0m37LdDF:,Li:,6WNbP:\Epoc32\Wins\C\System\Apps\EZPaeDZ_revo\EZPaeDZ_revo.app!:\System\Apps\EZPaeDZ_revo\EZPaeDZ_revo.appP:\Epoc32\Wins\C\System\Apps\EZPaeDZ_revo\EZPaeDZ_revo.aif!:\System\Apps\EZPaeDZ_revo\EZPaeDZ_revo.aifEZPaeDZ7t0jWLc:\Documents\EZP\EZPaeDZ_revo,B|K%TOPBAR%MAIN% BOTTOMBAR%WTD&TD&AGEAGE1REPLY%NBMYRS MTHSACTHBDESHB$LDEFAULT_VARIABLESABOUT DISCLAIMER SETUP_SCREEN NEW_PATIENT MAIN_MENUSSSSSSO@[ W ("@[SO@[vPK%+8EZPDZ Paediatric Anaesthesia Calculator for Psion RevoO++(Version 2.0 Medi-CAL OnLine 11/05/2001O++?Based on 'Babyhelper' for Psion Series 3 Mcindoe/Hammond 1995O++(++-This program is FREEWARE - please distribute!O++ O|> (m|2\[+ 30 per min׿ (m|>[+ 24 per minv1MAIN%WTAGE1MTHSYRSAGEO {O(O +Normal Cardiovascular ValuesO {O(O+ Childs Age:(O-+ Childs Wt:(^O- OW+ KgK(O<+ Heart Rate:(OK+ Tachycardia:(OZ+ Bradycardia:(Oi+BP: O|2[a(^O OW+ daysK(^O<+133 bpm(^OK+>180 bpm(^OZ+<120 bpm(^Oi+ 67/42 mmHg׿ O|> (|2\[d(^O O|VOW+ wksK(^O<+120 bpm(^OK+>160 bpm(^OZ+<110 bpm(^Oi+ 89/60 mmHg׿% (|> (m|2\[a(^O OW+ mthsK(^O<+120 bpm(^OK+>140 bpm(^OZ+<100 bpm(^Oi+ 96/66 mmHg׿ (m|> (|2\[_(^O OW+ yrsK(^O<+105 bpm(^OK+>120 bpm(^OZ+<60 bpm(^Oi+ 99/64 mmHg׿C (|> O|2\[`(^O OW+ yrsK(^O<+101 bpm(^OK+>120 bpm(^OZ+<60 bpm(^Oi+ 100/67 mmHg׿ O|> O|2\[^(^O OW+ yrsK(^O<+90 bpm(^OK+>120 bpm(^OZ+<60 bpm(^Oi+ 94/55 mmHg׿f O|>[\(^O OW+ yrsK(^O<+70 bpm(^OK+>120 bpm(^OZ+<50 bpm(^Oi+ 109/58 mmHgv @MAIN%WTNBMO {OOO +Fluid MaintenanceO {O O|: O |6\[ O|RH O |: O|6\[ O |NO|RO(|J O|:[ O|NO|RO<|JO O+ Childs wt:OdO OW+ KgKO O-+ Maint/hr:OdO-OW+ ml/hrKO O<+ Maint/day:OdO<O|RWB}OW+ ml/dayKO OK+Deficit:OdOK RWB}OW+ mlKO {O(O +Suggested Peroperative RegimeO(O+ 1st hour:(^O RO|VJWB}OW+ ml/hrK(O-+ 2nd hour:(^O- RO|VJWB}OW+ ml/hrK(O<+ 3rd hour:(^O< RO|VJWB}OW+ ml/hrK(OKO {O +Then back to maintenance rateOv&HBACTHBDESHBK%O |O |+Enter patient details+Present Hb in g/dlO|O|+ Desired HbO|O|+OKO (`+AbortO(`  W7O @[Sv4.AGE1WTAGEDESHBACTHBMAIN% O|2[ OU|R8 O|> O |2\[ OK|R O |>[ OF|R&O| R  NRO {OOO +Transfusion CalculationsO {OO O+ Childs wt:OdO OW+ KgKO O-+ Blood Vol:OdO-WB}OW+ mlsKO O<+ Actual Hb:OdO< OW+ g/dlKO OK+ Desired Hb:OdOK OW+ g/dlKO {O(O +Transfusion Required:O(O&WB}OW+ mls of WHOLE bloodK(O-&O|VWB}OW+ mls of PACKED CELLSKv RESUSC2CVSSSv&"oAGE1WTAGEMAIN% O|2[ OU|R8 O|> O |2\[ OK|R O |>[ OF|RO {OOO +Resuscitation CalculationsO {OO O+ Childs wt:(O OW+ KgKO O-+Est Blood Volume:(O-WB}OW+ mlsKOOAO +Give:OO OPO| RWB}OW+ ml bolus over 15minsKO O_+Oliguric if U/O < O|VOWK+ mls/hrKO OsO +Tachycardia = HYPOVOLAEMIA!v*+WTMAIN%K% O|: O |6\[ O|RH O |: O|6\[ O |NO|RO(|J O|:[ O|NO|RO<|JO {OOO +Fluid Resuscitation for BurnsOO OO +Assess extent of burns:OOO2+Patient's hand = 1% BSAOOA+#N.B. 'Rule of Nines' doesn't apply!O OU+Try 2-4ml/kg/% BSA-burned/24hrsO OiO + Need 0.7-1 ml/kg/hr urine outputO+Estimated burnsOO "+ %BSA Burnt:O|Od|+OKO (`+AbortO(`  W7O @[vO {O(O + CalculationsO {O(O+Normal maintenance:(OWB}OW+ ml/hrK(O2O +From time of injury, add:O(OF+First 8 hours:(OF "RO|VWB}OW+-K "RO|VWB}OWK+ ml/hrK(OU+Next 16 hours:(OU "RO|VWB}OW+-K "RO|VWB}OWK+ ml/hrK(OiO +Aim for *ffffff?RWB}OWK+-K WB}OWK+ ml/hr urine outputKv'tMAIN%YRSMTHSAGEO {OOO +Endotracheal Tube SizingOO O+ Childs Age:OdO OW+y + K OWK+mthsKO O-+ ETT Size:OdO- *?2[++2.5mm uncuffedOdO<+ 10cm to lips׿ *?2[-+3.0mm uncuffedOdO<+10.5cm to lips׿T *?> *?2\[++3.5mm uncuffedOdO<+ 11cm to lips׿ *?> *?2\[++4.0mm uncuffedOdO<+ 12cm to lips׿ *?> O|2\[++4.5mm uncuffedOdO<+ 13cm to lips׿ *?> O|2\[++5.0mm uncuffedOdO<+ 14cm to lips׿H O|> O|2\[++5.5mm uncuffedOdO<+ 15cm to lips׿ O|> O|2\[++6.0mm uncuffedOdO<+ 16cm to lips׿ O|> O |2\[++6.5mm uncuffedOdO<+ 17cm to lips׿ O|> O |2\[++7.0mm uncuffedOdO<+ 18cm to lips׿` O |>[)+ 7.5mm cuffedOdO<+ 19cm to lips׿0 O |>[&+ 8.0mm cuffedOdO<+ 20cm to lips O |2[.O O {OiOK+N.B. There should be a leak!v&jMAIN%YRSMTHSWTO {OOO +Laryngeal Mask SizingOO O+ Childs Age:OdO OW+y + K OWK+mthsKO O2 *@2[(+Try #1 (CUFF VOLUME UP TO 4mls)׿ *@> O|2\[)+ Try #2 (CUFF VOLUME UP TO 10mls)׿ O|> O|2\[++"Try #2.5 (CUFF VOLUME UP TO 14mls)׿X O|>[N+ Try #3 (CUFF VOLUME UP TO 20mls)O OA+ Or #4 (CUFF VOLUME UP TO 30mls)vRCRSWTMAIN%"(|Od| RJ(|V"O|R*OF| R(|V2Od| R(|V:Ox| RBO | RJ:BVO {O(O +Breathing SystemsO(OO + Spontaneous:(OP+IPPV:O(O- O|2[+Suggest Ayres T-Piece(O<+using a FGF > OWK+ l/minK(O_+Suggest Ayres T-Piece(On+using a FGF > "OWK+ l/minK O|>[+Suggest Lack/Circle system(O<+Using a FGF > *OWK+ l/minK(O_+Suggest Bain circuit (JOWK+xKBOWK+ ml breaths)K(On+using a FGF > 2OWK+ l/minK*O|2[6((O O {+"If FGF<3 litres - USE CAPNOGRAPHY!SvNWTMAIN% O|R O|R& *?RF O|R. *?R6 *?R> *?RO {OOO + PremedicationOO O+ Atropine:(OOW+ mcg im/ivKO O-+Chloral hydrate:(O-OW+ mg poKO O<+ Diazepam:(O<&OW+ mg poKO OK+ Midazolam:(OK.OW+ mg poK(OZ6OW+ mg nasallyKO Oi+ Temazepam:(OiFOW+ mg poKO Ox+ Morphine:(Ox>OW+ mg imKO|O|&*?FO|.*?6*?>*?O O {(OOW+ mcg/kg im/ivK(O-OW+ mg/kg poK(O<&OW+ mg/kg poK(OK.OW+ mg/kg poK(OZ6OW+ mg/kg nasalK(OiFOW+ mg/kg poK(Ox>OW+ mg/kg imKv @}WTMAIN%AGE O|R O|R( *333333?R0 O|R8 O |RO {OOO +Anaesthetic Induction AgentsOO O+ Thiopentone:(OOW+ mg ivKO O-+Methohexitone:(O- OW+ mg ivKO O<+ Etomidate:(O<(OW+ mg ivKO OK+ Ketamine:(OK8O|VOW+ mg ivK(OZ8OW+ mg imKO Oi+ Propofol:(Oi0OW+ mg ivK O|2[BO OxO +1N.B. Propofol unlicenced, consider gas induction.OO| O|(*333333?0O|8O |O O {(OOW+ mg/kg ivK(O- OW+ mg/kg ivK(O<(OW+ mg/kg ivK(OK8O|VOW+ mg/kg ivK(OZ8OW+ mg/kg imK(Oi0OW+ mg/kg ivKOO {v6WTMAIN% *?R *?R& *{Gz?R. O|RO {OOO +&Neuromuscular Junction Blocking AgentsOO O+Suxamethonium:(O.OW+ mg ivKO O-+ Atracurium:(O-OW+ mg ivKO O<+ Vecuronium:(O<OW+ mg ivKO OK+ Pancuronium:(OK&OW+ mg ivK*?*?&*{Gz?.O|O O {(O.OW+ mg/kg ivK(O-OW+ mg/kg ivK(O<OW+ mg/kg ivK(OK&OW+ mg/kg ivKv>WTMAIN% O|R O |R. O2|R& 6 *{Gz?RO {OOO +NMJ Block Reversal AgentsOO O+ Atropine:(OOW+ mcg ivKO O-+Glycopyrrolate:(O-OW+ mcg ivKO O<+ Neostigmine:(O<.OW+ mcg ivKO OK+ Edrophonium:(OK&OW+ mg ivKO OZ+Neostig/Glycopyrrol:(OZ6OW+ ml ivKO|O |.O2|&O|6*{Gz?O O {(OOW+ mcg/kg ivK(O-OW+ mcg/kg ivK(O<.OW+ mcg/kg ivK(OK&OW+ mg/kg ivK(OZ6OW+ ml/kg ivKv!PWTMAIN%AGE1 O|RWB} WB}( O|RWB}0 O|RWB}8 WB}@ WB}H O |RO {OOO + AnalgesiaOO O+ Paracetamol:(OOW+ mg po/pr 6hrlyKO O-+ Fentanyl:(O-(OW+ mcg ivKO O<+ Morphine:(O<0Od|VOW+ mg im 4hrlyKO OK+ Pethidine:(OK8OW+ mg im 3hrlyKO OZ+Codeine:(OZ@OW+ mg im 4hrlyKO Oi+ Diclofenac:(Oi (m|>[R OW+ mg po/pr 8hrlyK O|O O {(Oi OW+ mg/kg po/prKOO {ʿ! (m|2[O + UnlicensedOO O}+ NALOXONE:(O}HOW+ mcg im/ivKO| O|(O|0*333333?8O|@O|HO |O O {(OOW+ mg/kg po/prK(O-(OW+ mcg/kg ivK(O<0OW+ mg/kg imK(OK8OW+ mg/kg imK(OZ@OW+ mg/kg imK(O}HOW+ mcg/kg im/ivKv! MAIN%WTAGE1O {OOO +Morphine InfusionOO O+Use a dedicated cannula orO O-+put a Cardiff valve on the IVIO OA+Put O|VOWK+ mg morphine (0.5mg/kg)KO OP+ in 50mls N/Saline (1ml=10mcg/kg)O Od+Give O|VOWK+ mg morphine loading doseKO Os O|:['+Then 1-4ml/hr (10-40mcg/kg/hr)׿1 O|6['+!Then 0.5-1.5ml/hr (5-15mcg/kg/hr)O(O + Morphine PCAO(O (|2['+Children under 6yrs unsuitable׿ (|>[+Use a dedicated cannula or(O-+put a Cardiff valve on the IVI(OA+Put OWK+ mg morphine (1mg/kg)K(OP+ in 50mls N/Saline (1ml=20mcg/kg)(Od+BOLUS: 1 ml (20mcg/kg)(Os+LOCKOUT: 5 mins O |RO (+ NALOXONE:((OW+ mcg im/ivKO O {O |((OW+ mcg/kg im/ivKvNWTMAIN% O|RWB} O|RWB}& O|RWB}. *?RWB}6 O|RWB}> O |RWB}F *)@RWB}O {OOO +Caudal AnalgesiaOO O+Sacral (Circum.):(O6O |VOW+ mlsKO O-+Lumbar (Hernia):(O->O |VOW+ mlsKO O<+Thoracic (Orchid.):(O<FO |VOW+ mlsKO O {OOZ+Use 0.25% PLAIN BupivacaineOOf+If vol >20ml dilute to 0.19%OOr+(2:1 mix of bupivacaine:saline)OO {(O +Maximum Doses of LAOO {(O+ Bupivacaine:(@OOW+ mg plain (2mg/kg)K(@O-O|ROW+ mg with adren. (4mg/kg)K(O<+ Lignocaine:(@O<OW+ mg plain (3mg/kg)K(@OKO|VO|ROW+ mg with adren. (7mg/kg)K(OZ+ Prilocaine:(@OZ&OW+ mg plain (6mg/kg)K(OnO +Absorption depends on sitevVWTMAIN% O|RWB} O2|R& O|RWB}. O2|R6 O|RWB}> *@RWB}F *@RWB}N O |RWB}O {OOO +Antibiotics (starting doses)OO O+ Ampicillin:(OOW+ mgKO O++Benzylpenicillin:(O+OW+ mgKO O8+ Cefotaxime:(O8.OW+ mgKO OE+ Cefuroxime:(OE6OW+ mgKO OR+ Erythromycin:(ORNOW+ mgKO O_+Flucloxacillin:(O_&OW+ mgKO Ol+ Gentamicin:(OlFOW+ mgKO Oy+Metronidazole:(Oy>OW+ mgKO (+ Nystatin:((+ 100,000 u O|O2|&O|.O2|6O|>*@F*@NO |O O {(OOW+ mg/kgK(O+OW+ mg/kgK(O8.OW+ mg/kgK(OE6OW+ mg/kgK(ORNOW+ mg/kgK(O_&OW+ mg/kgK(OlFOW+ mg/kgK(Oy>OW+ mg/kgKv6WTMAIN% O|R O |R& *?R. *?RO {OOO + Anticonvulsants (starting doses)OO O+Phenobarbitone:(OOW+ mg ivKO O++ Phenytoin:(O+OW+ mg iv slowlyKO O8+ Paraldehyde:(O8&OW+ ml im/prKO OE+ Diazepam:(OE.OW+ mg iv/pr slowlyKOOZO O {+!CHECK: Glucose, electrolytes, ABGO|O |&*?.*?O O {(OOW+ mg/kgK(O+OW+ mg/kgK(O8&OW+ ml/kgK(OE.OW+ mg/kgK(OZOO {+Therapeutic ranges...O(Oi+Phenobarb: 45-110 micmol/l(Ov+Phenytoin: 40-80 micmol/l((O O {+N.B Liver enzyme inductionv%UMETTWTMAIN%YRSE O|RWB}SO {O(O +Acute severe asthma dosesO(O+Aminophylline:(^OEOW+ mg iv slowlyK(O-+ Salbutamol:(^O-+ 2.5 mg neb(O<+Hydrocortisone:(^O< O|2[+25 mg iv slowly׿G O|> O|2\[+50 mg iv slowly׿ O|>[+100 mg iv slowly(OK+ Ketamine:(^OK O|VOW+ mg ivKv$K RESUSC2MAIN%WTSO {O(O + AnaphylaxisO(O+TYPE I reaction (IgE/IgG)(O-+1. Minimize exposure to cause(O<+2. 100% O2, IV access(OK+3. Adrenaline:(^OK O |VOW+ ml 1:10,000 ivK(O_O O {+Steroid & antihistamine cover?(Ok+"Bloods= FBC,Tryptase,Ig,Complement(O}O+Ref: Fisher BMJ 1995 311:731-4v HhWTMAIN%AGE *?ROd|RWB} *333333?ROd|RWB}( *?ROd|RWB}0Od|V8 Od|V@(Od|VO {OOO *?2[Q+Diabetic peri-operative regimeOO O+UNCOMMON - Seek specialist help׿+4Diabetic peri-operative regime (Shackleton Protocol)OO O+Book the patient 1st on listO O-+'Omit long-acting insulin evening beforeO OA+GIVEOKOA+10% Dex/0.18% NaCl at:(,OA O|VOW+ ml/hrKOKOP+#50u Actrapid in 50mls 0.9% NaCl at:(,OP0OW+ ml/hrKOPO_+-If BM>11 increase actrapid to:(,O_8OW+ ml/hrKOPOn+-If BM<7 decrease actrapid to:(,On@OW+ ml/hrKvMAIN%AGE1O {OOO + Normal U&E'sOO O+Na:O O++K:O O8+Cl:O OE+Ca:O OR+Glucose:O O_+Urea:O Ol+HCO3: O|2[OdO+136-143 mmol/lOdO++ 5-8 mmol/lOdO8+ 96-107 mmol/lOdOE+1.48-2.68 mmol/lOdOR+2.7-3.3 mmol/lOdO_+1.3-2.3 mmol/lOdOl+ 20 mmol/l׿ O|>[OdO+135-148 mmol/lOdO++ 3-5 mmol/lOdO8+ 98-106 mmol/lOdOE+2.13-2.6 mmol/lOdOR+2.4-5.3 mmol/lOdO_+6.6-8.6 mmol/lOdOl+ 24 mmol/lvMAIN%AGE1O {O(O + Normal FBCO(O+Hb:(O++Hct: O|2[R(O8+MCV:(OE+MCH:(OR+Retics:(O_+ Nucl RBC:(Ol+ Platelets: O|2[(@O+13.7-20.1 g/dl (HbF=80%)(@O++53%(@O8+ 96-118 fl(@OE+33-41 pg(@OR+3-7%(@O_+500 /mm3(@Ol+150-400 x1000/mm3׿ O|> O|2\[(@O+13.8-21.8 g/dl (HbF=80%)(@O++55%(@O8+99 fl(@OE+33 pg(@OR+1-3%(@O_+0-5 /mm3(@Ol+ 213 x1000/mm3׿_ O|> O|2\[(@O+14-20 g/dl (HbF=80%)(@O++54%(@O8+98 fl(@OE+32.5 pg(@OR+0-1%(@O_+0 /mm3(@Ol+ 248 x1000/mm3׿ O|> O|2\[(@O+13.8-19.8 g/dl (HbF=80%)(@O++52%(@O8+96 fl(@OE+31.5 pg(@OR+0-1%(@O_+0 /mm3(@Ol+ 252 x1000/mm3׿? O|> OZ|2\[,(@O+11.1-14.3 g/dl(@O++31-41%׿ OZ|> (|2\[)(@O+10.4-12.2 g/dl(@O++33%׿ (|> (m|2\[$(@O+ 11.8 g/dl(@O++35%׿ (m|> (|2\[$(@O+ 11.2 g/dl(@O++35%׿a (|> (B|2\[$(@O+ 12.8 g/dl(@O++37%׿, (B|>[!(@O+ 13.4 g/dl(@O++39%vCMAIN%AGE1O {OOO + Normal ABG'sOO O+pH:O O++PaO2:O O8+PaCO2:O OE+BE: O|2[(O+ 7.30-7.35(O++ 7.8-10.4 kPa(O8+ 3.9-5.2 kPa(OE+-5O OU+$Capillary sample = similar PCO2 & pHO Ob+PcO2 = 0.65-1.3kPa < PaO2O OoO +!Invalid if baby hypotensive/cold!׿% O|> O|2\[(O+ 7.35-7.40(O++ 9.1-11 kPa(O8+ 3.9-4.9 kPa(OE+-5O OU+$Capillary sample = similar PCO2 & pHO Ob+PcO2 = 0.65-1.3kPa < PaO2O OoO +!Invalid if baby hypotensive/cold!׿S O|>[I(O+ 7.35-7.45(O++ 10.7-12.7 kPa(O8+ 4.7-6.0 kPa(OE+0v.!. BOTTOMBARMAIN% BOTTOMBAR% OO((OOW9 O(((OOW9Sv7 BOTTOMBAR%YRSMTHSWTNBMMAIN%O {OOO+OO}OOO|O(dO(OOO(cOOOO O +Current Patient(O +Age:(O +Weight:(hO +NBM:O {O(O OW+y K OWK+mK(1O OW+KgK(O OW+hrsKvY NEW_PATIENTABOUTETTLMACIRCUITPREMEDINDUCTPARALREVERSANALGESLAFLUIDSTRANSFUSRESUSCBURNSUEFBCABGANAPHANTIBUGANTICONASTHMADIABETESANALGES2RSCVSK%MAIN%+ Analgesia+BolusO + Infusion/PCAO0+ EZPDZ+ New patientOh+AboutO+ExitO+ Airway+ETTO+LMAO+Breathing CircuitsO+ Anaesthetics+PremedO+ InductionO+ ParalysisO+ReversalO + Analgesia>O+LAO + Fluids+ MaintenanceO + TransfusionO + ResuscitationO+BurnsO+ Normal Values+FBC/U&EO+ABGO+CVS/Resp PhysiologyO+ Drugs+ AnaphylaxisO+ AntibioticsO+ AnalgesiaO+AnticonvulsantsO+AsthmaO+DiabetesO W6O@[ S8O@[ S}O@[ S&mO@[ S+]O@[ S0MO@[ S9=O@[ SA-O@[ SIO @[ SP O @[ SXO @[ SaO @[ SeO @[ SmO@[ SwO@[ SO@[SSO@[ SO@[ SyO@[ SiO@[ SXYO@[ SIO@[ S9O@[ S)O@[ SO@[SSv""NBMTD&D&WTO| WWWW@  O|vZBxAGEDISCESTIMATE BOTTOMBARWTD&NBMK%AGE1TD&AGEYRSMTHS+O++Enter the patients detailsO++(0+ Weight (Kg)O|OA| 2+ Date of BirthOO (W@OO(W@4+Hours Nil By MouthO|O|++(++#If Weight=0, will estimate from ageO+AbortO(`+OKO (`  6W76O @[t8 : 2M}< 8(m|V> 8(m|VWB}@ 8(m|V 8(m|VWB}NO |RWB} 0O|2 0O|:\[ S 0O|B[SS%6O @6O@`6O@`[v$AGEWTYRSMTHS O |>[ O|RWB}N O|> O |2\[ O|RO |JWB}' O|2 O|>\[ O|RO|JWB}+EZPDZO+Estimated weight: OW+kgKO+ Based on age: OW+yrs + K OWK+mthsKOW7vINIT2 ABOUTN DISCLAIMER+RS<CVS0`FLUIDS TRANSFUS HB3 RESUSC<RESUSC2>ABURNSgETT!LMACIRCUITP PREMED=INDUCTPARAL !REVERS#ANALGES %#ANALGES2A(sLAW+ANTIBUGj.ANTICON1=ASTHMA@4{ANAPH5DIABETES%7UE9FBC;ABG? SETUP_SCREENB BOTTOMBARwB MAIN_MENUCDEFAULT_VARIABLESG< NEW_PATIENTGCESTIMATEI_h J7j0!W4%(0-?U@UU\???Vf ggggggggggCj_(0-????SEZPDZ-0