Pediatric Emergency & Medications Doses By Dr Essam Sidqi

Essam Sidqi Yaqoob
Essam Sidqi YaqoobMBChB à Azadi Teaching Hospital / Duhok
1 | P r e p a r e d B y D r . E s s a m S i d q i - K u r d i s t a n R e g i o n / I r a q J a n 2 0 2 1
Augmentin syrup
30-50mg/kg/day ÷3
156.25mg/5ml → 1cc/kg/day ÷3
200mg/5ml → 0.75cc/kg/day ÷3
312.5mg/5ml → 0.5cc/kg/day ÷3
400mg/5mg → 0.35cc/kg/day ÷3
Amoxil Syrup
30-50mg/kg/day ÷3
125mg/5ml →
0.5-1cc/kg/day ÷3
250mg/5ml →
1-2cc/kg/day÷3
Acyclovir Syrup 200mg/5ml
<12 years 20mg/kg/dose x4
>12 years 10mg/kg/dose x4
(5 days)
Suprax Syrup
8mg/kg/day x1
100mg/5ml → 2cc/5kg x1
200mg/5ml → 1cc/5kg x1
Erythromycin Syrup
250mg/5ml
40mg/kg ÷3
1cc/kg/day ÷3
Flagyl Syrup 200mg/5ml
30mg/kg/day ÷3
1cc/kg ÷3
Metheprim Syrup 240mg/5ml
10mg/kg/day ÷2
1cc/5kg/day ÷2
Clarithromycin Syrup
125mg/5ml
15mg/kg/day
Nystatin oral drops
Infants 2cc x4
Children 4-6cc x4
Azithromycin syrup
10mg/kg/day ÷1
200mg/5ml → 1cc/4kg ÷1
Nalidoxic acid Syrup
250mg/ml
55mg/kg/day ÷4
Albendazole Syrup 100mg/5ml
<2 years → 200mg once
>2 years → 400mg once
Keflex Syrup 125mg/5ml
50mg/kg/day ÷4
Cefdinir Syrup
125mg/5ml, 250mg/5ml
6months-12 years: 7mg/kg x2
Profen Syrup 100mg/5ml
30mg/kg ÷3
1.5cc/kg ÷3
Parol Syrup
120mg/5ml, 250mg/5ml
10-15mg/kg x3
Adol oral drops 100mg/ml
2-3 drops/kg x3
Coldin Syrup 120mg/5ml
3 months-1 year 2.5cc x3
1-5 years 5cc x3
6-10 years 10cc x3
Pediatric Syrup Doses
2 | P r e p a r e d B y D r . E s s a m S i d q i - K u r d i s t a n R e g i o n / I r a q J a n 2 0 2 1
Ketotifen Syrup 1mg/5ml
>3 years 1mg x2
Fenistil oral drops
3 drops/kg/day ÷3
Loratadine Syrup 5mg/5ml
2-6 years 5cc/day
>6 years 10cc/day
Allermine syrup 10mg/5ml
0.25mg/kg/day ÷3
2-6 years 2.5cc x3
6-12 years 5cc x3
>12 years 10cc x3
Solvodin Syrup 4mg/5ml
<2 year 2.5cc x2
2-6 years 2.5cc x3
6-12 years 5cc x3
>12 years 10cc x3
Desloratadine Syrup
2-6 years 2.5cc x1
6-12 years 5cc x1
>12 years 10cc x1
Ventolin Syrup
2-6 years 0.75cc/kg/day ÷3
6-12 years 5cc x3
>12 years 10cc x3
Dexon Syrup 0.5mg/5ml
0.6mg/kg/day ÷2 or ÷3
5cc/kg/day ÷2 or ÷3
(5 days) Not >16mg/day
Prednisolone Syrup (5 days)
5mg/5ml, 15mg/5ml
1-2mg/kg/day ÷2
De-vomit Syrup 4mg/5ml
2mg/10kg x3
2cc/10kg x3
Zinc Syrup 20mg/5ml
0-6 months 10mg (2.5cc) x1
>6 months 20mg (5cc) x1
Biolact (franklin) sachet
<6 months x1
>6 months x2
Lactulose Syrup
<1 year→5cc x2 or x3
1-6 years→ 5-10cc x2 or x3
7-14 years→ 15cc x2 or x3
Motilium Syrup 5mg/5ml
1-2mg/kg/day ÷3
Ferrosam Syrup 50mg/5ml
1-2mg/kg/day ÷3 prophylaxis
3-4mg/kg/day ÷3 mild
4-6mg/kg/day ÷3 severe IDA
Colic EZ Syrup
<1 year → 0.5cc x4
>1 year → 1cc x4
Periactin Syrup 2mg/5ml
2-6 years → 5cc x2 or x3
>6 years → 10cc x2 or x3
X-M B.T. Enema 65ml once
Bisacodyl suppositories 10mg
<6 years→ 5mg x1
>6years→ 10mg x1
3 | P r e p a r e d B y D r . E s s a m S i d q i - K u r d i s t a n R e g i o n / I r a q J a n 2 0 2 1
Oframax 1gm / Claforan 1gm
vial (not >10cc or 1gm/dose)
50-100mg/kg/day ÷2
Or weight in kg/day ÷2
Flagyl bottle
500mg/100ml
30mg/kg/day ÷3
2cc/kg x3
Ampicillin 500mg / Amoxicillin
500mg vial(not>5cc or 500mg/dose)
50-100mg/kg/day ÷2
Or weight in kg/day ÷2
Meropenem / Imipenem vial
20mg/kg x3
Flucloxacillin vail
25mg/kg x3 or x4
Vancomycin vial 15mg/kg in 1hr
x3 or x4
Gentamicin amp
5-7mg/kg x1
Amikacin vial
15mg/kg/day ÷2
Clindamycin amp 300mg/2ml
20-40mg/kg/day ÷3 or ÷4
Levofloxacin bottle
500mg/100ml
8mg/kg x2
Parol bottle 1gm/100ml
1cc-1.5cc/kg x3 or x4
Zofran amp 4mg/2ml
1cc/10kg
Aminophylline amp 250mg/10cc
(1cc+9cc N.S.)
Loading: 5mg/kg or 2cc/kg
Maintenance: 1cc/kg x3
Hydrocortisone vial 100mg
5mg/kg/day ÷3
Allergic reaction:5mg/kg/dose
Voltarin amp IM
75mg/3ml
2mg/kg/dose x1 or x2
Decadron amp 8mg/2ml
Croup: 0.6mg/kg/day once
Others: 0.2-0.6mg/kg/day ÷2
Allarmine amp 10mg/1ml
0.25mg/kg/day (/dose allergic)
Lasix amp 20mg/2ml
1mg/kg/dose
Buscopan amp 0.5mg/ml
>12 years 1cc x3
Omeprazole vial 20mg or 40mg
1mg/kg x1
Zantac amp 50mg/2ml
1mg/kg/dose x2
Cimetidine amp 200mg/2ml
25mg/kg/day ÷4
Pediatric IV/IM Doses
*Age and Condition and Severity Dependent.
4 | P r e p a r e d B y D r . E s s a m S i d q i - K u r d i s t a n R e g i o n / I r a q J a n 2 0 2 1
Magnesium Sulphate vial
50% 5g/10ml → 0.2cc/kg ÷2
10% 1g/10ml → 1cc/kg ÷2
IM or Infusion
Calcium Gluconate 10%
10cc amp
1cc/kg, max 20cc. in
30min x2
KCl amp 1cc/kg/24hr over 4 hrs
(1cc for each 100cc IVF)
Mannitol bottle
20%: 7cc/kg x2
10%: 14cc/kg x2
Albumin bottle 20%
20g/100ml
2.5-5cc/kg/day in 2hrs
Sodium Bicarbonate vial 8.4%
1cc/kg/dose in 30min
Vit K amp 10mg/ml
Prophylaxis IM: term 1mg or
preterm 0.5mg
Treatment IV: 1mg
Cyklokapron amp
100mg/ml
10mg/kg/dose x3
Hypertonic G.W. 10% 100mg/ml
2-4cc/kg
2cc G.W50%+8cc D.W =G.W.10%
1cc GW50%+9ccGW5%=GW10%
Hypertonic G.W. 50%
25gm/50ml or 500mg/ml
0.5cc/kg diluted infusion
Caffeine amp
Bolus: 20mg/kg
Maintenance:5mg/kg/day
Amiodarone amp 150mg/3ml
Bolus: 5mg/kg in 30-60 min
Maintenance: 0.005mg/kg/min
24hr infusion
Dopamine amp 200mg/5ml
1-5mcg/kg/min infusion
Propranolol amp 1mg/ml
0.1mg/kg in 15 min
Isoptin amp 5mg/2ml
0.1-0.3mg/kg in 2 min, repeat if
needed after 30 min.
Adrenalin amp 1mg/1ml
(1:1000)
<30kg→0.1mg/kg or 10units/kg
>30kg → 0.3-0.5mg/kg
Repeat if needed after 5-10min
Atropine amp 0.6mg/1ml
0.03mg/kg/dose
1cc+4cc N.S. → 0.2cc/kg
Adenosine amp 10mg/2ml
0.1mg/kg
2 syringes: 1st
for adenosine, 2nd
for
5cc N.S. → To be pushed together
at same time in 3 sec. rapid flush.
5 | P r e p a r e d B y D r . E s s a m S i d q i - K u r d i s t a n R e g i o n / I r a q J a n 2 0 2 1
Diazepam 10mg/2ml
IV: 0.3mg/kg or 0.5cc/10kg or
5 units/kg
PR: 0.5mg/kg or 1cc/10kg or 10
units/kg
Use NG tube or Foley’s
catheter or small syringe.
Phenytoin amp
250mg/5ml
Bolus: 15-20mg/kg or 40
units/kg in 20min
Maintenance:
4-8mg/kg/day ÷2 in
30min only by N.S.
Luminal amp 200mg/ml
Bolus: 15-20mg/kg or 10 units/kg
in 20min
Maintenance: 3-5mg/kg/day ÷2 in
20min
Midazolam amp 15mg/3ml
Bolus: 0.3-0.5mg/kg in 3min or
5 units/kg
Maintenance: 0.1mg/kg/hr
24hr continuous infusion
Whole Blood 20cc/kg/over 4hr
(NEED ABO, Rh Compatibility)
PRBC 10–15cc/kg/over
4hr (NEED ABO, Rh)
FFP 15cc/kg in 20min (JUST ABO
Compatibility)
Platelets 15cc/kg in 20min
(JUST ABO Compatibility)
Cryoprecipitate 1pint/5kg (NO
need ABO, Rh Compatibility)
Voltaren supp.
12.5mg, 25mg, 50mg, 100mg
Paracetamol supp.
125 mg, 250 mg
NaCl nasal drops x4 or x6
Oral Rehydration Solution ORS
For Mild dehydration: Add 1 Scahet to 1 L of water for 24hr.
<2 years: 50-100cc after each loose stool
2-10 years: 100-200cc after each loose stool
>10 years: 200-400cc after each loose stool
6 | P r e p a r e d B y D r . E s s a m S i d q i - K u r d i s t a n R e g i o n / I r a q J a n 2 0 2 1
IV Fluids Therapy Maintenance for Neonates:
First 2 days is G.W. 10% then change to G.S.1/5.
If on Phototherapy: add 30cc/kg/24hr.
If on Feeding: 10-15cc/kg/day every 2-3hrs then
Subtract this amount from total maintenance.
Mature or >1kg Premature or <1kg
1st
day:60-70cc/kg/24hr
2nd
day: 80cc/kg/24hr
3rd
day: 100cc/kg/24hr
4th
day: 120cc/kg/24hr
5th
day: 140cc/kg/24hr
Others: 150cc/kg/24hr
1st
day: 80cc/kg/24hr
2nd
day: 95cc/kg/24hr
3rd
day: 110cc/kg/24hr
4th
day: 125cc/kg/24hr
5th
day: 140cc/kg/24hr
Others: 150cc/kg/24hr
Bolus (Shoot) of N.S. or R.L. 20cc/kg in
20min-1hr up to 3 times
Maintenance for older children: G.S.
<10kg (1st
10kg) 100cc/kg/24hr
10-20kg (2nd
10kg) (1000cc + 50cc/kg for
every Kg >10)/24hr
>20kg (3rd
10kg) (1500cc + 20cc/kg for
every Kg >20)/24hr
Deficit: (infant-older children cc/kg)
Mild dehydration: 30-50cc/kg
Moderate dehydration: 60-100cc/kg
Severe dehydration: 90-150cc/kg
• Inform the police for a police paper for cases of poisoning, inhalation and ingestion of
foreign body or animal bites and scorpion sting or any abuse or suspicious case.
• Any case Death on Arrival, inform the police and refer to Forensics.
• Any new case being referred or admitted to the floor (wards) from the emergency
department that needs follow-up medications and vitally, like DKA or convulsion etc, the
JHOs in ER should inform the JHO on call in the floor (wards).
24hr Fluid = Maintenance + Deficit – Bolus
½ amount in first 8hr.
½ amount in other 16hr.
7 | P r e p a r e d B y D r . E s s a m S i d q i - K u r d i s t a n R e g i o n / I r a q J a n 2 0 2 1
Sliding Scale for Sub-cutaneous Soluble Insulin injection in Diabetic Patients:
Pediatric DKA Management:
1. ABC and Double Cannula
2. Foley’s catheter
3. Bolus of N.S. 20cc/kg in 1hr then in the 2nd
hr start the below:
4. Fluid Per Hour for 23hr Equation:
[ ( Maintenance + Deficit 85cc/kg ) – Bolus] all divided by 23hr
If RBS >250mg/dl then use N.S.
If RBS <250mg/dl then use G.S.
5. Soluble Insulin Infusion Per Hour: 0.1 unit/kg/hr
Calculate dose for 6hrs, dilute it with 30cc N.S. to be infused in 6hrs with Syringe Pump.
6. Antibiotics and Analgesics: Oframax vial and Parol bottle etc..
7. KCl amp: 1cc/kg/24hr infusion in the fluid or 1cc for each 100cc of the fluid.
RBS every 6hr Amount of S.C. soluble insulin
0-100 mg/dl Nothing
100-200 mg/dl 0.1 unit/kg
200-300 mg/dl 0.2 unit/kg
300-400 mg/dl 0.3 unit/kg
400-500 mg/dl 0.4 unit/kg
>500 mg/dl 0.5 unit/kg
8 | P r e p a r e d B y D r . E s s a m S i d q i - K u r d i s t a n R e g i o n / I r a q J a n 2 0 2 1
IV cannula
Vital signs
including RBS,
if hypoglycemic
treat with 10%
G.W. 2-4cc/kg.
Luminal amp
200mg/ml
• 1cc+9cc D.W.
• Each 1cc is
20mg
• 1cc or
20mg/kg in
20 min
• if no response
give 2nd dose.
• if response
put on
maintenace
after 12hr as
3mg/kg x2.
If no response
then:
Phynitoin amp
250mg/5ml
• 50mg/ml
• 20mg/kg in
20 min
• 40 units/kg in
20 min
If no response
then:
Midazolam
amp 15mg/kg
• 5mg/ml
• 0.1mg/kg/hr
24hr
continuous
infusion.
• (calculated
above dose cc
+ cc D.W.) =
24cc then
1cc/hr
Diazepam amp
0.3mg/kg or 5
units/kg IV
0.5mg/kg or 10
units/kg PR
Up to 3 doses
If no response:
Luminal amp
20mg/kg in
20min
10 units/kg in
20min
If no response:
Phynitoin amp
15-20mg/kg in
20min
40 units/kg in
20min
If no response:
Midazolam
amp
0.3-0.5mg/kg or
5 units/kg over
3min
Neonatal Convulsion
Older Children Convulsion
1 sur 8

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Pediatric Emergency & Medications Doses By Dr Essam Sidqi

  • 1. 1 | P r e p a r e d B y D r . E s s a m S i d q i - K u r d i s t a n R e g i o n / I r a q J a n 2 0 2 1 Augmentin syrup 30-50mg/kg/day ÷3 156.25mg/5ml → 1cc/kg/day ÷3 200mg/5ml → 0.75cc/kg/day ÷3 312.5mg/5ml → 0.5cc/kg/day ÷3 400mg/5mg → 0.35cc/kg/day ÷3 Amoxil Syrup 30-50mg/kg/day ÷3 125mg/5ml → 0.5-1cc/kg/day ÷3 250mg/5ml → 1-2cc/kg/day÷3 Acyclovir Syrup 200mg/5ml <12 years 20mg/kg/dose x4 >12 years 10mg/kg/dose x4 (5 days) Suprax Syrup 8mg/kg/day x1 100mg/5ml → 2cc/5kg x1 200mg/5ml → 1cc/5kg x1 Erythromycin Syrup 250mg/5ml 40mg/kg ÷3 1cc/kg/day ÷3 Flagyl Syrup 200mg/5ml 30mg/kg/day ÷3 1cc/kg ÷3 Metheprim Syrup 240mg/5ml 10mg/kg/day ÷2 1cc/5kg/day ÷2 Clarithromycin Syrup 125mg/5ml 15mg/kg/day Nystatin oral drops Infants 2cc x4 Children 4-6cc x4 Azithromycin syrup 10mg/kg/day ÷1 200mg/5ml → 1cc/4kg ÷1 Nalidoxic acid Syrup 250mg/ml 55mg/kg/day ÷4 Albendazole Syrup 100mg/5ml <2 years → 200mg once >2 years → 400mg once Keflex Syrup 125mg/5ml 50mg/kg/day ÷4 Cefdinir Syrup 125mg/5ml, 250mg/5ml 6months-12 years: 7mg/kg x2 Profen Syrup 100mg/5ml 30mg/kg ÷3 1.5cc/kg ÷3 Parol Syrup 120mg/5ml, 250mg/5ml 10-15mg/kg x3 Adol oral drops 100mg/ml 2-3 drops/kg x3 Coldin Syrup 120mg/5ml 3 months-1 year 2.5cc x3 1-5 years 5cc x3 6-10 years 10cc x3 Pediatric Syrup Doses
  • 2. 2 | P r e p a r e d B y D r . E s s a m S i d q i - K u r d i s t a n R e g i o n / I r a q J a n 2 0 2 1 Ketotifen Syrup 1mg/5ml >3 years 1mg x2 Fenistil oral drops 3 drops/kg/day ÷3 Loratadine Syrup 5mg/5ml 2-6 years 5cc/day >6 years 10cc/day Allermine syrup 10mg/5ml 0.25mg/kg/day ÷3 2-6 years 2.5cc x3 6-12 years 5cc x3 >12 years 10cc x3 Solvodin Syrup 4mg/5ml <2 year 2.5cc x2 2-6 years 2.5cc x3 6-12 years 5cc x3 >12 years 10cc x3 Desloratadine Syrup 2-6 years 2.5cc x1 6-12 years 5cc x1 >12 years 10cc x1 Ventolin Syrup 2-6 years 0.75cc/kg/day ÷3 6-12 years 5cc x3 >12 years 10cc x3 Dexon Syrup 0.5mg/5ml 0.6mg/kg/day ÷2 or ÷3 5cc/kg/day ÷2 or ÷3 (5 days) Not >16mg/day Prednisolone Syrup (5 days) 5mg/5ml, 15mg/5ml 1-2mg/kg/day ÷2 De-vomit Syrup 4mg/5ml 2mg/10kg x3 2cc/10kg x3 Zinc Syrup 20mg/5ml 0-6 months 10mg (2.5cc) x1 >6 months 20mg (5cc) x1 Biolact (franklin) sachet <6 months x1 >6 months x2 Lactulose Syrup <1 year→5cc x2 or x3 1-6 years→ 5-10cc x2 or x3 7-14 years→ 15cc x2 or x3 Motilium Syrup 5mg/5ml 1-2mg/kg/day ÷3 Ferrosam Syrup 50mg/5ml 1-2mg/kg/day ÷3 prophylaxis 3-4mg/kg/day ÷3 mild 4-6mg/kg/day ÷3 severe IDA Colic EZ Syrup <1 year → 0.5cc x4 >1 year → 1cc x4 Periactin Syrup 2mg/5ml 2-6 years → 5cc x2 or x3 >6 years → 10cc x2 or x3 X-M B.T. Enema 65ml once Bisacodyl suppositories 10mg <6 years→ 5mg x1 >6years→ 10mg x1
  • 3. 3 | P r e p a r e d B y D r . E s s a m S i d q i - K u r d i s t a n R e g i o n / I r a q J a n 2 0 2 1 Oframax 1gm / Claforan 1gm vial (not >10cc or 1gm/dose) 50-100mg/kg/day ÷2 Or weight in kg/day ÷2 Flagyl bottle 500mg/100ml 30mg/kg/day ÷3 2cc/kg x3 Ampicillin 500mg / Amoxicillin 500mg vial(not>5cc or 500mg/dose) 50-100mg/kg/day ÷2 Or weight in kg/day ÷2 Meropenem / Imipenem vial 20mg/kg x3 Flucloxacillin vail 25mg/kg x3 or x4 Vancomycin vial 15mg/kg in 1hr x3 or x4 Gentamicin amp 5-7mg/kg x1 Amikacin vial 15mg/kg/day ÷2 Clindamycin amp 300mg/2ml 20-40mg/kg/day ÷3 or ÷4 Levofloxacin bottle 500mg/100ml 8mg/kg x2 Parol bottle 1gm/100ml 1cc-1.5cc/kg x3 or x4 Zofran amp 4mg/2ml 1cc/10kg Aminophylline amp 250mg/10cc (1cc+9cc N.S.) Loading: 5mg/kg or 2cc/kg Maintenance: 1cc/kg x3 Hydrocortisone vial 100mg 5mg/kg/day ÷3 Allergic reaction:5mg/kg/dose Voltarin amp IM 75mg/3ml 2mg/kg/dose x1 or x2 Decadron amp 8mg/2ml Croup: 0.6mg/kg/day once Others: 0.2-0.6mg/kg/day ÷2 Allarmine amp 10mg/1ml 0.25mg/kg/day (/dose allergic) Lasix amp 20mg/2ml 1mg/kg/dose Buscopan amp 0.5mg/ml >12 years 1cc x3 Omeprazole vial 20mg or 40mg 1mg/kg x1 Zantac amp 50mg/2ml 1mg/kg/dose x2 Cimetidine amp 200mg/2ml 25mg/kg/day ÷4 Pediatric IV/IM Doses *Age and Condition and Severity Dependent.
  • 4. 4 | P r e p a r e d B y D r . E s s a m S i d q i - K u r d i s t a n R e g i o n / I r a q J a n 2 0 2 1 Magnesium Sulphate vial 50% 5g/10ml → 0.2cc/kg ÷2 10% 1g/10ml → 1cc/kg ÷2 IM or Infusion Calcium Gluconate 10% 10cc amp 1cc/kg, max 20cc. in 30min x2 KCl amp 1cc/kg/24hr over 4 hrs (1cc for each 100cc IVF) Mannitol bottle 20%: 7cc/kg x2 10%: 14cc/kg x2 Albumin bottle 20% 20g/100ml 2.5-5cc/kg/day in 2hrs Sodium Bicarbonate vial 8.4% 1cc/kg/dose in 30min Vit K amp 10mg/ml Prophylaxis IM: term 1mg or preterm 0.5mg Treatment IV: 1mg Cyklokapron amp 100mg/ml 10mg/kg/dose x3 Hypertonic G.W. 10% 100mg/ml 2-4cc/kg 2cc G.W50%+8cc D.W =G.W.10% 1cc GW50%+9ccGW5%=GW10% Hypertonic G.W. 50% 25gm/50ml or 500mg/ml 0.5cc/kg diluted infusion Caffeine amp Bolus: 20mg/kg Maintenance:5mg/kg/day Amiodarone amp 150mg/3ml Bolus: 5mg/kg in 30-60 min Maintenance: 0.005mg/kg/min 24hr infusion Dopamine amp 200mg/5ml 1-5mcg/kg/min infusion Propranolol amp 1mg/ml 0.1mg/kg in 15 min Isoptin amp 5mg/2ml 0.1-0.3mg/kg in 2 min, repeat if needed after 30 min. Adrenalin amp 1mg/1ml (1:1000) <30kg→0.1mg/kg or 10units/kg >30kg → 0.3-0.5mg/kg Repeat if needed after 5-10min Atropine amp 0.6mg/1ml 0.03mg/kg/dose 1cc+4cc N.S. → 0.2cc/kg Adenosine amp 10mg/2ml 0.1mg/kg 2 syringes: 1st for adenosine, 2nd for 5cc N.S. → To be pushed together at same time in 3 sec. rapid flush.
  • 5. 5 | P r e p a r e d B y D r . E s s a m S i d q i - K u r d i s t a n R e g i o n / I r a q J a n 2 0 2 1 Diazepam 10mg/2ml IV: 0.3mg/kg or 0.5cc/10kg or 5 units/kg PR: 0.5mg/kg or 1cc/10kg or 10 units/kg Use NG tube or Foley’s catheter or small syringe. Phenytoin amp 250mg/5ml Bolus: 15-20mg/kg or 40 units/kg in 20min Maintenance: 4-8mg/kg/day ÷2 in 30min only by N.S. Luminal amp 200mg/ml Bolus: 15-20mg/kg or 10 units/kg in 20min Maintenance: 3-5mg/kg/day ÷2 in 20min Midazolam amp 15mg/3ml Bolus: 0.3-0.5mg/kg in 3min or 5 units/kg Maintenance: 0.1mg/kg/hr 24hr continuous infusion Whole Blood 20cc/kg/over 4hr (NEED ABO, Rh Compatibility) PRBC 10–15cc/kg/over 4hr (NEED ABO, Rh) FFP 15cc/kg in 20min (JUST ABO Compatibility) Platelets 15cc/kg in 20min (JUST ABO Compatibility) Cryoprecipitate 1pint/5kg (NO need ABO, Rh Compatibility) Voltaren supp. 12.5mg, 25mg, 50mg, 100mg Paracetamol supp. 125 mg, 250 mg NaCl nasal drops x4 or x6 Oral Rehydration Solution ORS For Mild dehydration: Add 1 Scahet to 1 L of water for 24hr. <2 years: 50-100cc after each loose stool 2-10 years: 100-200cc after each loose stool >10 years: 200-400cc after each loose stool
  • 6. 6 | P r e p a r e d B y D r . E s s a m S i d q i - K u r d i s t a n R e g i o n / I r a q J a n 2 0 2 1 IV Fluids Therapy Maintenance for Neonates: First 2 days is G.W. 10% then change to G.S.1/5. If on Phototherapy: add 30cc/kg/24hr. If on Feeding: 10-15cc/kg/day every 2-3hrs then Subtract this amount from total maintenance. Mature or >1kg Premature or <1kg 1st day:60-70cc/kg/24hr 2nd day: 80cc/kg/24hr 3rd day: 100cc/kg/24hr 4th day: 120cc/kg/24hr 5th day: 140cc/kg/24hr Others: 150cc/kg/24hr 1st day: 80cc/kg/24hr 2nd day: 95cc/kg/24hr 3rd day: 110cc/kg/24hr 4th day: 125cc/kg/24hr 5th day: 140cc/kg/24hr Others: 150cc/kg/24hr Bolus (Shoot) of N.S. or R.L. 20cc/kg in 20min-1hr up to 3 times Maintenance for older children: G.S. <10kg (1st 10kg) 100cc/kg/24hr 10-20kg (2nd 10kg) (1000cc + 50cc/kg for every Kg >10)/24hr >20kg (3rd 10kg) (1500cc + 20cc/kg for every Kg >20)/24hr Deficit: (infant-older children cc/kg) Mild dehydration: 30-50cc/kg Moderate dehydration: 60-100cc/kg Severe dehydration: 90-150cc/kg • Inform the police for a police paper for cases of poisoning, inhalation and ingestion of foreign body or animal bites and scorpion sting or any abuse or suspicious case. • Any case Death on Arrival, inform the police and refer to Forensics. • Any new case being referred or admitted to the floor (wards) from the emergency department that needs follow-up medications and vitally, like DKA or convulsion etc, the JHOs in ER should inform the JHO on call in the floor (wards). 24hr Fluid = Maintenance + Deficit – Bolus ½ amount in first 8hr. ½ amount in other 16hr.
  • 7. 7 | P r e p a r e d B y D r . E s s a m S i d q i - K u r d i s t a n R e g i o n / I r a q J a n 2 0 2 1 Sliding Scale for Sub-cutaneous Soluble Insulin injection in Diabetic Patients: Pediatric DKA Management: 1. ABC and Double Cannula 2. Foley’s catheter 3. Bolus of N.S. 20cc/kg in 1hr then in the 2nd hr start the below: 4. Fluid Per Hour for 23hr Equation: [ ( Maintenance + Deficit 85cc/kg ) – Bolus] all divided by 23hr If RBS >250mg/dl then use N.S. If RBS <250mg/dl then use G.S. 5. Soluble Insulin Infusion Per Hour: 0.1 unit/kg/hr Calculate dose for 6hrs, dilute it with 30cc N.S. to be infused in 6hrs with Syringe Pump. 6. Antibiotics and Analgesics: Oframax vial and Parol bottle etc.. 7. KCl amp: 1cc/kg/24hr infusion in the fluid or 1cc for each 100cc of the fluid. RBS every 6hr Amount of S.C. soluble insulin 0-100 mg/dl Nothing 100-200 mg/dl 0.1 unit/kg 200-300 mg/dl 0.2 unit/kg 300-400 mg/dl 0.3 unit/kg 400-500 mg/dl 0.4 unit/kg >500 mg/dl 0.5 unit/kg
  • 8. 8 | P r e p a r e d B y D r . E s s a m S i d q i - K u r d i s t a n R e g i o n / I r a q J a n 2 0 2 1 IV cannula Vital signs including RBS, if hypoglycemic treat with 10% G.W. 2-4cc/kg. Luminal amp 200mg/ml • 1cc+9cc D.W. • Each 1cc is 20mg • 1cc or 20mg/kg in 20 min • if no response give 2nd dose. • if response put on maintenace after 12hr as 3mg/kg x2. If no response then: Phynitoin amp 250mg/5ml • 50mg/ml • 20mg/kg in 20 min • 40 units/kg in 20 min If no response then: Midazolam amp 15mg/kg • 5mg/ml • 0.1mg/kg/hr 24hr continuous infusion. • (calculated above dose cc + cc D.W.) = 24cc then 1cc/hr Diazepam amp 0.3mg/kg or 5 units/kg IV 0.5mg/kg or 10 units/kg PR Up to 3 doses If no response: Luminal amp 20mg/kg in 20min 10 units/kg in 20min If no response: Phynitoin amp 15-20mg/kg in 20min 40 units/kg in 20min If no response: Midazolam amp 0.3-0.5mg/kg or 5 units/kg over 3min Neonatal Convulsion Older Children Convulsion