EM - Drug Doses crc

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Thiopental

3-4mg/kg

Etomidate

0.3mg/kg

Vecuronium

0.01mg/kg

Pancuronium

0.01mg/kg

Acetaminophen, peds

15mg/kg po q4-6 h

Fentanyl, peds

1-2mcg/kg IV/IM

Hydrocodone

0.1-0.2mg/kg po q4-6h

Ibuprofen, peds dose

10mg/kg/dose q6-8h

What pain control drug should you not give a peds chemo patient?

Ibuprofen

Ketorolac, peds

0.5mg/kg IV, but not for over 48 hours

Morphine, peds

0.1-0.2mg/kg IV/IM q2-4 hrs, OR 0.2-0.5mg/kg PO q4-6 hrs

Oxycodone, peds

0.05-0.15mg/kg PO q4-6h, max 10mg/dose

Tylenol

650-1000mg, PO q4-6h, do not exceed 4gm/24 h, or 2gm in liver disease

ASA for pain

650mg po q6. Avoid in PUD or gastritis

Ibuprofen for pain

600-800mg, PO q6h. Good for MSK pain, Avoid in renal disease, PUD/gastritis/post op.

Good drug choice for musculoskeletal pain

Good: Ibuprofen, Naproxen. Great: Toradol

Naproxen for pain

250-500mg PO q12, good for MSK pain, NSAID and thus avoid in renal or PUD/gastritis

Toradol for pain

15-30mg IV q6, Great drug for MSK pain. Often restricted to 48h use. Avoid renal disease. DO NOT GIVE IF PATIENT TOOK IBUPROFEN IN LAST 6 HOURS

Good opiate for kids

Tylenol #3. 1-2 tabs po q4h

Vicodin (hydrocodone)

1-2 tabs PO q6-8h. Basic PO narcotic

Percocet (oxycodone)

1-2 tabs PO q4-6h, Stronger than vicodin.

MS contin

10-30mg PO, q8-12 h. Good for chronic pain

Morphine

0.1mg/kg. 2Mg in little old ladies, up to 4mg oto 6 to 8mg. Has a 2-4 duration

Dilaudid

0.5-1mg IV q4. Four hour duration. 1Mg dilaudid = 10mg morphine

Fentanyl

25-50mcg IV q2h. Has one hour duration. Also comes in a patch for longer acting

Empiric antibiotics for CAP, admitted to general wards

1g Ceftriazone and 500mg Azithro, IV... OR Levofloxacin 750mg IV or PO QD. Don't forget two sets of Bcs before administering

Empiric agents for CAP, ICU admitted

Beta lactam (Ceftriaxone, Cefotaxime, Augmentin) + either IV azithro or antipneumococcal Fluro (moxi or levo). If Pseudo is specifically a concern (CF, COPD, or frequent antimicrobiral use or chronic steroid use), antipseudomonal agent such as Zosyn, imipenem, meropenem, or cefepime) + antipseudomonal quinolone (cipro or levo). If MRSA is a concern, add vanc or levo

HAP

At DH: Vanc 1g + Zosyn 3.375mg IV

When to treat standard COPD exacerbation

Abx if sputum color change or fever: Z pak

Epi for anaphylaxis

Epi 0.01mg/kg or 0.1ml/kg of 1:1000 IM. Repeat q15m

Benadryl for anaphylaxis

1-2mg/kg IV

Dexa for anaphylaxis (alt methylprednisolone)

0.6mg/kg IV/IM

Methylprednisone for anaphylaxis (alt dexa)

2-4mg/kg IV bolus, +|/- Ranitidine 1.5mg/kg IV/PO

Croup score >=4

O2, racemic Epi 0.05ml/kg/dose, Dexa 0.15-0.6mg/kg oral or IM x 1

Croup score >=7

Everything four got, but without quick response should be intubated. Use smaller tube than predicted due to edema.

Every child that gets racemic epi should have what done

Obs for 2-4 hours to ensure there is no rebound effect

Bolus of fluid for kids

10-20cc/kg of isotonic fluid

Maintenance fluids for kids

D5 1/4NS for <2 yo. D5 1/2NS for >2 yo. 4/2/1cc rule. 10Kg/10kg/+1kg

Medications used for sedation in kids

Ketamine, etomidate (Not FDA approved for <10yo), fentanyl, midazolam, propofol

Etomidate for kids, conscious/procedural sedation

0.2-0.4mg/kg IV (not FDA approved <10 yo)

Fentanyl for kids sedation

1-2mcg/kg IV/IM

Ketamine for kids

0.5-2mg/kg IV or 2-4 mg/kg IM

Midazolam for kids sedation

0.05-0.1 mg/kg IV/IM, or 0.4 mg/kg intranasal

Propofol for kids sedation

0.25-0.5 mg/kg IV. May repeat q2-4 mins (titrate to sedation)

Abdominal pain orders

CBC, BMP, Lipase, LFTs, UA, UPT (always if female). Consider US or CTA/P depending on exam. PO contrast when you order labs (2 h prep) to save time

SOB orders

CXR, CBC, BMP, ?D-dimer, EKG

Chest pain orders

CBC, BMP, Coags, CXR, EKG, ?Trop, ?D-dimer

Headache orders

Migraine cocktail, possibly labs if relevant. Always ask about anticoagulation and get coags if needed

Mydriatic medications

Parasymp antag, e.g. Tropicamide (6h), Cyclopentolate (24h), Homotropine (2-3 days), Atropine (1-2 weeks). Symp agonists, e.g. Phenylephrine (3-6 h)

Eye complaint orders

Slit lamp exam. Order proparicaine or tetracaine for anesthesia, also Fluorescein strips from Pyxis

Vag bleeding with pregnancy

CBC, UA, bHCG, Rh, ?ab labs, GC/Chlamydia, wet prep. TVUS

Lidocaine, airway pretreatment

1.5mg/kg, about 100mg in adult, 150mg in large adult. 3Mg in premie, 5.25mg in NB, 7.5 in 2 m/o

Fentanyl airway pretreatment

3mcg/kg. 200Mcg in adult, 300 in large adult. Do not use in kids

Atropine, airway pretreatment

0.02mg/kg. Usually in kids, with 0.01mg in premies, NB, and 2 m/o

Defasci dose of vec for airway pretreatment

0.01mg/kg. 0.7mg in adult, 1mg in large adult

Etomidate for RSI

0.3mg/kg. 21Mg for adult, 30 for large adult, 0.6 for premie, 1mg for NB, 1.5 mg for 2m/o

Succinylcholine for RSI

1.5mg/kg. 105 mg for avg adult, 150 for large adult, 3mg for premie, 5mg for NB, 7.5 mg for 2 m/o

Versed for RSI

0.1mg/kg. 7 mg for adult, 10mg for large adult, 0.2 mg for premie, 0.35 mg for NB, 0.5 mg for 2 m/o

Ketamine for RSI

2mg/kg. 140Mg for avg adult, 200mg for large adult, 4mg for premei, 7mg for NB, 10mg for 2 m/o

Vec for RSI dose

0.1mg/kg. 7Mg for adults, 10mg for large adults. 0.2 mg for premie, 0.35 for NB, 0.5mg for 2 m/o

Roc for RSI dose

1mg/kg. 70Mg for adults, 100 mg for large adults, 2mg for premeis, 3.5mg for NB, 5mg for 2 m/o

Pavulon aka Pancuronium

0.1mg/kg, 7mg for adults, 10mg for large adults, 0.2mg for premies, 0.35 mg for newborns, 0.5mg for 2 m/o

Ativan/versed for sedation intubation

0.05mg/kg, 2mg for avg adult and large adults, 0.1mg for premie, 0.2mg for nb, 0.25 mg for 2 m/o

Morphine for intubation sedation

0.1mg/kg. 7Mg for avg adult, 10mg for large adult. 0.2mg for premie, 0.35mg for nb, 0.5mg for 2 m/o

Fentanyl for intubation sedation

1 mcg/kg. 70Mcg for adult, 100mcg for large adults. 2Mcg for premie, 3.5mcg for nb, 5mcg for2 m/o

Ketamine for intubation sedation

1mg/kg. Usually used in kids. 2Mg for premies, 3.5 for nb, 5 for 2 m/o... doesnt seem right

Good ET tube sizes

for kids, Age/4 +4. 7.5c for normal adults. 8C for large adults. 2.5 for premies, 3 for nb, 3.5 for 2 m/o

Blade sizes for intubation

Usually 4. 0s for premeis, 1s for nb, 1s for 2 m/o

NG tube sizes

18 fr usually good. 5 for little babies, 8 for 2 m/o.

Chest tube sizes

42 fr. 8 for premies, 10 for babies

Grade I Anaphylaxis/HSN reaction

Mild (skin and SQ tissues): generalized edema, urticaria, periorbital edema, angioedema

Grade II anaphylaxis/HSN

Moderate (respiratory, CV, GI involvement), dyspnea, stridor, wheeze, N/V, chest or throat tightness, abdominal pain

Grade III Anaphylaxis/HSN

Severe (hypoxia, hypotension, Neuro changes) Cyansois, O2 sat <90%, BP<90, confusion, incontinence,

Treatment for Grade I anaphylaxis

Obs

Treatment for Grade II anaphylaxis

Epi IM, SQ (1:1000) 0.2-0.5ml q15-20 min x 3. H1 blockers Benadryl IV/IM, Hydroxyzine IM. H2 blockers CimetidienIV/PO, Ranitidine IV. Steroids Solumedrol, Hydrocortisone, Prednisone

Doses of Epi for Anaphylaxis II

Epi IM/SQ (1:1000) 0.2-0.5 ml q15-20 min x3

Doses of H1 blockers for Anaphylaxis II

Benadryl IV/IM/PO 25-50mg q6-8 hrs. Hydroxyzine IM 25-50mg q6-8 hrs

Doses of H2 blockers for anaphylaxis II

Cimetidine IV/PO 300mg q6hrs. Ranitidine IV 50mg or 150mg PO

Steroid doses for Anaphylaxis II

Solumedrol IV 80-125mg. Hydrocortisone IV 250-300mg q6h x2-4 doses. Pred\nisone PO 40-60mg daily for 5 days

Standard Epi doses for Grade III anaphylaxis

Epi IM (Not SQ) 1:1000, 0.3mg q15-20 min x 3. Epi IV 1:10,000 Give 0.1mg of 1:10,000 slution over 5-10 minutes. Epi IV 1:1000. Add 1 mg or 1 ml to 250ml D5W. Start at 1mcg/min, increase to 1-10mcg/min to effect

Racemic Epi neb for anaphylaxis

Use for grade III. 2.25% use 0.05 ml/kg (max 1.5ml) q1-2 hrs for stridor

Epinephrine in ETT for anaphyalxis

Use for grade III. 1:1000, 0.1mg if no IV

Norepinephrine IV for anaphylaxis

Grade III. 4Mg in 1L D5W at 2-12mcg (0.5-3ml)/min for severe hypotension

Drug to use for severe hypotension in the setting of anaphylaxis

Norepinephrine IV. 4Mg in 1L D5W at 2-12mcg (0.5-3ml)/min

Additional drug to epi/NE for grade III anaphylaxis

Glucagon IV. 1 mg in 1 L D5W at 5-15 mcg/min (0.5-3ml) or 1-5mg bolus q5min then 2-5 mg/hr

Anaphylaxis in the setting of BB meds

Tends to be more severe, which may be due to a blunted response to epi. Glucagon can help. Bypasses beta receptors to directly activate cAMP. In children, 20-30 ug/kg to a max dose of 1 mg

Side effect of glucagon

Emesis

Patients with anaphylaxis who exhibit bronchospasm

Neb albuterol. 2.5-5mg of albuterol to 3ml of NS

Pretreating defasciculating dose before rest of intubation procedural sedation

0.01mg/kg of Vecuronium or pancuronium

Adult dose of succinylcholine

1-1.5mg/kg
3-4 mg/kg IM
0.15mg/kg priming dose

Pediatric dose of succinylcholine

1mg/kg

Adutl dose of roc

0.6-1.2mg/kg

Ped dose of roc

same as adult: 0.6-1.2mg/kg

Panc adult dose

0.1 mg/kg
0.01mg/kg priming dose

Panc ped dose

0.04-0.1 mg/kg

Vec adult dose

0.1-0.2mg/kg

Vec ped dose

Do not administer if less than 7 weeks of age. 0.1-0.2mg/kg

What should you use prior to succinylcholine in any child 5 years

Atropine 0.02mg/kg IV (min dose 0.1mg, max single dose 0.5mg child, 1mg adolescent).

Also use at any age repeat dosing. Supposedly to decrease the risk of succinylcholine releated bradycardia,.

Formula for tube size ages 2-20

(Age in years + 16)/4

Methohexital (Brevital) dose in adult and peds for RSI

Adult: 1-1.5mg/kg induction,0.25-1mg/kg sedation
Peds: 1-1.5mg/kg, 5-10mg/kg IM

Thiopental (pentothal) dose in adults and peds for RSI

Adult: 3-5mg/kg for induction, 0.5-1mg/kg for sdation
Peds: 4-6mg/kg

Propofol brand name

Diprivan

Propofol dose, adult vs peds

Adult: 1mg/kg bolus then 0.5mg/kg every 3-5 minutes as needed for procedural sedation
Peds: Loading dose 1mg/kg IV, followed by 0.5mg/kg q3-5mins as needed for sedation

Etomidate dose, adult vs peds

Adult: 0.2-0.6 mg/kg induction. Procedural sedation 0.1-0.2mg/kg IV over 30-60 seconds, followed by 0.05mg/kg q3-5 minutes as needed.

Kids: Not approved younger than 10. Older, use adult dosing.

Ketamine dose, adult vs peds

Adult: 1-2.5mg/kg induction
0.5-1mg/kg IV sedation
5-10mg/kg IM sedation

Peds: 1-2mg/kg IV, 2-4mg/kg IM

Durations of the major sedation and induction drugs for RSI

Methohexital: 5-10 mins
Thiopental: 3-5 mins
Propofol: 3-5 mins
Etomidate: 3-10mins
Ketamine: 5-15 mins IV, 10-25 mins IM

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