Balancing Like a Boss (Fluids)
Calculate the hourly rate of fluids for a 25 kg child
65 mL/kg
These 3 things need to be present for someone to be in DKA.
1. Blood glucose >200 mg/dL
2. Ketonuria/ketonemia
3. Acidosis pH<7.3
This is how you quickly estimate minimum SBP for a 5 y/o.
70 mmHg + 2*age (1-12 yr) = 80 mmHg
or
90 mmHg (>12 yr)
Name 3 things do you want to notice and document if you witness a patient having a seizure.
1. Date and time
2. Duration
3. Type; parts of the body affected
4. Any pre-seizure warning signs of aura or triggers
5. Interventions performed (O2, recovery position, rescue meds)
This is how CPP is calculated and the minimum goals/age range.
CPP = MAP-ICP
0-5 yr: >40-50 mmHg
6-12 yr: >50 mmHg
>12 yr: >60 mmHg
Calculate the hourly rate of fluids for a 9 kg child
36 mL/hr
This is how often you will check for urine ketones.
Q void
Name 3 neuro-protective measures you should take when caring for a patient with TBI.
1. Maintain neutral head position midline
2. C-collar with appropriate fit
3. HOB > 30 degrees
4. Secure the airway
5. Avoid hypoxia, sats > 90%
6. Mild hypothermia (36 C/96.8 F)
7. Avoid hypotension
Name the 3 parts to the Monro-Kellie Doctrine/Hypothesis?
1. Brain 80%
2. Blood 10%
3. CSF 10%
This is the greatest risk to your patient in DKA if you rehydrate them too quickly (fluid bolus them too fast).
Cerebral edema
Calculate the hourly rate of fluids for a 13 kg child
46 mL/hr
This is the goal range to keep your patient's blood glucose levels while on an insulin drip.
200-300 mg/dL until acidosis corrects
Your patient is 6-hours out from their initial insult, and you notice ICPs trending into the low 20s. You should anticipate some of these as next steps.
1. Call provider
2. Ensure adequate sedation on board
3. Give 3% saline bolus 5-10 mL/kg over 10-20 min
4. Consider starting NMB if SBS >-2
5. Need for EVD/LD to drain CSF
Based on the Monro-Kellie Doctrine, if the brain starts swelling, this other component needs to be manipulated to preserve brain tissue.
CSF
This is the hourly rate of fluids for a 33 kg child.
73 mL/hr
This is the total fluid intake estimate for your shift for a 43 kg child.
996 mL (1 liter)
This is the starting dose of the insulin infusion.
0.1 units/kg/hr
These are some Healthcare Associated Conditions (HACs) your patient is at risk for during this admission.
1. VAP
2. HAPI
3. CLABSI
4. CAUTI
5. Falls-transitioning out to PICU to acute care
Name 2 clinical interventions implemented to reduce ICP.
1. Place EVD
2. Craniotomy
3. Giving hypertonic saline
4. Giving Mannitol
Name 3 components to a neuro exam.
1. Pupillary response to light
2. LOC
3. GCS
4. Motor function
5. Sensation
6. Cranial nerves
This is the total 24 hr fluid intake estimate for an 18 kg child.
1344 mL
Name 3 things need to be present for your patient to be ready to transition to SQ insulin.
1. HCO3 15-18
2. Anion gap <13
3. Pt hemodynamically stable, neurologically intact, willing/able to eat, and electrolytes improving
You hear the activation of MTP. These are some things you expect to follow to get this protocol started.
1. Get the Belmont
2. Need tubing set-up
3. Need normal saline to prime
4. Need at least 2 large-bore PIVs
5. MTP blood from blood bank
6. 2 RNs verifying blood administration and hang blood, ready to run
Name the 3 components of Cushing's Triad.
1. Bradycardia
2. Widened pulse pressure
3. Irregular, decreased respirations
These 2 things need to be monitored in a DKA patient before adding any potassium to their IV fluids.
1. K <5 mmol
2. Adequate urine output