a Current Clinical Strategies Pediatrics De. Adtdaua Year 2000 Edition RBalese Paul D. Chan, MD Jane L. Gennrich, PharmD Current Clinical Strategies Publishing www.cespublishing.com Scanned with CamScannerDigital Book and Updates book can download the digital version and updates at the al Strategies Publishing web site: wwrw.cespublishing.com inal Strategies Publishing. Allrights reserved. ‘may not be reproduced or stored in an ission of the publisher. The Copyright © 2000 by Current Current Clinical Strategies Publishing 27071 Cabot Parkway wir cspublishing com fo@ cespublishing.com Printed in USA ISBN 1881528-85-5 Contents Discharge Note .. Prescription Wating . . Procedure Note ...... Developmental Milestones . Immunizations . Haemophilus Immunization . Varicella immunization Pediatric Symptomatic Ca Antiomotics Cardiology . 25 Pediatric Advanced Life Suppo. +25 Congestive Heart Failure +28 Arial Fibrilation -29 Hypertensive Crisis 31 Pulmonology . +99 33 35 36 Pleural Etfusion . . 37 Infectious Diseases Suspected Sepsis, Endocaris Prophyiaxis . Pneumonia . . . Community Aequied Preumonia Immunosuppressed, Nevtropen Specie Thara Bronciolts Pertussis Viral Laryngotracheitis (Croup) Varicelia Zoster infections . Preumocvetis Carin Phouvonia Scanned with CamScannerHerpes Simplex infections i Herpes Simplox Encephalitis Herpes Varicella Zo Cytomegalovirus int Toxoplasmosis stoplasmosis or Coccisomycosis Seeeanegeas "Narcotic or Propoxyphene Overdose .... Methanol or Ethylene Glycol Overdose Carbon Monoxide Inhalation Neurology and Endocrinology Seizure and Status Epilept ‘Now Onsot Diabetes Diabetic Ketoacidosis . Hematologic and Inflammatory Disorders Sickle Cell isis. Kawasak's Syndrome Fluids and Electrolytes Newborn Care... Hepatitis Prophylaxis . Neonatal HIV Prophylaxis. Commonly Used Formulas Scanned with CamScannerPediatric History and Physical Examination 7 General Pediatrics Pediatric History and Physical Examination History Gastrointestinal: Abdominal pain, nausea, vomiting, diarhea, constipation, 3k tarry stools), hematochezia (bright red blood Scanned with CamScanner{8 Pediatric History and Physical Examination Neuropsychiatric: Weakness, seizures. Physical Examination General appearance: Note whether malnourished, Vital Signs: Temper ‘Skin: Rashes, scars, moles, ski Lymph Nodes: |, allary, Inguinal nodes: Head: Bruising, masses, fontanels, Eyes: Pupils equal round and react to light and accommodation (PERALA); extra. ocular movements intact (EOMI). Funduscopy (papiledema, hemorrhages, exudates), ptosis. uty, tympanic membranes (dul, shiny, intact, injected, bulging). Mouth and Throat: Mucus membrane color and moisture; ora lesions, dentition, pharynx, tonsis. ‘Neck: Thyromagaly, lymphadenopathy asses. rubs, breath sounds. id socond heart sounds (S1, $2); 98, varicoceles. Uterine size, Inguinal masses, hernias, scrotum, t Vaginal mucosa, cervical dischar es, ovaries, range of motion, edema (grade 1~4+); cyanosis, clubbing, edema (CCE); pulses. ‘Sphincter tone, masses, fissures; test for occult blood, lental status and affect; gait, strength (graded 0-5), sensation, lexes (biceps, triceps, ‘graded 0-44). urine analysis (U ‘Assessment (Impression): Assign a number to each problem and discuss separately. Discuss di .gnosis and give reasons that support the working diag for excluding other diagnoses. be therapeutic plan fo Progress Notes 9 Progress Notes eae eed Jems and symptoms of tho patont should be pain, orfussiness may be included. 2s. Physical exam, including chest and abdomen, with particular attention to active problems. Emphasize changes trom previous physical exams. jans and dosages. ‘Assessment and Plan: This section should be organized by problem. Writing a separate assessment and plan should be writen for each problem. Discharge Note The discharge note should be written in the patient's chart prior aischarge. Caen Scanned with CamScanner10 Prescription Writing Prescription Writing Developmental Developmental + Patients name: ao) Age Milestones ‘* Drug name and preparation (eg, tablets size): Lasix 40 mg. + Quantity t dispense: #40 ‘trmonth | Raises head sighty when prone; alerts to sound; regards + Frequency of administration: Sig: 1 po qAM face, moves extremities equally None + Signature 23 Smiles, holds head up, coos, reaches or familiar objects, months | recognizes parent. ee |(eeere seo eenere rae Procedure Note months. propped; laughs, orients to voice; enjoys looking around; grasps rate, bears some weight on legs. ‘A procedure note should be writen inthe chart when a procedure is performed. peelinataisa nis ial commie Tact months | Sits unsupported: passes cube hand to hand; babbles: ses raking grasp; feeds st crackers. pers 2° to stand; pincer grasp; pays paa- months th bot; sis without support explores 12 months to the procedure were explained to the parents and patent. Note th and patient was given the opportunity to ask questions and pie months 240 describe the procedure, inclding a nt postion, devices used, anatomic ions and Estimated Blood Loss (EBL): Describe how the patent tolerated the procedure. years | Dresses and undresses; walks up and down steps; draws ‘Specimens: Describe any specimens oblained and labs tests which ‘ciel; knows more than 250 words; takes turns; shares. were ordered. Group pay. years | Hops, sips, catches bal; memorizes songs plays cooperatively; ows colors; copies a circle; uses plurals. lumps over objec; pri mother’s name; draws three part man; hops on o Scanned with CamScanner12 Immunizations Immunizations Cue daca toi Immunizations 13 CO aA Ld Frat viet DTP or DTaP, Hb HBV, MOM, PV om Ore orbTar Wo, | OTPandhib aw nati conbved a ev nTerware nea ‘mom | oreororae. nev, amo OFF obra, om “ 2 months DTP or DTaP, Hib, ww ome Orr eroTar ) * ee mee lie ove aor. rv, cen | reve or veteme | Hb.MWR VAR temo veieme | ouPoore — se Ino rr to ewer geen atge sy worm | ra en ey 178 4oy DTaP or DTP, Pv. Scanned with CamScanner14 immunizations eT ana enn as Immunized Previously Immunizations Comments HBV, PV, MI, Ta HEV, IV, Ta, VAR, ue Varicella immunization 15 Cet eee vaccine Product | Total Doses | Regimens 71 m0 Paar | 8 2 doeet Vaccine Product rete 2 2 doses? mons Tae rev. T4, aes Cnt MR cove was goon a we 0048 year towne | te Pepa oan 10 ear 155010 1 Single dove of any preaet Haemophilus Immunization Onn) 2106 Months of Age 25 yea anvwacine | 1 Totalumber | Regimens Pecvaxitis (PRP. on) HeTITER (806), Acti (ae. 4 {2 doves two months apart plus booster at 12-18 mons which must be atleast two Omnis (PAP-T) to be associated with an increased sik for Ht dseas0. Varicella Immunization Age 19 months tothe 13° binhday: Vaccination of susceptbe chi recommended nd maybe given any’ime during chidhoodbutbetore the 19" birthday because of the potential increased severity of natual varicella after this age. Suscopibie is dened by either lack of proof of varicella vaccination or a roliable history of varicella. One dose is recommended C. Healthy adolesconts and young adults: Healthy adolescents past their 13® bithday who have not been immunized proviusly and have no Scanned with CamScanner16 Influenza Immunization history of varicella infection should be immunized against varicella by Immunocompromised individuals) and who have not had a documented case of varicella Influenza Immunization ee aa a eae cu aaa Vaccine Type | Dosage 6-35 months 0.25 3-8 yrs Split virus only | 05 ot2yrs Split vies only | 05 1 > 128 Whole or spit | 0.5 1 virus —_| “Two doses administered a least one month apart are recommended for children who are receiving influenza vaccine forthe first time. Antipyretics 17 Pediatric Symptomatic Care Antipyretics Anaigestetanipyrat +160 mg, $00 mg: drops: 80 mg/.8 ml; elie: 0 mg/2.5 g/5 mL, 160 mg/5 mL, 325 mg/S mL, 500 mg/15 mL; caplet, ER: 650 mg; suppositories: 80, 120,325,650 mg. mgikg/dose PO q6-8h, ion: 100 m/S mL, tabs: 200,300, 409, 7200 mg] May cause Gi bleeding Antitussives, Decongestants and Antihistamines 4100 mg PO gan pm (max 600 mg/day) -200 mg PO aah pm (max 1.2 9/day) 100-400 mg PO qth pen (max 2.4 g/day) te gastric mucosa; take with large quantites of fids. Decongestants: Pseudoephedrine (Sudafed, Novaled)[Tabs: 30,60mg: sustained eloaso caps: 120.mg, syrup: 15 mg/S mL, 30 mg/S mL; drops: 7.5 mg/0.8 mL, (Chitdron <2 yr: 4 mg PO géh, 2.5 yr: 15 mg po gBh Scanned with CamScanner‘18 Antihistamines, Decongestants, and Antitussives 90 mg po qéh >12 yr: 30-60 mg/dose PO g6h or sustains Phenylephrine (Neo-synephrine) [nasal drops: jase 120 mg PO qt2h. nasal spray: 1/4, Children: Use 1/4 % spray or drops, 1-2 dropsfepray in each nostril q- 4h ‘Adults: Use 1/4-1/2% drops/spray, 1-2 drops/sprays in each nostri q3+ 4h Discontinue use after 3 days to avoid rebound congestion. Scortinve use after $ days to avoid rebound congestion. lon Antinistamine/DecongestanvAntitussives: OTC [per tab or 10 mL syrup: Trpraliine 2.5 mg, Pseudoephedcine 4 mtn-2 yr: 1.25 mL PO Q6-8h 24 yr: 2.5 mL PO @6-8h 4-6 yr: 3.75 mL PO 96-8n oudoephedrne/kglday PO ti-cid fed with Codeine cough syrup [sytup per S mL: Codeine 10mg, Tipro- lidine 1.25 mg, Pseudoephedrine 20 mg} 1.25 mL PO g6-8n 5 mL PO q6-8h 456 yr 8.75 mL PO g6-8n 6-11y:5 mL PO @6-sh 212 ye: 10 mL PO @6-8h OR 4 mg pseudoephedrinelkg/day PO tid-cid -Benyln DM Cough Syrup [syrup per 5 mL: Dextrometnorphan 10 mg] 246 yr 25:5 mg PO gdh pm or 7.5 mg PO g6-8h pen 6-11 yr5-10.mg PO gah pm or 15 mg PO a6-8h pn 12 yr: 10-20 mg PO aah pen or 30 mg PO 96-8 pr. -Dimetane [elixir OTC: Brompheniramine 2 mg/S mL; tab: 4 mg; SA tab: 8 mg, 12mg] (0.5 mg/kg/day PO géh prn 5-11 yr: 2-4 mg PO Q6-8h (max 2¢ mg/day). ine 4 mg, Phenylpropanolamine 25 mg; SR 2 mg, Phenylpropanolamine 75 mg] 41-6 mth: 4.25 mL PO 96-8h 7-24 m: 25 mL PO g6-8h 24 y: 3.75 mL PO g6-8h 4-11 yrc 5 mL PO g6-th Antihistamines, Decongestants, and Antitussives 19 212yr: 510 mL or 1 tab PO 6-Bh or 1 SR tab po qi2h -Entex LA [SR tab: Phenyipropanolamine 75 mg, quatenesin 400 mg] 212 PO bid ‘5 mL: Phenylpropanoiamine 20 mg, Phenylephrine § mg, 100 mg} 2-4 yr: 2.5 mL PO aah pn 46 yr: § mL PO g6h pn 6-11 yr, 75 mL PO gen pm 212 yr. 10 mL PO g6h pm -Entex Capsules (Phenyipropanclamine 45 mg, Phonylephrina 5 mg, ‘uaitenesin 200 mg] > 12 yr 1 cap po qh -PediaCare Cough-Cold Chewable Tablets: [Pseudoephedrine 15 mg, ;Pheniramine 1 mg, Dextromethorphan § mg) Ye 2 tabs PO q4-6h (max 8 tabs/day) 2 yr 4 tabs PO q4-6h (max 16 tabs/day) -PeciaCare Night Rest Cough-Cold Liquid [per § mL: Psoudoaphediine 15 mg, Chlorpheriramine 1 mg, Dextromethorphan 7.5 mg] 6-11 yr: 10 mL PO g6-8h pn 212 yr: 20 ml. PO g6-8h pn -Phenergan with Codeine [per 5 mL: Promethazine 6.25 mg, Codeine 10 -Phenergan with Dextromethorphan [per § mL: Promethazine 6.25 mg, Dextromethorphan 15 mg) mL PO g48h pm 1 DM [per 5 ml: Pherylpropanclamine 12.5 mg, Brompheni ‘amine 2 mg, Dextromethorphan 10 mg] 41-6 mth: 1.25 mL PO tid-gd pn 7-24 mth: 2.5 mL PO tg-qid pm 2-4 ye 3.75 mL PO tdgid pn 411 ye 5 mL PO td-gd pn 2 yr: 10 mL PO tid-ad pn. -Polyhistine CS [per mL: Phenylpropanolamine 12.5mg, Brompheniramine 2 mg, Codsine 10mg] Scanned with CamScanner20 Antihistamines, Decongestants, and Antitussives 1-6 mth: 1.25 mL PO tid-gid pr 7-24 mth: 2.5 mL PO tid-gid pen 264 yr: 3.75 mL PO tid-aid pm 4-11 yr: 5 mL PO tid-qid pm 212 yr: 10 mL PO tid-aid pen, Robitussin AC [per § mL: Guaifenesin 100 mg, Codeine 10 ma] 2:6 yrs: 2.5 mL PO gah prn 6-11 yrs: § mL PO qth pm 212 yrs: 10 mL PO gé-6h pm. Robitussin CF {per § mL: Guaifenesin 100 mg, Dextromethorphan t0 mg, Phenylpropanolamine 12.5 mg] 26 yrs: 25 mL PO qth pm 6-11 yrs: 5 mL PO gah pm 212 yrs: 10 mL PO q4-8h pm, Robitussin DM {per § mL: Guaifenesin 100 mg, Dextromethorphan 10 mol 5 mL PO qh prn, max 10 mUday 0 mL PO gdh pm, max 20 mLiday -Rlondee drops [per 1 mL: carbinoxamine maleate 2 mg, pseudoephecting 25mg) 4-5 mg pseudoephedrina/kg/day PO ¢6h prn; OR 1-9 m: 1/4 droppertul (1/4 mL) PO gBh pn 9-18 m: 1 croppertl (1 mL) PO gBh pen. -Flondec syrup [per 5 mL: Pseudoephedrine 60 mg, carbinaxamine 4 mg} 4-5 mg pseudoephadrinerkg/day PO qéh prn. -Rondec DM drops [per mL: carbinoxamine maleate 2mg, pseudoephedrine 25 mg, dextromathorphan 4 ma) -Flondec OM syrup [per 5 ml. Carbinoxamine 4 mg, pseudoephedrine 60 ‘mg, dextrometnorphan 15 mg) 4-5 mg pseudoephedrine/kgiday PO qh pr. -Sudated Plus [per § mL: pseudoephedrine 30 mg, chlorpheniramine 2 mg tab: pseudoephedrine 60 mg, chlorpheniramine 4 mg} 4-5 mg pseudoephodrine/kg/day PO qéh pen. -Sudafed Cough Syrup [per 5 mL: Dextromethorphan § mg, guaifenesin 100 ‘mg, pseudoephedrine 15 mg] 4-5 mg pseudoephedrinelkg/day PO ash pm. Analgesia and Sedation 21 Analgesia and Sedation Analgesics: -Acelaminopher/Codeine [per 5 mL: Acetaminophen 120 mg and Codeine 2g; ortabs Tylenol #2: 15 mg codeine/300 mg acetaminophen; #3: 30 ‘mg codeine/300 mg acetaminophen; #4: 60 mg codeine/300 mg acetaminophen} 0.5-1.0 mg codeine’kg/dose PO ath pr. Acetaminophen (Tylenol) 10-15 mgkkg PO/PR q4-6h pm -AcelaminophervHydrocodone [elixir per 5 ml: hydrocodone 2.5 mg, acetaminophen 167 mg] Tab: Hydrocodone 2.5 mg, acetaminophen 500 mg Hydrocodone 5 mg, acetaminophen 500 mg Hydrocodone 7.5 mg, acetaminophen 500 mg (Children: 0.8 mg hydrocodoneskg/day PO q6-8h prn -<2 yr da not exceed 1.25 mo/dose 2412 yr: donot exceed § mg/dose 2 yr: do not exceed 10 mg/dose -EMLA cream (eutectic mixture of local anesthetics) [transdermal dsc; 5 gm, 30 gm: 2.5% lidocaine and 2.5% procaine). Apply and cover with hour (max 4 hours) prior to procedure. ‘pm or 1-3 meg/kg/hr continuous IV infusion. ‘occlusive dressing at le Fentanyl 1-2 mogrkg ro) 1 mgikg IV/IM @2-3h prn. mgikg IV q2-8h prnor0.02-0.06 mgkkg/hr continuous IV '0.1-0.15 mg/kg IM/SC q3-4h oF 0.2-0.5 mg/kg PO qé-6h. bo mixed together in one syringe and administered as a single IM injection. Scanned with CamScanner22 Antiometics May cause very Fentanyl and Midazol “Fentanyl 1 mogiag mg/mL, § mg/mL]. van) 0.05-0.10 mg/kg/dose IM/IV/PO, max 4 mg. 1 ) 0.2.0.5 malkg/dose POIPR or 0.05-0.2 mglkg/dose TMIV, max 10mg. Midazolam (Versed) 0.08-0.2 mg/kg/dose IMIV over 10-20 min, max 5 mg: (0F 0.2-0.4 mg/kg/dose PO x 1 (max 15 mg) 30-45 min (0F 0.2 mg/kg intranasal (using § mg/mL. injectabio sol nares with needleless tuberculin syringe.) -Chioral Hydrate 25-100 mg/kg/dose POIPR (max 1.5 g7dose), allow 30min for absorption. “Promethazine (Phenergan) 0.5-1 mg/kg/dose IM ot slow IV over 20 min (max 50 mg). “Chlorpromazine (Thorazine) 0.5-1 mg/kg/dose IM or slow IV over 20min (max 50 mg/dose). -Hydroxyzine (Vistar 0.5-1 mg/kg/dose IM (max 50 mg). insert into =Thiopental (Pentothal}: Sedation, rectal: 5-10 mg/kg; seizures, IV: 2-9 aos, NsaiD -Ketorolac (Toradol) single doge: 04-1 moh VM multiple doses: 0.4-0.5 mg/kg IV/IM q6h pm [inj: 15 mg/mL, 30 mg/mL} (Do not use for more than three days because of risk of GI bleed.) Antiemetics ‘concentrate 30 mg/mL; -Dimennydcinate (Dramamine) 300 mg/day, not recom ramidal side effects [oral ‘50 mg/ml]. -Diphentycramine {Benadn/) 1 mg/kg/dose IM/IV/PO gdh pm (max 50 ‘mg/dose) [oral quid 12.6 mg/S mL; tabs: 25, 60 mg; inj: 10, 50 mg/mL; in <12y due 10 high incidence of ext 2.5 mg/4 mL; cap: 50 mg; tab: 50 mg; in: Antiemetics 23 caps: 25, 50 mg} -Prochlorperazine (Compazine) 212 yrs: 0.1-0.18 mgkgldose IM (max 10 ‘mg/dose};§-10 mg PO g6-8h rg/day)l; not recommended in <1 trapyramidal side effects (tabs: syfup: 5 mg/S mL; supp: 0 mg, supp: mg/kg/day IM/POIPR g6-8h [eaps: 100, 250 100 mg/m). Ondansetron (Zofran) 0.15 mo/kg (max 4 mg) IV x1 -Droperidal0.01-0.05 mgykg Vii g4-6h pm (max § mg) [n:25 mg/mL] ‘Chemotherapy induced Nauses: (0.45 mg/kg/day as a continuous IV infusion OR Oral: -<0.3 m1 mg PO three times daily 9.0.8 nf: 2g PO se nee daly + 8 mg PO three times daily [in:2 mg/mL; oral soln: Amg/S mL; tab: 4, 8 mg (injectable solution may be (max 20 mg) IV x 1, then § mg/m‘/dose (max 10 mg) 1V Tin 4 mgimL, 10 mg/mL] -Granisotron (kyr) (9 'V given just prior to chemotherapy (single dos {inj 5 mgmt] Scanned with CamScanner24 Antiemeties -Dronabinot (Marino!) '5 mg/midose PO 1-3 hrs prior to chemotherapy then adh pm afterwards. ‘May titrate up in 2.5 mg/m*/dose increments to max of 15 mg/m/dose. leap: 25, 5, 10 mg] Pedlatte Advanced Life Support 25 Cardiology Pediatric Advanced Life Support General Measures: ‘Assess airway, braathing, and circulation. Begin CPR, 100% oxygen, and assess rhythm and pulse. Place nasogastric tube it supportive ventiation is tequired for longer than 2 min. 20 Uncutfed ET tube in children <8 yrs. Straight laryngoscope blade it <6-10 yrs; curved bk older. 1. Preoxygenate with 100% oxygen via air bag and mask. 2. Atropine 0.02 mg/kg IV or ET (nin 0.1 mg: max 0.5 mg or child, max 1 mg for adolescent), 3, Lorazepam (Ativan) 0.1 mg/kg IVAM (max 4 mg) OR Diazepam (Vallum) 0.2-0.5 mg/kg !V/IM (max 10 mg) OR sed) 0.1 mg/kg IVIM (max 5 mi 2 mg/kg IV (max 100 mg) or 2-4 mg/kg IM (max 150 Jum: 0,06-0.1 mgkg/dose IV OR (0.1 mgikg IV Supraventricular Tachycardia: 1. Mild to Moderate Severity: Apply vagal stimulation by neck extension or co bag to face for 18-20 seconds. If no conversion, give adenosine 0.1 ‘mg/kg (max 6 mg) rapid IV push with EKG monitoring. May double dose Scanned with CamScanner26 Pediatrie Advanced Life Support cardiovert with 1 Jikg. 3. Maintain oxygenation and venti Asystole: 1. Start CPR 1d confirm asystole with 2 leads. Secure alway and invous infusion of 0.05- route, give 0.1 mgikg (0.1 oxygen, chest compressions, 1. Epinephrine 0,01 mg/kg (0.1 mLikg of 0.1 mg/mL = 1:10,000) iVi0 amin, then consider 0.05-1 mogkkg/min continuous IV infusion. For en route, 0.1 mgrkg (0.1 mg/mL of 1 mg/mL = 1:1000), imum 0.5 mg for chil 10.04-0.06 mg/kg (0.4-0.6 mL/kg of 0.1 mg/mL = : luted with normal saline to final volume of 3:5 ma. 3, Isoproterenol 0.05-1.5 mog/kgimin cc increase every S- yyeardia due to heart block only. 4, External or Esopha tion or Ventricular Tachycardia Without P\ ‘chest compressions. access should be obt thronized 2 Joules/kg. If necessary, two more times. (0.01 mg/kg (0.1 mL/kg of 0.1 mg/mL = 1:10,000) Pediatric Advanced Life Support 27 ve 0.1 makg (0-1 mg/mL of 1 IViIO q 3 min. For endotracheal imglml. = 1:1000) dilated with normal Second and subsequont dos0s, 0.1 mg/kg (0 IAOVET. 4, Defibrilate with unsynchronized 4 Joules/kg, 30-80 seconds ater each ‘medication. 5 mgikg IV frst dose, 10 mg/kg IV second cose. 4. Defibilate ater each dose with unsynchronized 4 joules/kg. Unstable Ventricular Tachycardia with Pulse: 1nd ventilate with 100% oxygen. Sedate patient if time permits with Kg WV. ine 1 mg/kg IV it cardioversion will not be dotayed. tn synchronized 0.5 Joules/kg, may repeat with 1 kg. 4, Lidocaine 1 mg/kg IV bolus (max 100 mg), then 20-50 meglkgimin continuous infusion IV. Administer bolus prior to cardioversion it time permits 5.1 no conversion, eardiovert synchronized at 1 Jkg, or if recurrent ventricular tachycardia, cardiovert again starting at previously successful energy level 6, Bretyllum 5 mg/kg (max 500 mg) rapid IV over 1-2min, may double dose to 10 mg/kg and repeat in 20 min. ‘Stable Ventricular Tachycardia with Pulse: 1. Lidocaine 1 mg/kg (max 100 mg) IV, then 20-50 meglkg/min continuous infusion 1V OR. 2, Procainamide 3-6 mg/kg slow IV, may repeat to max 15 mg/kg or 100 mg: ‘pain, dyspnea or hypotension, use synchronized je ventricular tachycardia. ‘Dobulamine 2-20 mog/kg/min continuous IV infusion. ae Scanned with CamScanner28 Congestive Heart Failure Congestive Heart Failure 1. Admit to: 2. Diagnosis: Congestive Hear Failure 3. Condit 4. Vital signs: Call MO it administration: baseline ECG, sorum electrolytes (potassium), ation of renal function Initia! digitalization is glven over 24 hours in three divided doses: time 0 hours, 1/4 TOD at 8-12 hours, and 1/4 n started. ‘Total Digitalizing Dose Po y Premature infant 20-30 megikg 10-30 meghkg ‘newborn (0-2 weeks) 30 megkg 20-25 meghkg 40-50 megikg 30-40 mogkkg 30-40 meg/kg 25-30 mogkkg 0.75-1.5 mg 410 mogikg (max 1 ™) Maintenance digoxin dose wv Po w 4-10 mog/kg/day 4-9 meg/kg/day 6-10 meghg/say 6-8 meghgicay Preterm neonate Term neonate (0-2 wks) 2woeks -2yr 10-12 meghkg/day 10 meghkg/éay B10 meghkglday 6-8 mogikg/day 5 mogikg/day 2.3 megikgiday 0125.05 mglday —_—_—0.1-0.4 mg/day bs: 0.125, 0.250, 0.500 mg; oral elxir: 50 * Other inotrople Agents: Atrial Fibrillation 29 te cardiac output ‘Dodutamine 2.20 mog/kg/min continuous IV infusion, max of 40 meghg/min. -Wiroglyerine 0.5 meghkgmin continuous IV infusion, may increase by 1 eg/kg q20min; titrate to MAP >70 mmHg, systoic >90 mmHg; max § meghg/min. Captopril (Capoten), neonates: 0.05-0.1 mg/kg/dose PO g6-8h; infants: 0.15-0.3mghkpldose PO gBh. Chldren0.5mgkg/dose POg6-12h. Tato ‘as needed upto max of 6 mg/kg/day [tabs: 12.5,25,50, 100 mg]. Tablots can be crushed and made nto suspension -KOL 1-4 mEgg/day PO. 10, Extras and X-rays: CXR PA and LAT, ECG, echocardiogram. 11. Labs: ABG, SMA 7, CBC, iron studies, digoxin evel. UA Atrial Fibrillation 8. Special Medications: Cardloversion (it unstable or refractory to drug treatment): 1. It unstable, synchronized cardiovert immediately. In stable patient with tial fibrillation, consider starting quinicina or procainamide 24-48h prior to cardioversion. -Quinidine gluconate, 2-10 mg/ko/dase IV 3-68 -Procainamide, loading dose 3-8 mg/kg IV over 5 min (max 100 mg); may repeat every 5-10 minutes to max Maintenance 20-80 meg/kg/min continuo 2. Midazolam (Versed) 0.1 maykg IV over 2 min, repeat prn until amnesic. 3, Synchronous cardioversion: 05-1 Joules/kg. Consider esophageal overdiive Scanned with CamScanner30 Atal Fibriliation Maintenance therapy is then started. izing Dose 20 w Promature infant 2030 megkg 10-90 meghkg Full term newborn (0-2 weeks) 30 meghkg 20.25 meghg 40:50 megikg 90-40 megkg 30-40 megkg 25:30 meghkg O7515mq 10 mogg (max t mg) Maintenance Digoxin Dose Po w Preterm neonate HOmeg/kgiday 4-9 megkolday Term neonate (0-2 wks) 6-10 megkgiday 6-8 megkgiday 2 weeks -2yr 10-12 megkgiday 8-10 meghkg/day 2a0yr BtOmeghkg/éay 68 megkglay >10yr Smogkgiday 23 megkgday Divige bid it <10 yrs oF qd i 210 rs. (caps: 200 mi 0.125, 0.250, 0.500 mg; oral etx: 50 ‘meg/ml; in: 100, 250 megimL}. 00.5-4 mg/apiday PO 96-8h (max 60 mg/day) tabs 10, 3, 90 mg: in 1 mg/mL; eal solutions: 4 mgmt, 8 mgrmL, 60 -Procainamide: Loading dose of 2-6 mg/kg/dose IV over § min, then 20-80 megikg/min IV infusion (max 100 mg/dose or 2 gm/24h). Oral 15-50 mg/kg/day PO q3-6h (max 4 gm/day).[tab: 250, 975, 100 mg/mL, 500 mg/mL; tab, SR: 250, 500, 750, 1000 mg; ‘caps: 250, 375, 500 mg) 10, Extras and X-rays: Portable CXR, ECG, echocardiogram. 11, Labs: CBC, SMA 7, UA, ABG. Serum drug levels. Hypertensive Crisis 31 Hypertensive Crisis fusion, Titrateto ty may develop 5-10 meg/kg/min continuous ‘Cyanide and thiocyanat with prolonged uso or in renal impairment. -Labelaol (Trandate) 0.2 mg/kg (max 20 mg) IV over2 min or0.4-1 mgkkg/hr continuous infusion. 10. Extras and X-rays: CXA, ECG, renal Doppler and ultrasound, Creatinine, UA with micro. Urine speeitic gravity, ‘metanephrines; ANA, complement, ASO titer, y Vrwin unk Wey aby | i a Cards rae > ‘Le pa 4 ‘ay Scanned with CamScanner‘32 Hypertensive Crisis Asthma 33, Pulmonology Asthma ise oximeter, measure peak flow rate in older patients. {V4 NS or DS NS at maintenance rae. 8. Special Medications: Oxygen humidtied pen, 1-6 Limin by NC or 25-60% by mask, keop sat 292%. ines Nebuized Beta 2 Agonist: -Abuteral (Ventolin) (0.5% =5 mg/ml. soln) nebulized 02-05 mL in 2mL -Prodnisone 1-2 mg/kg/day PO q12-24nx3-5 days tabs: 1,2, 5, 10,20, ‘50 mg: oral solution: 1 mg/mL, § mg/mL] OR mglkg/dose IV q6h x 3-5 days ‘Aminophylline and Theophyi “Therapeutic range 10: L. Erythromycin or carbamazepine may levels. mg/kg total body weight in DS 1/4 NS IV ove 1 mgkkg of aminophyjline will raise levels by 2 meg/mL. ‘maintenance, continuous IV infusion (in DS 1/4 NS): Dosed based on ideal body weight 1-6 mth: 0.5 mg/kg/h 30 kg: 10mg PO qd. [tab: 10 mg; syrup 1mg/mL] Decongestants: -Pseudoephedtine (Sudaled, Novated): children <12 yr: 4 mg/kg/day PO ‘QBN. Children >12 yr and adults: 30-60 mg/dose PO g6-dh; sustained PO qi2n, Max dose: 240 mg/24h, (Tabs: 30, 60 mg; 380 caps: 120 mg; syrup: 15, 30 mg/5 mL; drops: 7.5 Scanned with CamScannerids and Cromotyn: one (Beconase AQ nasal, Vancenase nasal, Vancenase AQ sprays into each nost ‘pray into each nosti bid-td, -Cromotyn {Nasalerom) 1 put into each nostril q3-4h, “Tiameinolone (Nasacon) eye a4-6h. Anaphylaxis |. Admit to: 2. Diagnosis: Anaphylaxis 9. Condit . Vital signs: 1 MO it ‘5%, 5 mg/mL sin) nebulized 0.01-0.03 mL/kg (max. in2 mLNS q1-2n and pm; may be used in addition to epinephrine ild, give prednisone, inially 2 mg/kg/day (max 40 mg) PO.qt2h, then taper the dose over 4-5 days. For more severe symptoms, ive hydrocortisone § mg/kg IV qBh until stable, then change to oral Pleural Etfusion 37 prednisone. Antihistamines: -Diphernydramine (Benady xtras and X-rays: CXR PA and LAT, lateral decubitus, ulrasound, sputum ‘AFB, Pulmonary consult. . 3 with citferential, SMA 7, protein, albumin, ESR, UA. id ‘LDH, protein, amylase, triglycerides, glucose, specific gravity (10 mL red top). Tube 2 - Gram stain, culture and sensitivity, AFB, fungal culture and ‘onsiity (20-60 mL), ‘Tube 3 - Cell count and citferential (5-10 mL, EDTA purple top, Tube 4 - Cytology (25-50 mL, heparinized) Syringe - pH (2 mL, heparinized). See) Protein ratio pleural fivid/serum LDH ratio ploural fiuid/serum Scanned with CamScanner38 Pleural Ettusion Transudate Exudate Suspected Sepsis 39 Infectious Diseases wec 7 <<1,000/mm?* >1,000/mm? Glucose Equivalent to Serum | Less than serum Suspected Sepsis weights, cooling measures pen temp resent; NS 10-20 mL/kgIV bolus, then IV ‘months old (Group B strep E coll, or GpD strep, gram mnoeytogenes): Ampicilin and cefotaxime. 150 mglkglday qBh; >7e: 200 mgkgday ah (Claforan) VIM: <7 days: 100 mg/kglday at2h; >7 days: 150 mg/kg/day qBh ‘Aso S20 page $8. rep pneumonia, N meninghides, Gp 100 me/kg/day IV/IM q6h AND EITHER -Ceofotaxime (Ciatoran) 100 mg/kg/day IVIM qh OR Cottriaxone (Racephin) 50-75 mg/kg/day IV/IM q 12-24h OR. ‘Gentamicin 7.5 mglkg/day IV/IM gh >10 yr: §.0 mg/kg/day IV/IM gh AND Vancomycin central ine infection) 40-60 mg/kg/day IV g6h, max 2 gmvday. Scanned with CamScanner40 Meningitis Meni 1 10, Symptomatic Medications: ~Tbuproten (Advi) 5-10 mg/kg/dose PO q6h-sh. ~Acetaminophen (Tylenol) 10-15 mg/kg POIPR gé-6h pm temp >38°C or ‘3 months to 18 years old (S pneumonia, H flu, N. meninglides): 1d X-rays: CXR, SMA. Blood cuture and sensi biotic levels, Stool for wright stat -Dexametnasone (see above) 10-Simptomaie Mecentons: n 5-10 mg/kgidose PO a6-8h prn OR inophen 15 mg/kg PO/PR gdh prn temp >38°C or pain, Extras and X-rays: CXR, MA, sensitivity for bacteria, antigen screen CSF Tube 2 - Giucose, protein (1-2 mL). (CSF Tube 3 - Cell count and differential (1-2 ml) (CSF Tube 1- Gram sain, cuture and sonst, bacterial antigen screen, (2m). Meningitis (CSF Tube 2- Glucose, protein (1-2 ml) (CSF Tube 3- Cell count and diferential (1-2 mL) Specific Therapy of Meningitis and Encephalitis, first dose jesequelae Dexamet 16 mg/kg/day IV qh x 4 days) given bel isolation precautions. Inputs and outputs, daly weights; of antbi shearing deficits and possibly other neur measures pr temp >38°C; consent for lumbar puncture. Monitortor in Haemophilus inuenzae mening. eased intracranial pressure. ‘Streptococcus pneumonise: -Peniciin G 250,000-400,000 Urkp/day IV/IM qth x 100, max24MU/day OR -Cototaxime (Ciaforan) 200 moykg/day IV/IM gh, max 12 gmvday AND “Yarcanyein 89 moi IV gor. mas2oay OR Listeria) -Colotaxime (Claforan): <7¢: 100 mg/kg/day IVIIM qth; >7 days: 150 -Cettriaxone (Rocephin) 100 mg/kp/day IVIIM q12-24h AND Vancomycin 40-60 mg/kg/day IV qBh. idoselV: first dose of parenteral antibiotic -Cettriaxone (Rocephin) 100 mgkg/day IVIM qt2h, max 4 gm/day OR joe with the -Ampicilin (beta-lactamase negative) 200 mg/kg/day IV/IM q4-6h x 10d, max 12 gvday. Scanned with CamScannerold, and all close day care contact mg/kg/day PO q2éh x 4 days; >1 month: 20 o/kg/day PO qd x 4 doses (max 600 mg/dose). [caps: 150, 300 mg: extemporaneously prepared suspension can be made], Group A or non-enterococcal Group D Streptococcus: -Penicilin G 250,000 Ukg/day IV/IM Q4-Bh, max 24 MUI. Listeria monocytogenes or Group B strep: Ampicilin 200 mg/kg/day IV/IM qBh x 144, max 12 g/day AND (except neonates): 7.5 mg/kg/day VIM gBh. 510 yr: 6.0 mg/kg/day IVNM gah, >10 yr: 5.0 morkgiday VIM gh Staphylococcus aureus: -Nalclin 150-200 markoday VIM gt-6h, max 12 gmvday OR Vancomycin 40-60 mg/kg/day IV g6h, max 2 gmiday (may require concomitant intrathecal therapy). Herpes Simplex Encepha -Acyelovir Zovirax) 1500 mpl or 30 mg/kp/day IV over th or longer qh 1421 days OR ~Vigarabine 15 mg/kg/day IV infusion over 12-24 hr dally x 10 days. Infective Endocarditis 5. Activity: 6. Diet: 7.1V Fluids: 48. Special Medications: Subacute Bacterial Endocarditis Empirle Therapy: -Penicilin G 250,000 Uragiday IV/IM gé-6, max 24 MU'd AND >10 yr. 5.0 mg/kg/da} ‘Acute Bacterial Endocarditis Empiric Therapy (Including IV drug user): Gentamicin or tobramycin, soe above for dose AND EITHER -Nalcilin or oxacilin 150 mg/kg/day IV/IM q6h, max 12 gm/day OR | | Endocarditis Prophyiaxls 43 ‘Vancomycin 40-60 mg/kg/day IV qBh, max 2 gmiday ‘Sireptococc! viridans/bovis: “Penicilin G 150,000 ukg/day IV/M g4-Bh, max 24 MUId OR ‘Vancomycin 40 mgkkp/day IV qBh, max 2 g/day. Suphfococcus aureus (methclin senstiv or exacilin 150 mg/kg/day IVIM qBh, max 12 glday AND icin or tobramycin, see above for dose. Resistant Staphylococcus Aureus: -Vancomyein 40-60 mgkg/day IV qBh, max 2 gmiday. Staphylococcus epidermidis: Vancomycin 40-60 mg/kg/day lV qBh, max 2 gmiday AND -Gantamicin or tobramycin, see above for dose. 9, Extras and X-rays: CXR PA and LAT, echocardiogram, ECG. Cardiology and infectious disease consultation. culture and sensitivity x3-4 over 24n, MBC. Antibiotic levels. UA, urine culture and sensitivity. Endocarditis Prophylaxis Prophylactic Regimens for Dental, Oral, Respiratory Tract, or ae el Drug Situation —_ ‘Siandard gen- eral prophylaxis "Amroxictin Unable to take oral medication Scanned with CamScanner44 Endocarditis Prophylaxis Endocarts Prophylaxis 4s Situation Drug Regimen Maximum Situation Drug Regimen Maximum _| Dose a ‘Aiergicto | Gindamyein | 20 mgngPO | Gooms a peniciia or asa sing over M2 hours dose 1 hour Tsong vad etre proces: tobe comple Cephalexin or | 50 mg/kg PO 2000 mg catadroxi | asa single or dose 1 hour Delore proced- ieee | Katremvanor | ts mota FO Sore clanthvomyein area Alege | Cindamn | 2omorgna0 | Bo me mites bore procedure Vancoman —[ 20mpkav | 1000mo oral medi- Cetazolin 25 mgikg IviM | 1000 mg ‘over 1-2 hours catens vain 3 ie comlaed wt ties bore in20 mines procedure tating the procedure ee a and eee tion Drug Regimen ‘Maximum ‘Situat 9 ras igh-isk pat | Ampicilin Omang IvIM | 200mg | ients plus | Gentamicin | 1.5 mgikg WM | 120mg | within 30 i followed by 25mgkg vii | 1000m9 25 mgkgPO | 1000 mg sixhours later Scanned with CamScannernf Preumoate Pneumonia 47 Pneumonia in) 20-40 mgkg/day of amoxicilin PO goh tabs 125, 250 mg; tabs: 250, 500 mg: fawuianate (Augmentin BID) 30-40 mg/kg/day PO q12h, max 875 mg (amoxicilinydose [chew tabs 200, 400 mg; tab 875 mg: susp 200 may mL, 400 ma/S mL] Community Acquired Pneumonia 5-18 years old (viral, M pneumoniae, chlamydia pneumoniae, pneumococcus, legionel Fase r,t as pee Sot cnaen | MESA com Spemeneann sb so pay 0a Sma gy 2 pecan: Spm oa Miniter Cee a 24 Un or abso tyms ada wiey | ae eam ‘oma Sake ‘Term Neonates <1 month: Erythromycin ethylsuccinate 30-50 mg/kg/day PO g6-8h, max 29/6 -Ampicilin 100 mg/kg/day IVIM qSh AND ‘5089: 200 mg/5 mL, 400 ma mL Slow So eat tng wo | SORE eon ate Erythromycin base 90-50 mg/kg/day PO q6-8n, max 2914 tab: 250, 333, 500 mg jonate 20-40 mg/kg/day IV qh, max 4 gmiday 7.5 mg/kg/day IV/IM qBh. -lt chlamydia is strongly suspected, add erythromycin 40 mg/kg/day IV gBh. Oral Therapy: -Celuroxime axetil (Cetin) tab: child: 125-250 mg PO bid: adult: 250-500 mg PO bid ‘susp: 30 mg/kg/day PO q12h, max 500 mg/day (susp: 125 mg/S mL; tabs: ‘OR mg/kg/day IV/IM qBh, max 12 g/day AND Imontin) 200-300 mg/kg/day ol tcareilin IV g4-h, max 18 g/day OR, ‘Nafcilin 150 mg/kg/day IV/IM q6h, max 12 gmvday OR Vancomycin 40 mkkg/day IV Bh, max 2 grvday. -Piperacillin/tazobactam (Zosyn) 300 mg/kg/day of piperacillin IV g6-8h, max 12 omvday OR dren »2 ys: 12 mg/kg/day PO qd x § days, max 500 mg/day -Piporacilin 200-300 mgykp/day VII qi-Bh, max 24 g/day AND 216 ys: 500 mg PO on day 1, 250 mg PO ad on days 2-5 {susp: 100 mg/5 mL, 200 mg/' mk; cap: 250 mg) Scanned with CamScanner48 Pneumonia “Tobramycin: <5 yr (except neonates): 7.5 mg/kg/day IV/IM q@h, 5-10 yr: 6.0 mg’ka/day (V/IM ah. >10 yr: 5.0 mg/kg/day IV/IM ggh OR *Ceftazigime (Fortaz) 150 mg/kg/day IV/IM qBh, max 12 giday OR ~Aztreonam -Meropenem (Merrem) 60-120 mg/kg/day IV qBh, max Gold 10. Symptomatic Medications: Acetaminophen (Tylenol) 10-15 mgkkg PO/PR «3-4h pn temp >38°C ot pain. chlamydia) and cultures for respiratory viruses. UA. Specific Therapy for Pneumonia Pneumococcal pneumonia: Erythromycin estolate 30-50 mg/kg/day PO q8-12h, max 2 grvday cap: 125, 250 mg susp: ‘chew tab: 125,250 mg tab: 500 mg -Enythromyein ethylsuccinate 30-50 mg/kg/day PO q6-8h, max 29/4 susp: 200 mg/5 mL, 400 mg/5 mL ‘mg/S mL, 250 mg/5 mi. ‘chew tab: 200 mg tab: 400 mg Erythromycin base 30-50 mg/kg/day PO q6-8h, max 29/6 tab; 250, 389, 500 mg Erythromycin lactobionate 20-40 mg/kg/day IV qGh, max 4 gmiday inj: 500 mg, 19 OF Vancomycin 40 mg/kg/day IV q6h, max 2 g/day OR -Cefotaxime (Claforan) 100-150 mg/kg/day IV/IM g6h, max 12 g/day OR -Penicilin G 150,000 Ukg/day IV/IM q4-6h, max 24 MUIday. Staphylococcus -Oxacilin or nalcitin 150-200 mg/kg/day IV/IM q4-6h, max 12 g/day OR -Vancomycin 40 mg/kg/day IV qBh, max 2 g/day Preumonia 49 Haemophilus influenzae (8 yrs only) 25-50 moykg/day PO gGh x 14-21 days, max 2 '500 mg; susp: 125 mg/5 mL; tabs: 250, 500 mg] mg/kg/day PO qi2h, max 1 gm/day (susp: 125 tab: 250, 500 mg] OR 150 mg/kg/day IV/IM Bh, max 9 g/day OR -Enthromycin estolate 30-50 mgkg/day PO q8-12h, max 2 gmiday ‘cap: 125, 250 mg drops: 100 mg/mL. susp: 125 mg/5 mL, 250 mg/S mL ‘chew tab: 125,250 mg tab: 500 mg Erythromycin ethylsuccinate 90-50 mg/kg/day PO 96-8h, max 2g/d Susp: 200 mg/S mL, 400 mg/S mL 4 Scanned with CamScanner50 Bronchiolitis chow tab: 200 mg tab: 400 mg ~Enjthromycin base 30-50 mg/kg/day PO Q6-8h, max 29/4 tab: 250, 333, 500 mg -Enithromycin lactobionate 20-40 mg/kg/day IV g6h, max 4 grvday ‘nj: 00 mg, 1 gm OR “Trimetnoprin/SMX (Bactrim) 6-12 mg TMPkg/day PONV gt2h, max320mg ‘TMPIday [per § mL: Trimethoprim 40 mg, sul Single strength tab: 80 m9/400 mg; double svength Chlamydia pneumoniae (TWAR), psittaci, trachomatous: Erythromycin estolate 30-50 mglkg/day PO qB-T2h, max 2 gmviday ‘cap: 125, 250 mg ‘drops: 100 mg/mL ‘Susp: 125 mg/5 mL, 250 mg/s mL chew tab: 125,250 mg tab: 500 mg Erythromycin ethylsuccinate 30-50 mglkglday PO g6-8h, max 29/4 ‘susp: 200 mg ml, 400 mg/S mL ‘chew tab: 200 mg tab: 400 mg Erythromycin base 30-50 mg/kg'day PO q6-8h, max 29/4 tab: 250, 393, 500 mg Erythromycin lastobionate 20-40 mg/kg/day IV qBh, max 4 gmiday inj 500 mg, 1 gm OR -Aaitnvomyein (Zithromax) chiidron 22 yrs: 12 merkg/Say PO ad x 5 days, max 500 mg/day 216 yrs: 500 mg PO on day 1, 250 mg PO qd on days 2-5 0 mg/5 mL, 200 ma/S mL; cap: 20 mg] Influenza A: -Amantadine (Symmetrel) 1-9 yr: §-9 mgkkglday PO bid, max 150 mg/day; '>9 yr: 100-200 mg/day PO bid x 7d [syrup 50 mg/5 mL, cap: 100 mg] OR -Rimantagine (Flumadine) <10 yr 5 mg/kg/day PO qd, max 150 mg/day; >10 ye. 100 mg PO bid (syrup: 50 mg/S mL; tab: 100 mg}. Bronchiolitis Bronchiolts $1 8. IV Fluids: in by NC or 40-60% by mask, koop sat >92%. (S mg/mL. sin) nebuized 0.2-0.5 mL in 2 mL. ah pen it of Respiratory Syncyti 3 (severe lung disease or premature bir less than 35 weeks gestational age. “Ribavirin (Virazole) 6 g vial, aerosolized by SPAG nebulizer over 18-20h qd X3-5 days or 2 gm over2 his qBh x 3-5 days, Prophylaxis Against Respiratory Syncyti Underlying cardiopulmonary disease): “Recommended use in high risk chiidren < 2 yrs with BPD or with history of birth less than 35 weeks gestational age, (RespiGam) 750 mg/kg IV q month trom September to March. rus (severe lung disease or -Amantadine (Symmetrel) 1-9 yr: 5-9 mg/kg/day PO bid, max 150 mg/day; >9 yr: 100-200 mg/day PO bid x 7 (syrup: 50 mg/S mL, cap: 100 mg] OR -Rimantadine (Flumadine) <10 yr: 5 mg/kg/day PO qa, max 150 mg/day: >10 Ye: 100 mg PO bid [syrup: 50 mg/5 mL; tab: 100 mg) Pertussis: Erythromycin estolate 30-50 mg/kg/day PO q8-12h, max 2 gmiday ‘cap: 125, 250 mg ‘drops: 100 mg/mL, ‘susp: 125 mg/S mL, 250 mg/S mb ‘chew tab: 125, 250mg tab: 500 mg Erythromycin ethyisuccinate 30-50 mg/kg/day PO g6-8h, max 2g/d Susp: 200 mg/§ mL, 400 mg/S mL chew tat: 200 mg tab: 400 mg Erythromycin base 30-50 mg/kg/day PO q6-Bh, max 29/4 {BG/ABG, UA. Urine antigen screen. Nasopharyngeal Scanned with CamScanner52 Viral Laryngotracheltis (Croup) washings for dst thorescen antbody (ASV, adenovius, print influenza virus, chlamydia) ‘culture, + nine Viral Laryngotracheitis (Croup) 3, 4, Vital signs: Call MD it; 5. Activity: 6. 3. Nursing: Pulse oximeter, laryngoscope and endotracheal tube at bedside. Respiratory isolation, inputs and outputs. 7. Diet: 8 IV Fluids: ‘8. Special Medications and Treatment: Oxygen, cool mist, 1-2 Limin by NC or 40-60% by mask, keep sat >92%. -Rlacemic epinephi 15% sin) 0.05 mLIkg/dose (max0.5 mL) in 2-3 mL. ai-éh. -Dexamethiasone (Decadron) 0.25-0.5 mg/kg/dose IMIV g6h pm; maxdose _ 10mg OR -Predrisoione 1-2 mgkkg/day PO qt2-24h x 35 days [5 mg/5 mL, Prelone 15 mg/s mL] 10. Extras and X-rays: CXA PA and LAT, posteroanterior x-ray of neck. 11. Labs: CBC, CBGIABG, blood culture and sensitivity; UA, culture and ‘sensitivity. Urine antigen screen, Varicella Zoster Infections 'A. immunocompetent host. Oral acyciovir shouldbe given within24 hours of the onset of rash, Administration resuts in a modest decrease in the duration and mageitude of fever and in the number and duration of skin lesions, B. Therapy with oral acyclovir is not recommended routinely for treatment of uncomplicated varicella in the otherwise healthy child years of age. CC. Acyciovir 80 mg/kg/day po Bn for five days (max 3200 mg/day) (cap: 200 mg; tab: 400 mg, 800 mg; susp: 4omg/mL] Pneumocystis Carinil Preumonia 53 Pneumocystis Carinii Pneumonia TimethopriavSulfamethoxazole (Bactrim, Septra) 20 mg TMP/kg/day IVIPO géh x 14:21 days [susp per 5 mi: TMP 40 mg/SMX 200 mg: DS tab: TMP 160 mg/SMX 800 mg; inj per mi: TMP 16 mg/SMX 80 mg; SS tab: 80/400 mg] OF -Pentarigine isethionate (Pentam) 4 mg/kg/day IV over 1-2h for 14-216 Prednisone: -<13 yrs: 2mg/kg/day PO qd x 7-10 days, hen taper over the next 10-14 cays. 13 yrs old with hypoxia: 40 mg PO bid x 5 days, then 40 mg PO qd x5 days, then 20 mg PO qd x 11 days. PCP Prophylaxis: -TrimethopriavSMX 5 mg trimethoprinvkg/day PO bid three days per week. [susp per mi: TMP 40 mg/SMX 200 mg: DS tab: TMP 160 mg/SMX 800 img; SS tab: 80/400 mg] OR -Dapsone 2 mg/kg/day PO q2h, max 100 mg/day {tabs: 25,100 mg] OR -Aerosolized Pentamidine (it 25 yrs}: 900 mg nebulized q month 10. Extras and X-rays: CXR PA and LAT, PPD. Opportunistic Infections in AIDS Oropharyngeal Candidiasis: Ketoconazole (Nizoral) 5-10 mgkkg/day PO qd-bid, max 800 mg/day [lab 200 mg] OR -Nysiatin susp. Prom: Scanned with CamScannerPO or IV qd inj:2 mglml; tabs: 50, 100, 160, my pans 160, 200 mg, susp: 10 mol, -Amphotericin orl suspension tml swish and swallow tenn 1 swallow aid 100 mg/mL Invasive or Disseminated Candidiasis: Amphotericin B, test dose of 0.1 mg/kg (max 1 mg), followed by remainder of 1st days dose i tolerated, nial dose: 0.25 mg/kg/day; increase by 0.25 mofkg/day q1-2 days, Usual dose 0.5-1 mg/kg; usual max dose 50 ‘mg. Infuse over 2-4 hours. Pretreatment (except test dose) - Acetaminophen, hydroconisone, diphenhydramine; give Demerol tusion if ching occurs -Liposomal amphotericin (Ambisome) 3-5 mg/kg IV over 2 hs @d. Amphotericin 8 lipid complex (Abelcel) 5 mg/kg IV over 2 hrs qd. Antiretroviral Therapy: “Zidovudine (Retrovir, AZT) - oral <2 weeks: 8 mpkkg/day PO gén 2-4 woeks: 12 mg/kg/day PO qéh 4 weeks-3 min: 16 mgkkg/day PO 6h 3 mth-12 yr: 90-180 mp/m#/dose gh (min 75 mg/dose, max 200 mg/dose) >12 yr and Asymptomatic: 100 mg qa while awake (max 500 mg/day). >12yrand Symptomatic: 200 mg gah (max 1200 mgiday)x1 monty then 100 mg aan. [soln: 10 mg/mL; caps: 100 mg] “Zidovudine - intravenous <2 wooks: 5.6 mg/kg/day 1V g6n 2-4 weeks: 8.4 mokka/day IV géh ‘4 weeks-3 months: 11 mg/kg/day IV 6h 3 min-12 yr 05-18 mgkg/hr continuous IV ntsion or 100 mgindose | WW gon ‘3:mos-12 yr: 8 mg/kg/day PO bid (max 150 mg/dose) if < 50kg 2mgkg PO bid; if »50kg 150 mg PO bid ftab: 150 mg; soln: 10 mg/mL] -Dicanosine (Videx, ddl) 0.4 m®: 100-300 mg/m day PO qt2h (1 tablet per dose). 5: 100-300 mg/m*/day PO qt2h (2 tablets per dose). 35-49 kg: 125 mg PO q12h (2 tablets per dose) OR 167 mg PO qt2n (buttered oral soln) ‘250 mg PO qt2h (using butfered oral soln) OR Opportunistic Infections in AIDS 55 275 kg: 300 mg PO qt2h uso two tablets per dose) oF 375 mg PO at2h (using buttered oral sol). (single dose packet): 100, 167, 250, 375 mg 10 mg/mL. Take on empty stomach, 213 yr 0.75 mg PO qBh (lab: 0.375, 0.75 mal 213 yr: 600mg PO gah [cap: 200 mg) -Indinavie (DV, Crxivan) -<18 yr: dosa not established. 213 yr 800 mg PO Bh {cap: 200, 400 mg] -Altonavic (ATV, Norv) <<13 yr: 350 mgim? PO qi2h 213 yr: 600mg PO qizh [eap: 100 mg, soln: 80 mg/mL} Cryptococcus Neoformans Meningitis: Amphotericin B 1 mg/kg/day 1V qd over 2-th x 8-12 weeks (see test dose R 2 mg/kg/day IVIPO qa [in: 2 mg/mL; tabs: 50, 3: 10 mg/mL, 40 mg/mL}. 150 mg/kg/day PO g6h (cap: 250, 500 mg; may 18 In Immunocompromised Host: 350-500 mg/m"/dose IV qBh for 7-14 days (infuse each -Pyrimethamino (Daraprim) 1 mglkg/day (max 100 mg/day) PO q2th, max Scanned with CamScanner56 Septic Arthritis: £25 mg/day (tab: 25 mg] and folinic acid 5-10 mg PO q3 days [tab 5, 15, 25 mg) AND 100 mg/kg/day PO gid x3-6 weeks, with ample fluids (max ‘mg tab of suspension} -Azithromycin (Zithromax) 10-20 mg/kg/day PO qd, max 00 mg [eap: 250 ‘mg; susp: 100 mg/S mL, 200 mg/S mL] AND. in 10-20 mg/kg/day PO q12-24h, max 600 mg/day (cap: 150, 300 1n make extemporaneous suspension] .gimen should include at least two drugs and should continue ime of the patient. 5. Activity: No /arm compresses pm. Consent for arhrocentesis. 6: special Melestions: cree tnerapy tor infants 1-8 months (erp, staph, gram neg, mgykglday IV/IM gBh x 216, m (MRSA) 40-60 mg/kg/day I Perttonitis 57 10. Symptomatic Medications: Acetaminophen and cadaine 05-1 mg codeine/kg/dose PO @A-Gh pen pain 2m mL» acelaninophen 120:mg6 mL] 8 IVFluids: 9. Special Medications: Primary Peritonitis: -Peniclin 150,000 Ukg/day IV/IM q4-h x 7-104, max 24 MUIday. ‘Secondary Peritonitis (bowel perforation or appendicitis): 10 yr: 5.0 mg/kg/day IViIM q8h AND rerigazole (Fagy) 20 mg/day V 96-8, max 4 gray. CXR PA and LAT, abdominal ultrasound; KUB with panel, PT/PTT. ‘mL red top tube), ae Scanned with CamScanner58 Lower Urinary Tract Infection Syringe - pH (3 mL), Lower Urinary Tract Infection ‘Lower Urinary Tract Infection: -TrimetnoprinvSMX (Bactrim) 6-10 mg/kg/day TMP PO qi2h, max 320 mg ‘TMP /day [per § mL: Trimethoprim 40 mg, sullamethoxazole 200 mg; single strength tab: 80 mg/400 mg; double strength tab: 160 mg/B00 mg] oR -Cetpodoxime (Vantin) 10 mgfkg/day PO qi2h, max 800 mg/day (susp: 50 ‘mg/5 mL, 100 mg/5 ml; tabs: 100, 200 mg] OR -Catprozil (Cetzil) 30 mg/kg/day PO qt2h; max 1 g/day (susp: 125 mg/S mL, 250 mg/5 ml; labs: 250, 500 mg] OR Prophylactic Therapy: “Trimethoprin/SMX (Bactrim), 2mg TMPrkg/day and 10mg SMX/kg/day PO ahs [per § mL: Trimethoprim 40 mg, sulfamethoxazole 200 mg: single strength tab /400 mg; double strength tab: 160 mg/800 mg] OR -Sulfisoxazole (Gantrisin) 60 mg/kg/day PO q12-24h {tab 500 mg: syrup 500 gi mL}. 10. Symptomatic Medications: ).childeen 6-12 yrs: 12 mg/kg/day PO tid (max 12 yrs: 100-200 mg PO tid x 2 days prn dysura (tabs: 100, 200 ma]. 11, Extras and X-rays: Renal ullrasound. Voiding cystourethrogram 3 wooks ‘after infection. Radiological work up on all children <1 year ofa 42, Labs: CBC, SMA 7. UA with micro, urine Gram stain, c ‘sensitivity. Repeat urine culture and sensitivity 24-48 hours att blood culture and sensitivity. Pyelonephritis 69 Pyelonephritis 1. Admit to: 2, Diagnosis: Pyelonephritis ications: week old, see suspected sepsis, page 29. mg/kglday IV/IM géh, max 12 gm/day AND Gentamicin or tobramycin: 90 days-S yr: 7.5 mg/kg/day IV/IM gah. 5-10 yr: 6.0 mgkkg/day VIM qa, >10 yr: 5.0 mg/kg/day (VM gh OR Cofotaxime (Ciatoran) 100 mo/kg/day IV/IM q8h, max 12 gmiday. 10. Symptomat Ac \/kg POIPR q4-6h pm temp >38*. ound, ro, urine culture and sensitivity. Repeat Wd sensitivity 24-48 hours atte initiation therapy; blood culture and sensitivity x 2; drug levels. Osteomyelitis Scanned with CamScanner60 Otitis Media -Cetazolin (Ancef) 100 mg/kg/day IV/IM q6-8h, max 6 g/day OR -Goturoxime (Zinacef) 100-150 mg/kg/day IV/IM aBh, max 9 grvday, Postoperative or Traumatic (staph, gram neg, Pseudomonas -Ticarcilin/Ciavulanate (Timentin) 200-300 mg/kglday of 6h, max 18 gmvday OR Vancomycin 40-60 mg/kg/day IV g6h, max 2 gmiday AND Ceftazidime 150 mg/kg/day IV/IM aBh, max 12 g/day OR 30 days-5 yr: 7.5 mg/kg/day VIM Qh. 5-10 yr. 6.0 maka IVAN gan >10 yr 5.0 mglkg/day IV gBh. Chronic Osteomyelitis (staphylococcal): -Dicloxacilin 75-100 mgrkp/day PO Gh, max 2 gay foaps: 125,250,500 ‘mg; susp: 62.5 mg/S mL] OR Cephalexin (Ketlox) 50-100 mg%kp/day PO q6-12h, max 4 g/day [caps 250, '500 mg; drops 100 mg/mL; susp 125 mg/5 mL, 250 mg!5 mL; tab: 500, mg. 1 9m). 410. Symptomatic Medications: h pe pain. kg/dose IVIIM g3-ah prn pain g/kg POIPR o4-8h pm temp >38°, ‘and infectious disease consutatons. 'SMA 7, blood culture and sensitivity x3, ESR, sickle prep, UA, Otitis Media Acute Oe aac pneumoniae, non-typable H flu, Meatarthalis, Staph 7 img/ngicay PO gah; max 3 g/day tab, chew: 125,250 mg: ‘aps 250,500 mg; drops: §0 mg/mL: susp 125 mg/S ml, 250 m/S mL} on “Teimathoprinv SUX ( max 320mg TMPIA ‘mg; DS tab: 160 m9/800 mg] OR -Erythromycin/suisoxazole (Peciazole) ! mLKgld PO aid or 40 mg/kg/day of enthromycin PO gig; max 50 mLday|susp per mL: erytvomycin 200 rg/sulsoxazote 600 mg] OR icilinvclavulanate (Augmentin) 0 mg/kg/day of amoxicilin PO gBh x 10d, max 00 mg/dose [chew tabs 125, 250 mg; tabs: 250, 600 mg; Septra) 6-8 mg/kg/day of TMP PO bid PO bid; 3 per mL: 40.mg/200mg; SS tab: 80 mg/400 ar Ottis Media 61 mg/S mL, 250 mg/S mL} OR {chow tats 200, 400 mg: tab 875 mg; susp 200 ma/S mL, 400 mg/5 mL] -Azithromycin (Ztromax) '500 mg PO on day 1, 250 mg PO qd on days 2-5 100 mg’ ml, 200 ma/S mL; cap: 250 mg} OR (Biaxin) 15-30 mg/kg/day PO bid; max 1 gmi/éay (tb: 250, 95 ma/S mL, 250 ma/S mL} OR -Coixime (Suprax) 8 malkg/day PO bid-qd; max 400 mg/day (susp: 100 in) tab: child: 125-260 mg PO bid; adult: 250-500 mg PO bid ‘susp: 30 mg/kg/day PO qth, max 500 mg/day [susp: 125 mgy/S mL; tabs 125,250, 500 rng] OR Locacarbet (Lorabid) 30 mg/kg/day PO bid; max 400 mg/day {susp: 100 iin 20 ma/kg/Say PO qhs [tab, chew: 125,250 mg; caps 250,500 50 mg/mL; susp 125 mg/S mL, 250 mg/5 mL] OR \nVSMX 4 makkgiday of TMP PO ghs [susp: per S mt: 40 9; SS tab: 80 mg/400 mg; DS tab: 160 mg/800 mg}. ‘Symptomatic Therapy: -Ibuproten (Advi) 5-10 mg/kg PO 6-8 hrs [suspension: 100 mg/S mt, tabs: ‘AND/OR AA%ein 1OmLand 15 mL bottles] tympanogram; audiometry. Unresponsive cases may require ENT consult for tympanostomy and tube placement, Scanned with CamScanner62 Otitis Externa Otitis Externa Oiitis Externa (Pseudomonas, gram negatives, proteus): Polym) invhydrocortisone (Cortisporin tic suspor solution) 2-4 5 x 5-7 days. The susper 150 mg/kg/day IV/IM Bh, max 1agmvday OR reillin 200-300 mg/kg/day IV/IM g4-6h, max 24gm/day OR 7.5 mo/kg/day IV/IM gBh, 5-10 yr 6.0 mg/kg/day IV/IM Bh, >10 yr: 5.0 mg/kg/day IV qBh. Tonsillopharyngitis Streptococcal Pharyngitis: V 25-50 molkg/day PO aid x 10 days; max 3 gnvday {labs 125, 9: susp 125 mg/S mL, 250 mg/S mL] OR -Pericilin G benzathine (Bicilin LA) 25,000-50,000 Urkg (max 1.2 MU) IM x1 dose OR Azithromycin (Zithromax) 12 mg/kg/day PO qd x 5 days (max 500 mg/day). Clarithromycin 115 mg/kg/day PO bid; max tgrvday [tab 260, $00 lergc patients) 40 mg/ko'day PO qid x 10 days; Erythromycin ethylsuccinate ‘susp: 200 mg/5 mL, 400 mg/S mL. chew tab: 200 mg tab: 400 mg Enythromycin base tab: 250, 333, 500 mg OR -Clindamycin 30 mg/kg/day PO q6-8h, max 1.8 gm/day (caps: 75,150,900 ‘mg; susp: 75 mg/5 mL] Javalanate (Augmentin) 40 mg/kgday of amoxcllin PO aBh x 10d, max 500 mg/dose [chew tabs 125, 250 ma; abs: 250, 500 mg 1m9/5 mi, 250 mg mL] OR 50 mg/kpday PO aid: max2 ord [caps 125,250, 600 miJOR -Cophalexn (Ketiex) 50 mghkolday PO aiid max 4 gma caps 260,500 Img: susp 125 mg/S mL, 250 mg/S mL. Epigtotttis 63 Prophylaxis (5 strep infections in 6 months): -Periciln Vk 40 mg/kg/day PO bid [tabs 125, 250, 500 mg; susp 125 m/s mL, 250 mg! ml, Retropharyngeal Abscess (strep, anaerobes, E corrodens): -Cindamycin 25-40 mg/kg/day IVIM 6-8h, Epiglottitis 1. Admit to: Pediatric intensive care unit, Pulse oximeter. Keep head of bed elevated, allow patient to sit: curved blade laryngoscope, tracheostomy tray and oropharyngeal tube at bedside. Avoid excessive manipulation or agitation. No examination of the pharynx. Respiratory isolation. 11. Labs: CBC, CBG/ABG. Blood culture and sensitivity, latex agglutination; Urine antigen sereen. a Scanned with CamScanner64 Sinusitis: Sinusitis 40 mg/kg/day PO tid; max 3 grvday {tabs 125, 250, 500 mg; ‘Susp 125 mg/5 mL, 250 mg/5 mL] OR, N22 yrs: 12 mg/kg/day PO ad x § days, max 500 mg/day yrs: $00 mg PO on day 1, 250 mg PO qd on days 2-5 usp: 100 mg/5 mL, 200 mg/S mL; cap: 250 mg] OR “TrimethoprimvSMX (Bactrim, Septra) 6-8 mg/kg/day of TMP PO bid, max ‘320 mg TMP/day [susp per 5 mL: 40 mg/200 mg: SS tab: 80 mg/400 mg: '500 mg/dose [chew tabs 125, 250 mg; tabs: 250, 500 mg; elixir 125 ma! ‘mL, 250 mg/S mL] -Amoxicilin/ciavulanate (Augmentin BID) 40 mg/kg/day PO bid, max 875 mg (amoxicilinydose [chew tabs 200, 400 mg; tab 875 mg; susp 200 mg/S mL, 400 mp5 mL] OR -Coturoxime axetil (Cettin) tab: child: 125-250 mg PO bid; adult: 250-500 mg PO bid ‘susp: 30 mg/kg/day PO aid, max 500 mg/day [susp: 125 mg/S ml; tabs: 125, 250,500 mg] 2. Labs: Sinus x-rays, CT scan. Tuberculosis 65 Active Pulmonary Tuberculosis Twice Weekty | Dosage Forme Dore Ironia s018 mgkotday | 20-30 more, max 300m | maxscoma ab: 60,100, 200 mg: sy: 10 mg/m Rtampin w20mprgaay | 10-20 (Caps: 150, 300mg, ,max600mg | mokgiose,max | canmake 600mg suspension Pyraxitamise | 20-40ma%gad. | somgig,max | tadsoomg.can max 2000 mg | 2000mq make suspension poraay Ehameuiot | 15:25mgkgtay | somgig, max | Tad: 100, 400mg max 2500m9_ | 2500m9 Stroptamyen | 20-40mgigibt, | 20-40mpRg mM, | tn: 400.mpImL, Mt only is for skin test conversion: ilo: 10 mg/kg/day (max 800 mg) PO qd x 6-9 months. Rifampin, 10 mg/kg/day PO qd (max 600 mg} for 9 Scanned with CamScanner66 Cellulitis, months. 9. Extras and X-rays: /. ABG. First AM sputum for Isolate). Gastric aspirates for AFB max 2 gmvday [caps 125, 250, 500 mg; elixir 62.5 mg/S mL] OR -Cephalexin Ketlex) 25-50 mg/kg/day PO aid; max 4gmi/éay {caps: 250, 500 img: susp: 125 mg/5 mL, 250 mg/S mL] OR -Loracarbet (Lorabid) 30 mg/kg/day PO bid; max 800 mg/day [susp: 100 ‘mg’ mL, caps: 200 mg pavules] OR -Cefpodaxime (Vantin) 10 mg/kg/day PO bid; max 800 mg/day (susp: 50 mg] OR 1mg/S mL, 100 mg/S mL; tabs: 100 mg, 200 mg), : -Celprozil(Cetz) 30 mg/kg/day PO bid; max 1 g/day [susp 125 mg/S mL, 250 mg/5 mL; tabs 250 mg, 600 mg] OR -Mapirocin (Bactroban) ointment or cream, apply topically tid. Extensive requites systemic antibiotics. IAM q4-6h, max t2gm/day OR ‘q6-8h, max 6gmiday OR 150 mg/kg/day IV/IM gBh, max 12grVday OR anate (Timentin) 200-300 mg/kg/day IVIM qé-6h, max turoxime (Zinact -Gefotaxime (Clatoran) 100-150 mg/kg/day IV/IM 6-8, max 12 g/day Tetanus 67 Periorbital Ceitulitis(H. flu, preumococcus; consider lumbar puncture, Tetanus History of One or Two Primary immunizations of Unknown: Low risk wound - Tetarus toxoid 0.5 ml IM. Tetanus prone - Tetanus toxoid 0.5 mL IM plus tetanus immunoglobulin (716) 250 U im. ‘Three Primary Immunizations and 5-10 yrs since last Booster: ‘Low risk wound - None Tetanus prone - Tetanus toxoid, 0.5 mL IM. ‘Three Primary and <5 yrs since last Booster: Low tisk wound - None Tetanus prone - None ‘dose may be infitrated locally around the wound. Keep wound nd débrided. G 100,000 Uing/day IV g4-6h, max 24 MU/day x 10-14 days OR Metronidazole (Flagyl) 30 mg/kg/day POITV qh, max 2gmvday. Scanned with CamScanner68 Pelvic Inflammatory Disease Pelvic Inflammatory Disease 7. Diet: 8. IV Fluids: 9, Special Medications: ‘Adolescent Outpatients. Ceftriaxone (Rocephin) 250 mg IM x 1 dose and doxycycline 100 mg PO bid for 14 days OR in) 2 gm IM, with probenecid 1 gm PO and doxycycline 100 mg PO bid x 14 days 18 years may be given ofloxacin (Floxin) 400 mg PO bid 100 mg PO tid oF metronidazole 500 mg PO bid x 14 days. inpatients -Cotoxitn (Mefoxin) 2 gm IV qéh OR IV qt2h AND //PO ql2h (IV until afebrile for at least PO bid) feaps: 100 mg: tabs: 50,100 mg; susp: 5 mg/mL, 10 mg/mL] OR -Cindamycin 800 mg IV qBh plus gentamicin 2 mg/kg IV loading dose {followed by 1.5 mg/kg IV q8h. Continue for 48h after significant clinical 1d by doxyeyciine 100 mg PO bid orcindamycin 600 ite total of 14 days of treatment. less than 45 kg: Ceftriaxone (Flocephin) 125 mg IM x 1 dose (uncomplicated dis ‘OR SOmg/kg/day IVIM q24h (if ophthalmia, peritonitis, bacteremia, thts, reat for 7 days) OR -Spectinemycin 40 mg/kg IM (max 2 gm) x 1 dose AND -Esjthromycin 40 mg/kgiday PO qh (max 2gm/day) x7 days OR Azithromycin 20 mg/kg (max 19m) PO x 1 dose mg/kg/dose POIPR g4-6h pn. .sound; social services consul . Labs: CBC, SMA 7 and 12. GC and chlamydia cultures, APR or VORL. UA with micro; urine pregnancy test. Pediculosis 69 foving tygiene and cleaning clothes. Infested 1d and dried at hot temperatures to kil the lice. Treatment consists clothing can be we Podiculicidas are not necessary. Pediculosis Pubis (pubic lice, “crabs"): Any of the pediculicides used in the ‘teatment of pediculosis capitis may be used. Scabies ‘Treatment: ‘Bathe with soap and water; scrub and remove scaling or crusted detritus: towel ‘dy. Al clothing and bed linen contaminated within past 2 days should be washed in hot water for 20 min. Scanned with CamScanner70 Dermatophytoses Dermatophytoses Diagnostic procedures: (1) KOH prep of scales and skin scrapings for hyphae. (2) Cuttures are used for uncertain cases, Least 4 weeks: 9), eruris (jock itch), pedis (athlete's foot): 20 mokkg/day PO ad (max 1,000 mg/day) (ab: 250 mg; susp: 125 mg mL} 10 mg/kg/day PO ad (max 750 mg/day) (tab: ive with whole-mik o aty foods to increase Cover body surtace from face to knees with selenium sulfide lotion or Tinactin cream daily for 30 minutes x 1 week, then monthly x 3 to help prevent recurrences. Gastroentertis 71 Gastroenterology Gastroenteritis 38, urine specific gravity. \somil OF), bland diet lood and neutrophils in stoot INq 12-24h, max grv/dayOR “Getisime (Suprax) 8 mg/kg/day PO bid-qd; max 400 mg/day (susp: 100 ‘mg/S mi; tab: 200, 400 mg} -Trimethoprim/SMX (not effective against Campylobacter ‘TMP component '5 mL: 40 mg/200 mg; SS tab: 80 mg/400 mg; DS tab: 160 mg/8O0 mg} ated Diarrhea and Pseudomembranous Colitis (Clos- Fagy)} 20-90 mg/kg/day POV gh x7 days. max4gmiay. (tab: 250, 600 ma] OR 20 ma/Kglday PO gid x7 days, max2 gray caps: 125, 250 rmg/S mt, 500 mg/6 mi] 3s and patients with septic 50-75 mg/kg/day VIG uprax) 8 mghkglday PO bid-ad; max 400 mg/day [susp: 100 tab: 200, 400 mg] OR 00-200 mghkg/cay lV g6h, max 12 gmiday or 50-80 mo/ko'day 5-74, max 4 gniday (caps: 250, 500 mg; susp: 125 mS mL, ml OR -Trimethaprin/SMX 10mg TMP/Kg/day PObIdx5-74, maxS20mg TMPIGay [susp per § mL: 40 mg/200 mg; SS tab: 80 mg/400 mg; DS tab: 160 ‘mg/B00 mg} Rotavirus supportive treatment, see Dehydration page 83. 10, Extras and Xr abdomen, 11. Labs: SMA7, CBC; stool Wright stain for leukocytes, Rotazyme. Stool sensitivity for enteric pathogens; Cdificile toxin and cuture, ova ‘and parasites; occult blood. Urine specific gravity, UA, blood culture and Scanned with CamScanner‘72 Gastroenteritis sensitivity, Specific Therapy of Gastroenteritis Shigella Sonnel: -TrimethoprinvSMX, 10 mg TMP/kg/day PO/IV qi2h x 5 days {susp per 5 mL: 40 mg/200 mg; SS tab: 80 mg/400 mg; DS tab: 160 mg/800 m Ampicilin 50-80 mg/kg/day PO gBh, max 4 gvday; or 100 mg/kg/day IV/IM ‘abhor 5-7 days, max 12 grvday [caps:250, 500 mg; susp: 125 mg/S mL, Campylobacter jejuni: Erythromycin 40 mg/kg/day PO qBh x 5-7 days; max 2 gry. Erythromycin ethytsuccinate ‘susp: 200 mg/5 mL, 400 mg/S mL ‘chew tab: 200 mg tab: 400 mg Erythromycin base tab: 250, 333, 500 mg OR Enteropathogenic E. coli (Travelers Diarrhea): TrimetnoprimySMX 10 mg/kg/day TMP POM bid (susp per 5 mL: 40 ‘mg/200 mg; SS tab: 80 mg/400 mg; DS tab: 160 mg/800 mg] OR -Neomyein 100 morko/day PO ¢6-Bh la: oral soln: 125 mg/5 mL] ‘rH older than 8 years old: Doxyoycine (Vibram 150, 100 mg; tab: 0, 100 mg; susp: § mg/mL, rasive E coli: “Trimethoprien/SMX 10 mg/kg/day of TMP POV qt2n [susp per § mL: 40 ‘9/200 mg: SS tab: 0 mg/400 mg; DS tab: 160 mgB00 mg; in per mL: 16 mg/80 mg) Giardia Lamblia: -Mewonids 100 mg PO ad mg/mL, lay) 15 mg/day PO gBh x 5 days (max 4 g/day (ab R -Furazolidone 6 mg/kg/day PO qid x 7-10 days, max 100 mg/dose [tab: 100 rg; liquid: 50 mg/1$ mL}. Entamoeba Histolytica: ‘Asymptomatic cyst carriers: lodoquinot 30-40 mg/kg/day PO aBh (max 2 gm/day) x20 days tab: 210 img, 650 mg: powder for reconstitution] OR Paromomycin (Humatin): 25-95 mg/kg/day PO gBh x 7 days {cap 250 mg] OR -Dioxanide: 20 mgixgiday PO gBh x 10 days, max 1500 mg/day. {Available only through COC), Ulcerative Colitis 73 Mild-to-moderate intestinal symptoms with no dysentery: 35-50 mg/kg/day PO qBh x 10 days, max 2250 mg/day [tab: 250, 500 mg} followed by iodoquinol 40 mg/kg/day qBh for 20 days OR -Paromomycin: 30 mokkg/day PO aah x 7-10 days {cap 250 mg] or 12 yrs: 800 mg PO with food bid [eaps 250 m9 Hydrocortisone retention enema 100 mg PR ghs OR Hydrocortisone acetate 90 mg aerosol foam PR qd-bid or 25 mg supp PR. Scanned with CamScanner74 Parenteral Nutrition and parasites, C. dficile toxin, Wright's stain Parenteral Nutrition 1ent less fluid from lipid and requirement. 5 gruvkgid and increase to 2-3 38/d). For children and young adults ‘9FVkg/d and increase by 1.0 gmvKgid (max 2-3 grvkg/d) -Advance daily dextrose concentration as glucose levels. Maximum concentration 35% (O35W) Total Parenteral Nutrition Requirements fnfants- 254g | 25-45 ko ska cuore | 90-120 eotasKeangiay | 407s Keangtny reaageay a veoveomun | tzosomingey | 6075mungtiny soe ee ee ee ee ee Sodium 26 mEgkp/day | 2-6 mEqkglday 60-150 mEq/day Poussum | 2emeanoeny | e6mearpeer | 70-1s0meveey cnarse | 2ameanpiey | eaneerolay | 2amEaholty Coc [remeanccay | imewngiay | 0203meqigoy Prosoate | os-tmmonoeny | osmmongay | 740mm0000cal Parenteral Nutrition 75 Scanned with CamScanner children and young adults begin at 1 grvkg/d, advance as ted by 0.5-1 gmvkg/c: max 3 gnvkg/d or 40% of calories/day. infuse over 20-24h; children and infants - inuse over 16-24n, max 0.15 grvkgih, daily protein by 0.5-0.6 grvkg/day to maximum of 3 gmvkg/day. -Protein requirement in grams + Fluid requirement in mL x 100 = % amino acids. -Bogin. with maximum76 Gastroesophageal Reflux ‘Start with 0.5-1.0 grvkg/day lipid, andincrease by 0.5-1.0 gm’kg/day until 3 grvkg/day. Deliver over 18-24 hours. Draw blood 4-6h after end of infusion for triglyceride level 8, Extras and X-rays: CXR, plain fim for line placement, dietician consul SMAN2 1 direct and indirect IBC, transterrin,retino- Panel It; Panel | and Mg, BUN, creatinine, albumin, triglycerides, AST. Gastroesophageal Reflux ings: give small volume feedings; keep head of bed elevated 30 degrees. 0.15-0.3 mpkkg/dose PO tid-qid [10 mg scored tab; .lan) 0.1-0.2 mg/kg/dose PO gid 20-30 minutes prior ‘mg/kg/day [syrup: 1 mg/mL; tab 10 mg: concentrated s0in: 10 mg/mL] OR met) 20-40 mg/kg/day IVIPO qh (20-30 min belore feeding) [oral soln: 60 mg/mL; tabs 200, 300,400,800 mg, ij: 150 mg/mL) oR Ranitidine (Zantac) 2-3 mg/kg/day IV qBh or 4-6 ma/kg/day PO q12h [tabs 75, 160,300 mg; liquid 15, in 50 mg/mL} Erythromycin (a prokinetic a¢ mg/kg/dose PO q6-8h. Concomitant Cisapride is contraindicated due to potentially fatal drug interaction. 1B. Extras and X-rays: Upper Gl series; gastroesophageal nuciea scintigraphy (rik scan), endoscopy. Constipation 1. Management of Constipation in infants ‘A. Dilation with a lubricated rectal thermometer or finger diation may be successful in infants. B. Dietary measures should include increasing fluid Intake. Barley malt Constipation 77 -2 teaspoons, can be added to a feeding two to three times is, 1 suppository rectally pn. n>? years of Age lis tapered over 4 to 6 months. ‘Motamucil) should be initiated when the Wl, Stool Sotteners and Laxatives: ‘A. Docusate sodium (Colace): ay 20-40 mg/day PO 96-24h 38y 40-60 mg/day PO q6-24h ez 40-150 mg/day PO 96-24h a12y ‘50-400 mg/day PO q6-24h [oral soin 10 mg/mL, 50 mg/mL; caps 50,100,250 mg] 30-60 mL PO pm, yte oF Golytely) 15-20 mLikgyh PONG. IW. Diagnostic Evaluation: Anorectal manometry, anteroposterior andiateral ‘abdominal radiographs, lower GI study of unprepared colon, Scanned with CamScanner‘78 Constipation Poisoning 78 Toxicology Poisoning Gastric Decontamination: ‘Activated Charcoal: 1 gr/ko/dose (max 50 gm) POING; the first dose should be given using product containing sorbitol as a cathartic. Repeat of iia! dose qth if indicated. Gastrle Lavage: Left side down, with head slighty lower than body: place tube and check position by injecting air and aus- toxicological exam. Gastric lavage is contraindicated if corrosives, ‘hydrocarbons, or sharp abjects were ingested. >12 yrs: 150-300 ml POING Antidotes to Common Poisonings (Cyanide Ingestion: Amy! nitrite, inhale ampule contents for 90 seconds qimin until sodium Use new amp q3min AND 0.33 mL/kg (max 10 mL) 1V over § minutes. later it inadequate clinical response. imLkg of 25% sin (max $0 mL) IV, repeat ¥ dose ‘Narcotic or Propoxyphene Overdose: Naloxone (Narcan) 0.1 mg/kg/dose, max 4 mg IVIOYETIINIO, may repeat min, ‘Methanol or Ethylene Glycol Overdose: (Extrapyramidal Reaction): Jena!) 1 mg/kg IVIM géh x 4 doses; max 50 bby 5 mg/kg/day PO géh for 2-3 days. Scanned with CamScanner80 Acetaminophen Overdose -Flumazenil (Romazicon) 0.01 mg/kg IV. Repeat 60 megiml or signs of neurotoxicity, seizure, 410. Extras and X-rays: Portable ‘{HiLabs: CBC, SMA 7, theophyline level; PT/PTT, liver panel. Moritor K, Mg, ‘phosphorus, cakium, acid/base balance, urine drug screen. Iron Overdose General Considerations and Treatment: Induce emesis wih ipecae lf recent ingestion (<1 hour ago). Charcoal is not ctfective. Gastric Lavage if greater than 20 mgkkg of elemental iron ingested or it ‘unknown amount ingested or it symptomatic. ‘ross, CBC, electrolytes, serum Iron, TIBC, INA/PTT, blood jnclion tests, calcium, KUB to determine i tablets are present 3, Monitor eloctralytes. Blood products may be needed. 4. It peak serum iron >350 meg/dL or patients symptomatic, begin chelation Scanned with CamScanner82 Iron Overdose. ‘serum iron is within normal range. 6. Consider exchange transtusion in severely s conacerechange ly symptomatic patients with serum Selzure and Status Epilepticus 63 Neurology and Endocrinology Seizure and Status Epilepticus 9: Pediatric intensive care unt. Ad 2. Diagnos 3. Condition: 4, Vital signs: Neurochecks G2-6h; call MO i 5. Activity: 6, Nursing: Seizure and aspiration precautions, ECG and EEG monitoring. ‘glucose. 5. lI seizures continue, intubate and give phenabar 20 mg/kg IV or S mg/kg IV every 1 minutes until 0r30 mgkkgis reached. 6. If seizures are retractory, consider midazolam (Versed) infusion (0.1 mg/kg/h) or general anesthesia with EEG monitoring. 15 Malntenance Therapy: 1g PO bid or 10 mg/kg/day PO bid, then may increase by 100 mg/day at weekly intovals; usual maintenance dose 15-20 ma)ka/day PO bid-a 12 y:intally 200 mg PO bi, thon may increase by 200 m/day at weekly intervals; usually maintenance dose 800-1200 mg/day PO bichtid (tab: 200 mg; tab, chewable: 100 mg; susp: 100 mg/S mL] OR Scanned with CamScanner84 Diabetes, -Phenabarbital: Loading dose 10:20 mglkg 'VWPO, then maintenance dose 3-5 mglkg/day PO qd-bid [elii: 4 mg/m; tab: 30, 32, 60, 65,100 mg} OR -Phenytoin (Dilantin): ading dose 15-18 mg/kg IVIPO, then maintenance sustained eloase capsules may be dosed a2én) [eap: 90, 100 mg; ex: 125 mg/5 mL; tab, chewable: 50 mg] Partial Selzures and Secondary Generalized Seizures: -Carbamazepine (Tegretol), see above OR -Phenytoin, see above -Phencbarbita, see above OR -Valproic acid, see above. 10. Ext Yerays: MAI with and without gadolinium, EEG with hy- perventiation, CXR, ECG. Neurology consultation. 11. Labs: ABGICBG, CBC, SMA 7, calcium, phosphate, magnesium, lver panel, VORL, anticonvulsant levels, blood and urine culture. UA, drug and toxin screen. Cartamazepine 412 megimL Cionazepam 20-80 mgmt. Phenobarbital 15-40 megimL Prenpon | _1020ne9nt Prmidone 5-12 megimk Valpoe aac | 50-100 mepimt. New Onset Diabetes 1. Admit to: 2. Diagnosis: New Onset Diabetes Malitus 3. Condition: 4. Vital signs: Call MO it: Reecord labs on flow sheet. Fingerstick glucose at 0700, 1200, 0200; diabetic and dietetic teaching 7. Diet: Diabetic diet with 1000 kcal + 100 kcal/year of age. 3 meals and 3 Diabetic Ketoacidosis 85 (between each meal and ghs.) Hep-lock with flush q shit. ledications: reprandial glucose of 100-200 mg/dL. those who are in the remission phase required dosage exceeds these ness, causes of insulin resistance, or non Divide 2/8 belore breakfast and 1/3 before dinner. Give 2/9 of total insulin requirement 2s NPH and give 1/3 as regular insulin. ‘CXR, Endocrine and dietary consult. inulin, antiisle cell antibodies. UA, urine culture and pregnancy tes; urine ketones. is <200 mg/d, dally weights, inputs and outputs. O, at 2-4 Limin by NC. Record labs on flow sheet 7. Diet: NPO 8. IV Fluids: 0.9% saline 10-20 mLikg Scanned with CamScanner86 Diabetic Ketoacidosis ‘Add KCL when potassium is <6.0 mEqiL ‘Serum K+ lofusate KCL, 3 40-60 mEq a4 30 45 20 56 10 36 ° .05-0.1 U/kg/h (50 U in $00 mL NS) continuous ease glucose by 50-100 mgidL/n than 50 mg/dl, increase insulin 10 0.14-0.2 at 0.05-0.1 Urkgih and add DSW -When glucose approaches 250-300 ‘subcutaneous insul dose of insulin. 410. Extras and X-rays: Portable CXR, ECG. Endocrine and dietary ‘consultation. 11. Labs: Dextrostixs q1-2h until glucose <200, then q3-6h. Giucose, potassium, phosphate, bicarbonate q3-4h; serum acetone, CBC. UA, urine ketones, culture and sensitivity. Slekle Coll Crisis 87 Hematologic and Inflammatory Dis- orders orders Sickle Cell Crisis ‘2 mg/kg/dose (max 10-15 mg) IVIMW/SC q2-th pm ‘usion of 0.05-0.1 mg/kg/h pm or 0.3-0.5 mg/kg PO qth pm OR -Aeetaminophenicodeine 0.5-1 ma/kg/dose (max 60 mg/dose) of codeine ‘codeinesS mL] OR ‘acetaminophen 167 mg: tabs: Hycrocedene 2.5 mg, acetaminophen 500 mg: Hydrocodone § mg, acetaminophen 500 mg: Hydrocodone 7.5 mg, acetaminophen 500 rg] Children: 0.6 mg hydrocodonerkg/day PO q6-dh pen <2 yr: do not exceed 1.25 mg/cose Bolus frequency (lockout interva") every 6-18 min nce Therapy “Folic acid 1 mg PO qd (>t y. “Translusion PRBC 5 mLIkg over 2h, thon 10 mL/kg over 2h, then check Main Scanned with CamScanner188 Kawasaki's Syndrome hemoglobin, if hemoglobin <6-8 grVdL, give addtional 10 mLiKg -Pericilin VK (prophylaxis), <3 yrs: 125 mg PO bid; 23 yrs: 250 mg PO bid >6 yr 400 1U/day 10. Extras and Xerays: CXR. 111.Labs: CBC, blood culture and sensitivity, r ‘SMA 7, parvovirus titers, mycoplasma sensitivity ocyte count, type and eross, UA, urine culture and Kawasaki's Syndrome 1. Admit to: 2. Diagnosis: 3. Condition: 4, Vital signs: Call MD itt 5. Activity: Bedrest 6. Nursing: — rvkgidose IV x 1 dose. Administer dose at 0.02 to 0.04 Aspirin 100 mg/kg/day PO or PR 6h ‘mg/kg/day POIPR aq. (chew tab: 81 mg; tab: 325, 800, 850/mg; supp: 60, IV use if an anaphylactic 10, Labs: CBC with diferential and platelet count. ESR, CBC, liver function tests, eumatcid factor, salicylate levels, biood culture and sensitivity x2, MAT. Dehydration 89 Fluids and Electrolytes ees Oe _—__—_—_ Dehydration 4. Admit to: 2. Diagnosis: Dehydration 8. 1V Flulds: Maintenance Fluids: <10kg 100 mUkg/24h 10-20 kg 1000 mL plus 50 mL/Kg/24h for each kg >10 kg >20kg 1800 mL plus 20 mL/kg/24h for each kg >20 kg. Electrolyte Requirements: Sodium: 35 mEqkg/day Potassium: 2-9 mEqa/day Chloride: 3 mEd/ka/day Glucose: 5-10 grv100 mL. water a Degree of ehydation Weight Loss-tnfants Walght LossChiléren 10% Pulse Vary neroased Blood Pressure Behavior Normal Thirst ee Mucous Membranes Scanned with CamScanner0 Dehydration r Degree of Dehydration | ms Moderate | Severe Tears Present ecrensed — | Anson sun ees poveorFotanaie | Neat Nemao | Sunken tenken TexematuguarVeln | visio when | Netvaiie | Notable ven supine cxcoptwity | wiv supractave upracavie | lar pressure ar pressure ‘skin ‘capita ot <2uee Urine Specie Gravity | >1.020 >1.028; Orguia or ss) olga anus | roprorimate rind — | 145 mEq. Phase 1, Acute Fluid Resuscitation (Symptomatic Dehydrat Give NS at 20-20 mL/kg V at maximum rat; repeat ud boluses o1NS,20- ‘30 mUkg until adequate circulation. Phase 2, Deficit and Maintenance Therapy (Asymptomatic dehydration): Wuids and sodium deficit for 24h lids and electrolytes given in phase 1). isotonic or hyponatremic tion, replace 50% over 8h and 50% over next 16h. Jace ongoing losses 46-8. “Add potassium to IV solution after fist void. “Usually DS ¥4 NS or DS 1/4 NS saline with 10-40 mEq KOLItor 60 mUKg use at 6-8 mLkg/h for 12h. 1+ 190-150 mEglL): race ané replacement and electrolytes fivids for 24h ites givon in phase 1) and give hal over firth, Dehydration 91 “10 mEqIU/day; do not reduce sodium by mora than 15 mEq/L/24h or by 30.5 mEq/L -tt volume depleted, give NS 20-40 mUkg IV until adequat ‘give 1/4 NS in 2.5-5% dextrose to replace hal of free wat first 24h, Folow serial serum sodium levels and correct deficit over 48- 72h. Free water defielt: 4 mL/kg x (serum Na+ -145) -Also see “hypematremia” page void as KCL. mEq KCL. Estimate and replace ‘ongoing losses and maintenance. Replacement of ongoing losses (usual fluids): *Nasogastic suction: DS ¥% NS with 20 mEq KCLIL or ¥& NS with KCL 20 Jution (Rehydralyie, Pedialyte, Ricelyte, 3-80 mL/kg PO or via NG tube over 2h. ‘over remaining 18-20 hours; add an- Scanned with CamScanner2 Hyperkalemia Hyperkalemia 1. admit to: Peciatric ICU 5. Activity: 6. Nursing: Continuous ECG monitoring, inputs and outputs, daily weights. 7. Diet: 8. Fluids: Hyperkalemia (K + >7 or EKG Changes) "Calcium gluconate 50-100 mglkg (max 1 gm) IV over 5-10 minutes or calclum chloride 10-20 mg/kg (max 1 gr) IV over 10 minutes, _Rogulariasulin0.1 Uk plus glucose 0.5 g/kg V bolus (as 10% dextrose) {Eqikg IV over 3-5 min (give after calcium in 45 min f necessary. .kofdose (max 40 mg IV) 1V q6-12h pm, may Furosemide increase to 2 mg/kg/dose IV [inj: 10 mo/mL) _Kayeralate resin 05-1 givkg POIPR. 1 gm resin binds approximately 1 ‘mEq of potassium. 9, Extras and X-rays: ECG, dietetics, nephrology consults. +0, Labs: SMA7, Mg, caleium, CBC, platelets. UA; urine potassium. Hypokalemia 1. Admit to: Pediatic ICU 2, Diagnosis: Hypokalemia 1. Condition: 4. Vital signs: Call MO it: 5. Activity: 1. Nursing: ECG monitoring, inputs and outputs, daly wos. 2 8. IV Flulds: serum K>2.5 mEq/L and ECG changes are absent: arerpb ad en KGL 1a maininance IV fis. May ove 1-4 mea) seeinain normal serum potassium. May supplement wih orl potassium, K<25 mEq/L and ECG abnormalities: Gee Kor 1-2 meqhcglV at0.5 mEa/kgMn; maxrate 1 mEd/K9M in le teak “ring stuatons: max20 mEq, Recheck serum potassium, and rept IY boluses prn, ECG monitoring required. Hypernatremia 93 Hypernatremia 4. Admit to: 2, Diagnosis: Hypematremia 8. IV Fluids: It volume depleted or in shock, give NS 20-40 mL/kg IV until adequate “pretation, then give DS & NS IV to replace hal of body water deft wer fst 24h, Correct serum sodium slowly at 0.5-1 mEq/L. Correct Hypernatromia wi Furosemide (Lasix) 1 moka WV. “DSW oF other hypotonic Muid to correct body water deficit. nd X-rays: ECG. 1A camolaly, tigyeerides. UA, urine specific gravity; 24h urine ids: mia with Increased ECF and edema (Hypervolemia)(iow ine sodium <10 rmaVL: nephrosis, CHF, citthosis; urine Scanned with CamScanner‘94 Hypophosphatemia Furosemide (Lasix) 1 mg/kg/dose V over 1-2minor2-3mgkkgiday PO aB- 2h Hyponatremia with Isovolemia (low osmolality <280, urine sodium <10 mmol/L water intoxication; urine sodium >20 mmoVL: SIADH, hypothyroidism, renal lallue, Adcison's disease, stress, drugs): to ¥ maintenance, Hyponat th Hypovolemia (low osmolality <280; urine sodium <10 moll: vomiting, diarthea, 3rd space/respiratory/skin oss; urine sodium >20 mmoVL: ciuretcs, renal injury, renal tubuiar acidosis, adrenal insufficiency, pattial obstruction, salt wasting) /and sodium requirement and give half over fi 154 mEgiL se extracalular Na by mUkgfne x 12h. -it volume depleted, give mLkg until adequate circulation. “Determine vol of 3% hypertonic saline (513 mEdjL) to be infused as follows: alma) deficit = 0.6 x (wt kg) x (desired Na - actual Na) Volume of soln (L) = Sodium to (mq) + mEqjL in solution -Cortecthaif of sodium deft sI 28h, “For acute correction, the serur (goal is 125 mEq/L; max rate for ‘acute replacement is 1 mEq/kgfhr. Serum Na should be adjusted in ‘ots MEQ/L to reach 125 mEQlL. The fst dose is given over 4 ither correction for serum sodium toabove 125mEq, calculate mEq dose of socium and administer over 24-48. 8, Extras and X-rays: CXR, ECG. 10. Labs: SMA 7, osmolaliy, triglyceride. UA, urine specific graviy. Urine ‘osmolality, Na, K; 2h urine Na, K, creatinine. Hypophosphatemia Indications for i nt IV Administration: 1, Serum phosphate <1.0 mg/dl. or 2. Serum phosphate <2.0 mg/dL. and patient symptomatic oF 3. Serum phosphate <2.5 mg/dL and patient on ventilator Hypomagnesemia 95 0.08 mmfxg IV over 6 hrs Intermediate dose 0.16 mnvkg IV over 6 hrs (0.24 mmnikg 'V over 4 brs 0.96 mavkg V over 6 hrs Phosphate Cations: ‘Sodium phosphate: Contains sodium 4 mEq/mL, phosphate 3 mmolimt. Potassium phosphate: Contains potassium 4.4 meq/mL. phosphate 3 mmolmL Max rate 0.08 mEqrkg/hr Hypomagnesemia Indications for Intermittent IV Administration: 1. Serum magnesium <1.2 mg/dL 16 mg/dL_and patient symptomatic, Magnesium "25-50 mg/ug/dose (0:2-0.4 mEq/xg/dose) IV every 4-6 hrs x 3-4 doses as ‘noeded (max 2000 mg = 16 mEq/dose); max rate 1 mEqkkg/hr (125 mooi 2 1-2 mEqhkg/day ( Scanned with CamScanner96 Neonatal Resuscitation Newborn Care Neonatal Resuscitation oUt Sign Heart Rate Absent ‘Slow (<100) >100 per minute Respirations Slow, ireguiar_| Good, crying Muscle Tone ‘Active motion Reflex Irritability ink body with blue extremities ‘Completely ‘Assess APGAR score at 1 minute and § minutes, then continue ‘assessment at § minute intervals until APGAR >7. General Measures: 1. Review history, check equipment, oxygen, masks, laryngoscope, ET tubes, ‘medications. nt ivery room care for infants with heart rate >100 beats per spontaneous respirations, and good coler and tone. ‘outh then nose using bulb syringe; dry skin and maintain neutral ‘and heart rate is normal, gradually Neonatal Resuscitation 97 reduce ventilation rate until only using continuous positive alway pressure (CPAP). Wean to blow-by oxygen, but continue blow-by oxygen ithe baby after 90 seconds of beats per min. May >80 beats per minute P by mask using 100% ing. I condition Improves, change to then change to blow-by oxygen as tolerated. re is no change after 30 seconds, or it mask fagoscope to suction oropharynx and trachea pressure ventilation. Check bilateral breath sion. Check and adjust ET tube position if ac compressions it heart rate remains depressed. pinephrine 0.1-0.3 mL/kg (0.01-0.03 mofkg @@-Smin, Dilute ET dose to 2-3 mL in NS. mUikg IV over §-10 minutes. mia. ryiMetabollc Acidosis (not 2, Repe naloxone may be shorter than the duration of action ofthe narcotic. Intubat Premature intant<1.25 kg (2 bs): 25 mm tube; size 0 blade; 7.5 em tip to bp. Premature 1.25-2 kg (2 lbs): 3 mm tube; 0 blade; 8 em tp to lip. Full term >2 kg (6 lb): 3.5 mm tube; 1 biade; 8.5 em tp top. Scanned with CamScanner‘98 Suspected Neonatal Sepsis Suspected Neonatal Sepsis Newborn Infants <1 month old (group B strep, E coll, or group D strep, ‘gram negatives, Listeria monocytogent -Ampicilin and gentamicin OR ampicilin and cefotaxime as below. "Add vancomycin as below it >7 days old and a central ine is present. Neonatal Dosage of Ampici “<1200 gm 0-4 weeks: 100 mg/kg/day IV/IMgi2h 11200-2000 gm: 476: 100 mgkkg/day IVAM qt2h >74: 150 mg/kg/day IVIM q8h >2000 gm: £74: 150 mg/kg/day IVIIM gh > 1200 grams: 0-7 days: 100 mg/kg/day IV/IM qtzh '>7 days: 150 mg/kg/day IW/IM gh 2.5 mgkkg/dose IVIM Dosing Interval: Gestational Age <28 wks and <7 days old: @24h; >7 days: at6h 26-34 wks and <7 days old: q18h; >7 days: qt2h 334 wks and < 30 days: q12n ‘Neonatal Vancomycin Dosage: Wt 80.days: 30 mg/kg/day IV g8h ‘Wt 1.5:2 kg and age <7 days: 2h Wt 115-2 kg and age 7-30 days: 20 mg/kg/day 1V at2n Wi 15-2 kg and age >30 days: 30 mko/day IV qh Wio2kg and age <7 days: 20 mg/kg/day IV gt2h Wis2kg and age 7-30 days: 30 mg/kg/day IV g8h Wi>2 kg and age >30 days: 40 mg/kp/day IV a6h Note: I serum creatinine is »1.2 mg/dL, use an intial dosage of 15 mokkolday {q24n and determine serum vancomycin concectrations within 24-48 hours. Respiratory Distress Syndrome 99 gm: (0-4 waeks 50 mg/kg/day IVIM qi2h 1200-2000 gm: £7 days: 50 mg/kg/day IViIM qi2h >7 days: 75 mg/kg/day IV/IM gh 2000 gm: 47 days: 75 mg/kg/day IVIM gBh 7 days: 100 mg/kg/day VM géh Mezlocili -<1200 gm: 10-4 weeks 150 mg/kg/day IV/IM q12h 11200-2000 gm: <7 days: 150 mg/kg/day IV/M qt2h > days: 225 mgkkglday IV/IM qBh 2000 gm: {67 days: 150 mg/kg/day IV/IM qt2h >7 days: 225 mg/kg/day IV/IM qBh ‘Amikacin: 7.5 mg/kg/dose IVIM Dosing interval: Gestational Age <28 wks and <7 days old: q24h; >7 days: q18h 28-24 wks and <7 days old: q18h: >7 days: q 12h 304 wks and <30 4: g12h Laboratory Studies: CBC, SMA 7, blood culture and sensitivity, UA, culture ‘and sensitivity, antibiole levels. CKR. Nasopharyngeal washings for direct ibody and viral cultures. Urine antigen screen. {am stain, bacterial culture and sonsitvty, antigen sereen (1-2 CSF Tube 2 - Glucose protein (1-2 mL). (CSF Tube 3 - Cell count and differentia (1-2 ml). Respiratory Distress Syndrome 1. Provide mechanical ventilation as indicated. 2, Exogenous surfactant -Beractant (Survanta) 4 mL/kg of bith weight via endotracheal tube after clinical diagnosis is suspected, then 6h up to 4 doses total. -Exosurt 5 mLUkg of bith weight via endotracheal tube after ‘diagnosis is suspected, then qt2h for 2-3 doses total sinical Scanned with CamScanner100 Necrotizing Enterocolitis Necrotizing Enterocolitis rine output, tissue perfusion itoring. snemia, thrombocytopenia, 1. Give blood and. bio« coagulopathy. Monitor abdominal X-rays for free air from perforation tamicin or tobramycin or cefotaxime. ‘Monitor the patient frequently for perforation, lectroyte disturbances, and pneumatosis intestinalis and portal vein gas (X-ray). Surgical evaluation it perforation suspected. nea monitor, puse oximeter. . nursing: Hea rate monter, impedance a eat it at bed side. Rocker bed or Keep bag and mask resuscitation equipment ‘oscillating water bed. 8 8. Spectal Medications: ‘Apnea of PrematurityiCentral Apnes: Pe epntineioadng Jose 6 mpg Vs then maintenance § mpka/eay IV at2non -Theophyline: loading dose § mo/Kg PO. | Monitor levels. -cattoinecivater Loading dose 10-20 mg/kg PO, then S mg/day PO a2 24h, {sand X-rays: Preumogram, cranial va 3H probe. EEG. CBC, SMA 7, glucose, calcium, theophytine level, cate thon 5 mokg/day PO qt2h. x sound. Upper GI (ru Congenital Syphilis 101 urine drug screen, Congenital Syphilis ‘aqueous: 50,000 Ukg/dose IV/IM; 0-7 days of age: gt2h: >7 d: 1 10-14 days, If one or more days is missed, restart entire 150,000 wkg/day IM qd for 10-14 day. Procaine penicilin does not achieve adequate CSF concentrations. NOTE: Obtain follow-up serology at 3, 6, 22 months until nontreponemal test is non-reactive. Infectious skin precautions should be taken. Congenital Herpes Simplex Infection -Acyelovir (Zovirax) 30 mg/kg/day IV gBh. Infuse each dose over 1 hr x 14 ays. Infants with ocular involvement should also receive topical rine. -Trituridine ophthalmic solution (Viroptic) 1 drop in each affected eye 2h while awake (19%: 7.5 ml bottle}. Patent Ductus Arteriosus ‘Age at First Dose <4h 02 ot | 27d 02 02 | Scanned with CamScanner102 Hepatitis Prophylaxis a Dose (mg/kg/dose) | (mg/kg/dose) | (mg/kg/dose) =e Se IV ever 20-30 min. Check serum creatinine and urine each dose. Five dose course: (0.1 mg/kg/dose IV q24h x 5 days. Check serum creatinine and urine output prior to each dose, 5. Diagnostic Considerations: ABG, chest X-ray, ECG, CBC, electrolytes. Uttasound (to determine if PDA has closed). 6. Consider surgical intervention i two courses of indomethacin ailtoclose the PDA or if indomethacin therapy is contraindicated, 7. Cardiac consult for umbrella plug placement. Hepatitis Prophylaxis Infant born to HBs-Ag Positive Mother Hepatitis 8 immune globulin (HBIG) 0.5 mL IM x 1 within 12 hours of bith “Hepatitis B vaccine 0.5 mL IM within 12 hours of bith, second dose at age 4-2 months, third dose at age 6 months. Neonatal HIV Prophylaxis 'A. Pregnant women with HIV should be given oral zidovudine (100 mg PO five times daly) beginning at 14-34 weeks gestation and continuing througout he pregnancy ea pre shoul be given the nthe ing iabor nt dolvey (ging uningneeepor ad then mp 0 “e ‘should be . Oral administration of zidovudine to the immediately after bin and continued for at least six weeks ‘@mgkplday po qBh for the first two weeks, and then follow the dosing tegimers on page 54, The mother should not breastfeed the infant. Commonly Used Formulas Normal urine output = 50 mL/kg(day Oliguria <1 mL/kgihr Normal feedings = 5 o2/ko/d Formula = 20 calories/ounce, 24 caloz, 27 caloz (Ounce = 30 mL Caloric Noods = 100 Kealkg/day CaloriesiKg = mL of formula x 30 mL/oz x 20 calories/ez divided by weight. Weight in Kg = pounds divided by 2.2 Blood volume (mL) = 80 ml/kg x weight (ka) 0.1 univkg pl 1 Uikg of Factor ‘a gracent =((Py-PH,0) FO,- PCOJR]- PO, ateral Py 760 mm Hg PHO = 47 mmHg R= 0.8 NL <10-15 mmHg ‘Arterial oxygen capacty=Hgb9m100 mL. x 1.96 ml. O2/gm Hid Aro! 2 content= 1.36(Hgb)(Sa02}0,000(Pa02)=NL 20 vol% (02 dalvary = CO x arterial 2 contantaNt. 640-1000 ml. 02min Cardiac output = HR x stoke volume cOUmin= 125 ml O2/min Me x100 85 ((1.36)(Hgb)'Sa02) (1.96)(Hgb)(SvO2)) ‘SVR =_MAP - CVP x 80 = NL 800-1200 dynelsoolem? COL PVR = PA-PCWP x80=NL 45-120 dyna/seclem? £0 san ‘anion Gap = Na - (Ci + HCO3), Creatinine clearance = Creatinine (mg/100 mL) x time (1440 min tor 2¢h) Scanned with CamScanner‘Normal Adult Creatinine Clearance = 100-125 mL/min (males), 185-105 (lemales) Body water deficit (L) = 0 6(weight kal(Na serum)-140) 140 Osmolality = +.BUNL+ glucose = NL-270-200 mOsmvag 28 (16 Fractional excreted Na =, U Creatinine! Serum Creatinine Scanned with CamScannerScanned with CamScanner