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106 terms

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