0.5 4 mcg/kg/hour. 4 mcg/kg/hour mg/kg/hour. 0.2 mg/kg/hour

Transcription

1 PURPOSE* This guideline is intended to provide information about common critical care s in the pediatric emergency department. Information includes drug name, class, starting dose, titration information, dosing range, and nursing implications. It is intended for nursing use, but may be referenced by physicians, pharmacists, and other healthcare professions. For diluent and standard concentration information, please refer to the Standard Neonatal and Pediatric s Neonatal and Pediatrics guidelines. * This information is meant as a guideline only and not a substitute for physician order or clinical judgement Drug / Class Start Dose Titration Time/Dose Usual Dose Range Pharmacokinetic Parameters (Extrapolated from adult data whenever pediatric data unavailable) Fentanyl (Sublimaze ) Opioid analgesic/sedative Midazolam (Versed ) Benzodiazepine Sedative/hypnotic Loading dose (optional): mcg/kg/dose Continuous : mcg/kg/hour Loading dose (optional): mg/kg/dose Continuous : mg/kg/hour Bolus doses: mcg/kg/dose q min PRN to achieve goal SBS Goal SBS to be determined by attending. Refer to last page for the scale. General recommendation for goal is SBS of -1 to -2 If more than 2 boluses are required to maintain patient comfort, notify physician for possible rate increase (general guideline is to increase by 10% - 20%) If SBS score is less than goal (patient too sedated) notify physician for possible rate reduction Bolus doses: mg/kg/dose q min PRN to achieve goal SBS Goal SBS to be determined by attending. Refer to last page for the scale. General recommendation for goal is SBS of -1 to -2 If more than 2 boluses are required to maintain patient comfort, notify physician for possible rate increase (general guideline is to increase by 10% - 20%) mcg/kg/hour 4 mcg/kg/hour mg/kg/hour 0.2 mg/kg/hour Doses above 0.2 mg/kg/hour required usually only in cases of status epilepticus Immediate (Following single dose) hour Pediatric patients 5 months to 4.5 years: 2.4 hours Pediatric patients 6 months to 14 years (after long-term continuous ): ~21 hours (range: hours) 1-5 minutes (Following single dose) <2 hours 4.5 hours Nursing Implications - SBS goal to be determined by attending. Refer to last page for the scale. General guideline for goal is SBS of -1 to -2 - Assess pain and sedation scores q 2 hours and PRN - Can lead to hypotension - SBS goal to be determined by attending. Refer to last page for the scale. General guideline for goal is SBS of -1 to -2 - Assess pain and sedation scores q 2 hours and PRN - Can lead to hypotension

2 Epinephrine (Adrenalin ) : Initial dose: If SBS score is less than goal (patient too sedated) notify physician for possible rate reduction Titrate by q 5-10 min to desired response 0-6 months: 60 >6 months to 23 months: 70 Older than 10 years: should be physician. Consider adding a second vasoactive medication at those doses <5 minutes titration of Norepinephrine (Levophed ) Initial dose: Titrate by ute q 5-10 minutes to desired response Ascertain goal MAP/SBP/ heart rate from 0-6 months: 60 >6 months to 23 months: 70 Older than 10 years: should be physician. Consider adding a second vasoactive medication at those doses Rapid titration of

3 Dopamine Initial dose: 3-5 Titrate by q 5-10 minutes to desired response 0-6 months: 60 >6 months to 23 months: 70 Older than 10 years: should be physician. Strongly consider adding a second vasoactive medication Within 5 minutes <10 minutes 2 minutes titration of Phenylephrine (Neo-Synephrine ) Initial dose: Titrate by q 5-10 min to desired response 0-6 months: 60 >6 months to 23 months: 70 Older than 10 years: Immediate minutes Alpha phase: 5 minutes Terminal phase: 2-3 hours titration of bradyarrhythmia, and

4 Vasopressin Antidiuretic Hormone Analog Continuous : Hypotension/shock: 0.2 milliunit/kg/min Titrate by milliunit/kg/min q min to desired response milliunit/kg/min Max: 0.04 unit/min (2.4 units/hr) 15 minutes 20 minutes 10 minutes titration of Can lead to hypertension and 0-6 months: 60 >6 months to 23 months: 70 Older than 10 years: 90

5 State Behavioral Scale - SBS goal to be determined by attending:general guideline for goal is SBS of -1 to -2