Appendix 12ADULT/PEDIATRIC MEDICATION ADMINISTRATION GUIDELINES

Transcription

1 Manual: LifeLine Patient Care Protocols Section: Appendix Protocol #: Appendix 12 Approval Date: 04/2012 Effective Date: 05/01/2012 evision Due Date: 12/1/2018 Appendix 12ADULT/PEDIATIC MEDICATION ADMINISTATION GUIDELINES acetaminophen (Tylenol ) Fever mg/kg (Maximum dose-1g) Every 4 hours Max: 75mg/kg per 24 hrs or 5 doses per 24 hrs PO, P acyclovir (Zovirax ) Anti-Viral 10 mg/kg/dose *Use ideal body weight Infuse over 1 hour adenosine (Adenocard ) Symptomatic SVT Initial dose: 0.1 mg/kg Max single dose of 6 mg for initial dose apid bolus; follow with normal saline flush. Subsequent doses: 0.2 mg/kg Max total dose 30mg Max single dose of 12 mg for subsequent dose

2 albuterol sulfate (Ventolin ) Bronchospasm Intermittent Neb 5.0 mg Continuous Neb 0.5 mg/kg/hr Max single dose 3 mg/kg/hr Every 20 min times 3 doses then PN Continuous Inhaled nebulizer Hyperkalemia >7.0 or Wide QS Pediatric and Adult dose: 5mg Times one dose Acute Pulmonary Edema and CHF 5mg Every 20 min prn amiodarone (Cordarone ) Perfusing tachycardia Peds: 5 mg/kg. May repeat as needed to a maximum of 15 mg/kg. Adult: 150 mg See Appendices for drip concentrations. Infuse over min. May repeat as needed. Pulseless VF/VT Peds: 5 mg/kg. May repeat as needed to a maximum of 15 mg/kg. Adult: 300 mg 1 st dose 150 mg subsequent doses See Appendices for drip concentrations. apid bolus. May repeat as needed.

3 ampicillin Neonates <7 days of age >7 days of age mg/kg/dose mg/kg/dose Every 12 hrs Every 8 hrs IV, IM,IO Infants and Children Suspected meningitis: increase dose to 100 mg/kg/dose mg/kg/dose Max single dose of 2g *Pick highest mg/kg dose based on age if treating meningitis Every 6 hrs aspirin (ASA) Acute Coronary Syndrome Stemi Protocol 81 mg tab X 4 (chewable) PO 81 mg tab X 4 (chewable) atropine Pediatric <5 yrs for intubation 0.02 mg/kg Minimum 0.1mg Max single dose 0.5 mg Symptomatic bradycardia/asystole Dose as above. May repeat once if needed. MAX total given of 1 mg. Bolus

4 D U G A L E T calcium chloride (10%) HypEkalemia (>7.0) HypOcalcemia Calcium Channel Blocker Toxicity Pediatric: 20 mg/kg Max single dose of 1000mg calcium gluconate HypEkalemia Pediatric: 60 mg/kg Times one dose, slow over at least 5 Adults: 1 G Slow over at least 2 May repeat in 10 Once slow over at least 5 Max single dose of 1000mg Cardizem (Diltiazem) cefazolin (Kefzol ) Atrial Fib/Flutter w V PSVT Antibiotic for open fractures 20 mg or 0.25 mg/kg over 2 min Maintenance dose: 5-15 mg/hr Adult: 1 g Pediatric: 15 mg/kg Max single dose 1 g Bolus Every 15 min Bolus cefotaxime (Claforan ) Neonates <7 days of age 50 mg/kg/dose Every 12 hrs >7 days of age Infants & Children <50 kg >50 kg 50 mg/kg/dose 50 mg/kg/dose 1-2 g/dose Max single dose of 2g Every 8 hrs Every 6 hrs IV, IM, IO

5 cefotetan (Cefotan ) Antibiotic for bowel perforation Pediatric: mg/kg Adult: 1 g Infuse over 30 cefoxitin (Mefoxin ) ceftriaxone (ocephin ) clindamycin (Cleocin ) Antibiotic for bowel perforation Bacterial sepsis Pediatric>3 mo: mg/kg Adult: 1 g Peds patients > 1 mo: 75 mg/kg Infuse over *Concentration not to exceed 40mg/mL Infuse over 30 Adult: 1-2 grams Infants & Children 10 mg/kg/dose Every 6 hrs IV, IM, IO cis-atracurium (Nimbex ) *Paralytic* *Use only for intubation or in intubated patients* Defasciculation for Sedation 5 yrs Succinylcholine contraindicated Post intubation Neuromuscular blockade birth-12 yrs of age >12 yrs of age 0.02 mg/kg Bolus 0.2 mg/kg 1.1 mg/kg/dose 1.2 mg/kg/dose Shivering postcardiac arrest hypothermia See Appendices for drip concentrations. Adult: 10 mg See Appendices for drip concentrations. Bolus Every 30

6 Crystalloids (0.9%) Fluid esuscitation 20 ml/kg Bolus dexamethasome (Decadron ) Airway Edema mg/kg/dose Max dose of 10 mg Every 6 hrs Dextrose (50%) HypOglycemia HypEkalemia >45kg 4ml IVP for every 10mg/dL under 100mg/dL Bolus May repeat as needed in 10 min Dextrose (10%) HypOglycemia HypEkalemia Pregnant> 14yrs 4ml IVP for every 10mg/dL under 100mg/dL Neonate less than 1 month 2ml/kg Over 5 min May repeat as needed in 10 min Dextrose (25%) HypOglycemia <45kg 4ml/kg Bolus May repeat as needed in 10 min.

7 O D U G A L E T digoxin (Lanoxin ) diphenhydramine (Benadryl ) Preterm Neonates Full-termNeonates 1 mo 2 yrs 2 5 yrs 5-10 yrs >10 yrs >60 kg Allergic eaction Peds Adult 15 mcg/kg* 20 mcg/kg* 30 mcg/kg* 25 mcg/kg* 15 mcg/kg* 8 mcg/kg* 500 mcg *Do not give full total digitalizing dose (TTD) at once, give one half of the dose initially, then give one quarter of the TTD every 6 hrs times mg/kg Infuse slowly over 5 10 Q 4-6 Maximum dose 5 mg/kg/day IV, IM,IO 50 mg Max total dose: 300 mg/day O dobutamine Cardiac Support Acute Pulmonary Edema or CHF for increase in myocardial function dopamine BP Support Systemic Shock 5-20 mcg/kg/min Drip 5 mcg/kg/min 5-20 mcg/kg/min Drip

8 Enoxaparin (Lovenox ) on list, but not on formulary Treatment of venous thromboembolism Neonate: 1.5 mg/kg Children 2 months to 18 years: 1 mg/kg Adults: 1 mg/kg O Adults: 1.5 mg/kg Q12h Q12h Q12h Q24h Subcutaen ous epinephrine (gtt) 1:1000 Prevention of venous thromboembolism HypOtension Peds<50kg Adults Neonate: 0.75 mg/kg Children 2 months to 18 years: 0.5 mg/kg Adults: 30 mg O Adults: 40 mg mcg/kg/min 2-30 mcg/min Q12h Q12h Q12h Q24h Drip epinephrine 1:1000 (1mg/mL) Severe Allergic eaction 0.01mg/kg (0.01 ml/kg) Max single dose 0.3mg (0.3mL) May repeat every 5 min X 2 IM, SQ Asthma/COPD (not responsive to Albuterol) (consider half dose for elderly, HTN, CAD, or ventricular dysrhythmias) Times 1 dose epinephrine 1:10,000 (1mg/10mL) Cardiac Arrest Life threatening allergic reaction 0.01mg/kg (0.1mL/kg) Max single dose of 1 mg Adults: 0.1 mg Pediatric:0.01 mg/kg Max single dose 0.1 mg Bolus Every 3-5 Over 5

9 X etomidate (Amidate ) Induce unconsciousness 0.3 mg/kg Bolus X etomidate (Amidate ) famotidine (Pepcid ) Sedation 0.2 mg/kg Bolus over seconds Histamine Blocker Adults: 40 mg Bolus fentanyl Analgesia fentanyl Peds and Analgesia Peds and Adults<50 kg 1 3 mcg/kg/dose 1 3 mcg/kg/dose Max single dose of 50 mcg See Appendices for drip concentrations. Slow bolus over 3-5 Give every 10 Give every 10 prn for pain management Maxtotal dose of 250 mcg Intranasal Intranasal Adults 50 kg Infusion 1-3 mcg/kg/dose epeat mcg See Appendices for drip concentrations. 1 mcg/kg/hr Continuous Drip

10 O O fosphenytoin (Cerebyx ) furosemide (Lasix ) gentamicin Seizures *Dosed in phenytoin equivalents (mg PE) Diuretic Neonates (based on PCA= post conceptual age) Loading dose: 20 mg PE/kg/dose Pediatric: 1-2 mg/kg/dose Adult: mg Infuse at 3 mg PE/kg/min with a maximum rate or 150 mg PE/minute Once Drip over minimum of 30 IM (1-2 injection sites) IV, IM,IO 28 wks PCA wks PCA wks PCA >36 wks PCA to 0-7 days >7 days 3mg/kg/dose 3mg/kg/dose 3.5 mg/kg/dose 3.5 mg/kg/dose 2.5 mg/kg/dose q36h q24h q24h q18h q12h X glucagon Infants & Children Adults Open Fracture Beta Blocker Toxicity 2.5 mg/kg/dose 1.5mg/kg 6 mg/kg Adults: 3 mg Pediatric:1 mg q8h Over 3 mins IM,

11 D U G heparin (Unfractionated) Acute Coronary Syndrome Adult:5000 units IVP x 1 A L E T Pulmonary embolism 80 units/kg Followed by 18 units/kg/hr IVP Infusion hydralazine (Apresoline ) Neo/Peds HypEtension mg/kg/dose Max dose of 20mg Slow bolus q4-6h PN IV, IM,IO Adult HypEtension with pre-eclampsia/ eclampsia 5mg Max dose of 20mg Slow bolus every 15 prn X hydromorphone (Dilaudid ) Pain Management Pediatric<50kg mg/kg May give every 3 hours prn IV, IM, SQ,IO Adults 50kg 1 mg (half dose for the elderly) May give every 20 prn Max total dose of 4mg

12 D U G Insulin (100 unit/ml) HypEkalemia Pediatric: 1 unit for every 50 ml of D 10 W administered Adult: 10 units Infuse over 5 A L E T Insulin (1 unit/ml) *1 unit of Insulin diluted in 100 ml NS ipratropium (Atrovent ) HypEglycemia Asthma < 1yo 1yo Asthma/COPD Adults 0.1 unit/kg/hr *Verify drip concentration if from non-/clarian institution* 0.25 mg 0.5 mg 0.5 mg Continuous Drip Every 20 times 3 doses, then every 6 hrs PN With 1 st albuterol treatment only Nebulizer *May mix with albuterol labetalol (Trandate ) Acute Aortic Dissection to maintain SBP and HTN due to preeclampsia/ eclampsia 20 mg Bolus May repeat mg every 10 Max total dose 300 mg

13 lidocaine (Xylocaine ) Pre-medicate for pts with suspected head injury, for intubation 1 mg/kg Bolus Pre-medication for conscious patients prior to IO placement Adult 2 ml 2% Lidocaine then 10 ml 0.9 NS, then 1 ml Lidocaine >6kg 0.5 ml 2% Lidocaine then 5 ml NS, then 0.5 ml Lidocaine Push 1 st dose Lidocaine over 60sec. NS is a rapid flush Unconscious patient <6 kg 0.25 ml 2% Lidocaine then 5 ml NS, then 0.25 ml Lidocaine Flush with rapid 10ml NS bolus. Consider 2% Lidocaine. lorazepam (Ativan ) Sedation mg/kg dose Max single dose of 4 mg q4-8h PN Seizures Neonates Infants/children Adolescents/Adults 0.05 mg/kg over 2-5 min 0.1 mg/kg over 2-5 min 0.07 mg/kg over 2-5 min Max single dose of 4 mg q10min PN Max total dose of 4 mg in 12 hours

14 X D U G magnesium sulfate Chronic Alcoholism 2 grams Bolus over 2 Asthma/COPD Adult: 3 grams Bolus over 30 (contraindicated for renal insufficiency) Pediatric: 25-50mg/kg A L E mannitol (Osmitrol ) Pre-eclampsia/ Eclampsia and Pre-term labor Osmotic diuretic Cerebral edema Electrical Burns Peds Adult Load 4 grams Maintenance infusion 2-3 g/hr 0.5 gram/kg Maintenance: grams/kg 0.5-1gram/kg 25 grams Bolus over Drip Drip over Every 4-6 hours *Must be infused with 22 micron filter methylergometrine (Methergine ) methylprednisolone (Solu-Medrol ) Severe post-partum hemorrhage Status Asthmaticus Pediatric: <12 yrs of age 0.1 mg Bolus 1 mg/kg Maximum single dose of 30 mg Every 12 hours Max total dose of 60 mg/day Adult: Allergic eaction Asthma COPD 125 mg Asthma maximum dose; 80mg Bolus over 1minute

15 metoprolol (Lopressor ) Acute coronary syndrome with persistent tachycardia 5 mg Bolus every 10 Max total dose of 15mg metronidazole (Flagyl ) Anaerobic infections Neonates: 0-4 weeks AND less than 1.2 kg: 7.5 mg/kg Less than 7 days AND kg: 7.5 mg/kg Less than 7 days AND 2 kg or more: 7.5 mg/kg Greater than 7 days AND kg: 7.5 mg/kg Greater than 7 days AND 2 kg or more: 15 mg/kg Q48h Q24h Q12h Q12h Q12h Children and adults: 7.5 mg/kg Maximum single dose of 1 gm Q6h

16 midazolam (Versed ) Sedation, Persistent or e-occurring seizures Pediatric: mg/kg Max single dose of 5 mg Adult: <50kg: 2.5 mg 50kg: 5 mg Sedation: bolus PN Seizures: May repeat bolus once in 5 Continuous infusion mg/kg/hr *Concentration of continuous infusion 2mg/mL Drip Post cardiac arrest to prevent shivering Adult: 2 mg Bolus every 15 prn to prevent shivering morphine sulfate Pain; Sedation Pediatric: mg/kg/dose Max single dose of 15 mg Bolus PN Infusion: mg/kg/hr Continuous naloxone (Narcan ) Narcotic eversal <5 years of age or 20kg 0.1 mg/kg Max single dose of 0.4mg Bolus every 2-3 prn for respiratory depression 5 years of age or 20 kg 0.4 mg Max total dose of 2 mg

17 X nicardipine (Cardene ) nitroglycerin Anti-hypertensive Acute Coronary Syndrome with SBP > 110mm Hg *Mix 50mg of nicardipine in 250mL NS or D 5 W.. Peds: 0.5 mcg/kg/min, increase by 0.5 mcg/kg/min every 10 to desired MAP. Max dose 5 mcg/kg/min Adult: 5 mg/hr Titrate to lower MAP by at least 15%. Maximum dose: 15 mg/hr Continuous infusion 0.4 mg Give every 3 mins if SBP > 110mmHg and pain is present SL nitroprusside (Nipride ) Acute Aortic dissection to maintain SBP < 100mm Hg HypEtensive pts with suspected acute aortic dissection to keep SBP <100mm Hg 0.4 mg Then start infusion 10 mcg/min, titrate to SBP See Appendices for drip concentrations mcg/kg/min Usual maximum: 4 mcg/kg/min Every 5 X3 Drip Drip SL

18 O norepinephrine (Levophed ) Vasoconstriction Warm shock refractory to fluid and dopamine Pediatric<40kg: mcg/kg/min *Drip concentration: 4 mg/250 ml D 5 W >40 Adult: 2-100mcg/min *Drip concentration: 8mg/250 ml D 5 W Titrate to desired response. Max dose: 2 mcg/kg/min Titrate to desired response. octreotide (Sandostatin ) Ondansetron (Zofran ) Significant upper GI bleed Nausea 50 mcg Followed by 50 mcg/hr Pediatric: <40kg=0.1mg/kg 40 kg <12yrs= 4mg Bolus Drip Adult 12yrs + 40 kg=4-8mg oxytocin (Pitocin) Severe post-partum hemmorhage 20 units/1000ml NS 0.9% Titrate to maintain uterine contraction Drip

19 X A L E T Packed BC s Blood replacement Pediatric: 10 ml/kg until clinical improvement is evident Adult: Until adequate clinical improvement is evident Drip Phenobarbital Status Epilepticus Loading dose(pediatric): 15-20mg/kg IV times one dose May repeat after 15min if needed O Procainamide racemic epinephrine Life-threatening Ventricular Arrhythmia Stridor Croup Loading dose(adult): 10-20mg/kg IV times one dose Adult: 17 mg/kg slowly over min Maintenance: 1-4 mg/min Pediatric: 3-6 mg/kg over 5 min not to exceed 15 mg/kg Maintenance mg/kg/min <6 months: 0.25 ml >6 months: 0.5 ml *Dilute with saline to equal 3 ml Maximum total loading dose: Pediatrics-40mg/kg Adults-30mg/kg Drip May repeat as needed Inhaled nebulizer

20 sodium bicarbonate succinylcholine (Anectine ) Electrical burns 150 meq in 1 liter D5W Drip Near Drowning with suspected ph 7.0 HypEkalemia *If lung sounds clear 8.4% solution (1 meq/ml) Depolarizing Paralytic Adult 1 meq/kg Max single dose of 50 meq 2 mg/kg Infuse slowly over at least 2 min; 15+ min preferred May repeat in 10 as needed Bolus Pediatric <1 year of age 1-8 years of age > 8 years of age 2 mg/kg 2 mg/kg/dose 2 mg/kg/dose 2 mg/kg/dose X O Tetracaine eye drops 0.5% solution Chemical Burn Short term surface anesthesia 1-2 drops Every 5-10 X 3 doses vancomycin Suspected Sepsis 15 mg/kg/dose q6-8h, over 60 Opthalmic O vecuronium (Norcuron ) Non-depolarizing paralytic Pediatric:0.1mg/kg May repeat as needed