Emergency Paediatric Formulas

Formulas
ETT Sizes
Weight. Tube size. Catheter
1000gm. 2.5 mm 5 Fr.
1-2 kg. 3.0 mm 6 Fr
2-3 kg. 3.5 mm. 7 Fr
>3 kg. 4.5 mm 8 Fr
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ET tube length at lips
Wt+ 6 cm
——————————————-
UAC : 3 * birth wt + 9
UVC : (0.5 * UaC )+ 1
——————————————-
Blood Transfusion :
Desired rise in Hb *wt*4
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QTc = QT/square root of RR
RR are the small square between 2 RR
QT interval = count the no of small square then multiply by 0.04 sec
Normal : 0.35-0.45 @ 60-100/min

NaHco3 required = wt*(12-actual bicarbonate in mol/lit) *0.3

Base deficit*wt*0.3 = ml of 8.4 % sol

Nacl required = wt *(125-actual S sodium mmol/l ) *0.6

PRBC in ml = wt(kg) *4*(10-observed Hb)
WHOLE blood in ml =wt*6(10-observes Hb)

Paediatric Emergency Medication

Medication
Adrenaline(Epinephrine)
Resuscitation and severe Bradycardia 0.1-0.3 ml/kg, 0.01–0.03 mg/kg(10 to 30 mcg/kg 1:10,000 IV push
ETT 0.05-0.1mg/kg followed by 1ml NS
IV cont Infusion 0.1 mcg/kg/min adjust to desired response to max 1 mcg/kg/min
Monitor HR BP RBS continuously observe IV site for sign of infiltrates
——————————————-
SODIUM BICARBONATE:
In case of prolonged cardiac arrest
If significant acidosis is expected
Base deficit is> 10 and PH < 7.1
1-2mEq/kg over at least 30min OR
1 ml/kg of 7.5% NaHCO3
HCO3=HCO3 deficit mEq/L *(*0.3*body wt)
w/f hypocalcemia hypokalemia and hypernatraemia
——————————————-
MAGNESIUM SULFATE
Resuscitation 25-50 mg/kg IV over several min
Torsades pulseless 25-50mg/kg ovzyb nnner 10-20 min
Hypomagnesemia 25-50mg/kg Infusion overjzua 30-60 min(0.2-0.8 mEq/kg/dose)
IV q8-12h for 2-3 doses
Maintenance 0.25-0.5 mEq/kg/day.
Hypocalcemia :- 100mg/kg IV q12hrs for 2-3 doses

——————————————-MORPHINE SULPAHATE
0.05 to 0.2 mg/kg per dose IV over at least 5 min IM or SC repeat as required Q4H
Continuous infusion give a loading dose of 100 to 150 microgram /kg over 1 hr followed by 10 to 20 microgram/kg hour

_____________________________________________
Agent Type
Agent
Initial Dosage
Additional Factors
Volume expanders
Isotonic sodium chloride solution
10-20 mL/kg intravenous (IV)
Inexpensive, available
Albumin (5%)
10-20 mL/kg IV
Expensive
Plasma
10-20 mL/kg IV
Expensive
Lactated ringer solution
10-20 mL/kg IV
Inexpensive, available
Isotonic glucose
10-20 mL/kg IV
Inexpensive, available
Whole blood products
10-20 mL/kg IV
Limited availability
Reconstituted blood products
10-20 mL/kg IV
Use type

O negative

Vasoactive drugs
Dopamine
5-20 mcg/kg/min IV
Never administer intra-arterially
Dobutamine
5-20 mcg/kg/min IV
Never administer intra-arterially
Epinephrine
0.05-1 mcg/kg/min IV
Never administer intra-arterially
Hydralazine
0.1-0.5 mg/kg IV every 3-6 h
Afterload reducer
Isoproterenol
0.05-0.5 mcg/kg/min IV
Never administer intra-arterially
Nitroprusside
0.5-8 mcg/kg/min IV
Afterload reducer
Norepinephrine
0.05-1 mcg/kg/min IV
Never administer intra-arterially
Phentolamine
1-20 mcg/kg/min IV
Afterload reducer
Milrinone
22.5-45 mcg/kg/h continuous IV infusion (ie, 0.375-0.75 mcg/kg/min)
Afterload reducer in cardiac dysfunction; decrease dose with renal impairment

Albumin Human 20%
1-2 gm/kg or 5-10 ml/kg


ROP Screening in Newborn


ROP. Premature
ROP : < 1.5 kg or 32 weeks , who were on oxygen prolong ventilation
ROP screening :4 wks or 32 wks.
USG cranium :day 1, 7 , 28 days
Hearing test : 4 to 6 week of age
Indication for hearing test:
Had exchange transfusion
Whose SBR was near exchange
Meningitis
Intrauterine infection
HIE 2-3
On Aminoglycosides
Family history of deafness

Ventilator parameter

> PIP 》 > pao2, < paco2
>PEEP 》>pao2, >paco2
> rate 》<paco2
>Fio2 》 >pao2
>T¡ 》 >pao2 , > paco2

1} hypoxia & hypercapnia 》 > PIP
2} hypoxia with normal paco2 》 >Fio2
Then > T¡ or > RR or > PEEP(not>6)
without > PIP
3} hpercarbia with normoxemia
>RR 》 < PEEP 》》 < T¡


all about ventilotor😌
💥💥💥💥💥💥💥💥
✍look for co2 and PO2
if both high or low
(⬇⬇or⬆⬆)
🎈 play on peep

🗝⬆ co2 and⬆po2== decrease Peep

🗝⬇ co2 and ⬇ po2==increase peep

✍if one of them high and the other is low (or vise versa)
(⬆⬇) =
🎈play on pip
🗝⬆co2 & ⬇po2==
⬆ pip
🗝⬇ co2 &⬆po2==⬇pip

✍if po2 is normal but co2 is high or low
⬆↔️ =play on VR

🗝↔️po2⬆co2==
increase VR
🗝↔️po2 &⬇pco2==
decrease VR

🏆🏆🏆🏆🏆🏆🏆🏆
blood gas
if acidosis look for co2 & HCO3
✍BOTH ⬆⬆ & NORMAL Ph=
🎈compenated resp acidosis(if ph is still not normal so partial compensated resp)

if both⬇⬇ & ph normal ==
🎈compensated metabolic acidosis (if ph still acidotic then partial compensated metabolic)

if one ⬆ and the other is low =
🎈mixed

Ventilator parameters
FiO2. 21%———100%
PIP 10cmH20. —25cmH2O
PEEP 3cmH20 —-8 cmH20
RR. 20/min——-60/min
MAP. 10cmH2O—-12cmH2O
Ti. 0.35sec——-0.6sec
I:E. 1:1.2

Max PIP setting
<27 w 》24
27-32w 》26
33-35 w》28
Upto 25 in preterm 30 in fullterm

PEEP
as low as 3 and high as 8
Start at minimum 4-5
Inc to(6-7) if Fi02 needed >60%
May reach 8-10 if needed

Fio2
Start low at 40%
Fi02 may be Inc by (2-5) & allowing 4 max
consider Inc PEEP prior to Fi02

Rate
According to GA & Wt 50-60 if <34w or< 3 kg
40-50 if >34w or >3kg
30-40 if >40w
If rate >60 watch for air trapping
Adjust inspirstory time
Can be decreased to 20 during weaning

Ti
Start at 0.3-0.5
<1 Kg 》0.25-0.3 mim0.2
1-2 kg》0.3-0.4 mim0.2
2-3 kg 》0.35-0.55 min0.25
3-4 kg 》0.4 -0.6 Min 0.3

_________________________________
Respiratory Distress Syndrome
FiO2 0.4–0.6
Low PIP(10-20)cmH2o
Moderate PEEP 4-5
Flow rate 6-8 lit/min
Rapid rate >60/min
Ti 0.2-0.3 sec
I:E not less then1:1.2

Target Bl gas
PH : 7.25-7.35
PCO2: 45-55
Paco2: 50-70
_________________________________
Meconium Aspiration Syndrome
High PIP. 25-30
Mod PEEP 3-5
Mod rate 40-60
I:E > 1:3
If gas trapping occurs decrease PEEP and Increase exp time
Target Bl gas
PH: 7.3-7.4
PCO2: 35-45
Paco2 60-80

_________________________________
Air leak
Low PIap
Short Ti
Low PEEP
RR may be increased up to 60
High FiO2
_________________________________
Apnea
FiO2 0.21-0.3 / <25%
PIP 10-18
Low PEEP 3-4
Slow RR 30-40
Ti 0.35-0.4
Flow rate 7-8 / min
Target Bl has
PH: 7.25-7.35
Paco2 55
Pao2 50-70
__________________________________________
PPHN
Higher rate 50-75/min
PIP: 15-25
Low PEEP: 3-4
Ti 0.3-0.4
High Fio2 80-100%
__________________________________________
HIE
Rate: 30-40
PIP : 15-25
Low PEEP: 3-4
Fio2 to maintain spo2
PH 7.35 7.45
Paco2 :35-55
Pao2: 60-80
___________________________________________
Cong Diaphragmatic Hernia
Lowest PIP suffient for chest excursion
relatively rapid rate 40-80
Short Ti 0.3-0.5
PH: >7.25
Paco2 45-65
Pao2 50-70
__________________________________________
BPD
Lowest required PIP 10-20
Mod PEEP 4-5
Slow rate 20-40
To 0.4-0.7
PH 7.25-7.35
Paco2 50+
Pao2 50-70
___________________________________________

Apnea in NB

Apnea
All infants less then 32 weeks
Aminophyllin 5mg/kg as loading dose 5m/kg over 10 min then 2 mg/kg/dose every 8-12 hrly followed by oral 5mg /kg/day Q8H. Pt on Aminophyllin w/f irritability,seizure or gastric bleed,tachycardia,feed intolerance, jitteriness,and hyperglycaimia
Caffeine 10mg/kg laoading dose followed by 2.5mg/kg once a day maintence dose

Treatment Of HIE in NB

HIE

Maintain the bl gases and acid base status in the physiological ranges and prevent hypoxia hyperoxia hypercapnia & hypocapnia.

They are at risk of pulmonary HTN

Maintain mean BP > 35-40 mm If

promptly treat hypotension

Dopamine and dobutamine can be used to achieve adequate cardiac output

Avoid iatrogenic hypertensive episode

Avoid hypo and hyperglycemia

Avoid hypo and hypercaleciumia

Avoid hypertermia

Fluid restriction

W/f urine output , signs of NEC

NPO unroll the general level of alertness and conciousness improve

Treat seizures early and control them as fully as possible

Polycythemia

Polycythemia(Hct more the 65%)

SGA,Placental Insuffiency,Pre-eclampsia,maternal diabetes,post –term,IDM,CHD,Twin to Twin and Mother to fetus

Symtoms and signs: irritable lethargy,poor feeding,hypotonia

Complication: Hypogycemia,hypocalcemia, Hyperbilirubinemia, thrombocytopenia, respiratory distress, renal vein thrombosis , renal failure, NEC, seizures

Volume for partial exchange=wt in kg*80*(observed-desired Hct)/observed Hct

Simple rule is 20 ml/kg

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