pediatric must know

7/24/2019 pediatric must know

1/8

EXPANDED PROGRAM ON IMMUNIZATION

VACCINE AGE DOSE # ROUTE SITE INTERVAL

BCG-1 Birth

or 6 wks

0.05mL

(NB)0.1mL(older)

1 ID R-

Deltoid

DPT 6 wks 0.5mL 3 IM Upper Outerthigh

OPV 6 wks 2 drops 3 PO Mouth 4 wks

HEPA B 6 wks 0.5mL 3 IM Antero-lateralthigh

4 wks

MEASLES 9 mos 0.5mL 1 SC Outer upper

arm

4 wks

BCG-2 School entry 0.1mL 1 ID L-Deltoid

TetToxoid Childbearingwomen

0.5mL 3 IM Deltoid 1 mo then6-12 mos

ADVERSE REACTIONS FROM VACCINES

BCG 1. Wheal small abscess ulceration healing / scar formation in12 wks

2. Deep abscess formation, indolent ulceration, glandular enlargement,suppurative lymphadenitis

DPT 1. Fever, local soreness2. Convulsions, encephalitis / encephalopathy, permanent brain

damage

OPV Paralytic Polio

HEPA B Local soreness

MEASLES 1. Fever & mild rash2. Convulsions, encephalitis / encephalopathy, SSPE, death

ACTIVE PASSIVE

BCG Diphtheria

DPT Tetanus

OPV Tetanus Ig

Hep B Measles Ig

Measles Rabies (HRIg)

Hib Hep A Ig

MMR Hep B ig

Tetanus Toxoid Rubella Ig

Varicella

BODY TEMPERATURE

Subnormal 39.5CHyperpyrexia >42.0C

AGE HR (bpm) BP (mmHg) RR ( cpm)

Pr et erm 1 20 -1 70 5 5- 75 /3 5- 45 4 0- 70Term 120-160 65-85/45-55 30-600 -3 mo 1 00 -1 50 6 5- 85 /45 -55 3 5- 553-6 mo 90-120 70-90/50-65 30-45

6 -1 2 m o 8 0- 12 0 8 0- 10 0/5 5- 65 2 5- 401 -3 yr s 7 0- 11 0 9 0- 10 5/5 5-7 0 2 0- 303 -6 yr s 6 5- 11 0 9 5- 11 0/6 0-7 5 2 0- 256 -1 2 y rs 6 0- 95 1 00 -1 20 /6 0- 75 1 4- 221 2- 17 y rs 5 5- 85 1 10 -1 35 /6 5- 85 12 -1 8

BP cuff should cover2/3 of arm-: S MA LL cuf f: f alsely high B P-: LARGE cuf f: f alsely low B P

BMI

Asian CaucasianUnderweight AP

6 y 1.35 Transverse >>> AP

FONTANELS

Appropriate si ze at birth: 2 x 2 cm (anterior)Closes at: Anterior = 18 months, or as early

as 9-12 monthsPosterior = 6 8 weeks or

2 4 months

THORACIC INDEX

TI = transverse chest diameter

AP diameter

Birth : 1.01 year : 1.256 years : 1.35

APGAR

0 1 2

A Blue /

PalePink body/ Blue

extremitiesCompletely

pink

P Absent Slow ( 100

G (-)Response

GrimacesCoughs,

Sneezes,Cries

A (-)Movement

Some flexion /extension

Activemovement

R A bsent S low / I rregular Good,

strong cry

8 10: Normal4 7: Mild / Moderate Asphyxia0 3: Severe asphyxia

GCS

Function Infants/Young Older

EyeOpening 4- Spontaneous3- To speech2- To pain1- None

SpontaneousTo speechTo painNone

Verbal 5- Appropriate4- Inconsolable3- Irritable2- Moans1- None

OrientedConfusedInappropriateIncomprehensibleNone

Motor 6- Spontaneous5- Localize pain4- Withdraw3- Flexion2- Extension1- None

SpontaneousLocalize painWithdrawFlexionExtensionNone


2/8

H.E.A.D.S.S.S.

Sexual activities Sexual orientation? GF/BF? Typical date? Sexually active? When started? # of persons?

Contraceptives? Pregnancies? STDs?

Suicide/Depression Ever sad/tearful/unmotivated/hopeless? Thought of hurting self/others? Suicide plans?

Safety Use seatbelts/helmets? Enter into high risk situations? Member of frat/sorority/orgs? Firearm at home?

F.R.I.C.H.M.O.N.D.

Fluids Respiration Infection Cardiac Hematologic Metabolic Output & Input [cc/kg/h] N: 1-2 Neuro Diet

H.E.A.D.S.S.S.

Home Environment With whom does the adolescent live? Any recent changes in the living situation? How are things among siblings? Are parents employed? Are there things in the family he/she wants to

change?

Employment and Education Currently at school? Favorite subjects?

Patient performing academically? Have been truant / expelled from school? Problems with classmates/teachers? Currently employed? Future education/employment goals?

Activities What he/she does in spare time? Patient does for fun? Whom does patient spend spare time? Hobbies, interests, close friends?

Drugs Used tobacco/alcohol/steroids? Illicit drugs? Frequency? Amount?

Affected daily activities? Still using? Friends using/selling?

NUTRITION

AGE WT. CAL CHON

0-5 mo 3-6 115 3.5

8-11 mo 7-9 110 3.0

1-2 y 10-12 110 2.5

3-6 y 14-18 90-100 2.0

7-9 y 22-24 80-90 1.5

10-12 y 28-32 70-80 1.5

13-15 y 36-44 55-65 1.5

16-19 y 48-55 45-50 1.2

TCR = Wt at p50 x caloriesTCR = CHON X ABW

Total Caloric Intake : calories X amount ofintake (oz)

Gastric Capacity : age in months + 2

Gastric Emptying Time : 2-3 hours

1:1 1:2

Alacta Bonna

Enfalac Nursoy

Lactogen Promil

Lactum S-26

Nan Similac

Nestogen SMA

Nutraminogen

Pelargon

Prosobee

THE SEVEN HABITS OFHIGHLY EFFECTIVE PEOPLE

by Stephen R. Covey

Habit 1: Be ProactiveHabit 2: Begin with the end in mindHabit 3: Put First Things FirstHabit 4: Think Win-WinHabit 5: Seek first to understand and

then to be understoodHabit 6: SynergizeHabit 7: Sharpen the saw

EXPECTED LA SALLIANGRADUATE ATTRIBUTES

(ELGA)

1. Competent & safe physicians2. Ethical & socially responsible

Doctors / practitioners3. Reflective lifelong learners4. Effective communicators5. Efficient & innovative managers


3/8

TREATMENT PLAN B

Recommended amount of ORS over 4 hour period

Age up to: 4 mo 4 mo 12 mo 12 mo 2 yrs 2 yrs 5 yrs

Wt: 14 days, non-infectious causes Persistent : >14 days, infectious cause

ORS vol. after each loose stool 1 day

10 y.o. A s much as wanted 2000mL

For severe dehydration / WHO hydration

(fluid: PLR 100cc/kg)Age 30mL/kg 75mL/kg

12 30 mins 2 H

Patient inSHOCK

20-30cc/kg IV fast drip but in infants 10cc/kg IV (repeat if not stable) If responsive & stable 75/kg x 4-6 hours

ACUTE DIARRHEA (at least 3x BM in 24 hrs)

4 Major Mechanisms

1. Poorly absorbed osmotically active substances inlumen

2. Intestinal ion secretion (increased) or decreasedabsorption

3. Outpouring into the lumen of blood, mucus4. Derangement of intestinal motility

Rotaviral AGE(vomiting first then diarrhea)

Ingestion of rotavirus rotavirus in intestinal villi

destruction of villi

(secretory diarrhea absorption secretion) AGE

Assessment of dehydration (Skin Pinch Test)

(+) if > 2 seconds no dehydration if skin tenting goes back

immediately

ETIOLOGY of AGE

Bacteria VirusesAeromonas AstrovirusesBacillus cereus CalovirusesCampylobacter jejuni NorovirusClostridium perfringens Enteric AdenovirusClostridium difficile RotavirusEscherichia coli CytomegalovirusPlesiomonas shigelbides Herpes simplex virusSalmonellaShigellaStaphylococcus aureusVibrio cholerae 01 & 0139Vibrio parahaemolyticusYersinia enterocolitica

ParasitesBalantidium coliBlastocyctis hominisCryptosporidiumGiardia lamblia

A mo eba M et ro ni daz ol e

Ascariasis Al/mebendazole

C holer a Tetracyli ne

Shige lla TMP /SMX ( Cotri)

Salmonella Chloramphenicol

TREATMENT PLAN A

4 Rules of Home Treatment

1. Give extra fluid (as much as the child will take)

> Breastfeed frequently & longer at each feeding> if the child is exclusively breastfed, give one or

more of the following in addition to breastmilk ORS solution food based fluid (e.g. soup, rice, water)

clean water

How much fluid to be given in addition to the usualfluid intake?

Up t o 2 years: 50-100 mL aft er eachloose stool

2 years or more: 140-200 mL:- give frequent small sips from a cup:- if the child vomits, wait for 10 min then

resume:- continue giving extra fluids until diarrhea

stops

2. Give Zinc supplements

Up to 6 mo: 1 half tab per day for 10-14 days6 months or more: 1 tab or 20mgOD x 10-14 days

3. Continue feeding4. Know when to return

TREATMENT PLAN C

Treat severe dehydration QUICKLY!

1. Start IV fluid immediately2. If the child can drink, give ORS by mouth while the

IV drip is being set up3. Give 100mL/kg Lactated Ringers solution

Age First give Then give

30mL/kg in: 70mL/kg in:

Infants(


4/8

SMR GIRLSStage Pubic Hair Breasts

1 Preadolescent Preadolescent2

Sparse, lightly pigmented, straight,medial border of labia

Breast & papilla elevated, as smallmound, areola diameter increased

3 Darker, beginning to curl, amount Breast & areola enlarged, no contour

separation

4 Course, curly, abundant but amount 15 kg, 2 y/o 30 cc/kg 60 cc/kg 90 cc/kg

D5 0.3% in6-8 hours

1st hr: Plain LRNext 5-7 hrs: D5 0.3% in

5-7 hours

1st hr: Plain LRNext 5-7 hrs: D5 0.3% in

5-7 hours

HOLIDAY-SEGAR METHOD (MAINTENANCE)

WEIGHT TOTAL FLUID REQUIREMENT

0 - 10 kg 100 mL / kg

1 1- 20 kg 10 00 + [ 50 fo r e ach kg in e xcess of 10 kg]

> 2 0 kg 15 00 + [ 20 fo r e ach kg in e xcess of 20 kg]

NOTE: Computed Value is in mL/dayEx. 25kg child

Answer: 1500 + [100] = 1600 cc/day

ARIPROTOCOL(PROG

RAM

FORTHECONTROLOFARI)

ChildAge2monthsupto5years

IV-F

LUIDCOMPOSITIONS(Commo

nlyUsedforInfantsandChild):

YoungInfants Neonates ( 1-3 months* Febrile pneumonia

- RSV- Other respiratory viruses- Streptococcus pneumoniae- Haemophilus influenza (Type B)

*Afebrile pneumonia- Chlamydia trachomatis- Mycoplasma homilis- CMV

> 3-12 mo- RSV- Other respiratory viruses- Streptococcus pneumoniae- Haemophilus influenzae (Type B)- C. trachomatis- M. pneumoniae- Group A Streptococcus

> 2-5 yrs- RSV- Other respiratory viruses- Streptococcus pneumoniae- Haemophilus influenzae (Type B)- C. trachomatis- M. pneumoniae- Group A Streptococcus- Staph aureus

> 2-5 yrs- Streptococcus pneumoniae- Haemophilus influenzae (Type B)- C. trachomatis- M. pneumoniae- Group A Streptococcus- Staph aureus

Dengue Shock Syndrome

Manifestations of DHF plus signs of circulatory failure1. rapid & weak pulse2. narrow pulse pressure (MOT: mosquito bite (man as reservior)

>Vector: Aedes aegypti

>Factors affecting transmission:- breeding sites, high human population density,

mobile viremic human beings

> Age incidence peaks at 4-6 yrs

> Incubation period: 4-6 days

>Serotypes:- Type 2 most common- Types 1& 3- Type 4 least common but most severe

> Main pathophysiologic changes:a. increase in vascular permeability

extravasation of plasma

- hemoconcentration- 3 rd spacing of fluids

b. abnormal hemostasis- vasculopathy- thrombocytopenia- coagulopathy

Dengue Fever Syndrome (DFS)

Biphasic fever (2-7 days) with 2 or more of the ff:

1. headache2. myalgia or arthralgia3. retroorbital pain4. hemorrhagic manifestations

[petechiae, purpura, (+) torniquet test]5. leukopenia

Dengue Hemorrhagic Fever (DHF)

1. fever, persistently high grade (2-7 days)2. hemorrhagic manifestations

- (+) torniquet test- petechiae, ecchymoses, purpura- bleeding from mucusa, GIT, puncture sites- melena, hematemesis

3. Thrombocytopenia (< 100,000/mm3)4. Hemoconcentration

- hematocrit >40% or rise of >20% from baseline- a drop in >20% Hct (from baseline) following

volume replacement- signs of plasma leakage

[pleural effusion, ascites, hypoproteinemia]

DENGUE

PATHOPH

YSIOLOGY

MANAGEMENT OF DENGUE

A. Vital Signs and Laboratory MonitoringMonitor BP, Pulse RateWe have to watch out for Shock (Hypotension)

MANAGEMENT OF HEMORRHAGE


6/8

Torniquet Test: SBP + DBP = mean BP for 5 mins.2

if 20 petechial rash per sq. inch on antecubital fossa(+) test

Hermans Rash:- usually appears after fever lysed- initially appears on the lower extremities- not a common finding among dengue patients- an island of white in an ocean of red

Recommended Guidelines for Transfusion:

Transfuse:- PC < 100,000 with signs of bleeding- PC < 20,000 even if asymptomatic- use FFP if without overt bleeding- FWB in cases with overt bleeding or

signs of hypovolemia

> if PT & PTT are abnormal: FFP> if PTT only: cryprecipitate

3-7cc/kg/hr depending on the Hct (1st no.) level(D5LR)10-20cc/kgfast drip PLR - hypotension, narrow pulse

pressure fa ir pulse

Leukopenia in dengue: probable etiology isPseudomonas

therefore: give Meropenem or Ceftazidime

URINARY TRACT INFECTION

Suggestive UTI:- Pyuria: WBC 5/HPF or 10mm3

- Absence of pyuria doesnt rule out UTI- Pyuria can be present w/o UTI

Presumptive UTI:- (-) urine culture- lower colony counts may be due to:

* overhydration* recent bladder emptying* previous antibiotic intake

Proven or Confirmed UTI:- (+) urine culture 100,000 cfu/mL urine of a single

organism- multiple organisms in culture may indicate a

contaminated sample

ACUTE GLOMERULONEPHRITIS

Complications of AGN- CHF 2 to fluid overload- HPN encephalopathy- ARF due to GFR

STAGES of AGN- Oliguric phase [7-10days] complications sets in- Diuretic phase [7-10days] recovery starts- Convalescent phase [7-10days] patients are

usually sent home

Prognosis- Gross hematuria 2-3 weeks- Proteinuria 3-6 weeks- C3 8-12 weeks- mi cro scopic he ma tu ria 6 -1 2 mo o r

1-2 years- HPN 4-6 weeks

> Hyperkalemia may be seen due to Na + retention> Ca ++ decreases in PSAGN> in ASO titer

- normal within 2 weeks- peaks after 2 weeks- more pronounced in pharyngeal infection

than in cutaneous

RHEUMATIC FEVER

JONES CRITERIA:

A. Major Manifestations- Carditis (50-60%)- Polyarthritis (70%)- Chorea (15-20%)- Erythema Marginatum (3%)- Sub cutane ou s No dule s (1 %)

B. Minor Manifestations- Arthralgia- Fever

- Laboratory Findings of: Acute Phase Reactants (ESR / CRP)Prolonged PR interval

C. PLUS Supporting Evidence of AntecedentGroup-A Strep Infection- (+) Throat Culture or Rapid Strep-Ag Test- Rising Strep-AB Test

TREATMENT OF RHEUMATIC FEVER

A. Antibiotic Therapy- 10 days of Oral Penicillin or Erythromycin- IM Injection of Benzethine Penicillin

*** NOTE: Sumapen = Oral Penicillin!

B. Anti-Inflammatory Therapy

1. Aspirin (if Arthritis, NOT Carditis)Acute: 100mg/kg/day in 4 doses x 3-5daysThen, 75mg/kg/day in 4 doses x 4 weeks

2. Prednisone

2mg/kg/day in 4 doses x 2-3weeksThen, 5mg/24hrs every 2-3 days

PREVENTON

A. Primary Prevention

- 10 days of Oral Penicillin or Erythromycin- IM Injection of Benzethine Penicillin

B. Secondary Prevention

C. Duration of Chemoprophylaxis

BRONCHIAL ASTHMA (GINA GUIDELINES)

Controlled P artly Controlled Uncontrolled

Daysymptoms

none > 2x per wk

3 or more symptomsof Partly Controlled

Asthma in any wee k

Limitation ofactivities

none any

Nocturnal Sx(awakening)

none any

Need forreliever

< 2x per wk > 2x per wk

Lungfunction

normal < 80%

Exacerbation none > 1x per yr 1x / week


7/8

KAWASAKI DISEASE

CDC-CRITERIA FOR DIAGNOSIS:ADOPTED FROM KAWASAKI(ALL SHOULD BE PRESENT)

A) HIGH Grade Fever (>38.5 Rectally) PRESENTfor AT LEAST 5-days without other ExplanationHigh Grade Fever of at least 5 daysDOES NOT Respond to any kind of Antibiotic!

B) Presence of 4 of the 5 Criteria1. Bilateral CONGESTION of the Ocular Conjunctiva

(seen in 94%)2. Changes of the Lips and Oral Cavity (At least ONE)3. Changes of t he E xt remities (At least ONE)

4 . Po ly mo rp ho us Exa nth em ( 92 %)5. Cervical Adenopathy = Non-Suppurative Cervical

Adenopathy (sh ould be >1.5cm) in 42%)

HARADA Criteria- used to determine whether IVIg should be given- assessed within 9 days from onset of illness

1. WBC > 12,0002. PC 3+4. Hct Epilepsy: tendency for recurrent seizures that areunprovoked by an immediate cause

> Status epilepticus: >30min or back-to-backw/o return to baseline

> Etiology:- V a sc ul ar : AV M, st ro ke , h em or rh ag e- I n fe ct io ns : m en in gi ti s, e nce ph al it is- T ra uma ti c :- A utoimmune : S LE , vasculitis, A DE M- M e ta bo li c : e le ct ro ly te i mb al an ce- I d io pa th ic : id io pa th ic e pi le ps y- N e op la st ic : s pa ce o cc up yi ng l es io n- S t ru ct ur al : c or ti ca l m al fo rm at io n,

prior stroke- S ynd rome : g en etic d isor der

SIMPLE FEBRILE SEIZURE

A. Criteria for an SFS < 15 minutes Generalized-tonic-clonic Fever > 100.4 re ctal to 101 F (38 to 38.4 C) No recurren ce in 24 hour s No post-ictal neuro a bnormalities ( e.g. Todds

paresis) Most common 6 months to 5 years Normal de velopment No CNS infection or prior afe brile seizur es

B. Risk Factors Febrile seizur e in 1st / 2nd degree relative Neonatal nu rsery stay of >30 days Developmental delay Height of temperature

C. Risk Factors for Epilepsy(2 to 10% will go on to have epilepsy)

Developmental delay Complex FS (possibly > 1 complex feature) 5% > 30 mins => _ of all childhood status Family History of Epilepsy Duration of fever

TUBERCULOSIS

A. Pulmonary TB fully susceptible M. tuberculosis, no histor y of previous a nti-TB drugs low loca l persistence of primary resistance to

Isoniazid (H)

2HRZ OD then 4HR OD or 3x/wk DOT

Microbial susceptibility unkn own or initial dr ugresistance suspected (e.g. cavitary)

previous a nti-TB use close conta ct w/ r esistant source case or living

in high areas w/ high pulmonary resistance toH.

2HRZ + E/S OD, then 4 HR + E/S OD or

3x/week DOT

B. Extrapulmonary TB Same in PTB

For seve re life threatening disease(e.g. miliary, meningitis, bone, etc)

2HRZ + E/S OD, then 10HR + E/S OD or3x/wk DOT

RESPIRATORY DISTRESS SYNDROME(Hyaline Membrane Disease)

o Male, preterm, low BW, maternal DM, & perinatalasphyxia

o Corticosteroids: most successful method to induce fetal lung

maturation Administered 24-48 hours before delivery

decrease incidence of RDS Most effective before 34 weeks AOG

o Microscopically: diffuse atelectasis, eosinophilicmembrane

Pathophysiology:

1. Impaired/delayed surfactant synthesis & secretion2. V/Q (ventilation/perfusion) imbalance due to

deficiency of surfactant and decreased lungcompliance

3. Hypoxemia and systemic hypoperfusion4. Respiratory and metabolic acidosis5. Pulmonary vasoconstriction6. Impaired endothelial &epithelial integrity7. Proteinous exudates8. RDS

Clinical Features:

1. Tachypnea, nasal flaring, subcostal andintercostal retractions, cyanosis, grunting

2. Pallor from anemia,peripheral vasoconstriction

3. Onset within 6 hours of lifePea k seve rity 2 -3 da ysRecovery 72 hours

Retractions:o Due to (-) intrapleural pressure produced by

interaction b/w contraction of diaphragm & otherrespiratory muscles and mechanical properties ofthe lungs & chest wall

Nasal flaring:o Due to contraction of alae nasi muscles leading to

marked reduction in nasal resistance

Grunting:o Expiration through partially closed vocal cords

Initial expiration: glottis closedlungs w/ gasinc. transpulmo P w/o airflow

Last part of expiration: gas expelled againstpartially closed cords

Cyanosis:o Central tongue & mnucosa (imp. Indicator of

impaired gas exchange); depends ontotal amount of desaturated Hgb


8/8

LUMBAR PUNCTURE

the technique of using a needle to withdrawcerebrospinal fluid (CSF) from the spinal canal.

SPINE spinal cord stops near L2

lower lumbar spine (usually between L3-L4 orL45) is preferable

CSF clear, watery liquid that protects the central

nervous system from injury cushions the brain from the surrounding bone. It contains:

glucose (sugar) protein white blood cells

Rate : 500ml/day or 0.35ml/min Range : 0.3-04 ml/min Volume : 50ml (infants)

150ml (adults)

Indication

to diagnose some malignancies (brain cancer andleukemia)

to assess patients with certain psychiatricsymptoms and conditions.

for injecting chemotherapy directly into the CSF(intrathecal therapy)

To diagnose other medical conditions such as: viral and bacterial meningitis

syphilis, a sexually transmitted disease

bleeding around the brain and spinal cord

multiple sclerosis, (affects the myelin coating ofthe nerve fibers of the brain and spinal cord)

Guillain-Barr syndrome, (inflammation of thenerves)

Complication Local pain Infection Bleeding Spinal fluid leak Hematoma (spinal subdural hematoma Spinal headache Acquired epidermal spinal cord tumor

Caution & Contraindications Increased ICP Bleeding diasthesis

Traumatic Tap Overlying skin infection Unstable patient

Empirical dose

6 months tsp TID QID

6 mos 2 yrs tsp

2-6 1 tsp

6-9 1 tsp

9-12 2 tsp

NEWBORN RESUSCITATION

AIRWAY: open & clear

Positioning

Suctioning

Endotracheal intubation (if necessary)

BREATHING is spontaneous or assisted

Tactile stimulation (drying, rubbing)

Positive-pressure ventilation

CIRCULATIONof oxygenated blood is adequate

Chest compressions

Medication and volume expansion

RESUSCITAION MEDICATIONS

Atropine 0.02 ml/k IM, IV, ET

Bicarbonate 1-2 meq/k

C al ci um 1 0 mg e le m C a/k s low I V

Calcium chloride 0.33/k (27 mg Ca/cc)

Calcium gluconate 1 cc/k (9 mg Ca/ cc)

Dextrose 1g/k = 2 cc/k D50

4 cc/k D25

Ep ine ph ri ne 0 .01 cc/k IV, ET

UMBILICAL CATHERIZATION

Indications Vascular access (UV) Blood Pressure (UA) and blood gas monitoring in

critically ill infants

Complications Infection Bleeding Hemorrhage Perforation of vessel Thrombosis w/ distal embolization Ischemia or infarction of lower extremities, bowel

or kidney Arrhythmia Air embolus

Cautions

Never for:

Omphalitis

Peritonitis

Contraindicated in

NEC

Intestinal hypoperfusion

Line Placement

Arterial line

Low line

Tip lie above the bifurcation between L3 & L5

High line

Tip is above the diaphram between T6 & T9

Cathether length Standardize Graph

Perpedicular line from the tip of the shoulder tothe umbilicus

Measure length from Xiphoid to umbilicus and add0.5 to 1cm.

Birth weight regression formula Low line : UA catheter in cm = BW + 7 High l ine : UA cat heter = [ 3xBW] + 9 UV catheter length = [0.5xhigh line] + 1

Procedure Determine the length of the catheter Restrain infant and prep the area using sterile

technique Flush catheter with sterile saline solution

Place umbilical tape around the cord. Cut cordabout 1.5-2cm from the skin.

Identify the blood vessels.(1thin=vein, 2thick=artery)

Grasp the catheter 1cm from the tip. Insert into thevein, aiming toward the feet.

Secure the catheter

Observe for possible complications

MKD COMPUTATION

Wt x mkd x preparation [mg/mL] = mL per dose

e .g. 1 2kg x 1 0mg x 5ml = 5mL p er do se120mg

*If per day, divide total (mL) by the # of divided doses

Dose x preparation x frequency = mkdweight

Paracetamol Drops = Wt: move 1 decimalpoint to the left

Age Wt1 10 kg2 123 144 165 186 20

1 drop = 1/20 mL1 t ea sp oon fu l = 5 m L1 tablespoonful = 15 mL1 w in eg la ss fu l = 6 0 mL = 2 o un ce s1 glassful = 250 mL = 8 ounces1 grain = 60 mg1 pint = 500 mL1 quart = 1000 mL1 ounce = 30 mL1 Kg = 2.2 lbs1 lb = 0.45359 Kg

BILIRUBIN

PRETERM:

mg/dl mmol/L

0-1 hr 1-6 17-100

1-2 d 6-8 100-140

3-5 d 10-12 170-200

TERM

mg/dl mmol/L

0-1 hr 2-6 34-100

1-2 d 6-7 100-120

3-5 d 4-12 70-200

1 mo

Documents

pediatric must know