MKD COMPUTATION H.E.A.D.S.S.S. H.E.A.D.S.S.S.

Wt x mkd x preparation [mg/mL] = mL per dose Home Environment Sexual activities

◦ With whom does the adolescent live? ◦ Sexual orientation?
e.g. 12kg x 10mg x 5ml = 5mL per dose ◦ Any recent changes in the living ◦ GF/BF? Typical date?
120mg situation? ◦ Sexually active? When started? # of persons?
◦ How are things among siblings? Contraceptives? Pregnancies? STDs?
* If per day, divide total (mL) by the # of divided doses ◦ Are parents employed?
◦ Are there things in the family he/she Suicide/Depression
Dose x preparation x frequency = mkd wants to change? ◦ Ever sad/tearful/unmotivated/hopeless?
weight ◦ Thought of hurting self/others?
Employment and Education ◦ Suicide plans?
◦ Currently at school? Favorite subjects?
 Paracetamol Drops = Wt: move 1 decimal ◦ Patient performing academically? Safety
point to the left ◦ Have been truant / expelled from ◦ Use seatbelts/helmets?
Age Wt school? ◦ Enter into high risk situations?
1 10 kg ◦ Problems with classmates/teachers? ◦ Member of frat/sorority/orgs?
2 12 ◦ Currently employed? ◦ Firearm at home?
3 14 ◦ Future education/employment goals?
4 16
5 18 Activities F.R.I.C.H.M.O.N.D.
6 20 ◦ What he/she does in spare time?
◦ Patient does for fun? ◦ Fluids
1 drop = 1/20 mL ◦ Whom does patient spend spare time? ◦ Respiration
1 teaspoonful = 5 mL ◦ Hobbies, interests, close friends? ◦ Infection
1 tablespoonful = 15 mL ◦ Cardiac
1 wineglassful = 60 mL = 2 ounces Drugs ◦ Hematologic
1 glassful = 250 mL = 8 ounces ◦ Used tobacco/alcohol/steroids? ◦ Metabolic
1 grain = 60 mg ◦ Illicit drugs? Frequency? Amount? ◦ Output & Input [cc/kg/h] N: 1-2
1 pint = 500 mL Affected daily activities? ◦ Neuro
1 quart = 1000 mL ◦ Still using? Friends using/selling? ◦ Diet
1 ounce = 30 mL
1 Kg = 2.2 lbs
1 lb = 0.45359 Kg

ADVERSE REACTIONS FROM VACCINES

EXPANDED PROGRAM ON IMMUNIZATION
BCG 1. Wheal ► small ► abscess ► ulceration ► healing / scar formation in
VACCINE AGE DOSE # ROUTE SITE INTERVAL 12 wks
BCG-1 Birth 0.05mL 1 ID R- 2. Deep abscess formation, indolent ulceration, glandular enlargement,
or 6 wks (NB) Deltoid suppurative lymphadenitis
0.1mL DPT 1. Fever, local soreness
(older) 2. Convulsions, encephalitis / encephalopathy, permanent brain
DPT 6 wks 0.5mL 3 IM Upper damage
Outer OPV Paralytic Polio
thigh HEPA B Local soreness
OPV 6 wks 2 drops 3 PO Mouth 4 wks MEASLES 1. Fever & mild rash
HEPA B 6 wks 0.5mL 3 IM Antero- 4 wks 2. Convulsions, encephalitis / encephalopathy, SSPE, death
lateral
thigh ACTIVE PASSIVE
MEASLES 9 mos 0.5mL 1 SC Outer 4 wks BCG Diphtheria
upper DPT Tetanus
arm OPV Tetanus Ig
BCG-2 School entry 0.1mL 1 ID L- Hep B Measles Ig
Measles Rabies (HRIg)
Deltoid
Hib Hep A Ig
TetToxoid Childbearin 0.5mL 3 IM Deltoid 1 mo then MMR Hep B ig
g women 6-12 mos Tetanus Toxoid Rubella Ig
Varicella

LUDAN’S HYDRATION
MILD MODERATE SEVERE HOLIDAY SEGAR
<15 Kg 50 100 150
>15 Kg 30 60 90 <10 Kg: 100 x Weight
Mild 24hours
Wt x factor (50 or 30) = _ugtts/min D5 0.3 NaCl >10Kg: Weight -10 x 50 + 1000
6 or 8 hours 24 hours
>20Kg:Weight-20 x20 + 500
Moderate 24 hours
Wt x Factor (100 or 60) = _cc
IVF:
1st hour: 1/4(PNSS or PLR) to run for 1 hour <20Kg: D5IMB (500cc is the only preparation)
Next 7hours: 3/4 (D50.3NaCl) to run for 7 hours >20Kg: D5NM

Severe Add 10% if there are losses (Fever, vomiting, lbm…)

Wt x Factor (150 or 90) = _cc

1st hour: 1/3 (PNSS or PLR) to run for 1 hour

Next 7hours: 2/3 (PNSS or PLR) to run for 7 hours

IVF
Use PLR if with UO, PNSS if without UO
Use D5.03 if 0-7 years old, D5LR if 8-10 years old

pH HCO3 pCO2
Metabolic Acidosis ↓ ↓ ↓
Metabolic Alkalosis ↑ ↑ ↑
WHO Hydration
Respiratory ↓ ↑ ↑
Plan A
Acidosis
<24 months 50-100mL
Respiratory ↑ ↓ ↓
2-10 years old 100-200mL
Alkalosis
>10 year old Ad libitum

Plan B For every 5 kg = 1ml of Para 250/5

Weight (Kg) x 75mL to be given in 4 hours WEIGHT IN KG Paracetamol Ibuprofen
(10mg/kg/dose) 250/5 200/5
10 2 ml 2.5 ml
Plan C 11 2.2 ml
Age 30cc/kg 70cc/kg 12 2.4 ml 3 ml
<12 months 1st hour 5 hours 13 2.6 ml
>12 months 30 minute 2 ½ hours 14 2.8 ml 3.5 ml
15 3vml
 SAMPLE ADMITTING ORDERS

“A-D-M-I-T”
 Admit under the service of ______
(HMO?)
 Secure consent for admission
 Diet: ______
 Monitor vital signs every 4 hours and
record
 Monitor input and output accordingly
 IVF: _____
 Diagnostics
1.
 Therapeutics:
1.
 Watch out for: ___
 Inform AP and PROD once with room
 Refer accordingly

*side notes: Diagnosis & PE

*If with HMO card, inform HMO coordinator of

o Name, age/gender, diagnosis, Attending
and room

*Inform AP, HMO coordinator, Wards PROD once with

room

**Message PRODs via Telegram on admission

RABIES IMMUNIZATION
***Call Ward PROD to endorse theCAT case,
1 pending labs CAT 2
if applicable and other special Endorsement .
Touching/ feeding Superficial scratch without bleeding
Licks on intact skin Superficial scratch induced bleeding
Nibbling of skin with hematoma

RIG Not recommended Not recommended

Rabies Not recommended (PrEP Recommended
Vaccine consider)
PrEP PEP (Post Exposure Vaccination
Schedule)
PVRV (0.5ml ) or PCECV
(1.0 ml) IM PVRV/PCECV PVRV (Verorab)
Day 0 ____ 0.1ml ID at 2 0.5 ml IM or
Day 7 _____ sites PCEV (Rabipur)
Day 28 ____ 1.0 ml IM
Day 0 ____
(or 0.1ml PVRV/ PCECV at 2 Day 3 ____ Day 0 ____
sites ID Days 0,7, 21/28) Day 7 ____ Day 3 ____
Day 28/30 _ Day 7 ____
Day 14 ___
Day 28/30 _