x 5 + 80 - difficulties in 1 or more of the ff 7 areas: GASTROENTEROLOGY
Catch up growth Basic reading skills, reading comprehension, oral expression,
= Cal for wt age x IBW for height listening comprehension, written expression, mathematical Normal stooling patterns
actual body weight calculation, mathematical reasoning Infants 0-3mos – 2-3 BM/day
Cerebral palsy 6-12mos – 1.8/day
- disorder of movement and posture resulting from a 1-3yo – 1.4/day
Head Circumference permanent, nonprogressive lesion of the immature brain >3 yrs – 1/day
- diagnosis made at a mean age of 13mos
Term
Birth 34-35 cm Autism Spectrum Disorder
6mos 44 cm 1. Autism – impaired social interaction and communication and
1yo 47 cm a restricted group of activities and inteerests
Functional Constipation 1. Normal term infants 2 wk 11.4(5-20) 4.5(1-9.5) 40 5.5(2-17) 48
1 mo 10.8(5-19.5) 3.8(1-8.5) 35 6.0(2.5-16.5) 56
- after at least 24h of normal protein and lactose feeding
6 mo 11.9(6-17.5) 3.8(1-8.5) 32 7.3(4-13.5) 61
Infants and Toddlers - formula-fed infants may not have a diagnostic abnormality 1 yr 11.4(6-17.5) 3.5(1.5-8.5) 31 7.0(4-10.5) 61
at least 2 of the ff: before 36 hrs of age 2 yr 10.6(6-17) 3.5(1.5-8.5) 33 6.3(3-9.5) 59
• ≤2 defecations per week - breastfed infants may not have a diagnostic abnormality before 4 yr 9.1(5.5-15.5) 3.8(1.5-8.5) 42 4.5(2-8) 50
6 yr 8.5(5-14.5) 4.3(1.5-8) 51 3.5(1.5-7) 42
• ≥1 episode of incontinence after the acquisition of toilet 48-72 hrs of age
8 yr 8.3(4.5-13.5) 4.4(1.5-8) 53 3.3(1.5-6.8) 39
training skills 10 yr 8.1(4.5-13.5) 4.4(1.5-8.5) 54 3.1(1.5-6.5) 38
2. premature or ill infants 16 yr 7.8(4.5-13.0) 4.4(1.8-8) 57 2.8(1.2-5.2) 35
• History of excessive stool retention
- initial screening at or near 7 days of age regardless of feeding 21 yr 7.4(4.5-11.0) 4.4(1.8-7.7) 59 2.5(1-4.8) 34
• History of painful or hard bowel movements status
• Presence of a large fecal mass in the rectum - repeat screen at 28 days of age or at hospital discharge, Reticulocyte Index
• History of a large-diameter stool that might obstruct the whichever comes first RI = Actual Hct X Reticct
toilet Desired Hct 10
* all infants must be screened by 7 days of age
st
- if 1 screen is before 24h of age, send repeat by 14days of age Interpretation
Children with a developmental age 4-18yrs - some tests are affected by blood transfusions and require a 1-1.5 Normal
At least 2 of the following: repeat test at least 90 days after transfusion >1 Inc. erythropoiesis, Inc Bone marrow Activity, hemolysis
• ≤2 defecations per week <1 Dec. erythropoiesis, Bone marrow failure
• ≥1 episode of fecal incontinence per week
HEMATOLOGY Actual Neutrophilic Count [ANC]
• History of retentive posturing or excessive volitional stool
retention AGE-SPECIFIC BLOOD CELL INDICES ANC= WBC x [Neutrophils + Bands]
• History of painful or hard bowel movements AGE Hb(g/dL)* HCT(%)* WBCs Platelets
3 + 3 +
(x10 /uL) (10 /uL)
• Presence of a large fecal mass in the rectum ANC RISK OF INFECTION
26-30 wk 13.4(11) 41.5(34.9) 4.4(2.7) 254(180-327) >500 Normal
• History of a large-diameter stool that might obstruct the
gestation
toilet >1000-1500 Little or none
28 wk 14.5 45 - 275
> 500-1000 Moderate
32 wk 15.0 47 - 290
< 500 Severe
Term (cord) 16.5(13.5) 51(42) 18.1(9-30) 290

1-3 day 18.5(14.5) 56(45) 18.9(9.4-34) 192

Anemia
2 wk 16.6(13.4) 53(41) 11.4(5-20) 252
Serologic Markers of Hep B 1 mo 13.9(10.7) 44(33) 10.8(4-19.5) - Iron-Deficiency
HBsAG HBcAB IgMHBcAB HBsAB Interpretation 2 mo 11.2(9.4) 35(28) - - - hypochromic/ microcytic
- - - - no prior infection, not 6 mo 12.6(11.1) 36(31) 11.9(6-17.5) - - low reticulocyte count
immune
6 mo – 2 yr 12.0(10.5) 36(33) 10.6(6-17) (150-350) - elevated red cell distribution width
- - - + immune after hepB
vaccination 2-6 yr 12.5(11.5) 37(34) 8.5(5-15.5) (150-350)
- + - + immune after recovery 6-12 yr 13.5(11.5) 40(35) 8.1(4.5-13.5) (150-350) Serum ferritin – reflects total body iron stores after age 6 mos
from HBV infection st
12-18 yr - 1 value to fall in iron deficiency
+ + + - Acute HBV infection Male 14.5(13) 43(36) 7.8(4.5-13.5) (150-350)
+ + - - Chronic HBV Female 14.0(12) 41(37) 7.8(4.5-13.5) (150-350)
- may be falsely elevated with inflammation or infection
Iron therapy should result in an increased reticylocyte count in
Adult
GENETICS Male 15.5(13.5) 47(41) 7.4(4.5-11) (150-350)
2-3 days and increase in hematocrit after 1-4 weeks of therapy.
Female 14.0(12) 41(36) 7.4(4.5-11) (150-350) Iron stores are generally repleted with 3 months of therapy.
Iron – 3-6mkD x 3 mos
Newborn Screening
1. 17 hdroxyprogesterone (CAH)
2. galactose metabolites
AGE-SPECIFIC LEUKOCYTE DIFFERENTIAL IDA Thalassemia
Total Leukocytes Neutrophils Lymphocytes
3. G6PD AGE
MCV Dec Dec
Mean(range) Mean(range) % Mean (range) %
4. Leucine (MSD) Birth 18.1(9-30) 11(6-26) 61 5.5(2-11) 31 Iron Dec N
5. phenylalanine (PKU) 12 hr 22.8(13-38) 15.5(6-28) 68 5.5(2-11) 24 TIBC Inc N
24 hr 18.9(9.4-34) 11.5(5-21) 61 5.8(2-11.5) 31
6. TSH (C) ferritin dec N
1 wk 12.2(5-21) 5.5(1.5-10) 45 5.0(2-17) 41
Megalobastic anemia – deficient Vit B12, folic IMMUNOLOGY 4. Onset type defined by type of articular
Folic acid – 25-35ug/day involvement in the 1st 6 mo after onset:
MINIMUM AGE FOR INITIAL VACCINATION AND Polyarthritis: ≥5 inflamed joints
Estimated Blood Volume MINIMUM INTERVAL BETWEEN VACCINE DOSES, BY Oligoarthritis: ≤4 inflamed joints
Age total blood volume TYPE OF VACCINE Systemic disease: arthritis with rash and a
(ml/Kg) Minimu Minimum Interval from characteristic quotidian fever
preterm 90-105 Vaccine m Age Dose to Dose
term newborns 78-86 for First 1 to 2 2 to 3 3 to 4 Hep B
1-12mos 73-78 Dose
1-3yr 74-82 DTaP 6 wk 1 mo 1 mo 6 mo
4-6yr 80-86 Hib(PRP- 6 wk 1 mo 2 mo -
7-18yr 83-90 OMP)
Adults 68-88 PCV7 6 wk 1 mo 1 mo 2 mo
IPV 6 wk 1 mo 1 mo 1 mo
Packed RBC MMR 12 mo 1 mo - -
-concentrated RBCs, with hematocrit of 55-70% HBV Birth 1 mo 2 mo -
-infuse no faster than 2-3ml/kg/hr to void congestive heart Varicella 12 mo 1 mo - -
failure – generally 10-15ml/kg aliquots over 4 hrs HAV 12 mo 6 mo - -
- rule of thumb in severe compensated anemia: Influenza 6 mo 1 mo - -
X ml/kg aliquot, where X=patient Hgb (g/dL) Rotavirus 6 wk 4 mo 4 mo -

Calculate volume of pRBC GUIDELINE FOR SPACING LIVE AND INACTIVATED VACCINES
Volume of pRBC (ml) = Antigen Combination Minimum Interval Between Doses
EBV (ml) x (desired-actual Hct) >2 inactivated or None, can give simultaneously
Hct of pRBCs inactivated and live
>2 live parenteral 28-day minimum interval, if not
Cryoprecipitate – 1 unit/5kg given at same time
FWB – 15-20cc/kg
pRBC – 10-15cc/kg
Indications for tetanus prophylaxis
Clean, Minor Wound All Other wound
Platelet Concentrate
Prior TT Tetanus TIG Tetanus TIG
0-30kg – 10cc/kg
doses Vaccine Vaccine
>30kg – 3-6 units
Adult – 6 units unknown or yes no yes yes
Child – 0.1-0.2 unites/kg or 1 unit/5-7kg <3
>3, last <5yr no no no no
FFP transfusion ago
- if PT/PTT and control difference is >20 >3, last 5-10 no no yes no
yr ago
Mentzer Index >3, last >10 yes no yes no
= MCV/RBC x 106 yr ago
<12 thalassemia trait, >13 IDA
Juvenile Rheumatoid Arthritis
Naproxen test 1. Age at onset: <16 yr
- 10mkd 2. Arthritis (swelling or effusion, or the
- (+) fever = infection presence of 2 or more of the following signs:
- (-) fever = malignancy limitation of range of motion, tenderness or
pain on motion, increased heat) in ≥1 joints
3. Duration of disease: ≥6 wk
NEONATOLOGY Calcium DOUBLE VOLUME EXCHANGE TRANSFUSION (DVET)
__ cc in 24 hr = Wt x 100 or 200
Apgar 100 Pre-DVET Orders:
0 1 2 Amino Acids (6%) - NPO, insert OGT asceptically
Appearance Blue Pink Completely Wt x (1-3) x 100 - Insert umbicath
pink 6 - Baseline diagnostics
Pulse Rate (-) <100 >100 Cbc w/ apc
Grimace (-) Grimace Cry, cough MgSO4 Bld CS
Activity Limp Some flexion Active LD 200mg/kg PBS, Retic Ct
Respiration (-) Slow, Good, strong MD – 20-40mg/kg Serum Elec w/ Ca
irregular cry = Wt x dose x 24 ABG
* Ballard score most accurate when performed between age 12 250 (prep) Hgt
and 20 hrs Dir & Indir Coomb’s
UVC Bld Typing
NRP Wt x 3 + 9 / 2 + length of stump TB B1
Newborn Screening
size weight AOG
Ideal Body Weight  Save blood for chromosomal analysis if needed
2.5 <1000g <28
Preterm – DOL – 14 d x 20-30 g/day + BW - Prepare 1 U FWB properly typed & x-matched with
3 1-2 kg 28-34
Fullterm – DOL – 10 d x 30 g/day + BW mother’s BT (O +)
3.5 2-3 kg 34-38
- Hook patient to continuous pulse oximeter
3.5-4 >3 kg >38 Breastfeeding jaundice
Tip to lip – wt in kg + 6 -
st
1 week of life
- caloric deprivation and/or insufficient frequency of
feeding Post DVET orders:
Apnea - inadequate quantities of BM to remove bilirubin from - Repeat ABG, Hgt, Blood CS IMMEDIATELY post DVET
- cessation of breathing > 20s or any duration if accompanied by the baby - Repeat CBC, Elec w/ Ca 6 hrs post-DVET
cyanosis, bradycardia, desaturation - accentuated unconjugated hyperbilirubin - May resume BF / MF after 4 hrs if stable
- poor caloric intake
DVET (Double-volume Exchange Transfusion) To compute for aliquots
1. FT 160ml/kg PT 160-200ml/kg Breastmilk Jaundice Wt x 80 x 2 = N
2. Blood is removed through the UAC and an equal volume is - (+) glucoronidase in BM N / 10 ml for Term N/8 ml for Preterm
infused through the UVC Ex. 3.8 kg x 80 (TBV) x 2 = 608
3. vigorous, full-term infants - exchange in 15ml increments ROP 608 / 10 ml = 60.8 aliquots to be pushed
Premature/ less stable – exchange at 2-3ml/kg/min to avoid - BW <1500g, AOG <28weeks; or 1500-2000g w/ OUT  IN
trauma to red blood cells unstable clinical course
- at least 2 funduscopic exam MECHANICAL VENTILATOR
Corrected age in preterms -
st st
1 exam – bet 4-6 weeks post natal age w/in 21 -33
rd

CA = Actual age in weeks + 40 – AOG at birth week (whichever is late) *Physiologic Set-up (NEONATES)
= days of life/7 = __ + AOG
Neonat Nutrition PIP 18-26
Cranial Ultrasound AA ____g x 4 = _____ cal PEEP 3-6
Indications Lipids = ___ g x 9 = ___ cal RR 40-60
1. Birth wt < 1200g EBM (20 cal/oz) or 20 cal / 30 ml IT 0.5-0.7
2. PT <27 weeks, requiring ventilator D10 = ____ ml x 0.4 = ___ cal FR 8
3. asphyxia with CNS manifestations D7.5 = ___ ml x 0.3 = ___ cal
4. PT <36 wks with head trauma D5 = ____ ml x 0.2 = ____ cal **Management
5. full and bulging fontanelle Pneumothorax dec PIP and PEEP
6. PT with apnea (1-2 days)
7. seizure Respi Acidosis Inc RR and TV
Dec Dead Space
Respi Alkalosis dec RR and TV NOT Recommended crying – late sign of hunger
Inc Dead Space 1. perineal shaving on admission
2. routine enema * do not touch the baby unless there is a medical indication
Met Acidosis = correct if pH <7.2 or HCO3 <12-14 but correlate if 3. routine vaginal douching
pH is compensated 4. routine amniotomy Suctioning
- no proven benefit
nd
Met Alkalosis = know the cause and treat it! 2 stage of labor - may cause apnea, vagal-induced bradycardi, slow-rise in
Check electrolytes, diuretic use? Recommendations oxygen saturation, mucosal trauma with possible increase risk of
Anti-convulsant use? 1. upright position during delivery infection
2. selective (non-routine) episiotomy - only done if:
rd
PRE-EXTUBATION ORDERS 3. prophylactic oxytocin for management of 3 stage of labor - chest not rising with bag and mask ventilation
- Suction secretions per ET/Orem - given within 1 minute of delivery of baby - (+) visible secretions in the mouth and nose
- Epi neb 0.3-0.5 ml + 1.7 – 1.5 ml PNSS (SNS Neb - oxytocin – DOC for postpartum hemorrhage
depending on AMD) 4. delayed cord clamping Vernix – protective barrier to E. coli and GBS
- Do ABG 5. controlled cord traction with countertraction to deliver the
** if patient still has no voice post-extubation, may give placenta Early bathing – removes vernix, hinders crawling effect
neb x 24 hrs 6. uterine massage after delivery of placenta Bathing done at least at 6 hours of life
rd
POST-EXTUBATION ORDERS 3 stage of labor Stomach capacity – 6ml/kg
- O2 Inhalation at 6 lpm/mask NOT recommended At 20-60min – Newborn is ready to be breastfed
st nd
- Monitor VS q15 for the 1 hr, q30 for the next hr, 1. perineal massage in the 2 stage
then q1 thereafter 2. fundal pressure
- ABG 1 hr post-extubation 3. coaching the mother to push NEPHROLOGY
- Epi neb q6 for 24 hrs
Postpartum Care Edema
rd th
- prophylactic antibiotic for 3 or 4 degree perineal tear - sec to excessive accumulation of both Na and water
- early postpartum discharge - causes
Essential Intrapartum Care 1. inability to excrete Na with or without water
NOT RECOMMENDED 2. decreased oncotic pressure
- Mother should have at least 4 prenatal visits - ice packs over the hypogastric area 3. reduced cardiac output
Screen for - manual exploration of uterus 4. mineralocorticoid excess
- anemia, pre-eclampsia, DM, syphilis, HIV - oral methergine
th
Tetanus toxoid – given on 5 month of pregnancy Oliguria
- at least 2 doses before delivery (5 weeks prior to EDC) - UO <300 ml/m2/24h
For Preterm Labor <0.5 ml/kg/hr in children
1. betamethasone 12mg IM q24 x 2 doses <1 ml/kg/hr in infants
CPG 2. dexamethasone 5mg IM q12 x 4 doses
In Labor TFR = BSA x 400-600 + UO in 24h
1. admission when already in active phase Essential Newborn Care BSA = kg x cm/3600 then square root
- 4cm dilated, 2-3 contractions in 10min
2. continuous maternal support Core Steps Nephrotic Nephritic
st
3. upright position during 1 stage of labor (in low risk 1. drying massive proteinuria hypertension
uncomplicated women in labor) 2. skin-to-skin contact hypoalbuminemia hematuria
Supine position - worst 3. properly timed cord clamping edema edema
4. routine use of WHO partograph to monitor progress of labor 4. non-separation of newborn from the mother hyperlipidemia oliguria
5. limit total number of IE to 5 or less for early breastfeeding
st
weighing, bathing, eye care, PE, injections – done after 1 full
breastfeed
 Normal BP Values Anti-hypertensives 250 mg / 5 mL PO
Age 95%le Cut-off Agents Preparations Dose & Route 50, 100 cap 5-7 mkd OD IV IM
NB-7d ≥95mmhg, syst Amlodipine 2.5,5, 2.5-10mg OD 1 g vial 55 mkd QID PO
8-30d ≥105 10mg 0.5-2mkd BID-QID 10, 40 mg vial 5-7 mkd Q6 hours
1mo-2y ≥115/75 Captopril 5, 50mg tab 0.05-0.3mg/dose BID-TID PO
2-5y ≥130/80 Clonidine 0.1, 0.2mg 0.1-0.5mg/kg/day OD-BID 300 mkd Q6 hours IV
6-11y ≥135/85 Enalapril5mg tab 0.18-0.56 mg/kg/day OD-BID 5 mkd Q8 hours IV
>12y ≥140/90 Felodipine5,10 mg tab 1-2mkd Q6-12h IV/PO
Furosemide 20, 0.1-0.5 mkdo Q4-IV Methylprednisolone (Pulse, IV)
Hypertension 40mg tab 1-3mkd(mkdo) Q6-12h PO Dose: 30mg/kg/dose x 3 doses monthly
Definition: BP>95(%le) for age on 3 separate occasions Hydralazine 20mg 1mkd BID Prep: 500mg or 1g/vial
Mild 95 (%le) + 10 mmhg amp 0.5-3mcg/kg/min IV inf How to Give:
10 ,25,50mg 0.25-1mkd 4-6 dose, PO Dilute methylpred to make 50ml solution using D5W to run for
Moderate + 10-20 mmHg
Hydrochlor 25, TD: 5ug/KG, MD-25- 1h. Each Dose should be given at least 20hrs apart. Watch out
Severe +20 mmHg
50mg tab 150ugkdQ8h for hypertension. Hold prednisone while on methylprednisolne
Nicardipine 1-2mkd BID-QID Nephrotic Syndrome: Protocol
24 Hr Urine Protein 2.5mg/ml 1mkd BID-TID First Episode
g/24h x 1000- BSA +24hr Nifedipine 5, 10mg cap 50 mg/m2/day, daily 3+ doses (80mg/day) 4-6 wks
Nephrotic Range: ≥ 40mg/m2/hr Prazosin1mg tab 40mg/m2/day every other day 3+ doses 4-6 wks
Propranolol 5, 10
Body Surface Area mg tab Tapering: Remove 5mg every 2-4wks depending on the+/- of
Weight (kg) Formula Spironolactone 25mg tab edema &albuminuria
0-5 Wt x 0.05 + 0.05
6-10 Wt x 0.04 + 0.10 Relapse: 60mg/m2/day daily 3+doses x 2 wks or until (-
10-20 Wt x 0.03 + 0.20 Antibiotics for UTI )CHONuria x 3 consec days then 40 mg/m2/day every other day
20-40 Wt x 0.02 + 0.40 Agent Preparation Dose and Route 4-6 wks then taper
>40 Wt x 0.01 + 0.80 Amikacin 50, 100, 150mg amp 15mkd Q 8 hours IV,
Amoxicillin* 100/ml, 125, IM
Albumin Ampicillin 250/5ml 20-40 mkd TID PO
Dose: 0.5-1 g/kg/dose Cefalexin 250, 500 mg vial 100 mkd Q6 hours IV NEUROLOGY
25% wt x 4= ml of albumin Cefazolin 125/5ml, 250/cap 25-100 mkd QID PO
28% wt x 5 = needed Cefixime 500 mg vial 50 mkd Q8 hours IV Strength Rating Scale
Give Furo 1mkdose IV Cefotaxime 100 mg/5ml 8mkd BID PO 0/5 No movement; no palpable tension at the tendon
Mild, immediately post &4-6 hrs Cefrozil 250, 500mg vial 150 mkd Q8 HR IV 1/5 flicker of movement or < full ROM in a gravity-neutral
Post- transfusion Ceftazidime 125, 250 mg/5mL 30 mkd BID PO plane
Watch out for congestion Ceftriaxone 250, 500 mg vial 150 mkd Q6 hours IV 2/5 movement in a gravity neutral plane
Cefuroxime 250, 500, 1g vial 75 mkd Q24 hours IV 3/5 movement against gravity but not resistance
125 mg/5mL IM
4/5 subnormal strength against resistance
Ciprofloxacin* 500 mg vial 20-30mkd BID PO
Fluid Restriction 5/5 normal strength against resistance
250, 500 mg tab 75-150 mkdQ8 hours
Total Fluid Replacement
CoAmoxyclav* 100, 200, 400 mg IV
BSA(m2) x 400- 500 ml/m2 + UO/24 (ml) Muscle Power
Cotrimoxazole* vial 20-30 mkd BID PO
0 No contraction
228, 475mg/5mL 10-20 mkd Q12
IF with no accurate UO yet: 1 Flicker or trace of contraction
Fluconazole 40-200/80-400 hours IV
BSA x 400-500 ml/m2 2 Active movement, gravity eliminated
Gentamicin mg/5mL 20-40 mkd TID-BID
Nalidixic Acid* 80-400/100-800 mg T – 6-12 mg 3 Active movement, against gravity
IF on Furosemide: 4 Active movement, against gravity and resistance
Nitrofurantoin* tab S – 30-60 mkd BID
BSA x 400 ml/m2 + ½ UO/24hr 5 Normal power
Ticarcillin 50 mg tab PO
Tobramycin* 80 mg ampule 3-9 mkd Q 12 hours
Upper and Lower Motor Neuron Findings Stuporous: appears asleep but rouses to vigorous verbal stimuli, Protein, Sugar
On Exam Upper Lower may awaken spontaneously for brief periods, but Save Specimen
Power dec dec with cloudedsensorium, shows some spontaneous movements Indications
Reflexes inc dec and follows some brief commands Fever, infection, sudden severe headaches, headache worse
Tone inc N or dec Semicoma [Light coma]: no response to verbal stimuli, moves when lying down and improves on standing
Babinski present absent on painful stimuli, reflexes intact (corneals, pupillary), Contraindications
adequaterespiration elevated ICP or mass effect due to concern for herniation,
Reflex Rating Scale Coma [deep coma]: no spontaneous movement or arousal, no infection on site of puncture, blood disorders
0 none reflexes, breathing impaired or absent
1+ diminished (need use of clasped hands/ gritting teeth Bloody tap
International Classification of Epileptic Seizures For every 1000 RBC 1 WBC
to engage reflex
2+ normal For every 800 RBC Inc of 1mg protein
I. Partial seizures (seizures with focal onset) For every 1 WBC 600-1000 RBC
3+ increased (reflexes cross neighboring joint or cross to
A. Simple partial seizures (consciousness unimpaired)
the other side) CSF/blood ratio 0.6
1. With motor signs
4+ hyperactive with clonus
2. With somatosensory or special sensory symptoms
3. With autonomic symptoms or signs
Dermatomes INFECTIOUS
4. With psychic symptoms (higher cerebral functions)
B. Complex partial seizures (consciousness impaired)
S/Sx Laboratory
1. Starting as simple partial seizures
DF Fever with two of the Leukopenia
(a) Without automatisms
following: (WBC <5000 cells/mm3)
(b) With automatisms (such as lip smacking and
- Headache. Thrombocytopenia
drooling, dazed eyes look)
- Retro-orbital pain. (<150 000 cells/mm3)
2. With impairment of consciousness at onset
- Myalgia. Hematocrit rise > 20%
(a) Without automatisms
-Arthtralgia/ bone pain. No evidence of plasma
(b) With automatisms
- Rash. leakage
C. Partial seizures evolving into secondarily generalized seizures
- Haemorrhagic
manifestations.
II. Generalized seizures
- No evidence of plasma
A. Absence seizures: Brief lapse in awareness without
Leakage
postictal impairment (atypical absence seizures may
have the following: mild clonic, atonic, DHF Fever and haemorrhagic Thrombocytopenia
tonic, automatism, or autonomic components) I manifestation <100 000 cells/mm3
B. Myoclonic seizures: Brief, repetitive, symmetrical (positive tourniquet Hematocrit rise > 20%
muscle contractions test) and
C. Clonic seizures: Rhythmic jerking; flexor spasm of evidence of plasma
extremities leakage
D. Tonic seizures: Sustained muscle contraction DHF As in Grade I Thrombocytopenia
E. Tonic-clonic seizures II plusspontaneous <100 000 cells/mm3
F. Atonic seizures: Abrupt loss of muscle tone bleeding. Hematocrit rise > 20%
DHF As in Grade I or II plus Thrombocytopenia
Level of Consciousness III. Unclassified epileptic seizures III circulatory <100 000 cells/mm3
Awake: sensorium fully intact. Asleep at appropriate times. failure Hematocrit rise > 20%
Maintains waking state Lumbar Puncture (weak pulse, narrow
Delirium: Disorientation, fear, irritability, often with pulse pressure,
1. Flat on bed x 4hrs
visual hallucination restlessness).
2. NPO x 4hrs
Drowsy: sleepy but can follow commands DHF As in Grade III plus Thrombocytopenia
3. Send CSF to lab
Lethargic: can follow commands. But very slow IV profound shock < 100 000 cells/mm3
GS/CS
Obtunded: easily falls asleep. Now aware of environment with undetectable BP Hematocrit rise > 20%
Cell count/ Diff count
and pulse
Viral Exanthems Anti-Koch’s 50mg/ml drops
Inh – 200/5 – 10-15mkd 125/250/5
RUBEOLA RUBELLA ROSEOLA ERYTHEMA Rif – 200/5 – 10-20mkd
(MEASLES) (GERMAN INFANTUM INFECTIOSUM
Cefazolin 50-100mkD q8 500mg, 1g vial
MEASLES) (EXANTHEM (5TH DISEASE) Prz – 250/5, 500/5 – 20-40mkd Cefepime 100mkD q12 500mg, 1g vial
SUBITUM)
ETIOLOGY Paramyxoviridae Togaviridae Virus (Prob) Virus (Prob) meninigitic:
(RNA Virus) (RNA Virus) PPD (tuberculin skin test) 150mkD q8
INCUBATION 10-12 days 14-21 days 7-17 days 7-28 days
EPIDEMIOLOGY All ages 6-18 months All ages Rarely >3y/o
- if +, can be read up to 7d Cefixime 8mkD q12-24 20mg/ml
RASH Maculopapular Maculopapular Maculopapular Maculopapular - if -, accurate up to 72hrs only 100mg/5ml

SPREAD Begins face spread Begins trunk … …
DISTRIBUTION rapidly → arms and Last for 24 live virus vax may cause suppression of tuberculin Ceftazidime 90-150mkD q8 250, 500, 1g, 2g
neck-face-legs- hours reactivity; TST postponed at least 4-6weeks Ceftriaxone 50-75mkD q12-24 250, 500, 1g vial
3days
 2 mos after measles, mumps, chicken pox, whooping Cefuroxime IV 125/250/5, 250,
PRODOME 3-5 days Mild catarrhal None None
cough 75-150mkD q8 500mg tab
Low-moderate fever Retroauricular,
Hacking cough post cervical,
PO 20 -40mg
Coryza, Conjunctivitis post occipital reading of PPD 20mkD q12
Kopliks after 2-3 days lymphadeno - read perpendicular to the forearm Cefalexin 25-100mkD q6 125/250/5
FEVER PATTERN ↑To abruptly [40- Sudden onset Absent or low
40.5oC] as rash ↑To 39-41oC grade - if -, do not write negative; write 0mm Cetirizine 6mos-2yo 5, 10mg tab
appears ↓To on 3rd –
↓To when rash 4th day as 2.5mg OD 5mg/5ml
reaches legs and feet rashes appear
INFECT PERIOD Isolate – 7th day post 9th-10th day 3rd day of fever
1-5yrs 2.5mg/ml drops
exposure until 5 days post exposure and 1st day of
PEDIATRIC DRUGS 2-5mg OD
after rash appeared (peak) rash
RASH Lateral neck, ears, Absence of PE Rash 3 stages >6yrs
hairline → back, finding to 1.“Slapped Drug Dose Preparation 5-10mg
abdomen→thigh→feet explain fever cheek” Aciclovir IV: 30mkD q8 x 7- 200mg cap
on 2nd trunk and 2. Chloramphenicol IV 125/5 susp; 1g vial
extremities Maculopapular 10days 200mg/5ml 50-75mkD q6
on 3rd day as
face fades
PO: 80 mkDqid x meningitic
3. Lacy or 5d 75-100mkD q6
reticulated
appearance – Amikacin 15-22.5mkD q8 50mg/ml Ciprofloxacin IV 100mg, 250, 500
rash fades
central
125, 250mg/ml 10-20mkD q12
clearing Amoxicillin 25-50mkD q8 250, 500mg cap PO
pruritic last 2- 30-50mkD
39 days 125/250mg/5ml 20-30mkD q12
DESQUAMATION Branny desquamation Minimal Desquamation No Amoxicillin- <3mos TID Clarithromycin 15mkD q12 125/5, 250/5, 250,
[Brownish desquamation rare desquamation
discoloration] Clavulanic Acid 30mkD q12 125/31.25, 500 tab
COMPLICATIONS Otitis media Congenital None None
Pneumonia Rubella
>3mos 250/62.5 Clindamycin IV/IM 75mg/5ml sy
Exacerbate / Sydrome 20-40mkD q8 or BID 25-40mkD q6-q8
Reactivate TB Esp< 14thwk
Myocarditis. SSPE AOG 25-45mkDq12 200/28.5, 400/57 PO
Encephalomyelitis IV 10-30mkD q6-q8
PROPHYLAXIS Immune Serum / ISG 20-30ml to None None
Gamma Globulin pregnant 30mkD q8 Co-trimoxazole IV/PO 80 TMP/400 SMX;
0.25ml/kg ASAP up to exposed only
5 days post-exposure
Ampicillin 100-200mkD q6 250, 500mg vial 8-10mkD q12 40/200/5
meningitic dose: (based on TMP)
200-400mkD q4-q6 Diazepam IV 10mg/2ml amp
PULMONOLOGY Ampicillin- IV-IM 375mg 0.2-0.5mkd 2.5mg rectal gel
Sulbactam 100-200mkD q6 Sulbactam 125, per rectum
Desired CA = 100 – desired FiO2 x PEEP meningitic: ampi 250 0.5mkd
79 200-400mkD q4-q6 750mg Diphenhydramine 1-2mkdose q6 12.5/5, 25, 50 tab
250/500 5mkD q6 50mg/ml amp
FiO2 = CA + 0.21 + pure air 1.5g
Epinephrine IV: 0.01 mg/kg
CA + PA (PEEP) 500/1000
1:10,000 solution
Azithromycin 10mkD OD x 3d 250, 500 tab ET: 0.1 mg/kg
100/5ml 1:1,000 solution
Cefaclor 20-40mkD q8 250, 500cap Erythromycin 30-50 mkD q6 250/5, 500 tab
Famotidine IV 40mg/5ml 2-4mkD q6-8 15-20mkd (max 1g in 24h)
0.6-0.8 mkD q8-12 10, 20, 40 tab (MCU 1mkd) MD
PO PO 5-8mkD
1-1.2mkD q8-12 2-4mkD q12 Valproic Acid PO
Ferrous Sulfate 3-6mkD OD-TID Salbutamol 0.1mkd q6-8 2mg/5ml Initial
Furosemide IV 20mg/2ml 1-2 puffs q4-6 prn 10-15mkD od-tid
0.5-2 mkd q6-12 20, 40 tab Vancomycin 15mkD q6-8 500mg Increments of 5-10mkD at weekly interval
PO Zinc sulfate 10-20mg/day 10/ml MD
1-6mkd q12-24 20/5 30-60mkD bid-tid
Gentamycin 7.5mkD q8 Neuro
Hydrocortisone LD 4-8mkd 100mg, 250mg vial Diazepam Sedative/ Muscle Relaxant Emergency/ Resuscitation/ Cardiac
MD 8mkd q6 IM/IV Epinephrine
(MCU 5mkd) child 0.04-0.2mkd q2-4 Adenosine SVT
st
Hydroxyzine 2mkD q6-8 10/5, 10, 25, 50 adult 2-10mg/dose q3-4 prn 1 dose - 0.1mg/kg rapid push
nd
Ibuprofen 5-10mkd q6-8 100/5, 200/5, PO 2 dose – 0.2mg/kg rapid
40/ml, 100, 200 child 0.12-.8mkD q6-8 push
tab adult 2-10mg/dose q6-12 Atropine Sulfate Bradycardia (symptomatic)
Mebendazole 100mg q12 bid x 50mg/ml IV/IO 0.02 mg/kg
3d; or 20mg/5ml Status Epilepticus ETT 0.04-0.06 mg/kg
500mg single dose 100, 500 tab neonate
Meropenem >3mos 1g 0.3-0.75mkd q15-30min x 2-3 doses (max Toxins/ Overdose
60mkD q8 2mg) <12yo – 0.02-0.05 initially
meningitic >1month then repeat q20-30mins until
120mkD q8 0.2-0.5mkd q15-30 (max <5yo - 5, >5yo - muscarinic symptoms reverse
Metronidazole 35-50mkD q8 x 10d 125/5, 250, 500 10mg)
Montelukast 2-5yrs - 4mg adult >12yo – 0.05 initially then 1-
6-14yrs – 5mg 5-10mkd q10-15min (max 30mg in 8h) 2mg repeat q20-30mins until
>15yrs – 10mg Lorazepam IV/IO/IM muscarinic symptoms reverse
Oxacillin/ PO 500mg 0.05-0.1mkd
Cloxacillin 50-100mkD q6 125/5 Mannitol 0.5-1gkd Rapid sequence intubation
IM-IV Midazolam 6mos-5yo 0.01-0.02 mg/kg
100-200mkD q4-6 0.05-0.1mkd Lidocaine VFib, Pulseless VT, wide-
Paracetamol PO/IV 6-12yrs complex Tachy
10-15mkd q4-6 0.025-0.05mkd Initial dose 1mg/kg loading
Penicillin G IM/IV 1M units/vial >12yrs bolus
100,000-400,000 0.5-2mkd MD 20-50 mcg/kg/miin
U/kg/day Phenobarbital Status Epilepticus infusion
LD ET – 2-3mg/kg/ET
Penicillin V 25-50mkD q6-8 125/5, 250/5, 250,
500 cap 15-20 mkd single or divided doses; give MgSO4 Refractory status asthmaticus
Piperacillin- <6mos 2g/250mg, additional 5mkd q15-30min 25-50mg/kg over 15-30min
MD (max 2g)
Tazobactam 150-300mkD q6-8 4g/500mg
>6mos neonat 3-5mkD od-bid NaHCO3 metab acidosis, hyperkalemia
300-400mkD q6-8 infant 5-6mkD 1 meq/kg slow bolus
1-5yrs 6-8mkd Dobutamine 6 x wt (kg) / 12.5 = __ ml to
Prednisone Asthma 6-12 yrs 4-6mkd add to diluent, to make 100ml
2mkD q12-24 >12yrs 1-3mkd
Anti-inflammatory Sedation: 1-3mkd as one dose, given 60- 1ml/hr delivers 1mcg/kg/,im
0.5-2mkD q12-24 90min prior to proc
Phenytoin LD CHF/ cardiogenic shock
Ranitidine IV 15mg/ml
 2-20mcg/kg/min infusion
max 40 Conversion factors
Dopamine 6 x wt (kg) / 40 = __ ml to Hct 0.01
add to diluent, to make 100ml Hgb 0.155
Plt 1101
1ml/hr delivers 1mcg/kg/,im Retic 0.01
TB 17.17
Distributive/ cardiogenic Chole 0.026
shock Crea 88.4
2-20mcg/kg/min infusion FBS 0.56
max 40 TPAG 10
Furosemide Drip OT/PT 0.46
Dilute furo 100mg (20mg/ml) BUN 0.357
in 90ml D5W to run at ___.
CSF Ca 0.5
Norepinephrine 0.6 x wt = __ ml to add to
CSF glc 0.005
diluent, to make 100ml
Hgt 18.18
1ml/hr delivers
0.1mcg/kg/min

hypotensive shock
0.1-2 mcg/kg/min infusion
Insulin Drip 100 units Humulin R in 100ml
PNSS to run at ____

Hyperglycemia
IV infusion
neonat: 0.01-0.1 U/kg/hr
children: 0.5-1 U/kg/day
adolescents: 0.8/1.2 U/kg/day
DKA
IV infusion – 0.1 U/kg/hr
adjusted to serum glucose
Naloxone Narcotic Reversal
total reversal required
2013/ ivy
0.1 mg/kg bolus q2mins PRN
max 2mg

total reversal not required

1-5mcg/kg
0.002-0.16mg/kg/hr
Vit K deficiency
2.5-5mg/day
adult – 2.5-25mg/day
Neonatal Resuscitation Program - breathing rate is 30 breaths per minute and respiration, persistent cyanosis, or low oxygen
compression rate is 90 compressions per minute saturation
Ventilation – most important and effective action in neonatal - 1 cycle = 3 compressions, 1 breath = 2sec
resuscitation * Discontinuation of resuscitation efforts may be appropriate
After 30sec of chest compressions, if HR is after 10minutes of absent HR following complete and adequate
Steps - >60 bpm – discontinue compressions and cont resuscitation efforts.
a. Initial ventilation at 40-60 breaths per minute
- provide warmth - >100 bpm – discontinue compressions and gradually Guidelines:
- position head and clear airway as necessary discontinue ventilation if NB is breathing 1. initially CPAP is set at 6cm water if there is no
- dry and stimulate the baby to breath spontaneously increase in PO2 in 15 minutes pressure must be
- evaluate respirations, heart rate and color - <60 bpm – intubate newborn and give epi increase in 2cm increments to a maximum of 10cm (if
b. provide positive-pressure ventilation with a resuscitation bag Intubation by ET tube) or by 12cm in other methods
and supplemental oxygen - laryngoscope is always held in the operator’s left 2. if there is an increase in PO2 reduce pressure
c. provide chest compressions as you continue assisted hand 3. if 10-12cm water pressure is attained and if PO2
ventilation - blade 0 – pre-term, blade 1 – term remains under 50 FiO2 must be increase by 5-10%
d. administer epinephrine as you continue assisted ventilation - intubation process should be completed within 20 increments
and chest compressions sec 4. CPAP failure is evident if PO2 remains less than
50inch 100% FiO2 with 10-12cm water
Meconium-stained Tube size Weight (g) Gestational Length
Baby not vigorous Inside Age (wks) - if CPAP fails under a non invasive method an ET tube
- suction baby’s trachea before proceeding with any diameter must be inserted
other steps 2.5 <1000g <28 7 - if CPAP fails with ET tube mechanical ventilation is
Vigorous 3.0 1-2 kg 28-34 8 indicated
- suction mouth and nose only, proceed with 3.5 2-3kg 34-38 9
resuscitation as required 3.5-4.0 >3000 >38 10 Complications:
Pneumothorax
Vigorous – newborn who has strong respiratory efforts, good Tip to lip measurement: Emphysema
muscle tone, and HR >100bpm weight + 6 = ___ ET level Apnea
Chronic lung disease
Epinephrine Gastric dilatation & rupture
Tactile stimulation - 1:10000 (0.1 mg/mL) Troubleshooting
- slapping or flicking the soles of feet - dose 0.1-0.3ml/K (ET 0.3-1mk) -poor air entry increase flow rate
- gently rubbing the back - preparation: 1:10,000 solution -retaining CO2
- cant tolerate CPAP
HR – beats in 6 sec x 10 = ___ bpm Indications for volume expansion - amubag to blow off excess CO2
- baby not responding to resuscitation - always suction before requesting for ABG
Free-flow oxygen indicated for central cyanosis - baby appears in shock – pale color, weak pulses, Weaning From CPAP
persistently low heart rate, no improvement in 1. dec FiO2 by 3-5% every time PO2 decrease
Indications for positive-pressure ventilation cicrculatory status despite resuscitation efforts) 2. FiO2 of 50% reduce pressure by increments of 2cm
- apnea/ gasping - hx of condition assoc with fetal blood loss water every 2-4 hours until pressure of 2-3cm is
- HR <100bpm even if breathing achieved
- persistent central cyanosis despite 100% free-flow Recommended volume expander 3. transfer patient to oxygen hood with FiO2 of 15-50%
oxygen - NSS, LRs, O- blood
- 10ml/kg in over 5-10min Parameter to be met before weaning
Chest compressions 1. improvement in CXR- clearing infiltrates/fluid
- indicated when the heart rate remains <60bpm CPAP 2. ABGs showing PO2 > 50mmHg
despite 30sec of effective positive-pressure - if baby is breathing spontaneously and has a HR 3. Blood PH > 7.3
ventilation >100bpm, but is having difficulty such as labored 4. PCO@ < 55mmHg
- thumb technique and 2-finger technique 5. Hb 12-15gm/dL or Hct 36-45
- one-and-two-and-three-and-breathe-and… Room air: 21%
 Pressure Controlled Ventilator D5IMB D10IMB
Oxygen Input Normal Range %
Oxygen N lungs RDS
2 lpm 25-30 PIP 12-18 20-25 Caffeine citrate for apnea
4 lpm 29-35 PEEP 2-3 4-5
6 lpm 33-41 Rate 10-20 20-26 Reconstitute 2 grams of Nescafe classic in 25 ml sterile water;
8 lpm 37-52 I:E Ratio 1:2-1:10 1:1-1:3 containing 5mg of caffeine.
10 lpm 47-75
12 lpm 65-95 Give 10mg as loading dose then 5mg as maintenance dose every
Surfactant: 12 hours.
- < 1 week intubated
racemic epinephrine prior extubation for 3 dose every 15 Rescue treatment for RDS: Umbilical Vein Catheter
minutes (0.1ml epinephrine + 0.9 ml PNSS then salbutamol 4ml/kg/dose every 6 hours for 4 doses
nebulization every 6 hours) Length of umbilical vein catheter :
- > 1week intubated Surfactant for RDS Weight x 3 + 9 div by 2 + length of stump
start dexamethasone for 1 day prior extubation at
0.5mg/kg/dose every 6 hours for 6 doses then extubate Eg 695 grams x 4 = 2.74 ml or 3ml Determine the shoulder-umbilical length by
measuring the perpendicular line dropped from the tip of the
APGAR Give surfactant 3 ml via ET tube as follows: shoulder to the level of the umbilicus. Then plot.
st
0 1 2 Give 1 dose instillation intratracheally of 1.5 ml via through 5
french end hole catheter protruding just beyond the end of the High (T6 to T9) or low (L3 to L5) position
Appearance Blue Pink Completely
pink ET tube above the infants carina. Before inserting the catheter
Pulse Rate (-) <100 >100 through the ETbtube, the length of the catheter should be
nd
Grimace (-) Grimace Cry, cough shortened then after 5-10minutes give the 2 dose.
Activity Limp Some Active
flexion After giving the dose, do not suction for 3-4 hours.
Watch out for respiratory distress, desaturastion, bradycardia
Respiration (-) Slow, Good,
irregular strong cry
G-CSF
10mcg x wt/300=
* Ballard score most accurate when performed bet age 12
10 x 1.475/ 300= 0.05ml SQ x 3 doses
and 20hrs
Mechanical Ventilation
Theophylline can be discontinued
1. by postconceptional age (usually 37 weeks)
Indications
2. depending on the weight of the infant (usually 1800-
- marked retractions in CPAP
2000grams)
- frequent apnea and brady on CPAP
3. infant has been free of apnea for 7 days
- PaO2 <50mmHg with FiO2 60-100%
- PaCO2 >70mmHg
- Intractable metabolic acidosis -base deficit DAY Term PT SGA
>10meqs/L after tx with NaHCO3 1 70 80 80
- Cardiovascular collapse 2 80 90 90
- Neuromuscular disorder 3 90 100 120
4 110 110 150
5 130 120 180
PEEP= 5 if premature to open up alveoli 6 140 160 210
PIP= expansion of lung 7 160 180 240
Preterm RDS = 18 8 160 200 270
st
Pneumonia supportive = 12 1 day <1kg – D5W >1kg – D10W
nd
2 day <1kg – D5 0.3 or >1kg – D10 0.3 or
 Phenobarbital Broad spectrum 3-5mkD
except in Migraine Intermittent attacks of vasoconstriction and
absence vasodilation
st
- 1 line if cost is
a major concern
Classic - Biphasic course
Phenytoin Partial seizure 5-8mkD - Transient neurologic abnormalities (aura)
and primarily followed by headache, nausea and vomiting
generalized - Aura is usually visual
seizures - pain is throbbing, pounding, pulsatile or
Topiramate Partial seizures, 0.5-1mkD Titrate to 5- diffuse
West syndrome, 9mkD in 2 div - pain lasts for 2-6hrs
Lennox-Gestaut doses
- vomiting heralds the end of the attack and
Valproic Acid Absence, 10mkD Inc by 5-
myoclonic, tonic, 10mkD
the child goes into deep sleep and wakes up
atonic, partial, weekly until looking normal
primary seizures are Common - MC type of childhood migraine
generalized TC, controlled or - attack usually happens in the afternoon and
Lennox 30mkD is is preceded by irritability, pallor and mood
reached changes
- monophasic pattern
- assoc with anorexia, nausea, vomiting
* After 2 yrs of being seizure free, we can try to slowly withdraw - recurrent vomiting may be the only feature
NEUROLOGY
medications - pain throbbing or pounding
Seizures - Single seizure type, normal neuro exam, normal IQ and dev’t, - diffuse or bifrontal
normal EEG following tx, absence of cerebral disorder and good - phonophobia or photophobia
Seizure – sudden and abnormal discharge of the brain cells initial response to AED favour a good prognosis after - pain aggravated by physical activity and
Convulsion – motor movements like shaking, jerking or stiffening discontinuation of AEDs, such that after at least 2 seizure-free relieved by sleep
years, tx may be gradually withdrawn over 6 weeks to 6 months.
Epilepsy – 2 or more seizures that occurred without provocation
and cause - There is a 20-30% probability of seizure recurrence during
withdrawal
Status epilepticus – seizures that last for a sufficient duration of
time or repeated seizures wherein the patient does not regain Headache
consciousness in between attacks - pain located above the orbitomeatal line
- medical emergency - pain in the head and neck region that may be either a
disorder in its own right or a symptom of an
- 30min of continuous seizures
underlying medical condition
- cephalalgia
st
Carbamazepine 1 line – partial/ 5-10mkD in 2- Inc weekly 5-
focal epilepsy 3 div doses 10mkD not 1. Primary Headache with no known
to exceed structural/organic cause
30mkD - migraine headache
Clonazepam Myoclonus and 0.01-0.02 mkD Inc 0.1- - tension headache
myoclonic jerks OD or BID 0.2mkD - cluster headaches
Gabapentin Limited use in 15mkD in 3 Inc to 30mkD
focal epilepsy div doses
2. Secondary to a structural disease or organic cause
Lamotrigine Broad spectrum; 0.15mkD Titrate to MD
not for 1-5mkD OD
myoclonic jerks or BID Specific Headache symptom
Levetiracetam
st
1 choice – focal 5-10mkD Titrate to 20- 1. Acute headache – single event with no previous hx of
and myoclonic 40mkD BID similar events
st
Oxcarbazepine 1 line – partial 10mkD Titrate to 30- 2. Acute recurrent headaches – periodic events
and focal 45mkD in 2-3 separated by pain-free intervals
epoilepsy div doses - best represented by migraine