Archive for the ‘Emergency Medicine’ Category

Paediatric RSI Drug Dosages (KKH)   Leave a comment

please note that these dosages are recommended for an Asian population residing in Singapore.
 

Age weight Atropine Succinylcholine Midazolam Etomidate Ketamine
dose 0.01-0.02mg/kg 1mg/kg* 0.1-0.3mg/kg 0.3mg/kg 1-2mg/kg
2m 5kg 0.1mg NA 0.5-1.5mg 1.5mg 5-10mg
6m 8kg 0.16mg 12mg 0.8-2.4mg 2.4mg 8-16mg
1y 10kg 0.2mg 15mg 1-3mg 3mg 10-20mg
3y 15kg 0.2mg 15mg 1.5-4.5mg 4.5mg 15-30mg
5y 19kg 0.4mg 19mg 2-6mg 5.7mg 19-38mg
7y 23kg 0.5mg 23mg 2.5-7mg 6.9mg 23-46mg
9y 29kg 0.6mg 29mg 3-9mg 8.7mg 29-58mg
11y 36kg 0.6mg 36mg 3.5-11mg 10.8mg 36-72mg
12y 44kg 0.6mg 44mg 4.5-13mg 13.2mg 44-88mg
14y 50kg 0.6mg 50mg 5-15mg 15mg 50-100mg
16y 58kg 0.6mg 58mg 15mg 17.4mg 58-116mg
Adult 65kg 0.6mg 65mg 15mg 19.5mg 65-130mg

*succinylcholine: dose 1.5mg/kg for <10kg; second dose is contraindicated in infants and young children (increased risk of bradycardia, asystole)

Atropine pre-medication is required in:

  • all <1y/o
  • bradycardic
  • children receiving succinylcholine
  • adolescents and adults receiving 2nd dose of succinylcholine
  • when ketamine is used

 
Special indications:

  • head injury with no hypotension: use midazolam/thiopental
  • hypotension: use ketamine or not at all
  • status asthmaticus: use ketamine; thiopentone contraindicated

CURB-65 score for Community-Acquired Pneumonia   Leave a comment

5-point score for defining community acquired pneumonia severity on presentation to hospital.
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When to do CT head for minor head injury?   Leave a comment

Canadian CT Head Rule here.

Parvolex infusion schedule & Nomogram   Leave a comment

Rumack-Matthew nomogram on the Carlson-Edwards homepage

traditional Rumack-Matthew nomograms with both S.I units and U.S conventional units, on Ars Informatica

  • paracetamol conversion: 1μg/mL = 1 mg/L = 6.62μmol/L
  • use high-risk line if patient is on Cyt450 inducers
  • 25% line drawn below traditional line to allow for errors and differences in pharmacokinetics; the results that fall in between these lines are “probable risk of hepatotoxicity”
  • use normogram at 4 hours, to max <24 hours after ingestion
  • rough guide: high risk of hepatotoxicity if >200mg/L at 4 hours, or >50mg/L at 12 hours

Dosage of Parvolex (N-acetyle cysteine) intravenously:

  • 150mg/kg in 200ml D5% over 15 minutes; then
  • 50mg/kg in 500ml D5% over 4 hours; then
  • 100mg/kg in 1,000ml D5% over 16 hours

Ref:

  1. South African electronic package insert for Parvolex, available at http://home.intekom.com/pharm/aspen-p/parvolex.html pub. 19 July 1984 (accessed 16 Nov 2010)

Hyponatremia: acute correction of low sodium   Leave a comment

Sodium deficit (in mmol or mEq)
= body weight(kg) × (target Na – measured Na) × 0.6 (if male, or 0.5 for female)

  • set ‘target Na’ as 120mmol/L in the first 24 hours and calculate volume of solution required to correct Na deficit; infuse over 24 hours; most centres require the actual rate (in ml/h) to be calculated

  • then correct slowly to 130mmol/L in the next 24-48 hours

  • NEVER correct more than 10mmol/L in 24 hours (or 0.5mEq/L/h): patient may develop central pontine demyelinosis

  • use Na 0.9% as far as possible; reserve Na 3% for emergencies eg. coma, seizures, severe confusion, brainstem herniation where rapid correction is required (but never more than 0.5mEq/L/h).

  • in cases of heart/renal failure and volume overload, water restriction is required; consider iv frusemide.

  • asymptomatic chronic hyponatremia: no urgency to correct using iv saline; instead, investigate and address the cause.

Concentration of Na in various forms:
NaCl 0.9%: 154mEq in 1L (ie. normal saline)
NaCl 3%: 513mEq in 1L
NaCl 300mg tabs: 5mEq per tab