ABG (chang/obra)

neonate
x
ph
7.3-7.4
pCO2
30-40
35
HCO3
20-22
22
O2
50-80

7.35

older
7.35-7.45
7.4
35-45
40
22-26
24
>95

HCO3/CO2
MET ACID
pCO2:1.5 x HCO3 + 8.4 +- 2
{limit of 10}
MET ALK
chang:
CO2: inc by 0.5-1 per HCO3 inc 1
35 or 40 + {limit of 55}
obra:
pCO2: 0.9 x HCO3 + 9 +- 2
RESP ACID
obra:
HCO3(24+):^ pCO2/10 x 2.5
chang:
acute=
HCO3(24+):0.1 x ^pCO2 +-3
{max 27-28}
chronic=
HCO3(24+):0.4 x ^pCO2 +-3
{>30}
RESP ALK
obra:
HCO3 (24-):^ pCO2/10 x 4
chang:
acute=
HCO3(24-):0.1-0.3 x ^ pCO2
{20-22}
chronic=
HCO3(24-):0.5 x ^ pCO2
{12-15}
ACUTE VS CHRONIC
RESPI ACID
^H: 24 x pCO2
: ^H -40
--------------HCO3
^pCO2
if = <0.3 : chronic
0.3-0.8:acute/chronic
>0.8:acute
RESPI ALK
pH=7.41-7.45 : chronic
>7.45 : acute
HCO3 DEFICIT
ABE x wt x 0.3 (1/2 correction)
half bolus, half drip

hco3 + dist water

ABE
HCO3 (desired-actual) x 0.6
desired=22
ABG INTERPRETATION
Rule #1:
An acute change in PaCO2 of
1mmHg is asso w/ an inc or a dec
in pH of 0.008 units thus, when the
PaCO2 increases by 10mmHg will
dec by 0.08 units (inversely
proportional).
> determine the resp component of
acid-base balance
To asses the resp component of aid-base balance:
1. calculate the amt by which the reported PaCO2 either falls below or exceeds 4
0mmHg. Subtract the patient's PaCO2 from 40mmHg.
2. Predict the pH based on the measured PaCO2 accdg to rule #1.
3. Compare the measured pH w/ the predicted pH.
*If the predicted pH is equal to the
measured pH, all change in the oH
are resp in origin.
*If the measured pH is > than the
predicted pH, an asso. metabolic
alkalosis is present.
*If the measured pH is < than that
predicted from PaCO2 an asso.
metabolic acidosis is present.
Rule #2:
A pH change w/ 0.01 units is the
result of a base change of 0.67
mEq/L, therefore, pH inc or dec by
0.15 units, corresponding inc or dec
in base by 10 mEq/L (directly
proportional).
> the diff bet calc pH & measured pH (ABG result) x 2/3 (0.66)meq/L is equal to
base excess
> if BE is > 4 either +/- AbN
+ 4: met alkalosis
- 4: met. acidosis
BD/BE calculated by multiplying the difference between the actual pH and predict
ed pH from the PaCO2 by 67. The predited pH is always subtracted from the actual
pH before multiplying the difference by 67. If the actual pH is lower than the
predicted pH, the difference will be anumber indicating a base deficit & the pre
sence of metabolic acidosis.
Rule #3:
The total body HCO3 deficit = base

deficit x pt's wt (kg) x 0.3

ABG READING
METABOLIC ACIDOSIS
Expected pCO2 = HCO3 x 1.5 + 8.4+-2
Limit = 10mmHg
METABOLIC ALKALOSIS
Expected pCO2 = each mEq inc in
HCO3 will inc pCO3
by 0.5 - 1mmHg
Limit = 55mmHg
RESPIRATORY ACIDOSIS
Acute
= HCO3 inc by 3-4mEq/L every10
Limit = 30mmHg
Chronic
= each mmHg inc in pCO2 will inc
HCO3 by 0.4mEq/L
RESPIRATORY ALKALOSIS
Acute
= HCO3 dec by 2-4mEq/L every 10
Limit = 18mmHg
Chronic
= each mmHg dec in pCO2 will dec
HCO3 by 0.5mEq/L
Limit = 12 - 15mmHg
ABG VALUES
pH
NV
ACID
ALK

pCO2

7.35-7.45
< 7.35
> 7.45

35-45
>45
<35

HCO3
22-26
<22
>26

Ex: pCO2 = 50 mmHg

pH
= 7.26
Rule # 1:
50-40 = 10
10
0.08

10
x

x = 0.08
N pH : 7.40 - 0.08 = 7.32
Actual pH - Measured pH
7.26
7.32

= -0.06

BD/BE=0.06 x 67=4.02 (met acidosis)

Total HCO3 deficit:
4.02 x wt x 0.03 = amt of HCO3
givenas 1/2,
1/4, 1/4
corection

OXYGENATION (PaO2)
newborn: 50-80
> 1 mo:
>80
60-80
40-60
<40

normal
mild
moderate
severe

RESPIRATORY DISTRESS
paO2 < 60 mmHg at room air
pCO2 > 50
paO2/FiO2 (dec) < 200
ALVEOLAR TO ARTERIAL O2 GRADIENT
AaDO2=
<(FiO2)(Pb-47)-(PaCO2/R)> - PaO2
Pb:760 (barometric pressure at sea level)
R:1 (respiratory quotient)
47: water vapor pressure
if > 500; 80% mortality
AO2=
713 x FiO2%(dec) - (pCO2/0.8)
a/AO2= pO2/AO2
if . 500, 80% mortality in OR
CALCULATED PAO2 (partial alveolar O2)
(pb - PH20) (FiO2) - PaCO2
pb=760
PH20=47
if diff bet PAO2 and PAO2 is <205, normal

ACUTE MI
CRITERIA
1. Typical pain
retrosternal, severe, lasting >30 min, unrelieved by nitrates, asso with cold cl
ammy perspiration
2. Evolutionary ECG abn
St elevation ff by Q wave formation and t wave inversion
3. Elevated serum CPK-MB
Labs for AMI
Onset Peak
CK-MB
4-6h
SGOT
8-12h
LDH
12-24h
ALEC GODCHILDREN
NAME
MA/PA
1
2
3
4
5

Duration
12-24h
36-48h
2-4D
BIRTHDAY
rachel
ryan
nefer
al
nenet

24-48h
3-5D
7-10D

6 tisay
7
anthea
ALL HIGH RISK PROTOCOL
PHASE
induction
consolidation
maintenance
vincristine 15 mg/m2 on D0,7,14,21
doxorubicin 25 mg/m2 on D0,7,14,21
prednisone 40 mg/m2 on D21-25L aspariginase 6mg/m2 for 9 doses
(3 doses per week; mwf/mtw)
ALLOPURINOL
10 mkD
AMINOGLYCOSIDES
Amikacin 10-15 MKD
OD in NB & infants
q 12 in older children
<27wks: q48H
28-30wks: q36H
31-33wks: q36H
>34wks: q24H
Amikacide 100/2; 250/2
Kanamycin 30-50 MKD
Netilmycin 30-50 MKD
Netromycin 50/2
Tobramycin 6-8 MKD
Gentamycin 4-8 MKD
<29wks: 5
30-33wks:
34-37wks:
>38wks: 4
Garamycin
AMIODARONE
5 mkd q 8 for 1
q 12 for 1 week
od for 1 week
ANALGESICS

MKd q48H
4.5 MKd q48H
4 MKd q36H
MKd q24H
20; 40; 80/2
week

Mefenamic Acid 3-5 MKd

Ponstan 50/5
Nalbuphine 0.1-0.15 MKd
Nubain 10/ml
Midazolam 0.1 mkd
iv: 5/1; 5/5; 15/3
po:5 mg/tab
Pancuronium 0.04-0.15 MKd q1-2h
Fentanyl
low:

2ug/k/d

mod: 2-20 ug/k/d

high: 20-50 ug/k/d
Infusion rate: 1-5 ug/k/H
Anesthesia: 5-50 ug/k/d
Sublimaze (Janssen) 50 ug/2
50/1
Promethazine
Phenergan

IV: 50/2
PO: 1/1;10

Morphine 0.1-0.2 mkd

10/mL
Meperidine 0.5-1.5 MKd
Max 2 MKd IV: 4MKd PO
Demerol
Ibuprofen 5-10 MKd q6-8
Dolan 100/5
ANEMIA
DEFINITION
neonate: > 34 weeks
venous hgb=<13 g/dl
capillary hgb=<14.5
PHYSIO
venous hgb
retic
mcv

birth=14-20 (17)
3-7%
107 fl

physio anemia of infancy

term
dec on 3rd wk
nadir of 11 at 8-12 wks
preterm
nadir of 7-9 at 4-8 wks
causes:
dec rbc mass at birth
inc losses fr sampling
shorter rbc lifespan
inadeq erythropoietin
rapid body growth
MANAGEMENT
1. REPLACEMENT TRANSFUSION
acute hgic anemia
ongoing deficit replacement
maint of effective O2 carrying
hct <35 severe cp disease
hct <30
mild-mod cp dis
signif apnea
>9-12h
sx anemia
wt g <10gkd
at ful caloric
hr >180 fr 24h
major surg
hct <21

asx with low retic

2.EXCHANGE TRANSFUSION
chronic hem anemia
severe isoimmune hem anemia
o ab
consumption coag
3. NUTRITIONAL REPLACEMENT
iron
fetomat hge
twin-twin
increm ext bld loss
consumption coag
preterm <36
folate
preterm <1500g or <34w
chronic hem anemia
infants on phenytoin
vit E
<34 weeks unless breastfed
15-25 iu/day
PROPHYLACTIC
erythropoietin
nutritional supplement
iron:1-2 mkD beg at 2mo til
1yo
folic acid:
preterm:1-2 m/wk
term:50 ug/dy
vit E:25 iu/day until
4mo
d age
ANTACIDS
Cimetidine 10-20 MKD q12H
Tagamet syr 200/1,100/5
tab 200; 400; 800
IV 200/2; 300/2
Ranitidine 4-5 MKD q8H
Zantac
PO: 15/ml; 150, 300/tab
IV: 50/2
+ DW to make 20 cc
slow ivtt
Cisapride 0.2 MKD q8
Prepulsid 1mg/ml
Maalox 10-15cc 1hr pc and HS
Novaluzid 1hr pc and HS
Famotidine 0.7 MKd q12
iv:20/2
po: 20,40 mg tab
Omeprazole 0.6-0.7 mkd
Losec 20 mg, 40 mg

w sensitized rbc and is

correcte

Sucralfate 40-80 mkD q6-8

1 g tab
pptab, dissolve in water
ANTI-ASTHMA
Aminophylline LD 8-10 MKd
MD 3-5 MKd
Q8-12H very slow IVTT to be
diluted w/ equal amount of
dist. water. For older infant,
dosage may be increased to
25-30 MKD q4-8H
prep:250mg / 10mL
*if changing IV to PO aminophylline, inc dose by 20%
*from IV to PO Theophylline, no adjustment
DRIP: 0.4-0.9 MKH
How to drip:
e.g. 5kg @ 0.4 MKH in 8H drip
5 x 0.4 x 8 = 16mg in 8H
if IVF rate is 5cc/H, fill SS w/
40cc IVF + 16mg Amino
(0.64ml)
e.g. wt x 0.5 x 24 (hrs)=ml/day
if drip in 12 hrs:1/2 + 60 cc DW
60=5cc x 12 h
Neonate: 1 mkd q8 or 2 mkd q 12
Apnea: LD 5-6 mkd
MD 2 mk 12 hrs post LD
Theophylline 3-5 MKd q8H
Neullin 80/15; 50;125;250,
Doxophylline 6-9 mkd q 12
100/5
Terbutaline SQ: 0.005 MKd
PO: 0.075 MKd
Drip: 0.003 MKH
Bricanyl IV: 0.5/ml
PO: 1.5/5; 2.5
Neb. 5mg/2
Salbutamol 0.15 MKd
Ventolin 2/5 syr; 1.2/5 exp;
2/tab
Neb: 2.5mg/2.5ml
Librentin 2/5; 2/tab
Prox-S: 2/5
Atrovent 4gtts/ml NSS
0.4-1 ml TID-QID
Berodual neb: 4-10gtts + 3cc Nss
alternate w/ Terbutaline
even up to q2H

(rate of 5 cc / hr)

26/5

Budecort neb q12H

Bambuterol 0.17 mkd od-bid
1 ng/cc
Singulair
2y-9y
6y-14y
> 14 y
Prep:

4 mg
5 mg
10 mg
4 mg grain
4.5 chewable tab
10 mg tab

Mesna administration
mesna 0.5 ml + PNSS 1 ml
5-8 gtts/ET
bag
suction
MgSO4 0.1-0.2 mk q6-8 iv
MgSO4 10%
ANTI-FUNGALS
Nystatin 0.5-1.0ml TID-QID x 7D
1 ml(PT)-2 ml(FT) of 100 TU q6
NB: 400 TU/D
inf/child: 1-2 MU/D
Mycostatin 100 TU/ml susp
500 TU/tab
Aphotericin B
Initial dose: 0.25-0.5 mg/kg
MD: 0.5-1mg/k q24H to 48H
50mg powder dilute in 10ml
dist water
Griseofulvin 10 MK SD
Adult:500-1000 mD but not < 10
ses
Child: 10 mkD in divided doses
Grisovin 125 mg tab
Fluconazole
Systemic infxn in meningitis:
LD: 12mg/kg
MD: 6mg/kg x 1 week
<29wks (0-14 D): q72H
(>14D): q48H
30-36wks (0-14D): q48H
(>14D): q24H
37-44wks (0-7D): q48H
(7D): q24H
>45 wks: q24H
Thrush: 6MK day 1,then
3 MKd q24H PO
Diflucan 2mg/ml
50, 150, 200 mg/cap

mkd single or divided do

Ketoconazole
<15kg: 5mg
15-30kg: 100mg OD
>30kg: 200mg OD
NIzral 200mg/tab
ANTI-TB DRUGS
Rifampicin 10-15 MKD OD, ac
< 12y: 10-15 mkD
> 12 y: 10 mkD
liver, orange colored secretions
Natricin 200/5
Ricyn 200/5
Rimactane 100/5; 200/5
*Meningococemia
3mo-1yo: 5 MK q12H x 4 doses
1yo-12yo:10 MK q12 x 4 doses
adult: 600 MK q12 x 4 doses
INH 15-20 MKD Tx
10-15 MKD Px
< 12 y: 5-10
> 12 y: 5
OD, ac
liver, peripheral neuritis
Trisovit 50/5
Nicetal 100/5
Primafort 100/5
Odinah 150/5
PyrobinH 150/5
Trisofort 200/5
Comprilex 200/5
Pyrazinamide 15-30 MKD TID pc
if in school: can be given OD
delayed growth, lag period
PZA-Ciba 250/5
Pharex PZA 250/5

factor

Ethambutol 15-25 MKD q8H ac

Ethambin 125/5; 200mg/tab
Myambutol 200/5
Isoetam 150/5
Ethambin INH 125; 150/5
Pediambutol: Etham 125/5
INH 15/5
Pyridoxine 6/5
Streptomycin 20-30 MKD OD IM
< 12 y: 20-30
> 12 y: 15
ototoxic
ANTIAMOEBIC
Metronidazole 40-50 MKD
NB<2kg: 15 MKD q12H
NB>2kg, <7D: 15 MKD q8H
NB>2kg, >7D: 30 MKD q8H
IV LD: 15 MK

MD: 7.5 MKd q8H

Flagyl 125/5; 25; 500mg
IV: 500/100
Servizole 200/5
Tinidazole 50-60 MK OD x 3 days
Fasigyn 300; 500
Etofamide 15-20 MKD
Kitnos 100mg/5ml; 250; 500
Secnidazole 30 MKonce w/in 4H or
12H for children (4tabs)
Flagentyl 500mg/tab
Furazolidone 5-7 MKD q8H
Furoxone 16.7/5
Diloxanide furoate
RD: 20 MKD x 10 days
Furamide 125/5
Nitrofuroxazide (Ercefuryl)
< 6 mo 5 mL bid
> 6 mo 5 ml tid
60mkD q8
Ercefuryl 220/5
ANTIBIOTICS
PCN G
NB: 50-100 T U q12
beyond NB: 100-200 T U q6H
Meningitis: 200-400 T U q6h
Congenital Syhillis: 50 T U
cc = 5
---------TU IM
625 mg = 1 M U
250/5 = 400 TU/5ml
312.5/5 = 500 TU/5 ml
500 mg = 800 TU/5 ml
Oral PCN 50-100 MKD
Pentacillin 50/5; 500
Sumapen 25/5; 250; 500
Megapen 50/ml drops
312/5; 625
Amoxicillin 40-60 MKD q8H
Pediamox
Glamox
Himox
Moxillin
prep 250/5
at er.. 25mkdose bid x 3days
Amox/Clavulanic Acid 40-60 MKD
Augmentin 312.5/5 (250)BID
156/5

(125) TID, 457/5 (400)

Amoclav 228.5/5 (200), 312.5/5 (250) tid, 457/5 (400) bid
Co-Amoxiclav 156/5, 312/5
Naficillin 100-200 MKD q6H
25-50 MKd
Vigopen 250/5
<29wks (0-28days): q12H
(>28days): q8H
30-36wks (0-14days): q12H
(>14days): q8H
37-44wks (0-7days): q12H
(>7days): q8H
>45wks: q6H
Stafloxin 100-200 MKD
Ampicillin NB:50-100 mkD
100-200 MKD
mening: 300-400 mkD
Ampicillin + Sulbactam 25-50 mkD
Unasyn 375 mg (250)
750 mg (500)
Bacampicillin 25-50 MKD
Penglobe 200/5
Vancomycin 40-60 MKD give in 2 hrs
10 mkd
q12 in neonates
q 6 in children
<29wks: 20 MKd q24H
30-33wks: 20 MKd q18H
34-37wks: 20 MKd q12H
38-44wks: 15 MKd q8H
>45wks: 10 MKd q6H
*reconstitute 500mg vial with
10cc sterile water for
injection (or D5W, PNSS) then
ck
sol with D5W, D5IMB, PNSS)
inal conc
of 5mg/ml. Solution is stable
for 14 days.

make a sol total 100cc (sto

to make a f

Oxacillin 50-100 MKD

25-50 MKd
Prostaphlin
IV = 100-200 MKD
NB: 35-50 mkd q 12
<29wks (0-28days): q12H
(>28days): q8H
30-36wks (0-14days): q12H
(>14days): q8H
37-44wks (0-7days): q12H
(>7days): q8H
>45wks: q6H
*reconstitute 1g vial with 5.7
cc sterile water to make a final
7cc conc of 167mg/ml.

Solution is stable for 3 days at

room temperature, 7 days ref
IV drip over 30 min
Prostaphlin 125/5
Orbenin 125/5; 250; 500
Cloxacillin 50-100 mkD q6
Prostaphlin A 125/5
Pharex 250/5
Flucloxacillin 100-200 mkD
Stafloxin
Ciprofloxacin 15-30 mkD q 12 (iv,po)
for px older than 6mos
ANTICONVULSANT
Diazepam 0.2-0.4 MKd
Max 2-5 mg
or wt x 0.04=ml
Valium 10/2
Trazepam 10/2
DRIP
0.3 mkh dilute in NSS makes
conc: mg/total vol(ml)
Rate: RD x wt x 60
------------------conc
AD: rate x conc
------------wt x 60

0.1mg/mL

Phenobarbital
LD 15-20 MKd
MD 3-5 MKD q8-12
Luminal IV 130/ml
PO 20/5
Gr I(65mg)
1/2(30mg)
1/4(15 mg)
Phenytoin
LD 15-30 MKd
MD 5-8 MKD q8
or 3-9 mkd q12
Dilantin IV 100/2
PO 30/5; 125/5; 30; 100
*to be diluted w/ equal amt of
dist water, to be given very
slow IVTT while monitoring the
heart rate. Hold if with
arrythmias. Flush dist. water
prior to & after giving dilantin.
not added to glucose containing
* with ECG monitoring
Carbamazepine 10-20 MKD
Tegretol 100/5; 200

solution

Clonazepam 0.01-0.03 MKD

For Bael: LD 0.03 MKd
MD 0.08 MKD q12H
Rivotril 2/tab
Valproic Acid 10-15 MKD
Depakene 250/5 po, 400/4 iv
Epival 250/tab
Lorazepam 0.05-0.1 MKd
Max 0.4 MK
Midazolam
IV: 0.15-0.3 MKd q2-4H
IV Infusion: 0.01-0.06 m/k/H
(10-60ug/k/H)
Intranasal: 0.2-0.3 MKd; 5mg/ml
Sublingual: 0.2-0.3 MKd;
Oral: 0.3-0.5 MKd
Prep: 5/1, 15/3
Midazolam drip
Rate: RD x wt x60
-----------conc
AD:
rate x conc
-----------wt x 60
Dormicum drip
1-5 ugkmin (* x 60)
0.06-0.12 mkhr
ex: 5mg/ml + 9 ml NSS
= 0.5 mg/ml
Rate: wt x dose *x 60
----------------0.5
AD: rate x conc
---------------wt x *60
Morphine 0.05-0.2 MKd q4H
or 0.1-0.3 mkd
16mg/ml diluted to make 1:1
IV infusion: LD 100 ug/k x 1H
MD 10-15 ug/k/H
Thiopental
LD: 5 mkd (2-4)
Drip: 0.5 - 2 mkh (1)
Prep: 1g/50cc (20%)
ANTIDERMATOSIS
Hydrocortisone 1% TID x 2 wks
Hytone
Hydrotpic
Eczacort
Bethamethasone BID-TID
Betnovate

5mg/1ml

Fluccinolone acetonide bid-tid

Aplosyn 10,25 HP
Synalar 10,25,HP
Mometasone furoate od
Elica
Clobetasole propionate
Dermovate
Diflucortolone valerate bid-tid
ANTIHELMINTHICS
Oxantel pyrantel pamoate
RD: 10-20 MKd SD @ HS
11 mk once Max 1g
prep:
Quantrel 20mg/ml; 100/5
100mg/tab
Combantrin 125/5
125, 250/tab
RD: >15 yo
: 500mg
10-14 yo : 375mg
5-9 yo : 250mg
5 yo : 125mg
Tetramizole 2.5-5 MKd SD
TMZ 12.5/2.5; 50; 100/tab
Albendazole 400 mg po once
200/5 10mL one dose
Mebendazole
100mg BIDx 3D
or 500 mg once
Antiox 20mg/ml; 100;
500mg/tab
Combantrin
125mg,250mg/tab
125/5ml susp
>15yo =500 mg
10-14 yo=375 mg
5-9 yo=250mg
5yo=125 mg
Piperazine
ascaris bolus
150 mk po then 65 mk q 12 x 6 doses
ANTIHISTASMINES
Diphenhydramine 3-5 mkD tid-qid
IV/IM: 1 MKD
50/1 x 3 d
PO: 3-5 MKD TID
12.5/5, 25, 50
Methdilazine 0.3 MKD q12H-6H
Tacaryl 4/5; 4; 8

Clemastine 0.05 MKD q12H

Tavegyl 0.5/5; 1mg/tab
Hydroxyzine 1 MKD
Iterax 2mg/ml; 10; 25 mg/tab
Ceterizine 0.25 mkD od
Atopic derm=0.25 mkd bid
Virlix 10mg/ml; 10mg/tab
Zyrtec 1mg/ml sol
10mg/ml drops
20 gtts=10mg
10 gtts=5 mg
5 gtts=2.5 mg
1drop=0.5mg
Loratadine
2-12yo <30kg: 1tsp OD
>30kg: 2tsp OD
Claritin 5mg/5ml; 10mg/tab
Ketotifen 0.025 Mkd q12
Zadec 1mg/ml
Zaditen 0.2 mg/ml.
ANTISPASMODIC
Dicycloverine 1 MKd
Relestal 5mg/ml gtts
10mg/5 ml syr
Bentyl 10/5, 10 mg
Hyoscine-N-butly bromide
Buscopan 1-3 tab TID
1-2 tsp TID
PO: 5mg/5ml; 10mg/tab
IV: 25mg/amp
Metoclopramide 0.1 MKd q8
Plasil 10mg/tab; 5mg/ml susp
10mg/2ml amp
Motilium 0.4-0.6 mkd
1mg/ml qid 15 min ac
10 mg tab tid 15 min ac
ANTIVIRAL
Methisoprinosine 50-100 MKD
Isoprinosine 250/ml;
500mg/tab
Inosinoplex 50 MKD
Immunosine 250/5
Amantadine 5-8 MKD
Symmetrel 50/5
Acyclovir 10-15 MKD q4H
Zovirax 200/5; 200mg/tab
zoster: 30 mkD

Virazole 10 MKD
APGAR
A activity
0 no activity
1 some flexion
2 very active
P pulse
0 none
1 <100
2 >100
G grimace
0 no response
1 grimace
2 good cry
A appearance
0 blue
1 pink body, bluish ext
2 pink allover
R respiration
0 none
1 slow, irregular
2 regular
2-3 severely depressed
4-6 mod. depressed
7-10 vigorous
ASTHMA CLASSIFICATION
BASED ON SEVERITY
intrmtnt

persistent
mod

mild

severe

day sx
<1/w

>1/w

daily

daily

night sx
2/mo

>2/mo

>1/w

>1/w

PEFR exp
80

80

<20

20-30

60-79

<60

PEFR var
>30

>30

FEV1
80
ATHMA SCORING

80

60-79

<60

WOOD'S SCORE
1
70 in
rm air
40fio2
unequal absent
mod
max
mod
extrem
depresd/ coma
agitated
mild asthma attack
moderate, bedside
severe, intubate

p02 or
50-100
cyanosis
breath snds
N
acc muscles
N
exp wheeze
N
cerebal fxn
N
1-3
4-6
7 up

0
70 in

SILVERMAN'S SCORE
0
flaring

min

1
marked

lower chest
retractions upper chest
retractions synch

visible
in-

xyphoid
retractions
grunting
(audible)
3-4
give 02
7
intubate

marked

seesaw
drawing

visible
marked
steth
ears

Personal best Predictive Value of PEF

females: ht(cm) - 100 x 5 + 175
males:ht(cm) - 100 x 5 + 170
actual PEF >80%, normal
BETA-LACTAM
Imipenem 60 MKD q6H
Neonate: 20-25 MKd q12H
Tienam
48 hrs: PNSS
24 hrs: DW
reconstitute with 100cc pnss,

keep ref, iv drip 30 min

Meropenem 20-40 MKd q8-12H

10-20 mkd q8
60 mkD q8
Sepsis: 20 Mkd q12H
Meningitis & Psuedomomas
infections: 40 MKd q8H
*decrease in platelet ct
Piperacillin
less serious:100-200 mkD q6
serious:200-300 mkD
Tazocin (+Tazobactam) 2.25 g
t
48-96 hrs storage
Aztreonam 30 mkd slow iv 5-10 min
BLOOD FLOWS
CO= 5 lpm
coronary bld flow
cerebral
muscle
skin
renal
puolmonary

5% of CO
15
20
5
25
100

difference bet arms is 5-10 mmHg

postural hypotension: fall of systolic >20 mmHg
big heart, clear lungs:pericardial eff
big heart, pul congestion: LV failure, cardiomyopathy
BLOOD TRANSFUSION

vial + 10cc DW, slow ivt

Blood volume
neonate 85cc/k
infants 80cc/k
children
75cc/k
I. FWB
20 cc/k (max)
vol=desired-actual hb x 6 x wt
desired-actual hct x wt
rate=vol x 12gtts/ml
----------------- = gts/min
60 min x 4 hrs
time=4-6 hrs
II. PRBC
10cc/k
neonates=10-15 cc/k
vol=desired-actual hb x 3 x wt
desired-actual hct x wt
time=3hrs
cardiac= hgb x wt 2( 2 aliqs)
III. SEDIMENTED RBC
15 cc/k
IV. PLT CON
5-10 cc/k
1u /6 k bw
mfd (2hrs)
1u=30-50 cc; raises plt by 10t
V. CRYPPT
20cc/k
soluble (fv,viii)
CRYOSUPERNATE
insoluble
viii, xiii , fibrinogen
if inc aptt, normal pt
VI. FFP
fluid rate
5-20 cc/k/h
4 hrs
10 cc/k
allowable blood loss:12-15% of blood
volume
BRAIN DEATH CRITERIA
Harvard
absence of response
negative EEG response
(-) reflex and respiration
(-) cerebral perfusion
BRONCHOPULMONARY DYSPLASIA
(BPD)
Treatment
dexamethasone 0.5 mkd x 3 d
learning disability

not routine
pulse course-6 doses in pt
not weaned fr mv
aminophylline
furosemide 1 mkd
limit fluids to 130 cckD
nebulize
vit a: 5000 u/k q other day 1st
month of life to prevent

bpd

BURNS
I. LUND & BREWER CLASSIFICATION
Age(y) 0-1
1-4
5-9
10-14
Head
21
19
15
Trunk
15.5 (for all)
UE
9.5 (for all)
LE
14
15
17
Genitalia 1 (for all)
II. AMERICAN BURN ASSN
PEDIA
head
18
UE /
9
trunk / 18
LE /
14
genitalia
0

15
13

11
18

19

ADULT
9
9
18
18
1

m2=(kg x 4 + 9) / 100
m2 burned=(% burn x m2) / 100
if > 50% SA burn, compute up to
dangerous if >15% involved
if >10% fliud loss, severe fluid
do not exceed 4-5 L of fluid
III. PARKLAND
PEDIA
% BSA x 2ml/k + 1500ml/m2
1/2 : 1st 8 hrs
1/2 : next 16 hrs
ADULT
cc/D= 4 ml x % burn x kg
1st 8h = 1/2 of computed
2nd 8h= 1/4
3rd 8h= 1/4
UO: 30-70 cc/h
1st hrs: LR
2nd hrs:
D5W - to replace evaporative
serum na of 140
Colloid sol (plasma) - to maintain
h >
40% 2nd & 3rd degree
UO : 30-100 cc/h
IV. CINCINNATI UNIT
4ml/k/% burns + 1500 ml/m2 BSA
1st 8h = LR + 50 mg NaHCO3
2nd 8h= LR
3rd 8h= LR + 12.5g albumin

50% only
loss

per 24 hrs

water loss, maintaining

plasma volume in pts wit
burns

V. GALVESTONE UNIT (SBI)

5000 ml/m2 % burn + 2000 ml/ m2 BSA
*INDICATIONS FOR HOSPITALIZATION
>15% BSA
high tension wire electrical burn
inhalational injury
inadequate home situation
*SUSPECT ABUSE/NEGLECT:
burns to
hands
feet
genitalia
2nd-3rd degree burns > 20 TBSA
chemical burns

CALCIUM
CALCIUM GLUCONATE
IV MD 200-500 MKD
max 200
IV 100/ml (9 elem

10%
q6H as drip;
MKd in 10 min
Ca/ml or
0.45 mEq elem Ca/ml)
PO 500 (45 mg Ca); 650; 58.5
Ca sandoz=110mg/5ml
* 1-2cc k/dose q8H
* 1cc = 9mg elem Ca
DR. GO
maintenance=30-40 mg/k/D
correction=50-70
ml of 10% ca gluc=
wt x dose9.4=cc in 24 hrs
CALORIC REQUIREMENT
< 1 mo ----------1-11 mo --------1-2 yo ----------3-8 yo ----------7-9 yo ----------10-12 -----------13-15 yo --------18-19 yo ---------

110-140 cal/day
110-115
100-110
90-100
80-90
70-80
55-85
45-50

0-6 mo ----------6-12 mo ---------1-3 yo -----------4-6 yo -----------7-10 yo ----------11-14 yo (M) ----11-14 yo (F) ------

117 kcal/k
108 kcal/k
100 kcal/k
90 kcal/k
80 kcal/k
65 kcal/k
55 kcal/k

15-18 yo (M) ----- 50 kcal/k

15-18 yo (F) ------ 40 kcal/k
up to 10 kg=
11-20 kg
>20

100cal/k
1000 + 50 cal/k >10
1500+20
>20

preterm 110-140 kcal/k/D

term
100-120
cho
chon
fats

50%
20
30

4cal/g
4
9

1T sugar=60 cal
CATCH UP CALORIES
kcal/k/day=
kcal/k req wt age x ibw(wt for age)
-------------------------------------actual wt
chon=1g/k/D
cho =60%
fats=rest
p50
(wt-age)
0-6 mo
6-12 mo
1-3y
4-6y
7-10y
adolescent
male 11-14
15-18
female
11-14
15-18
CBC VALUES
WBC

Neutro Bands
Lymph
Mono
Eos
Baso
Platelets

Hgb

energy
(kcal/k)

chon
g/k

117
108
100
90
80

2.2
2
1.8
1.5
1.2

65
50

1
0.8

55
40

1
0.8

Birth 9-30
24 h
9.4-34
1 mo
5-19.5
1-3 yrs 6-17.5
4-7 yrs 5-15.5
8-13 yrs
4.5-13.5
Adult 4.5-11
3-5
Seg

54-62
25-33
3-7

1-3
0-0.75
NB
84-478T
after 1week = adults
Adults 150-400T
1-3 days
2 mos 9-14
6-12 yrs

14.5-22.5 g/dl
11.5-15.5

12-18 M 13-16
F
12-16
18-49 M 13.5-17.5
F
12-16
Hct

1 day 48-69
2 days 48-75
3 days 44-72
2 mos 28-42
6-12 yrs
12-18 M 37-49
F
18-49 M 41-53
F

35-45
36-46
36-46

Band : Neutrophil ratio if > 0.2, neonatal sepsis

MCV=yrs + 70
adults:80-92
MCHC increase in spherocytosis
Mentzer value:
MCV / RBC count
<11 : thalassemia
>11 : IDA
CEPHALOSPHORINS
FIRST GEN
Cephalexin 50-100 MKD
Ceporex (125/5; 250/5)
Selzef; Keflex
Cefradoxil 25-50 MKD BID
Cefazolin 50-100 MKD q6-8H
Stancef 500mg; 1g vial
Cefradine 25-50 MKD q6H
SECOND GEN
Cefuroxime 50-100 MKD q8H IV
20-40 MkD q12H PO
Zinacef 250; 750; 1.5g
Zinnat 125/5; 250/5
Cefamandole 50-100 MKD QID
Mandol 500mg; 1g vial
Cefaclor 20-40 MKD q12H
Ceclor 50mg/ml drops
125/5 susp
250; 500mg pulvule
THIRD GEN
Ceftazidime
50-100 MKD
>3mos-1yo: 80 MKD BID

>2yo: 160 MKD TID/QID

Adults: 1-6g/day BID/TID
Neo-2mos: 90-100 MKD TID
30 MKd
<29wks (0-28days): q12H
(>28days): q8H
30-36wks (0-14days): q12H
(>14days): q8H
37-44wks (0-7days): q12H
(>7days): q8H
>45wks: q8H
Fortum 250; 500mg; 1g, 2g
<2mo 25-50 MKD BID
>2mo 30-100 MKD TID
Adult
1-6gm/day TID
Ceftriaxone 50-100 MKD OD, iv drip
child:20-80 mkD od
adult:1-2 g od
Sepsis & Disseminated GC:
50 MK q24H
Meningitis: 100 MK LD, then
80 MKq24H
Uncomplicated GC opthalmia:
50 MK (max 125mg)SD
Rocephin 250; 500mg; 1g vial
Cefotaxime 50-100 MKD bid-qid
GC Infection: 25 MKd
GC opthalmia: 100 MK SD
>12yo: 1g BID
<29wks (0-28days): q12H
(>28): q8H
30-36 (0-14days): q12H
(>14days): q8H
37-44wks (0-7days): q12H
(>7days): q8H
>45wks: q6H
Claforan 250;500mg, 1; 2g vial
<1200g
<4w: 7.5 q 48
>4w:7.5 q 36
1.2-2 kg
<7D:7.5 q 24
>7D:7.5 q 12
>2kg
<7D:7.5 q 12
>7D:15 q 12
Cefoperazone 100-150 MKD BID
Cefobis 0.5g & 1g vial
child: 50-200 MKD BID
adult: 2-4gm KD q12H
Ceftizoxime 40-80 MKD BID/QID:C
500mg-2g/day BID/QID: adult
Tergecin 500mg; 1g vial
Ceftibuten 9 MKD BID/OD
Cedax 200;400 mg cap

38mg/ml susp; 180/5

Cefixime 3-6 MKD q12H
Tergecef 100/5; 20/ml
100mg/cap
Zefral 100/5
50mg/1g sachet
Cefprozil 20 MKD OD or 15 MKD BID
Procef 250/5
Cefoxitin 50-100 MKD
Mefoxin 1g vial
Cefdinir 9-18 MKD q8H
Omnicef 50mg/sachet
100mg/cap
Cefetamet 20 MKD q12H
Globocef 250/5
CEDAX 9 MKD OD 180/5
FOURTH GEN
Cefepime 100 mkD q12
for severe infection 50 mkq 8
<2mos: 30 MKd q12-8
>2mos: 50 MKd q12 x 10 D
(w/o ref: 24H, with ref: 7days)
decrease platelet count
Cepimax 1g vial
CEREBRAL EDEMA
seizure : cytotoxic edema
increased icp
tx: mannitol
meningitis : vasogenic edema
tx: dexamethasone
CHEMOTHERAPY
CYCLOPHOSPHAMIDE
D5W 250 x 2 h
or
Dr. cabral:
cyclo 500 + D5W = 100cc, pb to
mainline (closed) in 1 hr
materials:
gloves
d5w 250cc
dw vial
soluset
5cc syringe #2
adverse rxn: acute hemorrhagic
cystitis
order:
hydrate (sa x 1500) in 8h
cyclo 1hr drip
metoclopramide 1 tab 30
or, then ivtt q8

(D5.3)
min pri

prn
pred q other day (to
leucocyte

decrease
count & alopecia

CYTARABINE
50-100 mg/m2
24 hr infusion
may not protect fr light
DOXORUBICIN
30 ml PNSS x 1 hr infusion
protect fr light
METHOTREXATE
CNS prophy
age
0-1
1-3
3-6
>6
adult 15

dose
6mg
8
10
12

jra
5-30 mg/m2 or 0.15-1 m/k
once a week
monitor cbc, esr 3 weeks
VINCRISTINE
1.5 mg/m2
dilute w 9ml 0.9NaCl
COMPOSITION OF BODY FLUIDS
FLUID
Na
K
Cl
HCO3
Gastric
50
10-15 150
0
Pancreas
140
5
50-100
100
Bile
130
5
100
40
Ileostomy 130
15-20 120
25-30
Diarrhea
50
35
40
50
Blood
140
4-5
100
25
Urine
0-100 20-100 70-100
0
COMPOSITION,MILK et al
Abbot,wyeth = 1:2
MJ & Nestle = 1:1
MILK
CAL
alfare 72/dL
bm(t) 699/L
bm (pt)
bonna
d5
d7.5
d10
d12.5
d50
enfalac
gain

671/L
22/oz

CHON g
FAT
CHO
2.5
3.6
7.8
9.09
41.96 72.7
75/dl
1.1
20/oz
14.09
38.93 66.4
1.1/dl
cc x .2
cc x .3
cc x.4

4.5

cc x .5
67.6/dL

cc x 2
2
21/oz
22/oz

3.5
2.25/dl
2.8g/dL

7.4

lactum 21.4/oz
nan1
67/dL
nan ha 67/dL
neosure 22/oz
nutren jr
prenan 80/dL

3.42g/dL
1.2
3.6
20/oz
1.5/dl
1.51

7.5

promil 81/dL
s26
s26lbw 100/

100/dL
3
3.9
13.3
2.3
4.2
8.6
21/oz
2/dl
2.4
4.1
8.9
20/oz
2.25/dl
2.4/dL
125ml
24/oz

similac pm
Nepro 14% chon
60% carbohydrate
26% fats
cal
mct
7.7/ml
veg oil 9/ml
caro syr
120/oz
corn oil
813/dL
CONVERSION

fat

cho
31

82

Celsius = (F - 32) x 5/9

F
= (C x 9/5) + 32
1cc
1gtt
1cc

= 15 gtts
= 4 ugtts
= 60 ugtts

CONVULSION SCORING
factor
occurence
duration
severity

0
none
fleeting
mild

frequency >60mi
ventilation adeq

1
upon
10-60s
mod
twitch
60sapart
impair

2
spont
stimulation
>1min
severe
clonus
>10mi
10 mi
impair
cyanosis

COUGH MEDS
Ambroxol 1.2-1.6 MKD q12H
Mucosolvan 15/5; 7.5/5
Zobrixol 15/5; 6/1; 7.5/1.5
Ambrolex 15/5
Bromhexine 7-12 yo: 1 tsp TID
2-6 yo: 1/2 tsp TID
Bromulex 4/5; 8mg/tab
Bisolvan 0.8 mg/ml elixir
2mg/ml soln
4mg amp
SCMC 20-30 MKD
Loviscol 50/ml drops
100/5

250/5
Solmux 40/ml drops
200/5 susp
Diphenhydramine 3-5 MKD
Benadryl 12.5/5 syr
50/ml amp
25mg; 50mg
Phenylpropanolamine
Disudrin 6.25g/ml drops
12.5/5 syr
q6
RD: 1-3mo:
1/4 ml
4-6mo: 1/2 ml
7-12mo: 3/4 ml
1-2yo:
1 ml
2-6yo:
1/2 tsp
7-12yo: 1 tsp
Nafarin A 12.5/ml
RD: 2-6yo:
1/2 tsp
7-12yo: 1 tsp
Brompheneramine
Dimetapp 4/5ml syr
2/ml drops
RD: 0.1 ml/k/dose TID-QID
1-6mo: 0.5 ml
7-24mo: 1 tsp
3-12yo: 1-2 tsp
CPAP GUIDELINES
1. Initially CPAP is set @ 6cm water. If
there is no inc in PO2 in 15 min
pressure must be increased in 2cm
increments to a maximum of
10cm. (If by ETT) or by 12cm (in
other method).
2. If there is an increase in PaO2,
reduce pressure.
3. If 10-12cm water pressure is
attained and if PaO2 reamins
under50, FiO2 must be increased
by 5-10% increments.
4. CPAP failure is evident if PaO2
remains less than 50 in 100% FiO2
with 10-12cm water.
*If CPAP fails under non invasive method, an ETT must be inserted.
*If CPAP fails w/ ETT, mechanical mechanical ventilation is indicated.
O2: CA Flow Rate (cm H2O)
Fio2
4cm
40
1:3
50
1.5:2.5
60
2.2
70
2.5:1.5

6cm
8cm
10cm
12cm
1.5:4.5 2:6
2.5:7.5
3:9
2:4
3:5
4:6
4.5:7.5
3:3
4:4
5:5
6:6
4:2
5:3
6:4
7.5:4.5

80
90

3:1
3.5:0.5

4:1.5
6:2
5:1
7:1

7:2.5
4.3
9:1 10.5:1.5

ARRANGEMENT OF CPAP
Compressed air
\
/
I
O2
Patient

\
Bottle

Trouble Shooting:
1. Poor entry - increase flow rate
2. Retaining CO2 - cannot tolerate
CPAP
- ambubag to blow
excess O2
- always suction
before CPAP, ABG
Parameters To Be Met B4 Weaning
1. Improvement in CXR
2. AABG showing PO2 >/= 50 mmHg
3. Blood PH >/= 7.3
4. PCO2 </= 55 mmHg
5. Hgb 12-15g% or Hct 36-45
Weaning from CPAP
1. Decrease FiO2 by 3-5% every time
PaO2 > 70
2. With FiO2 of 40%, reduce pressure
by increments of 2 cm water every
2-4H until pressure of 2-3cm
is achieved.
3. transfer ptient to oxygen hood
with FiO2 of 15-50%
CPAP TECHNIQUE
1. Kink CA tube - adjust O2 guage,
read @ puf botle until 2.5L (even if
guage reads 6L).
2. Open CA, adjust CA to make puff
bottle reach 3L
Normal PaO2: FT: 60-80%
Monitor 1. ABGs after every
change in setting if
feasible
2. patient's condition
* with PaO2 > 100: dec FiO2
gradually while checking patien repeat ABG after 15-30 mins.
CPAP
TFR = WT X TV (10-15) X RR X I:E
Ratio (2) + 2000 (2L)
FiO2 = CA (0.2) + O2 (I) x 100
-----------------------------TFR or (CA+PA)
CA = 100 - FiO2

--------------79

x TFR

O2 = FR - CA
Materials Needed:
Cardence
y-tubing
rubber tubing
glass tubings
1L bottle w/ calibration w/ glass
tubing inserted into the cover
Compressed air
Pulse Oximeter
FORMULA:
F.R. = TV x wt x RR x I:E + 2000
1000
where: FR = flow rate
TD = tidaL volume
NB: 6-10cc/kg
Child: 10-15cc/kg
Adult: 15cc/kg
I:E = 2
Dead space = 2000
RR = 40-60 normal
e.g. NB, PT, BW = 1.2kg
FR = 6 x 1.2 x 40 x 2 + 2000
1000
= 3
CA + O2: determine FiO2 by assessing
patient plus CXR.
If septic, showing white out on CXR
--> increase FiO2 to 100%
If 90%:
CA = 100 - FiO2 x FR
79
= 100 - 90 x 3 = 0.4 L
79
O2 = FR - CA
= 3 - 0.4
= 2.6 L/min
if CA=PA, FiO2 is 60
CREATININE CLEARANCE
FORMULA
I. based on height
* 0.33 = preterm,lbw,<1yo
0.45=term, infant, <1yo
0.55=children, adolescent fem
0.7 =adolescent male

* x ht (cm)
------------------serum crea (mg/dl)
II. adult
* male=72
female=85
140-age x wt
----------------* x crea (mg/dl)
VALUES
80-120
50-80
20-50
5-20
<5

normal
renal impairment
renal insufficiency
renal failure
uremia

GFR=125 ml/min (75-150)

24 uribary crea
M=15-20 ug/k
F=10-15
CUSHING'S TRIAD
Cushing's
high then low
low
low
Hemorrhagic Fever

BP
HR
RR
Dengue

Sepsis
low

STAGES
I
II
III

febrile
afebrile
convalescent

fever
non-specific sysx
tourniquet test

II

grade I
spontaneous bleeding

III

grade II
circulatory failure
rapid,weak pulse
narrow pulse pressure
hypotension
cold,clammy,ext

IV

profound shock
undetectable BP, pulse

GRADING

CLASSICAL DENGUE FEVER

thrombocytopenia >100T
hemoconcentration not more than 20%
MAP : S + D / 2

high
high

DERMATOMAL PATTERN
C3
C6
C7
C8
T4
T10
L1
L3
L5
S1
S5

front or back of neck

thumb
middle finger
ring & middle finger
nipple
umbilicus
inguinal
knee
ankle, foot
heel
perianal

DIABETIC DIET
IBW = (Ht in cm - 100) - 10% x (Ht in cm - 100)
TCR = IBW X BMR
BMR: 25 = bedrest
30 = mild
40 = heavy
45 = hyper
DIAPHRAGMATIC HERNIA
Morgagni
minute (small)
medial, anterior
mature
Bochdalek
back (posterolat)
baby
big
DIAZEPAM DRIP
0.3MKH dilute in NSS to make
0.1mg/ml
RD: 0.03-0.04 m/k/min
Prep: 10/2
Conc: Mg
ml NS
e.g.:

wt = 2.8kg 100cc/k/d ugtts/min

4 amps + 92cc NS ---->
40=0.4mg/ml (8ml)

Rate = RD x wt x 60
-------Conc
= 0.03 x 2.8 x 60
----------------0.4
= 12.6 (12-13 ugtts/min)
AD = Rate x Conc
-----------Wt x 60
= 12.5 x 0.4
----------

2.8 x 60
= 0.029 --> 0.03 m/k/min.
DIGITALIS
0.04-0.06 m/k TDD
not given if HR < 100/min
Lanoxin 0.05/ml, 0.25/ml elixir
0.25mg tab
0.5mg/2cc amp IV
e.g. wt= 2.65 kg
= 0.04 x 2.65 kg
---------------------4
= given 4x in 24H
( q6H, 1/4 of TDD)
= after 4 doses, give 1/10 of
TDD q12H
++:
1st
2nd
3rd
12H

dose: 1/2 TDD

dose: 1/4 TDD (8H after)
dose: 1/4 TDD (8H after)
after; start MD: 1/5 TDD OD
1/10 TDD BID

DIURETICS
Furosemide 1-2 MKD
Lasix 20/2; 20; 40/tab
Frusema 20/2; 20; 40/tab
Diaxozide 5-10 MKd
300mg/2ml
Acetazolamide 20-30 MKD
Diamox 250mg/tab
Spironolactone 1.5-3.0 MKD
RD: edema: 100mg/day
Essen. HPN: 50-100mg/day
My. Gravis: 100-400mg/day
Aldactone 25mg/tab
Hydrochlorotiazide 1-2 MKD
Dichlotride 25, 50mg/tab
Mannitol 20% 1.5-2 gkd or 5 cc/kg/d
200 g/L; 1g = 5cc
DOBUTAMINE DRIP
Prep: 250/2
Factor
S
16.6
DS 33.2
QS 66.4
8.3

Conc
1000
2000
4000

Dobu
4cc
8cc
16cc
500

D5W
46cc
42cc
34cc
2

48

4.15

250

49

AD = rate x conc
----------Wt x 60
AD = rate x factor
-----------wt
Rate = RD x wt x 60
----------conc
Rate = Rd x wt
--------factor
NOREPINEPHRINE
4mg (4ml) + 1 L D5=4ug/ml
pedia: 2ug/min
CPR: 0.1 ugkmin
DOMPERIDONE
Motilium
mins before meals TID
DOPAMINE DRIP

0.4 mg/k/dose 15

1-5 ug/k/min: VD; inc renal &

splanchnic circulation
5-10 ug/k/min: inotropic,Inc heart contraction, no effect on HR
10-20 ug/k/min: inc BP
Prep: Dopa 200/5
S
DS
QS

Factor
13.3
26.6

Docard: 40/ml

Conc
800
1600
3200
3.33
200
6.65
400

Dopa
1cc
2cc
4cc
0.25
0.5

D5W
49cc
48cc
46cc
49.75
49.5

NB: mg dopa = 6 x wt x RD
Rate
Concentration:
200 = 0.25cc dopa + 49.75cc D5W
400 = 0.5cc dopa + 49.5cc D5W
800 = 1.0cc dopa + 49cc D5W
Rate = RD x wt x 60
---------------conc
Rate= RD x wt
--------factor
AD=rate x conc
----------wt x 60
AD= rate x factor
-------------wt
dope

displaced ett
obstructed ett
pneumothorax
equipment failure
Dosing
dose = rd x wt ml/mg
aminogly
amikacin 10-15mkD -od / q12 if oldr
prep 100/2
genta 5-8mkD
skintest >/=6mos
mef 50/5
nabuphine 0.1mkd
famotidine 0.7mkd q12
DOUBLE VOLUME EXCHANGE TRANSFUSION dvet
= KBW x EST. Blood vol. x 2
neonate bld vol: 80-85 cc/k
exchanges: total volume/10
materials:
1. NGT fr. 5 or 8 #1 (umbi cath.)
2. Three way stop cock
3. FWB
4. needle wd suture
5. 10cc syringe
6. 5 cc syring
7. forceps
8. blood set
9. microset
10. sterile bottle
11.gloves
12. PNSS
13. excision set
14. eye sheet
15. betadine
others:
Ca gluconate
HGT strip
newborn screening
test tube for specimen
EFW
station
fundic ht (in) - 13 x 155
12
11
normal wt for term: 2500-3800 g
Naloxone
Narcan cc=0.1 x efw
----------------0.4

0
+

given to bb whose mothers were given Demerol with in 4 hrsPTD

LBW
2000-2499
VLBW
1500-1999
ELBW
1000-1499
Electrolyte Balance
(desired-actual) x wt. x 0.6
for ex,
K: 2
Na:130
K def
(4-2) x 10kg x 0.6 = 12mEq
Km: wt x 2
=10 x 2
=20
Total= 32meq
Nad=60
Nam=wt x 3
=30
Total=90
step1 1000 PLR 130 4
step2 333 D5IMB <1yo 8.3 6.6
step3 333 D5IMB 8.3 6.6
146.6 17.2
D5IMB 500cc 12.5Na 10K
K delivery infusio rate
rate x k
-------vol x wt
42*20
-----500*10
=0.17 mEq/K/hr(0.1-0.3)
EPINEPHRINE DRIP
1:100,000
d5w 250 CC + 5 amps epi
0.1-1 M/K/MIN
Prep Conc = AMT EPI x 1000
--------------AMT IVF
Conc:
20 = 1 amp epi + 49 cc D5W
40 = 2 amp epi + 48 cc D5W
60 = 3 amp epi + 47 cc D5W
Infant: 6 x wt x RD
-----------Rate
= cc epi to be added to 100 c D5W

rate=Rd x kbw x 60
-------------------prep conc
AD= conc x rate
-------------wt x 60
conc=epi cc x 1000
-------ivf
EPINEPHRINE
0.1 mkd
RACEMIC EPI
epi 0.3 mL
PNSS 4.7 mL
2.5 cc once then repeat 12 hrs
GLUCOSE INFUSION RATE (GIR)

after

Rate x Dextrosity x 10
-------------------------Wt x 60
or
Rate x Dextrosity
----------------100
normal=ft:4-6 mg/k/min
pt:6-8 mg/k/min
dextrosity
cal/cc factor
D5
= 50
= 0.2 cal
D7.5
= 75
= 0.3 cal = 0.055
D10
= 100 = 0.4 cal = 0.11
D12.5 = 125 = 0.5 cal = 0.165
D15
= 150 = 0.6 cal
GLUCOSE LEVELS
1st 3 days of life
3-7 days old
by 1 wk old (adult)
GROWTH
I. WT GAIN
age
wt gain
(g/day)
0-3 mo 30
3-6 mo 20
6-9 mo 15
9-12mo 12
1-3y
8
4-6y
6

40 mg%
60-80 mg%
80-100 mg%
length hc
(cm/mo) cm/mo
3.5
2
1.5
1.2
1
3/y

II. Nails

1cm/3mo

III. Hair

1cm/mo

IV. Liver span

1 w : 4.5 5 cm
12 yo : M 7-8 cm
F 6-6.5

2
1
0.5
0.5
0.25
1/y

>12 yo
M: 0.032 x wt(lbs) + 0.18 x ht
F: 0.027 x wt + 0.22 x ht - 10.75

(in) - 7.86

V. Gallbladder
length
infants: 1.5-5.5 cm
adolesc: 4-8 cm
width
neonates: 0.8 cm
all ages : 0.5-2.5
HEPARIN
LD: 50 uk iv bolus
MD: 10-20 ukh
Heparin lock
0.5-1 u/ml NSS or
0.02 ml/50 ml NSS
HEPATIC ENCEPHALOPATHY
STAGE I
euphoria
mild confusion
slurred speech
disoriented sleep
asterixis + / EEG usu normal
STAGE II
lethargic
mod confusion
asterixis +
EEG abnormal
STAGE III
marked confusion
incoherent speech
sleepy but arousable
asterixis +
EEG abnormal
STAGE IV
coma
+ / - reponse to noxious stimuli
asterixis EEG abnormal
HYPERBIL MGT
HEALTHY TERM NEONATE
age(h) considr photo
photo
<24
25-48
49-72
>72

>12
>15
>17

ex

>15
>18
>20

ex
trans &
if foto
fails
>20
>25
>25

>25
>30
>25

foto

LBW
BW
PM
<1500
1500-1999
2000-2499

healthy
exchange

phototx
5-8
8-12
11-14

13-16
16-18
18-20

Fanaroff
healthy
FT
>2500

15-18

20-25
sick

>2500
12-15 18-20
HYPERNATREMIA
TBW=kg x 0.6
vol of d5w (L)=TBW x actual Na

-1
---------desired Na

hrs infusion=A Na - D Na
------0.5 meq/hr
*****
TBW x wt x Actual serum Na - 1
-----------------Desired serum Na
e.g. wt = 6.3
TBW = 50% ; 60%

ASNa = 164mEq
DSNa = 140mEq
0.5 x 6.3

x 164 - 1
---140

(3.15) (1.18 - 1)
= 0.567L = 567cc

No. of Hours:
@ least 0.5mEq dec in Na/hr
or
12mEq dec in na/24H
164 - 140 = 24mEq

= 48

0.5mEq/hr
--> 567 = 11.8cc/hr + (I H2O loss)
48
20cc
= 31.8cc/hr
Ideal bodywt
3-12 = mo+9/2
1-6y = yr x 2 + 8
7-12y = yr x 7 - 5 / 2
waterlow's clas
wasting:
act wt kg
--------- x 100
wt for ht
>90
80-90mild

70-80mod
<70severe
stunting
act ht
--------- x 100
ht 4 age
>95
90-95mild
80-90mod
<80severe
INDICATIONS FOR DIALYSIS IN ARF
1.
Volume overload with evidence
edema refractory to diuretuc
2.
Persistent hyperkalemia,
3.
Severe metabolic acidosis
management.
4.
Neurologic symptoms (altered

of HPN and/or pulmonary

therapy.

encephalathy
5.
Blood urea nitrogen greater
ower if
rapidly rising).
6.
Calcium/phosphorus imbalance,
7.
8.

uncontrolled
unresponsive to medical
mental status, ssizures), uremic
than 100-150 mg/dl (or l
with hypocalcemic tetany.

uremic pericarditis
bleeding diathesis

An additional indication for dialysis is the inability to provide adequa

te nutritional intake because of the need for severe fluid restriction.
INDOMETHACIN
IV @ 12-24 H interval
Initial: 0.2 m/kg
2nd <48H = 0.1 mk
2-7 D = 0.2 mk
> 8 D = 0.25mk
3rd <48H = 0.1 mk
2-7 D = 0.2 mk
>8H = 0.25 mk
add 25 cc DW
INSULIN
U = (CBG - 200) / 10 IF CRF = 1/2 U
MAINTENANCE
CBG 30 min prior to bf,lun,sup
Dose: 1 unit/k/D
wt: ideal + actual 2
humulin
N
2/3 AM
1/3 PM
2/3
or 1/2
DRIP
0.1 units/k/hr
50u/50cc pnss

R
1/3
1/2

INTESTINAL OBSTRUCTION
HIGH

onset
vomiting
vomitus
pain interval
distention

LOW
less acute
prominent
less prom
feculent
often fec
freq
less freq
min or noticeable
acute

INTRACEREBRAL HEMORRHAGE
PUTAMINAL
sensorial changes
coma
sysx of herniation
just like MCA sysx
THALAMIC
sensory>motor loss
eye sign
forced downwrd gaze
dificlty n upward gaze
deviated away fr the lesion
PONTINE
early coma
pinpoint pupils in midposition
bilateral decerebrate posturing
caloric testing (impaired/-)
CEREBELLAR
sudden diziness & vomiting
marked truncal ataxia
ipsilateral CN V (corneal), VI, VIII weakness

intraventricular hemorrhage
grade 1
bleeding confined to
subependymal region or
<10% of ventricle
35% of cases
grade 2
iv bleed 10-50% filling of
grade 3
>50% bleed with dilatec
ventricles
grade 4
gr 3 with intraparenchymal
hemorrhage
INTUBATION/EXTUBATION
INTUBATION
ET SIZE
> 2yo: age (yrs) + 16
---------------

germinal matrix-

vent

ricle

4
PT: 2 or 2.5
FT: 3 or 3.5
ET LENGTH
age/2 + 12
kg
1
2
3

cm
7
8
9

EXTUBATION CRITERIA
FiO2 < 50
P/F
no electrolyte imbalance
control of infection
good muscle mass
racemic epi (0.3 mL + 4.7 PNSS)
2.5 mL x 3 d (q4-6)
Dexamethasone 6 hrs prior then 24 hrs
IVIG
Kawasaki= 2g/kg
Loading dose = 0.018 cc/k/min (30 min)
Maintenance = 0.05 cc/k/min (6H)
0.5 cc/k/h for 30 min increments
max 8cc/k/h
adults 15 cc/k/H
JAUNDICE
Clinical Jaundice
- manifestation of color starting
mg%
Criteria to rule out physiologic jaundice:
1. Clinical jaundice in the 1st 24 hrs of
life.
2. Increase in total serum bilirubin at
> 5 mg/dL/day (85 umol/L).
3. Total serum bilirubin > 12 mg/dL in
full term, and > 15 mg/dL in
preterm.
4. Direct bilirubin > 1.5-2 mg/dL
(26-34 umol/L).
5. Jaundice lasting for more than 1
week for term, 2 weeks for
preterm.
KRAMER'S CLASSIFICATION:
Zone
I

Jaundice
Head/neck

Est. Levels
6-8 mg/dl

at serum bilirubin levels 5-7

II
III

Upper trunk
Lower trunk
to thigh
Arms/Legs/
Elbows/Knees
Hands/Feet

IV
V

9-12
12-14
15-18
> 18

K+
adults - 40-100meq/da'
pedia - 2-5meq/day
LAB VALUES
ALBUMIN

3.7-5 g/dL

ASOT
< 200 iu/ml
significant if > 320
CALCIUM ionized (mg/dL)
cord
3-24h
5-6
4.3-5.1
CALCIUM total
cord
3-24h
24-48h
4-7 D
child
after

24-48h
4-4.7

9-11.5
9-10.6
7-12
9-10.9
8.8-10.8
8.4-10.2

CRP < 6 mg/L

PHOSPHORUS nb 4.8-9 mg/dL
PROTIME

INR <1.2

RETICULOCYTE COUNT
term
4-5
preterm 6-10
1 D
0.4-6%
7 D
<0.1-1.3
1-4 w < 1-1.2
5-6 w < 0.1 - 2.4
7-8 w 0.1 2.9
9-10 w < 0.1 - 2.6
11-12 w 0.1 - 1.3
adult 0.5 - 1.54
SGPT

0-40 iu/L

Sodium 135-145
130 acceptable in NB if asx
Transferrin saturation
serum iron / TIBC
<12 : IDA
LUMBAR TAP

after
4.8-4.9

PRESSURE (cm H20)

g22 (1 1/2)=gtts in 21sec
g22 (3 1/2)=gtts in 39 sec
g20 (3 1/2)=gtts in 12 sec
WBC CORRECTION IN HEM TAP
Periph WBC
x 1000
---------------5million
=wbc/1000 rbc
1 wbc=750 rbc
1000 rbc=1 mg protein
CSF glucose=at least 60% of RBS
CONTRAINDICATIONS OF LP
increased ICP(other tan bulging
3&6 palsy
severe CP depression
infected skin over site
coagulopathy (plt <20-50)
brain abscess or mass
positioning would compromise CP status
POST LT ORDERS
flat on bed for 4 hrs
dat once fully awake
tube 1 gm staining
AFB staining
KOH staining
culture
tube 2 CSF CHON
glucose
tube 3 cell count
diff count

maam becka
maam stephanie
maam mayang
MACROLIDES
Erythromycin 30-50 MKD
Erythrocin 100/2.5 gtts
DS 200/5,250/5
400/5
500/vial
Azithromycin 10 MKD OD x 3 days
Zithromax 600/ml; 1200/ml,
200/5
Clarithromycin 15 MKD q12H
7.5 MKd
Klaricid 125/5 (dnt ref)
Roxithromycin 3-6 MKD q12H
Macrol 150mg/tab

fontanel) eg CN

MECH VENT TIPS

IPPV
intermittent positive pressure

ventilation

SIMV
synchronized intermittent

mandatory ventilation

* Tidal volume (normal): 10-15

In Ards:
decrease TV (6-8)
increase PEEP
* hyperventilation: goal to decrease CO2 to 25-30
* I:E=
(60/RR) - IT
---------------IT

Nicu duties feb 2

sojon 1.85
lariosa twin 1 2.40
twin 2 2.30
inoc
tanajura
less than 2 years is questionable.. Small airways.. Secretions cause wheeze
seesaw breathing.. Paradoxical breathing.. Abdomen rises..
Nicu duties
direct.. Neonatal hepatitis then biliary atresia
indirect.. Physiologic then breastfeeding jaundice.. ABO imcomp..
Bil atresia operated best at 3 to 6mos
NOREPINEPHRINE BITARTRATE
Hypotension, Shock, and Cardiopulmonary Resuscitation
* infusion solution is usually prepared by adding 4 mg of norepinephrine (4 mL o
f the commercially available injection) to 1 liter of 5% dextrose injection. The
resultant solution contains 4 mcg/mL..
@ In adults, the usual initial dosage of norepinephrine is 8 12 mcg/minute.mcg/min
ute.
@ For pediatric patients, norepinephrine usually is administered at a rate of 2
mcg/minute.
@ For pediatric advanced life support (PALS) during cardiopulmonary resuscitati
on, the recommended initial infusion rate is 0.1 mcg/kg per minute; the infusion
rate can range up to 2 mcg/kg per minute and should be adjusted to achieve the
desired change in blood pressure and perfusion.
@ The average adult maintenance dosage of norepinephrine is 2 4 mcg/minute.
NOREPINEPHRINE DRIP
levophed=2mg/2ml amp
concentration= ug/cc
single dose
stock mg
= --------x

1000 ug
--------

250 cc ivf
2mg
= --------250 cc
= 8 ug/cc

1 mg
x

1000 ug
-------1 mg

rate=cc/h
rd (ug/k/min)x wt (kg) x 60 min/h
= -------------------------------conc (ug/cc)
dose= ug/kg/min
=rate (cc/h)
conc (ug/cc)
---------- x ----------wt (kg
)
60 min/h
rd=0.2 ug/k/min increase by 0.2 q20

min til acceptable bp, max of 2

factor

ss
1 amp + d5w 250cc
ds
2
NORMAL ECG
Rate
age-dependent
Rhythm sinus
PR
0.12-0.2
QRS
0.04-0.08
QT
0.2-0.4
P wave gen upright except at AVR
Axis
-30 - + 30
Transition
V3
T wave upright
ST segment isoelectric
nutrition formulas #height
ht in cm = age in yrs x 5 + 80
ht in inchs = age in yrs x 2 + 32
nutrition formulas #waterlow gomez
-waterlow class for wasting
act. weight
---------- x 100 = ____
ideal weight for
ideal leght/height
N >/=90
mild 80-90%
mod 70-80%
sev </=70%
-waterlow class for stunting
act lenght/ht
--------------x100 = _______
ideal Lgt/ht for
age
N >/=95%

8
16

mild 90-95%
mod 80-90%
sev <80%
Gomez class of malnutrition
actual
------ x 100
ideal
N 91-100
1st 76-90
2nd 61-75
3rd <60
OSMOLARITY
normal serum osm=285-295 mosm/k
effective osm=2 Na + glucose
18
osm= 2 Na + glucose + BUN
-------18
or 2 Na
OXYGENATION

----2.8

FiO2
ambient air
nasal cannula

20.7
1 L
6 L (max)

4
saturate

dead space
airways
O2 hood

at upper
1 L
6
10 (max)

10/L

face mask
1L
6 L
10 L(max)
55
face mask with rebreathing bag

10/L
35
80-90

PARACETAMOL
10-15 MKd
drops: wt x 0.1
125/5: wt x 0.4
250/5: wt x 0.2
Afebrin
Biogesic
Calpol
Crocin
Defebrol
Naprex
Rexidol
Tempra
Tylenol
Winadol

120/5; 325; 500

100/ml; 250/5; 500
120/5; 250/5
125/5; 500
60/0.6; 20/5
250/5; 300/2
150/5; 600
120/5; 250/5
120/5
120/5; 500

Aeknil
300/2
Opigesic
125; 250 supp
PARTIAL EXCHANGE TRANSFUSION
= KBW x EST. Bld vol x (AHct - DHct)
-----------------------------Actual Hct
* (Arterial Line)
* may use Plain NSS or
ideally, pplasma
1 unit increases hgb by 2
hct by 3
PCAP GUIDELINES
PCAP A (Minimal Risk)
Co-morbid illness
Compliant caregiver
Yes
Ability to follow-up
Presence of dehydration None
Ability to feed
Age
Respiratory rate
2-12 mos
1-5 yrs
> 5 yrs
Signs of resp failure
retraction
head bobbing
cyanosis
grunting
apnea
sensorium
Complications
(effusion, pneumothorax)
PNEUMONIA DANGER SIGNS
< 2 mos
poor suck
wheezing
fever
convulsions
drowsy
stridor
2mos-5yrs
unabl to drink
convulsions
drowsy
stridor
Peds Hx nbp
Pre
-Aje
-PNC
-Alc smoke
-Dses
-Hpn DM Asth

None
Possible
Able
>11 mo
> 50
> 40
> 30
None
None
None
None
None
No ne
None

-efw
-lmp
-Bldtype of mother
Na
-hrs ptd contractions / hypo pain
-Labor Hours
-Term
-NSD
-PROM
-Meconium
-Cyanosis
-Cord
-Penatal comp.
-BW
-BRank
Post
-Immunizations receivd- number/wer
-Milestones
-Feeding
-illness
-Vit.
-rooting other reflex
-FDA
-Previous hosp.
WARM
AIRWAY
INFXN
NUTRITION
>1yo= Yrs * 2 + 70 // +90 = dia lower 30.
Pedsnutrition formulas #weight
<6mos
age in mos x 600 + BW (3000)
6-12mos
age in mos x 500 +BW
2yrs and up
age in yrs x 2 + 8 = KG
age in yrs x 7 + 5 = lbs
6-12yrs
age in yrs x 7 + 5 = lbs
3-12mos
caucasian
age in mos + 11 = lbs
pinoy
age in mos + 10 = lbs
PedsVax
BCG
0.5 @R deltoid intraD
PERINATAL ASPHYXIA
Diagnostic Criteria
cord bld pH <7

APGAR <= 3 at 5 min

multiorgan failure
neurologic mf
hx of fetal distress
Ponderal Index =
1000 x cube rt of mass/ht
NV= 20-25
bw x 100
------------crown-heel length to the 3
PERITONEAL DIALYSIS (PD)
Volume
30-50cc/k (1L)
Dialysis solution
4.25% x 6 straight exchanges
then 4.25% and 1.5% at 1:2
Infusion time
5-10 min
Equilibrium time
none
Indwelling time
none for 1st 3 exchanges then
15 min for the next 3 exchanges
then 30 min thereafter
Draining time
15-20min
Incorporate 2meq KCl/L of exchange
Refer for:
hypotension
cloudy dialysate
bloody dialysate
significant residual
poor drainage
other unusualities

starting on the 10th exchange

PHOTOTHERAPY
Indication
PT: 10 mg bb
FT: 15 mg bb
Complications
osmotic diarrhea
rashes
bronze baby syndrome
dehydration
hypo/hyperthermia
PIPERACILLIN
Less serious: 100-200 MKD q6H
Serious: 200-300 MKD
Neonate: 50-100 MKd
<29wks (0-28days): q12H
(28 days): q8H
30-36wks (0-14days): q12H
(>14days): q8H
37-44wks (0-7days): q12H
(>7days): q8H
>45wks: q6H

plan a
give more fluids and food dan usual
dilute milk formula <6mos
age | amount ORS after stool | at hom
<24mos | 50-100 | 500ml/day
2-10 yrs | 100-200ml | 1000ml/day
10 yrs or more | as much as can | 2000
plan b
ORS in 1st 4 hrs
age | wt | mL
<4mo | <5kg | 200-400
1-11mo | 5-7.9 | 400-600
12-23mo | 8-10kg | 600-800
2-4y | 11-15.9kg | 800-1200
5-14y | 16-29.9kg | 12-2200mL
reassess after 4 hrs, change or cont'
plan c for severe dhydration
age|first give 30ml/kg | then70ml/k
infants <12 m | in1hr | in 5hrs
>12mos | 30mins | 2.5hrs
reassess q 1-2hrs. may rpt 1x if pulse stl weak
as soon as can drink, ORS 5ml/kg/hr
if IV not available, ORS PO/NGT at 20ml/kg/hr for 6hrs
Preterm orders
(1.6kg)
npo temp
cbc bt hgt cxr-apl
venoclysis d10w 43cc/shift (80/k/D)
d5w 38.7 d10w 4.3 = 43cc/shirt
ampicillin 80 q12
amikacin 16 od
PREVENTIVE PEDIATRICS
PPS RECOMENDATION 2002
infancy* childhood*adolesc
birth-2y
3-8y
10-19y
Measurement
ht/wt
+
+
head cir
+ til 2yo
bp
+3yo
Sensory Screening
vision
at least 1x per grp(sub/ob)
hearing
same
Dev/behavioral
PE
+
+
Procedures-Gen
met/gen
2D-1m
immunize
+
+

+
+

+
+

hgb/hct

5m(2m if r)
7-12m 2-4y

10-13
14-19

ua
iron

+2-6y

if r

+6-11m

0.6m feS04(15mg el Fe
x 50 days
vit A
+6m
til 5y if r
6-11mo:100iu x 1
12-59 m:200 iu q 6m
deworming
+2y
til 14y
1 dose meben/pyran 1-3/y
Procedures-at risk
ppd
+1y
+
+
lead scrn
+9m-2y
cholesterol +2y
+
+
std
pelvic exam
+
Anticipatory guidance
injury prev +
+
+
violence prev+
+
+
nutrition
+
+
+
InitialDental +1y
til 3y

PROCAINAMIDE
15-50 mkD q 3-6 po
tablet 200, 375, 500
PROTEIN RDA
0-5 mo --------------8-11 mo ------------1-6 yo --------------7-17 yo -------------13-15 yo -----------18-19 yo ------------

2.5g/k/day
2.5 - 3.0
2.0 - 2.5
1.5 - 2.0
1.5
1.0 - 1.5

0-6 mo -------------6-12 mo ------------1-3 yo --------------4-6 yo --------------7-10 yo -------------11-14 (M) -----------15-18 (M) ------------

2.2 g/k
2.0
1.8
1.5
1.2
1.0
0.8

CHON REQT
= CHON req for wt-age x ideal wt for
ht/ actual wt for age
PULMONARY VOLUMES
TIDAL VOLUME (TV) 500 mL
vol inspired or expired with each
INSP RESERVE VOL (IRV) 3 L
vol that can be inspired over and
EXP RESERVE VOL (ERV) 1.1 L
RESIDUAL VOL (RV) 1.2 l

normal breath
above the TV

vol that remains in the lung

DEAD SPACE 150 mL
Anatomical-vol of the
ys
Physiological - functional
of the
lungs that does not
eliminate CO2 ( usually
with V/Q inequalities

after maximal expiration

conducting airwa
measurement, vol
greater in lung diseases

PULMONARY CAPACITIES
INSPIRATORY CAPACITY (IC)
TV + IRV = 3500 mL
FRC
ERV + RV= 2300 mL
VITAL CAPACITY
IRV + TV + ERV = 4500 mL
TOTAL LUNG CAPACITY
VC + RV or
IC + FRC = 5800 mL
RDS GRADING (XRAY)
(Bonsel Grading)
Grade I
almost normal
mildly hazy
generalized reticulogranular
clearly defined cardiothoracic
ground glass
Grade II
moderately generalized
still distinct CT shadow
air bronchogram just past CT
ground-glass, air bronchogram
pressure 15-25
Grade III
heavier and more confluent
ity
hazy, barely discernible CT
air bronchogram past 2/3 of the lung
1 side cardiac border wiped out
Grade IV
white-out lung fields
complete opacification
cardiac border no longer visible
pressure 25-40
LIGHT'S EQUATION
B-A/B=%
NORMAL 10-20
A: midline to inner border of the lung
B: midline to the outer border of the rib

pattern
shadow

reticulogranularity
border

reticulogranular
border

REFLEXES,fontanelles
1. Fontanelle Closure
Anterior
Posterior

: 12-18 mos
: 3-4 mos

2. Reflexes of Neonates
Moro
Stepping
Placing Birth
Sucking &
Rooting
Palmar Grasp
Plantar Grasp
Adductor
Spread of knee
Tonic Neck
Neck Righting
Landau
Parachute
Babinski

Birth
6 wks
Birth
Birth
Birth
jerk
2 mos
4-6 mos
3 mos
9 mos

appears disappears
8 mos
Birth 6 wks
4 mos,awake
7 mos, sleep
6 mos
10 mos
Birth 7 mos
6 mos
24 mos
24 mos
Persists
birth 8m-1y

REGULAR INSULIN, SLIDING SCALE

(Dr. J. Uy)
0.5 - 1 IU x wt = Insulin reqt/day/5
*Monitor CBG 5x/day:
pre-breakfast
pre-lunch
pre-supper
2am
baseline CBG 150mg/dl
*for every 50-70mg inc in CBG add 1 unit of Regular Insulin.
e.g. wt = 20kg
30 x 0.5 = 15 IU/5 = 3 IU
> 150mg/dl
200-249mg/dl
250-299mg/dl
300-349mg/dl
350-399mg/dl
400mg/dl & up

=
=
=
=
=

4
5
6
7
8

= 3 IU
IU
IU
IU
IU
IU

* get the total 24H Insulin Reqt based on the sliding scale then compute for the
split dose Insulin Therapy.
RENAL FAILURE
STAGES OF RF
GFR
BUN
CREA
I renal reserv 50-75 9
255
II renal insuff 25-50
9-18
256-530
III CRF
15-25 18-36 530-972
IV uremia
<10
36
972
STAGES OF PROGRESSIVE RF
1 reduced renal reserve

2
3
4
5

renal insufficiency
renal failure
uremic syndrome
end stage renal disease

RF INDEX
U Na x serum crea
------------U crea
<1=pre renal
>1=renal
OLIGURIC ARF
U/P
crea
prerenal >20
<20
ARF
<20
prerenal:azotemia
ARF: oliguria
RETIC COUNT,ABSOLUTE

U Na

Fe Na

osm
<1
>40

>1.2
>2

Actual Hct x retic ct

--------Desired Hct
Retic Index = ARC
2
> 2: Hemolysis
< 2: BM suppression
hypoproliferativ
RETINOBLASTOMA
Wk 0
CTX 40 mk 1h iv D1
ADR 0.67 mk 1h iv D1-3
VCR 0.05 mk ivtt D1
SALICYLATES
Anti-rheumatic: 80-100 MKD
Antithrombotic : 10-15 mkD
Anti-inflammatory: 50-100 mkD q8
Asaped: 81
Ascepitin: 325
Neo-Novaldin: 325
Superin: 180/5; 3g
Aspirin: Gr V (1g = 65mg )
Bayer : 300, 100 mg tab
WARFARIN
young children: 0.3 mkd
older children: 0.1 mkd
STATUS EPILEPTICUS
Valium
3x (5 min apart) until 10m/day
Phenobarbital

U/P
<1.2

LD: 20 mkd til 30

MD: 8-10 mkD q6-12
Phenytoin
LD: 16 mkd (til 40)
MD: 5-8 mkD
Valium/Midazolam drip
load: 0.4-0.5 mkd
30 mg in 50 ml DW
3 mk
1-18 ugkmin til 25
Rivotril SL
Valproic acid 50 mk
STEROIDS
Dexamethasone 0.15-0.4 MKd
Decadron 4mg/ml
Hydrocortisone LD: 10 MKd
MD: 5-10 MKD q6-8
Solu-cortef 100/2; 250/5; 500
Prednisolone 0.7 MKd 1-2 mkD
Solumedrol 125/2
Methylpred 16 mg tab
Medrol 16 mg tab
itp : 60 mg/m2
Prednisone 1-2 MKD
Asthma: 1 MKD
Neph. Syn: 60 m/SA/24H
in 2-3 divided doses
Prep: 5mg; 10mg
Pred 10
Diprolene
Diprosone
hydrocortisone 5
methylpred
prednisone

dose
0.8
0.8
1

Fluocinolone acetonide BID-TID

Aplosyn 10, 25, HP
Synalar 10, 25 HP
Mometasone OD
Elica
Clobetasol propionate
Dermovate
Diflucortolone valerate
Nerisona
Mupirocin
Bactroban

potency
5
1

Desoximethasone BID-TID
Esperson
Eumovate for <3mos
Cutivate for >3mos
Draoplene cream for diaper rash.
SULFONAMIDES
RD: 8-10 MKD q12H (tmp)
40/5 : wt x 0.5
80/5: wt x 0.25
Bacidal 80/5
Trizole 80/5
Triglobe 45/5
Bactrim 40/5; 10, 80 mg/tab
Septrin 40/5; 160;80 mg/tab
Synermed 40/5
Synerzole 40/5
Chloramphenicol 50-100 MKD q6H
mening: 100 mkD q6
Neonate: LD: 20mg/kg
MD: begin 12 after LD
PT<1mos 12.5 MKd q6H
FT<1wk PT>1mos 5 MKd q6
FT>1wk: 12.5 MKd q6H
Pedichlor 125/5
Chloromycetin 125/5
Chloramol 125/5
1gm vial
*+ 10 cc DW, iv drip
*4 days stored in the ref
Tetracycline 40-60 MKD
Clindamycin 10-40 mkD q6-8
16-20 mkD
30-50 MKD
NB: 5-7.5 MKd
<29wks (0-28days): q12H
(28days):q8H
30-36wks (0-14 days): q12H
(>14days): q8H
37-44wks (0-7days): q8H
(7days): q6H
>45wks: q6H
Dalacin 75/5 susp
iv: drip over 30 min
TETANUS
STAGES
mild
I

IP:14 D
onset 6-10 D
mild spasm, trismus,

a
mod

II

IP: 6-10 D

dysphagi

onset 3-6 D
trismus, spon spasm,
a, rigid abd
sev

III

dysphagi
mf

IP: <6D
onset <3 D
sust spasm, opisthotonus,

resp par

alysis
GRADING OF TETANUS
Score
I. Incubation Period
<48h
2-5D
5-10D
10-14D
>14D
II. Site of Infection
interval
head,neck,trunk 4
prox ext
distal ext
1
III. State of protection
none
possible safe
born of immune mother
protected >10y 4
<10y
IV. Complicating factor
illness & injury
immed hazardous
8
not hazardous 4
minor illness&injury 2
<10
>10 <20
>20 <25
>25%

5
4
3
2
1
5
3
2
10
8
2
hazardous to life

excellent prognosis
guarded but recover with
guarded, more extensive
poor prognosis, mortality

10

tx
tx

onset period = trismus to spasms

Tourniquet test
<5-10 petechiae in 2.5 cm circle on forearm (halfway between systolic and diasto
lic pressure for 5 min); 0-8 petechiae in 6 cm circle (50 mm Hg for 15 min); 1020 petechiae in 5 cm circle (80 mm Hg)
TPN
I. Intralipid
10%: 10 G/100
20%: 20 G/100
e.g. wt = 2kg @ lipid: 0.5 gkD
(perp 10 %)
2 x 0.5 x 100 = 10ml (10% il)
---------------10
*20 if 20%
*1g=9cal

50g/500 ml
10 ml=9 cal
II. ALBUMIN
A. Albumin 0.5-1 g/k/d
Max: 6g/k/D
Albumer, albutren
50/1 (5%); 250/1 (25%)
Albutein
12.5g/50 ml (25%)
B. Vamin
chon 2.5-4 gkD
gluc 5-9 mgKm
Prep/L:
chon 60g
Cal 650 cal
Gluc 100g
Start dose at chon 0.5gkD
e.g. wt = 1kg
1 x 0.5 x 1000 = 8.3 cc Vamin
----------------(24 hrs)
60
*60 if 6%
*100 if 10%
*aminosteril=7 hrs stable
C.Moriamin S2
9g CHON/100ml
RD x wt 1000
-------90
to run in 8-10H *565 kcal/L..
TUBERCULOSIS CLASSIFICATION
Class I TB Exposure
- (+) exposure to.an adult with
- (-) signs and symptoms of TB
- (-) Mantoux tuberculin test
- (-) chest radiograph
Class II
-

active TB

TB Infection
(+/-) history of exposure
(+) Mantoux test
(-) signs and symptoms of TB
(-) chest radiograph

Class III
TB Disease
- has 3 or more of the ff
- (+) hx of exposure
- (+) Mantoux test
- (+) SSx suggestive of TB
the ff):
cough/wheezing
fever >2 weeks
painless cervical &/or
other LAD
poor weight gain

(1 or more of

failure to make a quick

return to normal

after an infection
failure to respond to

appropriate Abx
- abnormal CXR suggestive
of TB
- lab findings suggestive of
TB
* a positive culture with/without
a positive smear for M. TB i
s
the gold standard for the
diagnosis of
TB and must be
sought for whenever possible.
Class IV
TB Inactive
- a child with/without history of
f the ff
- (+/-) previous chemotx
- (+) radiographic evidence
lcified TB
- (+) Mantoux test
- (-) Ssx suggestive of TB
- (-) smear/culture for M.

previous TB and any o

of healed/ca

TB

PPD testing (Mantoux test)

0.1 mL (5 TU PPD)
6-10 mm wheal
read 48-72 hrs
TUBERCULOSIS TREATMENT
Class I TB Exposure
<5 yrs old
>5 yrs old
Class II

3 mos INH
3 mos INH

TB Infection

PPD conv w/in 1-2 yrs, - CXR

9 mos INH
PPD (+) not d/t BCG, - CXR, - tx
9 mos INH
PPD (+) w/ stable lesion, - tx
9 mos INH
PPD (+) w/ stable lesion, + tx,
1-2 mos INH or
for the duration
HIV infection/person at risk
12 mos INH

at risk for reactivation

of risk

Class III
TB Disease
Pulmonary
- tx, <10% prev of resistance
2 mos HRZ; 4 mos
HR OD or as
DOTS 3x weekly
susceptibility unknown or
resistance suspected
2 mos HRZ+E OD;
4 mos HR +/-E/S
OD or as DOTS
3x weekly
Extrapulmonary
severe, life-threatening dse;
disseminated/miliary,
meningitis, bone/joint dse
2 mos HRZ+E/S;
10 mos HR+/-E/S
OD or as DOTS
3x weekly

Other extrapulmonary sites

same regimen as
pulmonary dse

U/A GLUCOSE
+ 4 = 20 U
+ 3 = 15 U
+ 2 = 5 U
trace = 0 U
UTZ : LIVER & RENAL TISSUE
0
liver brighter than renal cortex
1
liver same as renal cortex
2
renal cortex brighter than liver
3
renal archi cant be
tiated
VENTRICULOMEGALY

differen

ventricle size
dr bael:
0-0.6 normal
0.6-1.2 mild
1.2-2 moderate
2-3
severe
>3
very severe
nelson's
mild
moderate
severe

0.5-1 cm
1-1.5
>1.5

dr gigataras:
up to 6 cm
VITAMINS & MINERALS

normal

VIT A
< 6mo 50,000
6mo-1yo 100,000
1-5yo 200,000 then q 6mo
neonat:
bpd tx: prevent lung injury
aap guideline: 5000u/kg
other day for the
1st
bpd
VIT E
neonate 25-50 iu
children 1 iu/k
VIT K
0.3 mkd
max 5mg x 3 days
FT= 1 mg IM sq
PT=0.5 mg IM sq
ZINC
0.25 mg/k/dose OD

im q
month to prevent

Prozinc 20/5
Z vita 82/5
Vita zinc 5/5, 5/1
diarrhea (acute)
20 mg elemental zinc
for 10-14 days
WATERLOWE CLASSIFICATION
1. Weight for Age
= actual wt / wt at p50 * 100
> 90
no PEM
75-90 mild PEM
60-74 moderate PEM
< 60
severe PEM
2. Height for Age
= actual ht / ht at p50 * 100
Nelson's
> 95
no stunting
90-95 mild stunting
85-89 moderate stunting
< 85
severe stunting
del mundo
>95
no
90-95 mild
80-90 moderate
<80
severe
3. Weight for Height(wasting)
= actual wt / wt at p50 of ht at
Nelson's:
> 90
no wasting
75-90 mild wasting
60-74 moderate wasting
< 60
severe wasting
del mundo:
>90
no
80-89 mild
70-79 moderate
<70
severe

p50 * 100