Basic Vital Day to Day Knowledge Flashcards
What is the mnemonic for preparing to respond to a paediatric emergency?
WAFEELS GMS
WEIGHT
< 6/12: Birth weight x 2
6/12 to 1 year: Birth weight x 3
> 1 year: (Age + 4) x 2
ADRENALIN dose IV/IO (Cardiac Arrest)
10 mcg/kg
0.1 ml/kg of 100 mcg/ml
FLUID dose
10 or 20 ml/kg
ETT size (cuffed)
> 1 year is Age/4 + 3.5
ETT depth
–> ETT size x 3 (+2 for nose) = cm at lip
Lightning dose
Defib 1st dose: 2 J/kg
Defib 2nd dose: 4 J/kg
Glucose
Child: 5ml/kg of 10% glucose (different for neonates)
Morphine: 0.1mg/kg IVI
Sedation / Seizures
1. Lorazepam IO/IV 0.1 mg/kg
2 Midazolam SL 0.5mg/kg
3. Diazepam PR 0.5mg/kg
Define premature infants neonates, infants, toddlers, children and adolescents and define the normal range of HR, RR and SBP for these.
PREMATURE INFANTS (Born before 37 weeks gestation)
HR 140 - 170
RR 40 - 70
MAP = Gestational age
NEONATES (0 - 28 days)
HR 120 - 170 bpm
RR 25 - 50 breaths/min
SBP 80 - 90
INFANTS (28 days - 1 year)
HR 110 - 160
RR 20 - 40
SBP 85 - 95
TODDLERS (1 - 3 years)
HR 90 - 140
RR 20 - 35
SBP 85 - 100
CHILD (3 - 12)
HR 70 - 130
RR 15 - 30
SBP 90 - 110
ADOLESCENTS (>12)
HR 60 - 110
RR 12 - 24
SBP 90 - 120
How are CVC’s sized in paediatrics
< 10 kg ——-> 4 Fr
10 - 20 kg ——–> 4 - 5 Fr
20 - 40 kg ——–> 5 Fr
> 40 kg ———> 7 Fr
LENGTH: 10% of patient’s height (sizes available are 5 cm, 8cm and 13 cm)
Use smallest size and least number of lumens possible (increased complications)
Name medication, dose and administration timing of the premeds administered frequently at red cross hospital
Clonidine
- 3 - 4 ug/kg PO 90 minutes preop
Midazolam
- 0.2 - 0.3 mg/kg (max 7.5mg) PO 30 minutes prop ‘on trolley’
Describe the apnoea prevention protocol at red cross hospital
APNOEA PREVENTION
1. Prem babies < 60 weeks post conceptional age
Caffeine Citrate
- 20 mg/kg PO 2 hours preoperatively
- 10 mg/kg PO daily x 48 hours postoperatively
OR
Anhydrous caffeine
- 10 mg.kg PO 2 hours preoperatively
- 5 mg/kg PO daily x 48 hours postoperatively
OR
Aminophylline
- 5 - 10 mg/kg IV (slowly intraoperatively)
APNOEA MONITORING
- For 12 hours postoperatively
1. Term < 50 weeks postconceptional age
2. Prem < 60 weeks postconceptional age
What are the medications and dosage of medications given at RXH for PONV
- Ondansetron 0.15 mg/kg IV
- Dexamethasone 0.15 mg/kg IV
What is the name and dose of prophylactic antibiotics commonly given to patients undergoing surgery at RXH
- Cefazolin 50 mg/kg
- Metronidazole 15 mg/kg
Describe the dose of the agents required for reversal in paediatrics
Neostigmine 50 ug/kg
Atropine 20 ug/kg
Glycopyrrolate 10 ug/kg
At RXH
Neostigmine 2.5 mg + Glycopyrrolate 0.4 mg draw up to 5 mls
–> Give 1ml per 10kg
OR
–> 0.1 ml per 1kg if less 10 kg
Describe maintenance and bolus fluid management at RXH
Maintenance
4 ml/kg/hr - 1st 10 kg
2ml/kg/hr - 2nd 10 kg
1 ml/kg/hr - thereafter
Bolus
5 ml/kg (titrated) up to a max of 20ml/kg
–> Aim for UO of 0.5 - 1.0 ml/kg/hr
Describe how adrenalin infusions are mixed and infused at RXH
60 ug/kg in 50 ml normal saline
1ml/hr = 0.02 ug/kg/min
Describe how dexmedetomidine infusions are prepared and infused at RXH
Bolus: 1 ug/kg
Infusion: 10 ug/kg in 50 mls normal saline: 1 ml/hr = 0.2 ug/kg/hr
Dose range: 0.2 - 1.5 ug/kg/hr
Describe how a ketamine TIVA is done at RXH
200mg ketamine in 50 ml normal saline = 4mg/ml (consider 8 mg/ml for bigger kids / longer cases)
Induction: 1 - 2 mg/kg bolus
12mg/kg/hr for 20 minutes
8mg/kg/hr for 20 minutes
4 mg/kg/hr for remainder
Describe how milrinone is prepared and infused at RXH
1.5 mg/kg in 50 ml normal saline: 1 ml/hr = 0.5 ug/kg/min
Dose range: 0.25 - 0.75 ug/kg/min
Describe how noradrenalin is prepared and infused at RXH
60 ug/kg in 50 ml normal saline: 1ml/hr = 0.02ug/kg/min
Describe how remifentanil is prepared and infused at RXH
Concentration: 10 ug/ml
Weight (kg) x 0.6 = rate (ml/hour) = 0.1 ug/kg/minute
Dose range: 0.1 - 0.3 ug/kg/minute
Describe how sufentanyl is prepared and infused at RXH
10 ml of 5 ug/ml neat solution in 50 ml normal saline
Concentration 1ug/ml
< 20 kg: 10 ml/hr
> 20kg: 20 ml/hr
Discontinue 20 minutes prior to finish
How is Clysis mixture drawn up and administered at RXH
10 ml Bupivacaine 0.5% + 1 mg (1ml) adrenalin.
Take 4.5 mls of this mixture and add it to a 200 ml bag NaCl
Maximum dose 20ml/kg
Describe the dosing and administration of LA via wound infusion catheters depending on age at red cross hospital
< 4 months: 0.1% bupivacaine at 0.1 - 0.2 ml/kg/hr
> 4 months: ).2% bupivacaine at 0.1 - 0.2 ml/kg/hr
Describe the administration of caudals at Red Cross Hospital
0.25% bupivacaine
Sacro-lumbar block: 0.5ml/kg
Upper abdo block: 1 ml/kg
Mid thoracic block: 1.2 ml/kg (not always reliably achieved)
Note: 1ug/kg of clonidine can be added to the caudal
summarise Fasting guidelines for children
Solid food/formula milk - 6 hours
Breast milk - 4 hours
Clear fluid - 1 hour
Pulmonary aspiration is a rare event in children, with an incidence of 0.07%‐0.1%.
A Provided there are no specific contraindications (e.g. gastro-oesophageal reflux, cerebral palsy) a liberal clear fluid fasting regime does not affect the incidence of pulmonary aspiration in children. With a 2‐hour clear fluids fasting policy, studies indicate that this translates into a much longer duration of fasting (6‐7 hours), which is clearly undesirable.
These prolonged periods of fasting in children can increase thirst and irritability and can lead to other adverse physiological and metabolic effects.
Clear fluids are defined as water, clear (nonopaque) fruit juice or squash/cordial, ready diluted drinks, and nonfizzy sports drinks. Non‐thickened, non‐carbonated. The starting point would be 3 mL/kg based on estimated weight or banding according to age. This would mean 1‐ to 5‐year olds are allowed up to 55 mL, 6‐12 years up to 140 mL, and greater than 12 years up to 250 mL. Such banding avoids the need to wait for a current weight (if it is unknown) that could delay the offer of an appropriate volume.
The preoperative fasting for elective procedures for children aged 0-16 years of age are as follows:
Describe the epidural protocol at RXH
Estimated depth of epidural space from skin:
1mm/kg.
Length in epidural space = 3 - 4 cm
Bolus: 0.25% bupivacaine
–> 0.5ml/kg thoracic
–> 0.75 ml/kg lumbar
Alternatively use 0.5 - 1 ml per dermatome needing to be covered (check toxic dose)
Infusion
Bupivacaine: 0.1% bupivacaine
–> >6/12 and > 5kg: 0.1 - 0.4 ml/kg/hr
–> <6/12 or < 5kg: 0.1 - 0.2 ml/kg/hour
Describe the names and doses of 8 medications used for intra-operative analgaesia
Paracetamol 15mg/kg (20mg/kg loading)
*Diclofenac (PR) 1mg/kg
*Paracoxib 1mg/kg
Ketamine 0.25 - 0.5 mg/kg
Clonidine 1 - 2 ug/kg
Fentanyl 1 - 2 ug/kg
Morphine 0.1 ug/kg
Alfentanyl 10ug/kg
Describe the names and doses of 7 medications used for post op analgaesia at RXH
Paracetamol 15 mg/kg PO 6 hrly
*Ibuprofen 5 - 10 mg/kg PO 8 hrly
Clonidine 2 - 5 ug/kg PO 8 hrly
Morphine infusion: 0.5mg/kg in 50 ml NaCl @ 1 - 3 ml/hr
Morphine (oral):
–> Neonate: 0.05 mg/kg 6hrly
–> 1/12 to 1 yr: 0.05 - 0.2 mg/kg 4 - 6 hrly
–> >1yr: 0.2 - 0.4 mg/kg 4 - 6 hrly
Ketamine: 0.2 - 0.3 mg/kg/hr
–> 5mg/kg in 50 ml NaCl @ 2 -3 ml/hour
Gabapentin: 3 - 10 mg/kg 8 hourly
–> Initiate and wean over 3 days
E.g. Day 1: nocte. Day 2: 12 hourly. Day 3 8 hrly.
Describe the antiemetics and their doses used at RXH
1st line: Ondansetron 0.15mg/kg IV 8 hrly
2nd line: Droperidol 0.02mg/kg (max 0.5 mg) IV 6 - 8 hrly
3rd line: Metoclopramide 0.3 mg/kg (max 15 mg) IV 8 hrly
What stool softener is preferable and what is its dose at RXH
Lactulose 0.5 ml/kg PO 12 hrly PRN
What is the revised FLACC score?
The revised FLACC (Face, Legs, Activity, Cry, Consolability) is a behavioural pain assessment scale for use with children unable to self-report their level of pain due to developmental disabilities.
Observe child for 1 - 3 minutes if awake and 5 minutes if asleep
1 - 3 mild
4-6 moderate
7 - 10 severe pain
What is NIPS
Neonatal Infant Pain Scale
FLAACB - 0 - 1 - 2
Face relaxed - contracted - /
Legs Relaxed - flexed or stretched - /
Arms Relaxed - flexed or stretched - /
Alertness Calm - uncomfortabe - /
Cry - Absent - mumbling - Vigorous
Breathing - Relaxed - off baseline - /
0 - 2 = mild pain
2 - 4 = moderate
> 4 = severe pain
