The Harriet Lane Handbook: Mobile Medicine Series

1236 Pages·2014·22.19 MB·English

by  Branden Engorn, Jamie Flerlage

GLASGOW COMA SCALE
Activity Score Child/Adult Score Infant
Eye opening 4 Spontaneous 4 Spontaneous
3 To speech 3 To speech/sound
2 To pain 2 To pain
1 None 1 None
Verbal 5 Oriented 5 Coos/babbles
4 Confused 4 Irritable cry
3 Inappropriate 3 Cries to pain
2 Incomprehensible 2 Moans to pain
1 None 1 None
Motor 6 Obeys commands 6 Normal spontaneous
5 Localizes to pain 5 Withdraws to touch
4 Withdraws to pain 4 Withdraws to pain
3 Abnormal flexion 3 Abnormal flexion (decorticate)
2 Abnormal extension 2 Abnormal extension (decerebrate)
1 None 1 None
Adapted from Hunt B, Nelson K. The Johns Hopkins Children’s Center Kids Kard, 2014.
IV INFUSIONS*
Medication Dose (mcg/kg/min) Dilution in 100 mL D5W IV Infusion Rate
Alprostadil (prostaglandin E1) 0.05–0.1 0.3 mg/kg 1 mL/hr = 0.05 mcg/kg/min
Amiodarone 5–15 6 mg/kg 1 mL/hr = 1 mcg/kg/min
DOPamine 2–20 6 mg/kg 1 mL/hr = 1 mcg/kg/min
DOBUTamine 2–20 6 mg/kg 1 mL/hr = 1 mcg/kg/min
EPINEPHrine 0.1–1 0.6 mg/kg 1 mL/hr = 0.1 mcg/kg/min
Lidocaine 20–50 6 mg/kg 1 mL/hr = 1 mcg/kg/min
Phenylephrine 0.05–2 0.3 mg/kg 1 mL/hr = 0.05 mcg/kg/min
Terbutaline 0.1–10 0.6 mg/kg 1 mL/hr = 0.1 mcg/kg/min
Vasopressin (pressor) 0.5–2 milliunits/kg/min 6 milliunits/kg 1 mL/hr = 1 milliunit/kg/min
* Standardized concentrations are recommended when available.
RESUSCITATION MEDICATIONS
Adenosine 0.1 mg/kg IV/IO RAPID BOLUS (over 1-2 sec), Flush with 10 mL normal
Supraventricular tachycardia saline
May repeat at 0.2 mg/kg IV/IO after 2 min
Max first dose 6 mg, max subsequent dose 12 mg
Amiodarone 5 mg/kg IV/IO
Ventricular tachycardia No Pulse: Push Undiluted
Ventricular fibrillation Pulse: Dilute and give over 30 minutes
Max first dose 300 mg, max subsequent dose 150 mg
Monitor for hypotension
Atropine 0.02 mg/kg IV/IO, 0.04–0.06 mg/kg ETT
Bradycardia (increased vagal tone) Max single dose 0.5 mg
Primary AV block Repeat once if needed
Calcium chloride (10%) 20 mg/kg IV/IO
Hypocalcemia Max dose 1 g
Dextrose <5 kg: 10% dextrose 10 mL/kg
5-44 kg: 25% dextrose 4 mL/kg
≥45 kg: 50% dextrose 2 mL/kg, max single dose 50 g = 100 mL
Epinephrine 0.01 mg/kg (0.1 mL/kg) 1:10,000 IV/IO every 3–5 min (max single dose
Pulseless arrest 1 mg)
Bradycardia (symptomatic) 0.1 mg/kg (0.1 mL/kg) 1:1000 ETT every 3–5 min (max single dose 2.5 mg)
Anaphylaxis Anaphylaxis: 0.01 mg/kg (0.01 mL/kg) of 1:1000 IM (max 0.5 mg)
in thigh every 15 min PRN
Standardized/Autoinjector:
<10 kg: 0.01 mg/kg (0.01 mL/kg) of 1:1000 IM
10-30 kg: 0.15 mg IM
>30 kg: 0.3 mg IM
Insulin (Regular or Aspart) 0.1 units/kg IV/IO with 1 g/kg of dextrose
Hyperkalemia Max single dose 10 units
Magnesium sulfate 50 mg/kg IV/IO
Torsades de pointes No Pulse: Push
Hypomagnesemia Pulse: Give over 15-20 minutes
Max single dose 2 g
Monitor for hypotension/bradycardia
Naloxone Respiratory Depression: 0.001-0.005 mg/kg/dose IV/IO/IM/SubQ (max
Opioid overdose 0.08 mg first dose, may titrate to effect)
Coma Full Reversal/Arrest Dose: 0.1 mg/kg IV/IO/IM/SubQ (max dose 2 mg)
ETT dose 2–3 times IV dose. May give every 2 min PRN
Sodium Bicarbonate (8.4%) 1 mEq/kg IV/IO
Metabolic acidosis Dilute 1:1 with sterile water for <10 kg
Hyperkalemia Hyperkalemia: Max single dose 50 mEq
Tricyclic antidepressant overdose
Vasopressin 0.5 units/kg/dose IV/IO
Max single dose 40 units
ETT Meds (NAVEL: naloxone, atropine, vasopressin, epinephrine, lidocaine)—dilute meds to 5 mL with NS, follow with positive-pressure ventilation.
Special thanks to LeAnn McNamara and Angela Helder, Clinical Pharmacy Specialists, for their expert guidance with IV infusion and resuscitation
medications guidelines.
Adapted from Hunt B, Nelson K. The Johns Hopkins Children’s Center Kids Kard, 2014, and the American Heart Association, PALS Pocket Card,
2010.
TWENTIETH
EDITION
THE
HARRIET LANE
HANDBOOK
A Manual for Pediatric House Officers
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TWENTIETH
EDITION
THE
HARRIET LANE
HANDBOOK
A Manual for Pediatric House Officers
The Harriet Lane Service at
The Charlotte R. Bloomberg Children’s Center of
The Johns Hopkins Hospital
EDITORS
Branden Engorn, MD
Jamie Flerlage, MD
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
THE HARRIET LANE HANDBOOK, TWENTIETH EDITION ISBN: 978-0-323-09644-7
Copyright © 2015 by Saunders, an imprint of Elsevier Inc. International Edition: 978-0-323-1124-4
No part of this publication may be reproduced or transmitted in any form or by any means, elec-
tronic or mechanical, including photocopying, recording, or any information storage and retrieval
system, without permission in writing from the publisher. Details on how to seek permission, further
information about the Publisher’s permissions policies and our arrangements with organizations
such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our
website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the
Publisher (other than as may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and experi-
ence broaden our understanding, changes in research methods, professional practices, or
medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds, or experiments described herein.
In using such information or methods they should be mindful of their own safety and the safety
of others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised
to check the most current information provided (i) on procedures featured or (ii) by the
manufacturer of each product to be administered, to verify the recommended dose or formula,
the method and duration of administration, and contraindications. It is the responsibility
of practitioners, relying on their own experience and knowledge of their patients, to make
diagnoses, to determine dosages and the best treatment for each individual patient, and to
take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or
editors assume any liability for any injury and/or damage to persons or property as a matter
of products liability, negligence or otherwise, or from any use or operation of any methods,
products, instructions, or ideas contained in the material herein.
Previous editions copyrighted 2012, 2009, 2005, 2002, 2000, 1996, 1993, 1991, 1987, 1984,
1981, 1978, 1975, 1972, 1969 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Library of Congress Cataloging-in-Publication Data
Harriet Lane Service (Johns Hopkins Hospital), author.
The Harriet Lane handbook : a manual for pediatric house officers / the Harriet Lane Service,
Children’s Medical and Surgical Center of the Johns Hopkins Hospital ; editors, Jamie Flerlage,
Branden Engorn. -- Twentieth edition.
p. ; cm.
Preceded by the Harriet Lane handbook / editors, Megan M. Tschudy, Kristin M. Arcara. 19th ed.
c2012.
Includes bibliographical references and index.
ISBN 978-0-323-09644-7 (pbk. : alk. paper)
I. Flerlage, Jamie, editor of compilation. II. Engorn, Branden, editor of compilation. III. Title.
[DNLM: 1. Pediatrics--Handbooks. WS 29]
RJ48
618.92--dc23 2014003506
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Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
To all who use this book
May the work you do better the lives
of children everywhere.
To our patients
May we serve you well and learn
from you each day.
To our families
To Anne and Bob Laubisch and my
entire family, thank you for your endless
encouragement in my life that has allowed
me to follow my dreams.
To Jayne and Steven Engorn and my
entire family, thank you for teaching me
to work hard and never give up, and that
family gets us through both the good times
and the bad times.
To our spouses
To Tim Flerlage, my amazing husband
and best friend, thank you for your daily
support that allows me to do what I love,
and for that I am forever grateful.
To Kristin Moosmann Engorn, my
wonderful wife and best friend,
coming home to you is the perfect
ending to every day.
To our mentors
To Julia McMillan, may you know that
your mentorship has shaped our lives
and that you are the physician
we will always strive to be.
To George Dover, The Johns Hopkins
Children’s Center will forever be indebted
to you for all the love, compassion,
dedication, and time that you have given
to enhance the lives of countless children
and families.
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