Paediatric Anaesthetic Paediatric Anaesthetic Emergency Drug - - PowerPoint PPT Presentation
Paediatric Anaesthetic Paediatric Anaesthetic Emergency Drug Solution PAEDS Donovan Dwyer Emergency Staff Specialist St George and Sydney Childrens Hospitals ECI Emergency Care Symposium g y y p Friday 9 November 2012 6 6 year
Donovan Dwyer
Emergency Staff Specialist St George and Sydney Children’s Hospitals ECI Emergency Care Symposium g y y p
Friday 9 November 2012
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A simple and safe system for rapid draw up and delivery
All patients receive 0.1mL/kg of any/all of the drugs drawn up according to specified formulations
e.g 35kg child receives 3.5mLs
drugs for the situation
−Condition of child Resuscitation fluid choices and volumes −Resuscitation fluid choices and volumes −Age, weight, development factors D −Drugs
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− What are their formulations
− What weight is this based on? − How do you want them diluted?
− What size syringe O l t d d d t t l i l d d − Only want dose needed or total vial drawn up and administering Dr gives dose?
How labelled?
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intubation scenarios − Atropine − Thiopentone/ketamine Suxamethonium − Suxamethonium − Midazolam − Fentanyl/Morphine Fentanyl/Morphine − Vecuronium/Rocuronium
p p g setting is wide (some exceptions)
Drug dose calculator that lists RSI drugs separately
− Allows all RSI drugs to be drawn up rapidly − With specific formulations all drugs drawn up to 10 mL f − Drugs labelled and stored in sequence of delivery − Allows dosing of all drugs to be 0.1mL/kg
Atropine Dose Required Thiopentone Dose Required 5mg/kg Ketamine Dose Required 2mg/kg Suxamethoniu m Dose Required 1mg/kg Midazolam Dose Required 0 15mg/kg Morphine Dose Required 0.1mg/kg Fentanyl Dose Required 1μg/kg Vecuronium Dose Required 0.1mg/kg 20 µgm/kg 5mg/kg 1mg/kg 0.15mg/kg Atropine Formulation Thiopentone Formulation Ketamine Formulation Suxamethoniu m Formulation Midazolam Formulation Morphine Formulation Morphine Formulation Vecuronium Formulation Formulation 600µgm/mL Formulation 500mg dry formulation Formulation 200mg/2mL m Formulation 100mg/2mL Formulation 15mg/3mL Formulation 10mg/mL Formulation 100μg/2mL Formulation 10mg dry formulation Atropine Dilution Draw up to 3mL in 3mL syringe with t Thiopentone Dilution Draw up to 10mL in 10mL syringe ith t Ketamine Dilution Draw up to 10mL in 10mL syringe with t Suxamethoniu m Dilution Draw up to 10mL in 10mL syringe with t Midazolam Dilution Draw up to 10mL in 10mL syringe ith t Morphine Dilution Draw up to 10mL in 10mL syringe with t Morphine Dilution Draw up to 10mL in 10mL syringe with t Vecuronium Dilution Draw up to 10mL in 10mL syringe with t water with water water water with water water water water Labelling Add Atropine Label and write 200μgm/mL Labelling Add Thiopentone Label and write Labelling Add Ketamine Label and write 20mg/mL Labelling Add Suxamethoniu m Label and write 10mg/mL Labelling Add Midazolam Label and write Labelling Add Morphine Label and write 1mg/mL Labelling Add Morphine Label and write 10μg/mL Labelling Add Vecuronium Label and write 1mg/mL 50mg/mL 1.5mg/mL
Zealand standard AS 4375 and stored in order of likely usage. F i f t ti t d t h
weights < 10 kg − drugs are diluted as above g − attached by way of a 3 way tap to a 1mL syringe − appropriate dose drawn into the pp p 1mL syringe. − Example 5kg infant receives 0.5 mL.
Ensure volume to be given is recorded on box e g 2 2mL
appropriate time appropriate time
− Infants under 5 kg should receive a minimum dose of 0.5mL of atropine (100micrograms). − Where adult doses are reached computer will default to that as a maximum e.g Midazolam stops at 5mg (3.3mL) − Ketamine at 0.1mL/kg should be considered the drug of choice for the septic, hypotensive asthmatic child and the potentially haemodynamically hypotensive, asthmatic child and the potentially haemodynamically compromised child with a head injury. − Thiopentone at 0.1mL/kg is a maximum dose and lower doses will usually be more appropriate. Avoid maximum dose in septic, hypotensive, hypovolaemic children
g y uncommon but stressful
easy to remember dosing may improve process at your institution
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