FLUID THERAPY AND

MEDICATIONS

Fluid resuscitation
Specific drug therapy
– Delivery
– Infusions

Komisi Resusitasi Pediatrik

UKK PGD IDAI
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 Resuscitation Fluids
Used for
– Volume replacement
Fluid of choice
– Normal saline
– Lactated Ringer’s solution
– Acetated Ringer’s solution
– (Colloid solution)

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Rapid Infusion is determined by :

• Dimension of vascular catheter

(diameter & length)

• Pressure
• Viscosity

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Dextrose - containing solutions
Indication :
Hypoglycemia

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 Drug Delivery
Drugs must ultimately reach the central
circulation

Intravascular boluses should be followed

by at least a 2 - 5mL normal saline bolus

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Sites for Drug Administration

Peripheral veins
Intraosseous
Central veins
Endotracheal

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Drugs that can be given
endotracheally

Lidocaine
Epinephrine
Atropine
Naloxone

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 Endotracheal Drug Doses

Epinephrine dose is 10 x IV dose :

0.1 mg/kg (use 1 : 1.000)

Other drug doses are increased :

2 – 3 x IV dose

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Endotracheal Drug Delivery

Drug

Dilute with Instill via catheter

3 – 5 mL NS

Instill directly Flush 3 – 5 mL NS

Positive-pressure breaths

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 Epinephrine Doses
Indication IV/IO Dose ET Dose
Bradycardia 0.01 mg/kg 0.1 mg/kg
0.1 mL/kg 0.1 mL/kg
(1:10.000) (1:1.000)
Asystole/VF/VT
Initial dose 0.01 mg/kg 0.1 mg/kg
0.1 mL/kg 0.1 mL/kg
(1:10.000) (1:1.000)
Subsequent doses 0.1 mg/kg 0.1 mg/kg
0.1 mL/kg 0.1 mL/kg
(1:10.000) (1:1.000)

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 Other resuscitation Drugs
Drug Indication for use

Atropine Symptomatic bradycardia

Sodium bicarbonate Documented acidosis

Naloxone Narcotic-induced
respiratory depression
Calcium chloride Hypocalcemia,
hyperkalemia,
hypermagnesemia,
calcium channel blocker
overdose
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 Comparison of Inotropic Drugs
Drug Uses

Epinephrine Symptomatic bradycardia

Shock (incl.anaphylactic)
Hypotension
Cardiopulmonary arrest
Dobutamine Normotensive cardiogenic shock

Dopamine

Low dose Improve renal, splanchnic blood

flow
High dose Hypotension

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Preparation of Drug Infusions
The Rule of 6

Drug: Calculation rule:

Epinephrine 0.6 x BW(kg) = # mg
to add to diluent to
make 100 mL
volume

1 mL/h delivers 0.1 g/kg per minute

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Preparation of Drug Infusions
The Rule of 6

Drug: Calculation rule:

Dopamine 6 x BW(kg) = # mg
Dobutamine to add to diluent to
make 100 mL
volume

1 mL/h delivers 1 g/kg per minute

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 Aids to Drug Calculations

Percent solution
Percentage = number of grams per
100 mL (regardless of the substance)
10 % solution = 10 g / 100 mL
= 0.1 g / mL
= 100 mg/ mL
D5W = 50 mg glucose per mL
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 Aids to Drug Calculation
Serial dilution
1 : 100 ; 1 : 1.000 ; 1 : 10.000 =
1 g of any substance per 100; 1.000; 10.000 mL

1 : 10.000 epinephrine = 1 g/10.000 mL

= 1 mg/10 mL
= 0,1 mg/mL

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Aids to Drug Calculation
Microgram (g)
1 g = 1/1000 of a milligram, or
1 mg = 1000 g
How many g/mL are in a 1 : 10.000
solution of epinephrine ?
1 : 10.000 = 1 g/10.000 mL
= 1000 mg/10.000 mL
= 1 mg/10 mL
= 1000 g/10 mL
= 100 g/mL
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