Pediatric Maintenance Fluids
4mL/kg/hr for the first 10kg
2mL/kg/hr for the second 10kg
1mL/kg/hr for each kg of body weight above
... [Show More] 20kg
Pediatric DKA Interventions
-Begin regular insulin infusion at 0.1 units/kg/hr
-Monitor BGL every 30 min and adjust therapy to decrease serum glucose no more than 100 per hour
-If serum glucose decreases by more than 100 per hour add D5 to it fluids
-change IV fluids to D5W if serum glucose drops below 300
-Potassium replacement should be started once urinary output is confirmed 10-20 mEq per hour (with physician order only)
-if serum K+ <5 consider potassium supplement KCI IV
- if signs of cerebral edema consider mannitol 1g/kg IV with physicians order
VASOPRESSIN
Dose, MOA, Indication
Dose: 0.01-0.04 units/min
Indication: Septic Shock refractory to Levo & Epi
MOA: Vasoconstriction with no Beta 1 Effects
PHENYTOIN (Dilantin)
Bolus, Infusion, and Pediatric Dose
Bolus: 15-20 mg/kg IV Diluted in NS
Infusion: should not exceed 50mg/min
Pediatric: 15-20 mg/kg IV diluted in NS, Infusion should not exceed 1 mg/kg/min
ESMOLOL
Bolus and Infusion Dose
Bolus: 50mcg/kg over 1 min
Infusion: 50mcg/kg/min; If no response consider repeating IV Bolus and increase infusion by 50mcg/kg/mi IV increments every 5-15 min up to 300 mcg/kg/min
LABETOLOL
Dose
10-20 mg IV may repeat every 10 minutes with additional doses of 40mg then 80mg until max dose of 300mg
OXYTOCIN
Dose, MOA, Indication, IM Dose
Post Partum Hemorrhage Dose: 20 units/1,000mL NS or LR at 20-40 miliunits/min (120-140 mL/hr) IV
IM dose: 10 units
MOA: Stimulates uterine contraction
CARDENE
MOA, Dose
Dose: 2.5mg/hr IV continuous infusion. Increase by 2.5mg/hr every 5-15 min up to a max dose of 15mg/hr IV. Once target BP is achieved titrate dose down by 2.5 mg/hr to target 3mg/hr IV infusion.
MOA: Inhibits Calcium Ion influx into vascular smooth muscle and myocardium (calcium channel blocker); relaxes and widens arterial walls.
MAG SULFATE
Indications & Doses
Torsades: 2g over 2 min
Bronchospasm: 2g over 20min
Pre-Eclampsia/Tocolysis: 4g IV Bolus over 20 min then continuous Infusion of 2-4 g/hr IV
Pediatric Reactive Airway & Torsades: 50mg/kg IV max single dose 2g over 20 min
Hydralazine
Indications &Dose, MOA
Hypertensive Emergency: 10mg SIVP, may repeat in 20 min up to max dose 40mg
Pre-Eclampsia: 5mg IV repeated as needed every 20 minutes at a dose of 5-10mg IV to a total dose of 40mg
MOA: Directly dilates peripheral vessels, Antihypertensive, nitrate
LEVOPHED
Dose, MOA
Dose: 2-20 mcg/min max 30mcg
MOA: Peripheral vasoconstriction, Inotropy, Dilates Coronary Arteries
TXA
Loading & Maintenance Doses, Criteria, MOA
Loading Dose: 1g in 100mL NS over 10 minutes
Maintenance Dose: 1g in 500mL NS infusing at 60mL/hr IV for 8 hours
Inclusion Criteria:
-blunt of penetrating trauma
- >12 years old
- Initial injury <3 hours (prefer <1 hour)
-S/S of severe hemorrhage
~ SBP <90
~ HR >110
~ RR >24
~ pale/cool skin
~ cap refill <2 seconds
MOA: decreases plasmin formation and fibrinolylsis
ROCURONIUM
Dose, Onset, Duration
Dose: 1mg/kg
Onset: 30-60 seconds
Duration: 30-45 minutes
SUCCINYLCHOLINE
Dose, Onset, Duration, Antidote, Contraindications
Dose: 2mg/kg
Onset: 30 sec- 1min
Duration: 5-8 minutes
Contraindications:
-known or suspected hyperkalemia
-Severe crush or traumatic injuries > 2 days old
-Spinal Cord injuries > 2 days old
-Burn injuries >24 hours old
- Renal Failure
- Known hx of malignant hyperthermia
- neuromuscular disorders
- penetrating eye injuries
Antidote: Dantrolene
Ketamine
Doses & Indications, contraindication
Pain Management: 0.1-0.25 mg/kg may repeat every 10 min
Delirium: 0.5-1 mg/kg may repeat X1 or 2mg/kg IM
RSI: 2mg/kg IV or 4mg/kg IM
Post Intubation Sedation: bolus of 0.5-1mg/kg every 10 min or Infusion 0.1-0.5 mg/min
Contraindications:
-hypertension or when hypertension would be detrimental (AMI, cerebral hemorrhage, AAA etc.)
Nitroglycerine
Doses & Indications
ACS Dose: 0.4 mg SL every 5 min x3; may continue if relieving pain. If not relieving pain 10 mcg/kg/min IV Infusion- titrate to max 200mcg/min
CHF/Pulmonary Edema Dose: 0.4 mg SL every 3-5 min x3 doses. Initiate infusion at 40mcg/min not to exceed 200 mcg/min
INSULIN
Doses & Indications
Adult DKA Dose: 100 units /100mL NS at
0.1 units/kg/hr
Hyperkalemia: 10 Units IVP (after administering 25g D50 IVP)
PEDIATRIC DKA: 0.1 units/kg/hr
CALCIUM
Doses & Indications
Hyperkalemia Dose:
-Calcium Chloride 10%: 500-1,000 mg over 2 min; repeat every 10 minutes
OR
-Calcium Gluconate: 1g slow IVP over 5 min repeat every 10 minutes [Show Less]