This document provides guidance on managing high or total spinal anesthesia and hypotension during spinal anesthesia. Key recommendations include:
1) Call for help, start CPR and refer to ACLS protocols if cardiac arrest occurs. Support ventilation and consider intubation if necessary.
2) For significant bradycardia or hypotension, give 10mcg boluses of epinephrine and increase as needed, consider ACLS protocols and pacing pads.
3) Give IV fluid bolus and place parturient in left lateral position with legs elevated if applicable. Alert OB team and prepare for possible cesarean section.
The use of algorithms & emergency boxes in obstetric emergencyWafaa Benjamin
1. Communicate the emergency and alert all necessary staff.
2. Resuscitate the patient with oxygen, IV fluids, and blood products to restore circulation and oxygen-carrying capacity.
3. Continuously monitor vital signs and investigate laboratory values every 15 minutes to guide resuscitation efforts. Stop the bleeding through techniques like bimanual compression, uterotonic drugs, balloon tamponade, or surgical interventions if needed.
1. The document outlines the key initial management steps for several acute medical emergencies including rapid assessment, timely management, asking for help, liaising with consultants, and avoiding harm.
2. For each condition, it provides guidance on important investigations, treatments, and management decisions. The conditions covered include acute coronary syndrome, acute heart failure, acute kidney injury, severe asthma, diabetic ketoacidosis, sepsis, headache, gastrointestinal bleed, stroke, and pulmonary embolism.
3. The overall objective is to provide concise guidance to support rapid evaluation and treatment of acute medical emergencies to optimize patient outcomes.
This document provides definitions, guidelines, and clinical information relevant to obstetrics and gynecology. It includes abbreviations and definitions commonly used in OB/GYN, normal physiological changes in pregnancy, prenatal care guidelines by trimester, common pregnancy complaints/problems, screening tests, complications like ectopic pregnancy and spontaneous abortion, and information on chromosomes and genetic disorders. The document aims to serve as a study guide and clinical survival guide for OB/GYN students and providers.
This document provides definitions and abbreviations commonly used in OB/GYN. It also summarizes key aspects of pregnancy including diagnosis, prenatal care, routine problems, screening tests, and fetal lung maturity assessments. Normal physiological changes in pregnancy are outlined covering the cardiovascular, pulmonary, gastrointestinal, renal, hematologic, endocrine, musculoskeletal and nutritional systems. Key details on ectopic pregnancy diagnosis and treatment are also included.
This document provides a concise summary of key pediatric medical information including normal vital signs, common lab values, disease processes, medications, and other important clinical references organized by topic for quick reference. Key areas covered include normal heart rates, temperatures, electrolytes, endocrine labs, ABG values, common infections, newborn assessments, growth charts, and more.
A collection of important CCS Cases for USMLE step 3 that are practiced in Dr.Red USMLE step 3 CCS Workshop ( Archer CCS workshop). Please also find brief high-yield guidelines for some of these cases in the document.
The use of algorithms & emergency boxes in obstetric emergencyWafaa Benjamin
1. Communicate the emergency and alert all necessary staff.
2. Resuscitate the patient with oxygen, IV fluids, and blood products to restore circulation and oxygen-carrying capacity.
3. Continuously monitor vital signs and investigate laboratory values every 15 minutes to guide resuscitation efforts. Stop the bleeding through techniques like bimanual compression, uterotonic drugs, balloon tamponade, or surgical interventions if needed.
1. The document outlines the key initial management steps for several acute medical emergencies including rapid assessment, timely management, asking for help, liaising with consultants, and avoiding harm.
2. For each condition, it provides guidance on important investigations, treatments, and management decisions. The conditions covered include acute coronary syndrome, acute heart failure, acute kidney injury, severe asthma, diabetic ketoacidosis, sepsis, headache, gastrointestinal bleed, stroke, and pulmonary embolism.
3. The overall objective is to provide concise guidance to support rapid evaluation and treatment of acute medical emergencies to optimize patient outcomes.
This document provides definitions, guidelines, and clinical information relevant to obstetrics and gynecology. It includes abbreviations and definitions commonly used in OB/GYN, normal physiological changes in pregnancy, prenatal care guidelines by trimester, common pregnancy complaints/problems, screening tests, complications like ectopic pregnancy and spontaneous abortion, and information on chromosomes and genetic disorders. The document aims to serve as a study guide and clinical survival guide for OB/GYN students and providers.
This document provides definitions and abbreviations commonly used in OB/GYN. It also summarizes key aspects of pregnancy including diagnosis, prenatal care, routine problems, screening tests, and fetal lung maturity assessments. Normal physiological changes in pregnancy are outlined covering the cardiovascular, pulmonary, gastrointestinal, renal, hematologic, endocrine, musculoskeletal and nutritional systems. Key details on ectopic pregnancy diagnosis and treatment are also included.
This document provides a concise summary of key pediatric medical information including normal vital signs, common lab values, disease processes, medications, and other important clinical references organized by topic for quick reference. Key areas covered include normal heart rates, temperatures, electrolytes, endocrine labs, ABG values, common infections, newborn assessments, growth charts, and more.
A collection of important CCS Cases for USMLE step 3 that are practiced in Dr.Red USMLE step 3 CCS Workshop ( Archer CCS workshop). Please also find brief high-yield guidelines for some of these cases in the document.
Anaesthesia challenges in neonatal emergencies-1.pptxsouravdash24
Neonatal emergencies present unique challenges in anesthesia, requiring specialized knowledge and skills to ensure safe and effective care for these vulnerable patients. This presentation delves into the intricacies of providing anesthesia to neonates in emergency situations, discussing physiological differences, equipment considerations, medication dosages, and monitoring techniques tailored to this population. Explore essential strategies and best practices for managing airway, ventilation, and hemodynamic stability in neonatal emergencies, aiming to optimize outcomes and mitigate risks. Whether you're a seasoned anesthesiologist or a healthcare professional seeking insight into neonatal anesthesia, this presentation offers valuable insights into navigating the complexities of neonatal emergencies with confidence and expertise.
This document provides guidelines for cardiac resuscitation and emergency cardiovascular care. It outlines objectives such as performing BLS procedures, using an AED, and diagnosing death. It also discusses the chain of survival, including factors like bystander CPR and early defibrillation that impact outcomes. Procedures covered include airway management, IV access, monitoring, and treating reversible causes of cardiac arrest like hypoxia, hypothermia, and electrolyte abnormalities. Indications for starting and stopping CPR are also reviewed.
The document outlines a curriculum for managing various acute medical conditions commonly seen in a low resource setting, including stroke, unconsciousness, seizures, paraplegia, meningitis, head injury, myocardial infarction, chest pain, shortness of breath, hypertension, abdominal issues, diarrhea, renal problems, shock, poisoning, snake bites, fractures, trauma, electrolyte imbalances, and psychiatric conditions. Guidelines are provided for determining when referral is needed for conditions that cannot be adequately managed in a low resource setting.
1) Pre-eclampsia is a multisystem disorder characterized by new onset hypertension and proteinuria after 20 weeks of gestation. It can progress to eclampsia, defined as seizures in pregnancy not caused by other conditions.
2) Management of severe pre-eclampsia/eclampsia involves controlling blood pressure, preventing seizures with magnesium sulfate, close maternal-fetal monitoring, careful fluid management, and timely delivery once the mother is stabilized.
3) Delivery, whether by induction of labor or caesarean section, is usually needed to fully resolve pre-eclampsia, but the timing depends on balancing maternal and fetal risks.
The document summarizes key points from the Neonatal Resuscitation Program (NRP) 8th edition. It discusses improvements to teamwork and communication during resuscitation. It provides clinical guidance on ventilation, temperature management, medications and other aspects of resuscitation. The document emphasizes preparation, effective communication, and ongoing quality improvement to optimize neonatal outcomes.
The document discusses obstetric hemorrhage and postpartum hemorrhage (PPH), which is a leading cause of maternal mortality. It outlines protocols for recognizing and treating different classes of hemorrhage through initial fluid resuscitation and administration of uterotonic medications. It emphasizes the importance of a coordinated multidisciplinary team approach and following treatment protocols to escalate interventions rapidly to prevent hemorrhagic shock.
The document discusses using echocardiography to assess cardiac function and hemodynamics in sick newborn infants. It provides basics of echocardiography, standard views used, and how echocardiography can be used to diagnose conditions like patent ductus arteriosus, pulmonary hypertension, and neonatal shock. Key indicators are discussed such as ductal features, pulmonary overflow measurements, and signs of systemic hypoperfusion that can demonstrate the severity and hemodynamic effects of various conditions.
Approach to hypertensive emergencies in childrenAshwiniBelur2
This document discusses hypertensive emergencies in children, including definitions, etiology, management, and the updated AAP guidelines. It defines hypertensive urgency as elevated blood pressure without end organ damage, while hypertensive emergency involves acute elevation with end organ damage. Common causes in children include kidney disease, endocrine disorders, and drugs. Management involves stabilizing vital signs, confirming hypertension and end organ damage, evaluating for the underlying cause, and lowering blood pressure gradually using drugs like labetalol, sodium nitroprusside, and nicardipine. The updated AAP guidelines revised blood pressure classifications, recommended ambulatory blood pressure monitoring, and suggested screening investigations based on risk factors.
The unconscious patient and patient with altered consciousness- medicalbhawesh rai
This document provides guidance on evaluating and managing an unconscious patient. It outlines steps to take a history, check vital signs, perform analyses based on common causes, and provide general management. Key points include taking a history from the patient or bystander; checking respiration, pulse, blood pressure, temperature and blood sugar; considering common conditions like alcohol/drug abuse, hypertension, diabetes, fever or epilepsy; and managing the patient's airway, breathing, circulation and blood sugar. Specific conditions discussed include hepatic encephalopathy, Wernicke's encephalopathy, diabetic ketoacidosis, hypoglycemia, acute liver failure, meningitis, encephalitis, cerebral malaria, stroke/TIA, hypertensive
Acute Shortness of Breath at 36 weeks of PregnancySujoy Dasgupta
lecture delivered by Dr Sujoy Dasgupta at BOGSCON 42, the Annual Conference of Bengal Obstetric and Gynaecological Society, where he was invited as Faculty in a session on "Difficult Clinical Scenario in Pregnancy"
This document provides guidelines for the management of hypertensive disorders in pregnancy, including gestational hypertension, preeclampsia, and eclampsia. It outlines criteria for inpatient versus outpatient management based on blood pressure and proteinuria levels. It describes recommended monitoring, testing, and treatment including antihypertensive medications. Indications for delivery are provided based on gestational age and severity of maternal and fetal conditions. Magnesium sulfate protocols are outlined for seizure prophylaxis and treatment in preeclampsia and eclampsia.
This document summarizes the diagnosis and management of common cardiac emergencies in children. It presents several case studies and uses them to discuss key considerations like differentiating various causes of cyanosis, shock, or arrhythmias in infants and children. For each case, it analyzes presenting signs and test results to identify the underlying condition. It then outlines the initial emergency management principles, focusing on stabilization, organ support, and addressing specific issues like restoring blood flow or minimizing pulmonary pressures. The document emphasizes the importance of early diagnosis and intervention for high mortality cardiac conditions in children.
A 34-year-old pregnant woman is diagnosed with preeclampsia. Nursing assessments for preeclampsia include monitoring blood pressure, urine output, neurological status, and fetal heart rate and movements. Interventions focus on preventing convulsions using magnesium sulfate, controlling blood pressure, and planning for delivery within 24 hours. Close monitoring of the woman and fetus is required throughout pregnancy, delivery, and the postpartum period to ensure a safe outcome.
PPH is a leading cause of maternal mortality. It can occur after vaginal or cesarean delivery. Uterine atony accounts for over 80% of cases. Initial management involves calling for help, uterine massage, IV access, rapid fluid resuscitation, and administration of uterotonic drugs like oxytocin, carboprost, and misoprostol. If bleeding continues, examination to check for lacerations or retained products is needed. Blood transfusion may be required based on Hb, platelets, fibrinogen levels. Secondary interventions include additional uterotonics, tamponade, or laparotomy for uncontrolled bleeding. Prompt recognition and treatment following protocols is key to reducing morbidity from PPH.
This document summarizes a seminar on childhood hypertension. It discusses the objectives of the seminar which include classification of hypertension, prevalence in children, common causes, screening candidates, measurement methods, approach to hypertensive children, and management. It then covers physiology and regulation of blood pressure, classification of hypertension in children, common etiologies like renal and endocrine diseases, conditions associated with transient hypertension, screening recommendations, measurement methods, clinical manifestations, hypertensive emergencies, and approach to evaluating a hypertensive child.
Pregnancy induced hypertension introduction
Classification of pregnancy induced hypertension
Preeclampsia -
Definition
Criteria for diagnosis of preeclampsia,
Epidemiology of preeclampsia,
Risk factors of preeclampsia,
Pathogenesis of preeclampsia,
Pathophysiology of preeclampsia,
Course of preeclampsia,
Complications of preeclampsia,
What is HELLP ?
Management of preeclampsia at home, at hospital, during labour, during puerperium,
Management of acute fulminant preeclampsia
This lecture provides an introduction to RECOVER, a campaign to standardize veterinary cardiopulmonary resuscitation (CPR) guidelines. The goals of RECOVER and this lecture are to establish evidence-based best practices for veterinary CPR with the aim of improving survival rates. The lecture covers the basic chain of survival, including preparation, basic life support, advanced life support, monitoring, and post-resuscitation care. Key recommendations include rapid initiation of chest compressions and ventilation, use of epinephrine and vasopressin, biphasic defibrillation when indicated, and monitoring end-tidal carbon dioxide to guide resuscitation efforts.
This document discusses cardiopulmonary cerebral resuscitation (CPCR) in dogs and cats. It defines key terms like respiratory arrest and cardiopulmonary arrest. It outlines that overall survival to discharge is around 6-7% for dogs and 3% for cats. The document then discusses the goals and steps of basic life support (BLS) including circulation, airway, and breathing. It also covers advanced life support (ALS) techniques like drug administration, electrical defibrillation, fluid therapy, and monitoring such as ECG and end-tidal CO2. Finally, it summarizes the RECOVER initiative which aimed to establish evidence-based guidelines for small animal CPR.
Digestive System Review anatomy for alliedDr Musadiq
The document summarizes key aspects of the digestive system, including:
1) It describes the main stages of digestion as ingestion, digestion, absorption, and defecation.
2) It explains the two types of digestion - mechanical and chemical digestion - and how they break down food.
3) It provides an overview of the mouth, esophagus, small intestine, and large intestine, outlining their functions and features.
Management of Diabetic Ketoacidosis DKA 2013 Guidelines.pdfDr Musadiq
This document provides guidelines for the management of diabetic ketoacidosis (DKA) in adults. It recommends managing DKA based on bedside monitoring of blood glucose and ketone levels using portable meters. The key steps in treatment include administering a fixed rate intravenous insulin infusion to suppress ketones and reverse acidosis, closely monitoring electrolytes, and involving the diabetes specialist team as soon as possible. Measurement of blood ketones rather than just glucose is important for assessing resolution of DKA. The guidelines emphasize point-of-care monitoring and emphasize the role of the diabetes specialist team in management and discharge planning.
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The document outlines a curriculum for managing various acute medical conditions commonly seen in a low resource setting, including stroke, unconsciousness, seizures, paraplegia, meningitis, head injury, myocardial infarction, chest pain, shortness of breath, hypertension, abdominal issues, diarrhea, renal problems, shock, poisoning, snake bites, fractures, trauma, electrolyte imbalances, and psychiatric conditions. Guidelines are provided for determining when referral is needed for conditions that cannot be adequately managed in a low resource setting.
1) Pre-eclampsia is a multisystem disorder characterized by new onset hypertension and proteinuria after 20 weeks of gestation. It can progress to eclampsia, defined as seizures in pregnancy not caused by other conditions.
2) Management of severe pre-eclampsia/eclampsia involves controlling blood pressure, preventing seizures with magnesium sulfate, close maternal-fetal monitoring, careful fluid management, and timely delivery once the mother is stabilized.
3) Delivery, whether by induction of labor or caesarean section, is usually needed to fully resolve pre-eclampsia, but the timing depends on balancing maternal and fetal risks.
The document summarizes key points from the Neonatal Resuscitation Program (NRP) 8th edition. It discusses improvements to teamwork and communication during resuscitation. It provides clinical guidance on ventilation, temperature management, medications and other aspects of resuscitation. The document emphasizes preparation, effective communication, and ongoing quality improvement to optimize neonatal outcomes.
The document discusses obstetric hemorrhage and postpartum hemorrhage (PPH), which is a leading cause of maternal mortality. It outlines protocols for recognizing and treating different classes of hemorrhage through initial fluid resuscitation and administration of uterotonic medications. It emphasizes the importance of a coordinated multidisciplinary team approach and following treatment protocols to escalate interventions rapidly to prevent hemorrhagic shock.
The document discusses using echocardiography to assess cardiac function and hemodynamics in sick newborn infants. It provides basics of echocardiography, standard views used, and how echocardiography can be used to diagnose conditions like patent ductus arteriosus, pulmonary hypertension, and neonatal shock. Key indicators are discussed such as ductal features, pulmonary overflow measurements, and signs of systemic hypoperfusion that can demonstrate the severity and hemodynamic effects of various conditions.
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This document discusses hypertensive emergencies in children, including definitions, etiology, management, and the updated AAP guidelines. It defines hypertensive urgency as elevated blood pressure without end organ damage, while hypertensive emergency involves acute elevation with end organ damage. Common causes in children include kidney disease, endocrine disorders, and drugs. Management involves stabilizing vital signs, confirming hypertension and end organ damage, evaluating for the underlying cause, and lowering blood pressure gradually using drugs like labetalol, sodium nitroprusside, and nicardipine. The updated AAP guidelines revised blood pressure classifications, recommended ambulatory blood pressure monitoring, and suggested screening investigations based on risk factors.
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This document provides guidance on evaluating and managing an unconscious patient. It outlines steps to take a history, check vital signs, perform analyses based on common causes, and provide general management. Key points include taking a history from the patient or bystander; checking respiration, pulse, blood pressure, temperature and blood sugar; considering common conditions like alcohol/drug abuse, hypertension, diabetes, fever or epilepsy; and managing the patient's airway, breathing, circulation and blood sugar. Specific conditions discussed include hepatic encephalopathy, Wernicke's encephalopathy, diabetic ketoacidosis, hypoglycemia, acute liver failure, meningitis, encephalitis, cerebral malaria, stroke/TIA, hypertensive
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A 34-year-old pregnant woman is diagnosed with preeclampsia. Nursing assessments for preeclampsia include monitoring blood pressure, urine output, neurological status, and fetal heart rate and movements. Interventions focus on preventing convulsions using magnesium sulfate, controlling blood pressure, and planning for delivery within 24 hours. Close monitoring of the woman and fetus is required throughout pregnancy, delivery, and the postpartum period to ensure a safe outcome.
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Risk factors of preeclampsia,
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1. High Spinal & Total Spinal
Signs •Numbness, paresthesia, or weakness of UE’s
•Rapid unexpected rise of sensory block
•SOB, apnea, bradycardia, hypotension, or nausea/vomiting
•Loss of consciousness (LOC = total spinal), Cardiac arrest
Tx •Call for help & code cart, inform team
•If cardiac arrest: start CPR, refer to ACLS protocol
•Support ventilation. Intubate if necessary
•If significant brady or hypotension: 10mcg boluses epi,
↑prn, consider ACLS/pacing pads
•If mild brady can try atropine, low threshold for epi
•Give IV fluid bolus
•IF PARTURIENT: LUD, alert OB, prepare for possible C/S,
monitor fetal HR. If arrest, see ACLS in parturient
Pocket Anesthesia
Reference Card
Card design by providers from many institutions including:
Disclaimer: This card is intended to be educational in nature and is not a substitute for clinical
decision making based on the medical condition presented. It is intended to serve as an introduction
to terminology. It is the responsibility of the user to ensure all information contained herein is current
and accurate by using published references. This card is a collaborative effort by representatives of
multiple academic medical centers.
Maintenance Fluids - “4-2-1” Rule
4 mL/kg/hr: each kg up to 10 kg
2 mL/kg/hr: each additional kg to 20 kg
1 mL/kg/hr: each additional kg > 20 kg
Example: a 22 kg pt needs 40+20+2 = 62ml/hr)
Average Blood Volume (ABV)
Premature 90-100 ml/kg 1yo 75 ml/kg
Term 80 ml/kg Adult 70 ml/kg
Calculation of Drug Concentrations
Percentage solutions:
100% solution = 1g/ml
•To convert: multiply % by 10
Ratio solutions: Number before : = grams in
solution. Number after : = mls in solution.
•To convert ratio to g/ml divide grams by mls.
• 1% solution = 1:100 = 10mg/ml
• 0.005% = 1:200,000 = 0.005mg/ml or 5 mcg/ml
Allowable Blood Loss (ABL)
Est blood volume (EBV) = Kg x Average Blood Volume (ABV)
Allowable Blood Loss (ABL) = [EBV x (initial Hgb-final Hgb)]/initial Hgb
NPO Guidelines (Hrs)
Clears 2 Formula, milk, light meal 6
Breast Milk 4 Full meals 8
GENERAL ANESTHESIA KNOWLEDGE
EMERGENCIES
Hypotension in Spinal Anesthesia
Most pts. receiving spinal anesthesia will need vasopressor support.
Prevention •See contraindications
•Bolus 500-1000ml IVF at time of placement & consider preemptive
phenylephrine gtt.
Signs: •AMS: confusion, agitation, somnolence, unconsciousness
•Nausea, vomiting
•Inability for BP cuff to read
•Increased HR
Tx: •IV ephedrine 5-10mg or IV phenylephrine 50-100mg
•Will likely need phenylephrine infusion
•Pt positioning (left lateral + reverse trendelenburg)
Common Local Anesthetics for Spinal Anesthesia
~Dose, mg ~Duration w/ epi
Procedure <
90 min
Chloroprocaine 40-60 n/a
Lidocaine 2% 60-80 30-45
Lidocaine 5% (Avoid 2/2 TNS) 60-75 60-70
Procaine 75-200 45 60-75
Procedure >
90 min
Bupivacaine 0.05% or 0.75% (iso or
hyperbaric )
5-20 90-110 100-150
Tetracaine 0.5% 5-20 90-120 120-240
NEURAXIAL ANESTHESIA
Common Adjuncts for Spinal Anesthesia
Epinephrine 0.1-0.2mg Morphine 50-300mcg
Fentanyl 10-25mcg Peak 2hr & 6-12hr: only for postop pain. Must monitor
24 hrs due to risk of delayed respiratory depression
Clonidine (caution black
box warning for maternal
hypoTN and bradycardia)
30-60 mcg
Common mix: 2.5-15 mg 0.5-0.75% hyperbaric bupiv +/- 10-15 mcg fentanyl +/-
100-150 mcg morphine +/- 50-100 mcg epinephrine
Key Points
•Uses: C/S, Gyn, Uro, Abdo & LE procedures
•High spinal is a significant cause of morbidity/mortality → see emergencies
•Monitor BP q1-5 min before, during, & after. Use standard monitors
•Ensure adequate IV access, vasoconstrictors & GA available
•Consider preloading with IVF (Avoid in pre-eclampsia)
•Consider starting vasopressor support at time of placement
•Ensure aseptic technique for placement
•Spread determined by: baricity, dose, volume, position, level of injection, ↓
CSF volume(↑ intra-abdominal pressure, pregnancy)
PPH EBL: Vaginal: > 500 mL, C-section: > 1000 mL
4 T’s: Tone/atony, Thrombin/coags, Tissue/retained placenta, Trauma/artery lac
Oxytocin/
Pitocin
(Syntocinon)
-Can be given: IM/IV/IU routes (WHO rec: 10 U IM/IV)
-Do NOT bolus IV rapidly
-Consider Rule of 3’s:
- Dose: 3 U load IV over 30 sec
- Consider repeat 3 U doses q 3 min for total 3 doses
- Infusion at 3 U/hr for up to 9 hr postop
- COMMUNICATE w/ OB TEAM re: TONE q 3 min
-SE: hypotension, N/V, coronary spasm
Methylergon
ovine/
Methergine
- Dose: 0.2 mg IM; q 5-10 min max 2 doses, then q 2-4 hr
- Avoid IV, but if IV, 0.2 mg/10 mL NS, give 2 mL q 1 min
- Relatively contraindicated if GHTN, HTN, Pre-E
- SE: HTN, seizures, HA, N/V, chest tightness
Hemabate/
Carboprost
- Dose: 0.25 mg only IM or IU q 15-90 min, Max 2 mg/24 hr
- Contraindicated in asthma
- SE: N/V, flushing, bronchospasm, diarrhea
Misoprostol/
Cytotec
- Dose: 600-1000 mcg buccal/PR (10 min onset)
- SE: temp ↑ to ~ 38.1, N/V, diarrhea
Tranexamic
Acid/TXA
- Consider for all PPH
- Dose: 1 g IV over 10 min, repeat x 1 after 30 min prn
Fibrinogen
concentrate/
RiaSTAP
- Consider for PPH w/ confirmed/suspected low fib state: (DIC, AFE,
abruption, major hemorrhage)
- 2 g fibrinogen = 2 vials RiaSTAP = 2-4 U FFP = 10-20 cryo U
- To ↑ fibrinogen 100 mg/dL, give 2-4 g fibrinogen conc
- Keep pt. warm
- Don’t forget CaCl
- Consider IR for uterine artery
embolization
- Call for help
- Consider MTP, cell salvage
- Consider POC testing/ROTEM
- Syntometrine = oxytocin + ergometrine
- Prepare for hysterectomy if bleeding still
uncontrolled (↑IV access, consider airway)
Post-Partum Hemorrhage
Urgent or Emergent C-Section & Emergent GA
For all: Pre-induction checklist
•Call for help, take AMPLE Hx, IV access, NaCit, pulse ox, LUD.
•Neuraxial preferred if time - plan determined by degree of urgency,
communication w/OB team, resources, & pt. condition
• If CS for fetal distress, ↑ O2 to baby: SPOILT-Stop oxytocin, Position-LUD, O2, IV fluid, Low
BP (give pressor), Tocolytics (terbutaline 250 mcg subQ, +/-NTG SL spray 400 mcg x2)
For Emergent GA:
•ENSURE OBs PREPPED AND DRAPED BEFORE INDUCTION
•Pre-oxygenate 4 breaths. RSI w/ cricoid:
•Meds: Sux 1.5 mg/kg w/ either: propofol 2-3 mg/kg or etomidate 0.2 mg/kg or
ketamine 1-2 mg/kg or thiopental 4-5 mg/kg
•Once ETT placement verified, INSTRUCT SURGEONS TO “CUT”
•Until cord clamp: High gas flow & 2 MAC. Try to avoid benzo/narcs
•After cord clamp: 0.5 MAC + 70% N2
O or TIVA .Benzo/narcs OK
•When able: Timeout, Abx, OG, +/-NMB, +/- post-op TAP block or PCA
C-section Antibiotics
• Standard: Cefazolin 2 gm IV (3 g if > 120 kg) Q 4 hr
• PCN-allergic: Clindamycin 900 mg IV q 6 hr & Gentamicin 5 mg/kg IV once
• High-risk (discuss w/ OB): Cefazolin as above & Azithromycin 500 mg IV x 1 (Do
NOT re-dose azithro & infuse over 1 hr, faster risks local IV site rxn)
OBSTETRICS & OB EMERGENCIES
(Please see full OB pocket card for details)
Hypertensive Disorders
Pre-Eclampsia: BP > 140/90 x2 ≥ 20 wks, proteinuria, +/- organ dysfunct.
•Consider delivery
•Prevent seizure: Mg 4-6 g IV over 15-20 min + 1-2 g/hr gtt for 24 hr post
delivery (do NOT d/c in OR); (10 g IM load described if no PIV)
•Tx severe HTN (SBP > 155, DBP > 105): 1st
line: Labetalol IV, hydralazine IV,
nifedipine PO and no IV (others okay if 1st line unavailable)
•Watch for Mg tox: ↓ DTRs, Resp/cardiac comp. Tx: CaCl 1g IV or CaGluc 1-3 g
IV
Eclampsia: Pre-E w/ Seizure
•Goal: prevent hypoxia, trauma, additional seizures.
•Tx HTN, eval for prompt delivery
•LUD/full lateral, O2, airway, +/- ETT (If intubation: control BP to avoid cerebral
hemorrhage)
•IV Mg load & gtt, as above
•If persistent/recurrent seizure: IV benzo (IM/IO okay)
•If severe HTN, tx as above
•Prepare for prompt delivery (NO neuraxial until rule out HELLP)
HELLP: hemolysis, ↑ LFTs, ↓ plt
•Tx: As above for seizure ppx, HTN, consider delivery (vaginal if able)
•If active bleeding, consider plt transfusion
•Prepare for delivery, likely GA if C-Section (Control BP to avoid cerebral
hemorrhage)
Normal Physiologic Parameters & Equipment
AGE KG HR MAP** RR LMA Blade ETT mm
ETT@
Lips
0-1mo <1* 140’s 30 <60 1 Miller 0 2.5 7 cm*
0-1mo 1-2* 140’s 30’s <60 1 Miller 0 3.0 8 cm*
0-1mo 2-3* 130-140 30’s <60 1 Mil 0/Mil 1 3.5 9 cm*
0-1mo >3 130-140 40’s <60 1 Mil 0/Mil 1 3.5-4.0 10 cm
1-6 mo 4-6 130’s 50’s 24-30 1-1.5 Mil1/Wis1.5 3.5-4.0 12 cm
6mo-1yr 6-10 130’s 60’s 22-26 1.5 Wis 1.5 4.0 13 cm
1-2 yr 10-12 120’s 60’s 20-24 2 Wis 1.5 4.5 14 cm
2-4 yr 12-16 110’s 60’s 18-22 2 Wis1.5/Mac2 5.0 15 cm
4-6 yr 16-20 90-110 70’s 16-20 2 Mil 2/Mac2 5.5 16 cm
6-8 yr 20-30 90’s 70’s 16-20 2.5 Mil 2/Mac2 6.0 17 cm
9-12 yr 30-45 80 70-80’s 12-18 3 Mil/Mac 2-3 6.5-7.0 18 cm
>14 yr >50 75 70-80’s 10-16 4 Mil/Mac 2-3 7.0 20-22
Neonatal & Peds General Estimates
•The Neonatal “1-2-3(kg)/7-8-9(ETT@Lips)
Rule”
•For preterm & term newborns: MAP
equals the # of weeks post conceptual
age(PCA)!
•By day of life 5, MAP = # of weeks PCA + 5
•ETT Size: (Age/4) + 4 or 5th finger
size
•ETT Depth: [(Height in cm)/10]+ 5
or 3 x ETT Size
•Age + 11 cm at lip
Intraop Glucose for Infants and Neonates
For any NPO infant < 6mo & recommended for infants that are:
1. < 45 wks PCA*
2. Premature/IUGR/SGA*
3. Septic, have fever or shock*
4. Born to diabetic mothers*
*will have higher glucose requirement
5. On TPN or Glucose/D10
6. Suspected inborn errors of
metabolism/TCA cycle
7. Having long procedures
Typical basal glucose requirement: 5-8 mg/kg/min. If in doubt, start at 5, adjust prn.
PEDIATRICS & NEONATES
OBSTETRICS & OB EMERGENCIES
(Please see full OB pocket card for details)
*Redose Cefazolin/Clinda if EBL > 1500ml
Examples:
Anesthesia/Pre-Induction Checklist – MSMAID Gelb et al 2018
M Machine: □ Complete standard machine check
□ Ensure backup ventilation and O2 available
S Suction: □ Confirm suction is available and working
M Monitors: □ Standard: Pulse Ox, BP, EKG, Capnography, Temp
□ Consider adjuncts: palpate pulse, auscultation, etc.
A Airway:
□ Confirm appropriate plan and backup
□ Prepare mask, ETT/LMA, laryngoscope/blades,
bougie, tape/tie
□ Optimize intubation positioning (sniffing, ramp)
I IV: □ Confirm adequate number & flow of IV’s
D Drugs: □ Availability of standard & emergency meds
Always know who to call for help!
Epidural
Indication Level Drug and Dosing
Thoracic T4-T7 PCEA (bolus/lockout/rate/hr limit)
0.1% bupiv 5 mL/10 min/8 mL/32 mL
Abdominal T7-T12 PCEA (bolus/lockout/rate/hr limit)
0.1% bupiv 5 mL/10 min/8 mL/32 mL
Lower Abdominal,
C-Sections, Lower-Extremity
L1-L5 PIB 0.0625-0.1% bupiv + fentanyl 5-10 mL/30 min
PCEA 5-10 mL/10-15 min
Anaphylaxis Treatment
•Epinephrine: If cardiac arrest, 0.5-1.0
mg IV and begin ACLS. If hypotensive
or bronchospasm, 10-50 mcg IV
increments. 300mcg IM if no IV.
•Open IV fluids, albuterol
•Diphenhydramine 25-50mg IV,
ranitidine 50mg IV
•Hydrocortisone 100mg IV or
methylprednisolone 125mg IV
v 0.9
Kovacheva et al, Anesthesiology, 2015
Wikkelso et al, BJA, 2015
Hyperkalemia Tx
Medication Dose
Calcium 0.5-1g CaCl
Bicarbonate 25-50mEq
Insulin Regular 5-10 units IV
Glucose (D50) 25-50gm IV
Kayexalate 15-50g PO
Albuterol Puffs or neb PRN
Furosemide 40-80mg IV
Reproduced From: Difficult Airway Society 2015 guidelines for management of unanticipated difficult
intubation in adults
Frerk et al, British Journal of Anaesthesia, 2015
Contraindications to Spinal Anesthesia
•Coagulopathy: INR>2, platelets <80x109/L). History of anticoag use & bleeding
•Sepsis and/or hypovolemia
•Skin infection at injection site
•Elevated ICP, indeterminate neurologic disease
•Lack of emergency meds & equipment
•Relative: Infection away from injection site, unclear surgical duration
2. MEDICATIONS* MEDICATIONS* MEDICATIONS (All IV drugs can be given IO)
MEDICATIONS (All IV drugs can be given IO)
Antibiotics for surgical ppx – dose & interval
(all IV unless otherwise noted)
Antibiotic Peds/Wt. Based Adult Interval
Amoxicillin PO 50 mg/kg
Ampicillin 25-50 mg/kg 2 g Q2H
Amp/Sulbactam 25-37.5 mg/kg 3 g Q2H
Cefazolin 25-50 mg/kg 2 g, 3 g if > 120kg Q4H
Cefotaxime 50 mg/kg 1 g Q3H
Cefotetan 25 mg/kg Q12H
Cefoxitin 20-40 mg/kg Q6-8H
Ceftriaxone 50-75 mg/kg 2 g Q12-24H
Cefuroxime 25-50 mg/kg Q6H
Cephalexin IV/PO 50 mg/kg
Ciprofloxacin 10 mg/kg Q12H
Clindamycin 10 mg/kg 900mg Q6H
Gentamicin 1.5mg/kg Q8-12H
Nafcillin 25-50 mg/kg 2 g Q6H
Ornidazole 20 mg/kg (over 2 doses, each
over 30 min)
500-1000 mg over
30 min
Oxacillin 25 mg/kg Q6H
Piperacillin/Tazo 37.5-75 mg/kg 3.375 g Q2H
Vancomycin 10-15 mg/kg 1 g, 1.5 g if > 80kg
Inhalational Anesthetics, MAC% by age
Neonate Infant Child Adult > 60yr
Halothane 0.87 1.2 0.95 0.75 0.6
Enflurane - - - 1.7 1.4
Isoflurane 1.6 1.87 1.6 1.2 1.05
Sevoflurane 3.3 3.0 2.5 2.1-2.6 1.5
Desflurane 9.2 10.0 8.1 6-7.3 5.2
Nitrous Oxide 105
Local Anesthetics
Note:
Onset
~ Duration (hrs) Toxic Dose mg/kg
Spinal Epidural Local Plain w/Epi
Lidocaine
(Lignocaine)
Fast 1-1.5 2-3 1-3 4.5 7
Bupivacaine Mod 1.5-2.5 3-4 4-12 2.5 3
Ropivacaine Mod 1.5-2.5 3-4 9-11 2.5 2-3
Mepivacaine Mod 2-3.5 2-3 4 7
Prilocaine Fast 1-3 1.5-3 6 9
Chloroprocaine Fast 0.5-1 1-1.5 11 14
Procaine Fast 0.5-1.5 0.5-1.5 0.5-1 8 14
Tetracaine Slow 1-4 3-5 6 1-1.5 2.5
MEDICATIONS*
ACETAMINOPHEN See Paracetamol
ADENOSINE Adult: 6 mg IV push; then 12 mg IV q1min x2 PRN
Peds: 0.1 mg/kg IV push (max 6 mg/dose), may repeat
0.2 mg/kg IV (max 12 mg/dose)
ADRENALINE
(EPINEPHRINE)
Adult: Arrest: 1 mg q3-5min IV prn; ETT 2-2.5 mg
q3-5min prn (dilute in 5-10 mL NS or sterile water)
Anaphylaxis/Hypotension: 0.05 - 0.1 mg IV q5min prn;
0.2 - 0.5 mg IM q5min prn;
Infusion: 0.5 - 20 mcg/min IV
Racemic 2.25% solut. 0.5ml via neb
Peds: Arrest: 10 mcg/kg IV (max 1 mg) q3-5min prn;
100 mcg/kg ETT q3-5 min prn
Anaphylaxis: Children >6mo < 30kg: 10mcg/kg IM,
>30kg then 300 mcg IM
Severe Hypotension: 0.5-10 mcg/kg IV
Infusion: 0.02 - 1 mcg/kg/min IV
Racemic 2.25% solut. 0.25-0.5 ml via neb
ALBUTEROL Adult & Peds: (bronchodilation) Nebulized: 2.5 mg in
3mL every 20 min or continuous (5-20 mg/hr)
AMIODARONE Adult: 150-300 mg IV (dependent on rhythm) then 1
mg/min x 6hrs, then 0.5 mg/min x 18hrs
Peds: 5 mg/kg IV (max 300 mg) over 30 minutes, may
repeat x2; Infusion: 5-15 mcg/kg/min IV
ATRACURIUM Adult & Peds: 0.4-0.5 mg/kg IV. (t½ = ~20 min)
ATROPINE Adult: Arrest/Bradycardia: 0.5mg IV q3-5min max
3mg; ETT 1-2 mg q3-5min prn
Peds: Arrest/brady: 0.02 mg/kg (max 0.5mg) IV,repeat
x 1 q5min prn; ETT 0.04-0.06 mg/kg; repeat x 1 prn
CALCIUM CHLORIDE Adult: Arrest, CCB toxicity: 1-2 gm IV slowly; repeat
q10min prn
Peds: Arrest, CCB toxicity: 20 mg/kg IV (max 2 gm);
repeat q10min prn
CARBOPROST
(HEMABATE)
Adult: 250 mcg IM, repeat q15min prn. Max 2 mg.
(See PPH for full details)
CISATRACURIUM Adult: 0.1-0.2 mg/kg IV. (t½ = ~ 25 min); Infusion 0.5 -
10 mcg/kg/min IV
Peds: 0.1-0.15 mg/kg IV; Infusion 0.5-4 mcg/kg/min IV
CODEINE Adult: 15-60 mg PO/IM/SQ; repeat q4h prn
Peds***: not recommended in children < 12 yo
DANTROLENE Adult & Peds: 2.5 mg/kg IV, repeat 1 mg/kg prn (max
of 10 mg/kg) (see MH protocol)
DEXMEDETOMIDINE Adult & Peds: Load: 0.5 -1 mcg/kg IV (over 10 min),
Infusion: 0.2-1.5 mcg/kg/hr IV
DEXAMETHASONE Adult & Peds: Airway edema: 0.5 mg/kg IV q6h
PONV: Adults 4-8 mg IV; Peds 0.1 mg/kg IV
DIAZEPAM Adult: 5-10 mg IV
Peds: 0.2-0.3 mg/kg IV
DICLOFENAC Adult: 50-100 mg PO
Peds: 0.5 mg/kg IV/IM, 1 mg/kg PO/PR
DIPHENHYDRAMINE Adult: 25-50 mg IV/IM/PO q4-6 hours
Peds: 0.5-1 mg/kg IV q 4-6 hours; Max 50 mg
DOBUTAMINE Adult & Peds: 0.5-20 mcg/kg/min IV Infusion
DOPAMINE Adult & Peds: 0.5-20 mcg/kg/min IV Infusion
EPINEPHRINE See Adrenaline
EPHEDRINE Adult: 5 - 10mg IV prn
Peds: 0.1-0.2 mg/kg (max 25 g/dose) IV prn
ERGOMETRINE Adult: 0.5 mg IV/IM slow
ESMOLOL Adult & Peds: Bolus: 0.5 mg/kg IV prn;
Infusion: 50-300 mcg/kg/min IV
ETOMIDATE Adult & Peds: 0.2-0.3 mg/kg IV
FENTANYL Adult: Analgesia: 25-100 mcg IV prn; Infusion 25-200
mcg/hr (or higher)
Peds: Analgesia: 0.5-1 mcg/kg IV prn; 1-2 mcg/kg
intranasal prn; Infusion: 0.5-5 mcg/kg/hr IV
GLYCOPYRROLATE Adult: Reversal: 0.1-0.2 mg IV
Peds: Reversal: 0.015 mg/kg IV; Antisialogogue: 4
mcg/kg IM
HYDRALAZINE Adult: 10-20 mg IV
Peds: 0.1-0.2 mg/kg IV
HYDROCODONE Adult: 20-40 mg PO
Peds: 0.2 mg/kg PO
HYDROCORTISONE Adult: 100 mg IV, Stress Dose 50 mg IV q6hr
Peds: (stress dose) 1-2 mg/kg IV
HYDROMORPHONE Adult: 0.5-2 mg IV prn
Peds: IV: 5-10 mcg/kg IV prn
PO/PR: 50-80 mcg/kg q3-6h prn
INTRALIPID Adult & Peds: LAST: 1.5 mL/kg followed by infusion 0.25
mL/kg/min up to 0.5 mL/kg/min (see LAST protocol);
use ideal body weight; NTE 12 ml/kg in peds
KETAMINE Adult: Induction: 0.5-2 mg/kg IV, 4-10 mg/kg IM;
Analgesia: 0.2-0.8 mg/kg IV; 2-4 mg/kg IM; Infusion 2-15
mcg/kg/min IV
Peds: Induction: 2-3 mg/kg IV, 5-8 mg/kg IM, 5-10
mg/kg PR; Analgesia: 0.2-0.5 mg/kg IV, 2-4 mg/kg IM,
Infusion: 2-10 mcg/kg/min IV
KETOROLAC Adult: 30-60 mg IV/IM, then 15-30 mg IV/IM q6h prn
Peds: 0.5 mg/kg (max 30 mg) IV q6h prn; 1 mg/kg IM
LABETALOL Adult: 10-20 mg IV, double dose q15min prn to max
300mg; infusion 0.5-2 mg/min (or higher)
Peds: 0.1 mg/kg IV q5-10min
LIDOCAINE Adult: Arrest: 1-1.5 mg/kg IV, 0.5-0.75 mg/kg
q5-10ming prn (max 3 mg/kg), ETT 2-3.75 mg/kg,
infusion 1-4 mg/min; Analgesia: 1-2 mg/kg IV, infusion:
0.5-3 mg/kg/hr IV
Peds: Arrest: 1 mg/kg IV, repeat x1 prn, ETT 2-3 mg/kg
infusion 20-50 mcg/kg/min IV; Analgesia: 1 mg/kg IV,
infusion: 1.5-2 mg/kg/hr IV
LORAZEPAM Adult: 1-4 mg IV prn
Peds: 0.1 mg/kg IV prn (max 4 mg/dose)
MAGNESIUM
SULFATE
Adult: Asthma: 2 gm IV over 20 min;
Eclampsia/preeclampsia: Load 4-6 gm IV, infusion 1-2
gm/hr IV; TdP: 1-2 gm IV, infusion 0.5-1 gm/hr IV
Peds: Asthma: 25-75 mg/kg (max 2 gm) IV over 20min;
TdP: 25-50 mg/kg/dose (max 2 gm) IV
MEPERIDINE See Pethidine
METARAMINOL Adult & Peds: 0.5 mg IV bolus, repeat q2-3min prn
(avoid in children <12)
METHADONE Adult: Analgesia: 2.5-10 mg PO/IM/IV/SQ (based on
opioid tolerance), repeat q8-12hr prn;
Peds: Analgesia: 0.05-0.1 mg/kg PO/IM/IV/SQ; (t½ =
18-24 hrs)
METHOHEXITAL Adult: Induction: 1-1.5 mg/kg IV
Peds: Induction: 1-3 mg/kg IV, 20-30 mg/kg PR
METHYLERGONOVINE/
METHERGINE
Adult: 0.2 mg IM; repeat q 5-10min max 2 doses
(See PPH for full details)
METHYLPREDNISOLONE Adult: Asthma: 40-80mg IV; Anaphylaxis: 125mg IV
Peds: Asthma: 1mg/kg IV; Anaphylaxis: 1-2mg/kg IV
METOCLOPRAMIDE Adult: 10-20 mg IV/PO, repeat 5-10 mg q6hr prn
Peds: 0.1-0.15 mg/kg IV/PO q6hr prn
MIDAZOLAM Adult: 0.5-4 mg IV
Peds: 0.1-0.2 mg/kg IV, 0.5 mg/kg PO/PR
MISOPROSTOL Adult: 1mg PR
MORPHINE SULFATE Adult: 2.5 - 10 mg IV/IM
Peds: 0.05-0.1 mg/kg IV/IM
NALOXONE Adult: Excessive sedation: 0.02-0.2 mgq4-8 ; Opioid
overdose: 0.1-2 mg IV/IM q2-3min prn, 2 mg
nebulized, 4 mg intranasal
Peds: Excessive sedation: 0.5-1 mcg/kg IV q2-3min
prn; Opioid overdose: 10 mcg/kg IV/IM q2-3min
prn; 4 mg intranasal
NEOSTIGMINE Adult & Peds: 0.03-0.07 mg/kg IV (max 5 mg)
Add atropine IV 0.5-1 mg (adults), 20 mcg/kg (peds)
or glycopyrrolate (see ‘glycopyrolate’)
NITROGLYCERIN Adult: Infusion: 10-200 mcg/min IV
Peds: 0.5-20 mcg/kg/min IV Infusion IV
NOREPINEPHRINE Adult: Infusion: 0.05-2 mcg/kg/min or 0.5-20
mcg/min IV
Peds: Infusion: 0.05-2 mcg/kg/min IV
ONDANSETRON Adult: 4-8 mg IV, repeat q4-8hr prn
Peds: 0.15 mg/kg IV; repeat q6-8hr prn
OXYCODONE Adult: 5-15 mg (or higher depending on opioid
tolerance), repeat q3-4hr prn
Peds: 0.1 mg/kg PO; repeat q3-4hr prn
OXYTOCIN
(PITOCIN)
Adult: 3 U load IV over 30 sec, consider repeat
dosing and infusion (See PPH for full details)
PANCURONIUM Adult: 0.04-0.1 mg/kg IV
Peds: 0.05-0.15 mg/kg IV. (t½ = ~110 min)
PARACETAMOL
(ACETAMINOPHEN)
Adult: 500-1000 mg IV/PO, repeat q4-6 prn (max
2-4 gm/day)
Peds: PO/IV: 10-15 mg/kg, repeat q6h prn, PR: 40
mg/kg x 1, Max: 75 mg/kg/24 hour
PETHIDINE
(MEPERIDINE)
Adult: Shivering/Analgesia: 12.5-50 mg IV
Peds: 0.5-1 mg/kg IV, max 400 mg daily
PHENOBARBITAL/
PHENOBARBITONE
Adult & Peds: Status epilepticus: 15-20 mg/kg IV,
may repeat 5-10 mg/kg in 10min prn x 1
PHENYLEPHRINE Adult: 40-100 mcg IV q1-2min prn; Infusion 10-200
mcg/min
PITOCIN See Oxytocin
PROCHLORPERAZINE Adult: 5-10 mg IV/IM/PO q3-6 hrs prn (max 40 mg/day)
Peds: 0.1-0.15 mg/kg PO/IM/IV q6-8h prn (max 10
mg/dose)
PROMETHAZINE Adult: 12.5-25 mg PO/PR q4-6hr prn
Peds: 0.2-0.5 mg/kg PO/PR q6-8h
Max 25 mg/dose (do not give if < 2 yo)
PROPOFOL Induction: Dose variable, Adults: 1-2.5 mg/kg, Children
2-4 mg/kg
Infusion: 10-250 mcg/kg/min
RANITIDINE Adult: 50 mg IV; 150-300 mg PO
Peds: 1 mg/kg IV; 2.5 mg/kg PO
REMIFENTANIL Adult & Peds: Bolus: 0.5-1 mcg/kg IV; Infusion: 0.05-0.5
mcg/kg/min IV
ROCURONIUM Adult: 0.6-1.2 mg/kg IV (t½ = ~60 min)
Peds: 0.9-1.2 mg/kg IV
SCOPOLAMINE Adult & Adolescents: 1 patch q72hr
Peds: 6 mcg/kg IV (max 0.3 mg)
SODIUM CITRATE
(Bicitra)
Adult: 15-30mL PO q6h prn
Peds ≥ 2 yo: 1-1.5 mL/kg q6-8h prn (max 30 mL/dose)
SODIUM
BICARBONATE
Adult: 50-100 mEq IV prn (1"Amp" of 50 mL 8.4% = 50
mEq)
Peds: 1-2 mEq/kg IV
SUCCINYLCHOLINE/
SUXAMETHONIUM
Adult: (induction) 0.6 - 2 mg/kg IV (high end for RSI)
IM: 3-4 mg/kg; Max 5 mL at injection site
(t½ = ~6-8 min)
Peds: 1-2 mg/kg IV; 3-4 mg/kg IM
SUFENTANIL Adult: Analgesia: 0.5-2 mcg/kg IV
Infusion: 0.05-2mcg/kg/hr
SUGAMMADEX Adult: 2 TOF Twitches: 2 mg/kg; 0 TOF, 1-2 PTC: 4
mg/kg; Immediate emergent reversal : 16 mg/kg
TERBUTALINE Adult: (tocolysis) 5-10 mcg/kg IV q15 min (max 250
mcg)
THIOPENTAL/
THIOPENTONE
Adult: (induction) 3-6 mg/kg
TRAMADOL Adult: 25-100 mg PO q4-6h prn
Peds: not recommended in children < 12 yo
TRANEXAMIC ACID Adult: 1 g IV over 10 min, repeat x 1 after 30 min prn
VASOPRESSIN Adult: (shock) 0.03 - 0.05 units/minute drip
Peds: (shock) Infusion: 0.0002-0.002 units/kg/min IV
VECURONIUM Adult & Peds: (induction) 0.1 mg/kg IV (t½ = ~ 65 min)
0.8-1.7 mcg/kg/min drip