05APRC TERAPI CAIRAN

8/6/2019 05APRC TERAPI CAIRAN

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FLUID THERAPY ANDFLUID THERAPY AND

MEDICATIONSMEDICATIONS

Fluid resuscitationFluid resuscitation

Specific drug therapySpecific drug therapy

DeliveryDelivery

InfusionsInfusions

Komisi Resusitasi Pediatrik

UKK PGD IDAI


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Resuscitation FluidsResuscitation Fluids

Used forUsed for

Volume replacementVolume replacement

Fluid of choiceFluid of choice

Normal salineNormal saline

Lactated Ringers solutionLactated Ringers solution

Acetated Ringers solutionAcetated Ringers solution

(Colloid solution)(Colloid solution)


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Rapid Infusion is determined by :

Dimension of vascular catheter

(diameter & length)

Pressure

Viscosity


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Drug DeliveryDrug Delivery

Drugs must ultimately reach the centralDrugs must ultimately reach the central

circulationcirculation

Intravascular boluses should be followedIntravascular boluses should be followed

by at least a 2by at least a 2 -- 5mL normal saline bolus5mL normal saline bolus


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Sites for Drug AdministrationSites for Drug Administration

Peripheral veinsPeripheral veins

IntraosseousIntraosseous

Central veinsCentral veins

EndotrachealEndotracheal


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Drugs that can be givenDrugs that can be given

endotracheallyendotracheally

LidocaineLidocaine

EpinephrineEpinephrineAtropineAtropine

NaloxoneNaloxone


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Endotracheal Drug DosesEndotracheal Drug Doses

Epinephrine dose is 10 x IV dose :Epinephrine dose is 10 x IV dose :

0.1 mg/kg (use 1 : 1.000)0.1 mg/kg (use 1 : 1.000)

Other drug doses are increased :Other drug doses are increased :

22 3 x IV dose3 x IV dose


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Endotracheal Drug DeliveryEndotracheal Drug Delivery

Drug

Dilute with3 5 mL NS

Instill directly

Positive-pressure breaths

Instill via catheter

Flush 3 5 mL NS


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Epinephrine DosesEpinephrine Doses

IndicationIndication IV/IO DoseIV/IO Dose ET DoseET Dose

BradycardiaBradycardia 0.01 mg/kg0.01 mg/kg 0.1 mg/kg0.1 mg/kg

0.1 mL/kg0.1 mL/kg

(1:10.000)(1:10.000)

0.1 mL/kg0.1 mL/kg

(1:1.000)(1:1.000)Asystole/VF/VTAsystole/VF/VT

Initial doseInitial dose 0.01 mg/kg0.01 mg/kg 0.1 mg/kg0.1 mg/kg

0.1 mL/kg0.1 mL/kg

(1:10.000)(1:10.000)

0.1 mL/kg0.1 mL/kg

(1:1.000)(1:1.000)

Subsequent dosesSubsequent doses 0.1 mg/kg0.1 mg/kg 0.1 mg/kg0.1 mg/kg

0.1 mL/kg0.1 mL/kg

(1:10.000)(1:10.000)

0.1 mL/kg0.1 mL/kg

(1:1.000)(1:1.000)


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Other resuscitation DrugsOther resuscitation Drugs

DrugDrug Indication for useIndication for use

AtropineAtropine Symptomatic bradycardiaSymptomatic bradycardia

Sodium bicarbonateSodium bicarbonate Documented acidosisDocumented acidosis

NaloxoneNaloxone NarcoticNarcotic--inducedinduced

respiratory depressionrespiratory depression

Calcium chlorideCalcium chloride Hypocalcemia,Hypocalcemia,hyperkalemia,hyperkalemia,

hypermagnesemia,hypermagnesemia,

calcium channel blockercalcium channel blocker

overdoseoverdose


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Comparison of Inotropic DrugsComparison of Inotropic Drugs

DrugDrug UsesUses

EpinephrineEpinephrine Symptomatic bradycardiaSymptomatic bradycardia

Shock (incl.anaphylactic)Shock (incl.anaphylactic)

HypotensionHypotension

Cardiopulmonary arrestCardiopulmonary arrest

DobutamineDobutamine Normotensive cardiogenic shockNormotensive cardiogenic shock

DopamineDopamine

Low doseLow dose Improve renal, splanchnic bloodImprove renal, splanchnic blood

flowflow

High doseHigh dose HypotensionHypotension


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Preparation of Drug InfusionsPreparation of Drug Infusions

The Rule of6The Rule of6

Drug:Drug:

EpinephrineEpinephrine

Calculation rule:Calculation rule:

0.6 x BW(kg) = # mg0.6 x BW(kg) = # mg

to add to diluent toto add to diluent to

make 100 mLmake 100 mL

volumevolume

1 mL/h delivers 0.1 Qg/kg per minute


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Preparation of Drug InfusionsPreparation of Drug Infusions

The Rule of6The Rule of6

Drug:Drug:

DopamineDopamine

DobutamineDobutamine

Calculation rule:Calculation rule:

6 x BW(kg) = # mg6 x BW(kg) = # mg

to add to diluent toto add to diluent to

make 100 mLmake 100 mL

volumevolume

1 mL/h delivers 1 Qg/kg per minute


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Caveats of Drug InfusionCaveats of Drug Infusion

TherapyTherapy

Drug delivery is delayed at slow infusionDrug delivery is delayed at slow infusionratesrates

Titrate the infusionTitrate the infusion

Monitor heart rate and blood pressureMonitor heart rate and blood pressurecontinuouslycontinuously


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Epinephrine Drip for a20Epinephrine Drip for a20--kgkgPatientPatient

Drug Dose Infusion Rate

12 mg

Dose = 0.6 x 20 = 12 mg in solution totaling 100 mL fluid

To deliver 0,1 Qg/kg per minute

1 mL/h

1.2 mg 10 mL/h

Dilute by factor of 10 Increase by factor of 10


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Aids to Drug CalculationsAids to Drug Calculations

Percent solutionPercent solution

Percentage = number of grams perPercentage = number of grams per

100 mL (regardless of the substance)100 mL (regardless of the substance)

10 % solution = 10 g / 100 mL10 % solution = 10 g / 100 mL

= 0.1 g / mL= 0.1 g / mL= 100 mg/ mL= 100 mg/ mL

DD55W = mg glucose per mLW = mg glucose per mL50


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Aids to Drug CalculationAids to Drug Calculation

Serial dilutionSerial dilution

1 : 100 ; 1 : 1.000 ; 1 : 10.000 =1 : 100 ; 1 : 1.000 ; 1 : 10.000 =

1 g of any substance per 100; 1.000; 10.000 mL1 g of any substance per 100; 1.000; 10.000 mL1 : 10.000 epinephrine = 1 g/10.000 mL1 : 10.000 epinephrine = 1 g/10.000 mL

= 1 mg/10 mL= 1 mg/10 mL

= 0,1 mg/mL= 0,1 mg/mL


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Aids to Drug CalculationAids to Drug Calculation

Microgram (Microgram (QQg)g)

11 QQg = 1/1000 of a milligram, org = 1/1000 of a milligram, or

1 mg = 10001 mg = 1000 QQgg

How manyHow many QQg/mL are in a 1 : 10.000g/mL are in a 1 : 10.000

solution of epinephrine ?solution of epinephrine ?

1 : 10.000 = 1 g/10.000 mL

= 1000 mg/10.000 mL= 1 mg/10 mL

= 1000 Qg/10 mL

= 100 Qg/mL

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05APRC TERAPI CAIRAN