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Emergency Pediatric Dosing 12-14 kilogram

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181. Hematopoietic Stem Cell Transplantation (Treatment)

. In addition, HSCT is used to allow patients with cancer to receive higher doses of chemotherapy than bone marrow can usually tolerate; bone marrow function is then salvaged by replacing the marrow with previously harvested stem cells. Examples of emerging indications for HSCT include replacement of marrow progenitors for the purpose of making normal red cells (eg, in hemoglobinopathies), making corrective enzymes (eg, in storage disorders), and mediating tissue repair (eg, in epidermolysis bullosa). HSCT (...) Vermylen 50 7.5 9-23 Sibling bone marrow 11 Bu/Cy ± TLI or ATG 2 42 (85) 20 10 5 Bernaudin 34 8 2-14 Sibling bone marrow 1 Bu/Cy ± TLI or ATG 3 31 9 2 1 Locatelli 11 5 1-20 Sibling cord blood 2 Bu/Cy ± ATG/ALG, Bu/Flu/TT 0 10 1 1 1 Panepinto 67 10 2-27 Bone marrow, peripheral blood stem cell, cord blood 5 Bu/Cy (63), other (4) 3 55 10 22 9 Adamkiewicz 3 6 3-12 4/6 Unrelated donor/umbilical cord blood 4 Bu/Cy/ATG 0 2 3 1 1 Abbreviations: ALG, antilymphocyte globulin; ATG, antithymocyte globulin; Bu

2014 eMedicine Pediatrics

182. Neonatal Resuscitation (Treatment)

because 81% of all babies in the United States are born in nonteaching, nonaffiliated level I or II hospitals. In such hospitals, the volume of delivery service may not be perceived as sufficient economic justification for the continuous in-hospital presence of personnel with high-risk delivery room experience, as recommended by the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG). [ ] Perinatal asphyxia and extreme are the 2 complications (...) to the heart, brain, head, and upper torso. The less saturated blood from the right ventricle passes into the pulmonary arteries. Because the pulmonary vessels are constricted and highly resistant to flow, only about 12% of this blood from the right ventricle enters the lungs; the remainder takes the path of least resistance through the patent ductus arteriosus into the descending aorta. Approximately one third of this blood is carried to the trunk, abdomen, and lower extremities, with the remainder

2014 eMedicine Pediatrics

183. Nutritional Requirements of Children Prior to Transplantation (Overview)

- 2.2 g/kg body weight Age 6-12 months - 2 g kg/body weight Age 1-3 years - 0.18 g/cm height Age 4-6 years - 0.21 g/cm height Age 7-10 years - 0.21 g/cm height Age 11-14 years - 0.29 g/cm height Age 15-18 years - 0.34 g/cm height Assessment of fluid requirements The daily fluid requirements of nonstressed pediatric patients are as follows: Premature neonates who weigh less than 2 kg - 150 mL/kg Neonates and infants who weigh 2-10 kg - 100 mL/kg for the first 10 kg Infants and children who weigh 10 (...) 12 1 300 1.8 14-18 65 1 1 14 1.2 400 2.4 19-30 75 1.1 1.1 14 1.3 400 2.4 31-50 75 1.1 1.1 14 1.5 400 2.4 51-70 75 1.1 1.1 14 1.5 400 2.4 >70 75 1.1 1.1 14 1.5 400 2.4 Pregnant women < 19 80 1.4 1.4 18 1.9 600 2.6 19-30 85 1.4 1.4 18 1.9 600 2.6 31-50 85 1.4 1.4 18 1.9 600 2.6 Lactating women < 19 115 1.4 1.6 17 2 500 2.8 19-30 120 1.4 1.6 17 2 500 2.8 31-50 120 1.4 1.6 17 2 500 2.8 * The allowances, expressed as average daily intakes over time, are intended to provide for individual variations

2014 eMedicine Pediatrics

184. Follow-up of the NICU Patient (Overview)

) infants who are born outside of a level III hospital (level III NICUs are defined by the Perinatal Section of the American Academy of Pediatrics). For VLBW infants, mortality for those born in level III hospitals was 21%, compared with 36% in lower-level hospitals; for infants weighing less than 1000 g, mortality was 32% versus 59%. For VPT infants, mortality was 7% versus 12%, respectively. [ ] At level I and level II hospitals, all perinatal caregivers are encouraged to refer pregnant women to level (...) . [ ] These SGA infants should be referred to a pediatric endocrinologist, because therapy with recombinant human growth hormone may be useful in some cases. Early growth and adult disease A current concern involves the rate of catch-up growth and its association with an increased risk of obesity and heart disease in later life. [ ] In part, the pathophysiology of low birth weight and later adult disease is derived from the Barker hypothesis. [ ] Emerging data are causing a reexamination of the best rate

2014 eMedicine Pediatrics

185. Hematopoietic Stem Cell Transplantation (Overview)

. In addition, HSCT is used to allow patients with cancer to receive higher doses of chemotherapy than bone marrow can usually tolerate; bone marrow function is then salvaged by replacing the marrow with previously harvested stem cells. Examples of emerging indications for HSCT include replacement of marrow progenitors for the purpose of making normal red cells (eg, in hemoglobinopathies), making corrective enzymes (eg, in storage disorders), and mediating tissue repair (eg, in epidermolysis bullosa). HSCT (...) Vermylen 50 7.5 9-23 Sibling bone marrow 11 Bu/Cy ± TLI or ATG 2 42 (85) 20 10 5 Bernaudin 34 8 2-14 Sibling bone marrow 1 Bu/Cy ± TLI or ATG 3 31 9 2 1 Locatelli 11 5 1-20 Sibling cord blood 2 Bu/Cy ± ATG/ALG, Bu/Flu/TT 0 10 1 1 1 Panepinto 67 10 2-27 Bone marrow, peripheral blood stem cell, cord blood 5 Bu/Cy (63), other (4) 3 55 10 22 9 Adamkiewicz 3 6 3-12 4/6 Unrelated donor/umbilical cord blood 4 Bu/Cy/ATG 0 2 3 1 1 Abbreviations: ALG, antilymphocyte globulin; ATG, antithymocyte globulin; Bu

2014 eMedicine Pediatrics

186. Neonatal Resuscitation (Overview)

because 81% of all babies in the United States are born in nonteaching, nonaffiliated level I or II hospitals. In such hospitals, the volume of delivery service may not be perceived as sufficient economic justification for the continuous in-hospital presence of personnel with high-risk delivery room experience, as recommended by the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG). [ ] Perinatal asphyxia and extreme are the 2 complications (...) to the heart, brain, head, and upper torso. The less saturated blood from the right ventricle passes into the pulmonary arteries. Because the pulmonary vessels are constricted and highly resistant to flow, only about 12% of this blood from the right ventricle enters the lungs; the remainder takes the path of least resistance through the patent ductus arteriosus into the descending aorta. Approximately one third of this blood is carried to the trunk, abdomen, and lower extremities, with the remainder

2014 eMedicine Pediatrics

187. Hematopoietic Stem Cell Transplantation (Diagnosis)

. In addition, HSCT is used to allow patients with cancer to receive higher doses of chemotherapy than bone marrow can usually tolerate; bone marrow function is then salvaged by replacing the marrow with previously harvested stem cells. Examples of emerging indications for HSCT include replacement of marrow progenitors for the purpose of making normal red cells (eg, in hemoglobinopathies), making corrective enzymes (eg, in storage disorders), and mediating tissue repair (eg, in epidermolysis bullosa). HSCT (...) Vermylen 50 7.5 9-23 Sibling bone marrow 11 Bu/Cy ± TLI or ATG 2 42 (85) 20 10 5 Bernaudin 34 8 2-14 Sibling bone marrow 1 Bu/Cy ± TLI or ATG 3 31 9 2 1 Locatelli 11 5 1-20 Sibling cord blood 2 Bu/Cy ± ATG/ALG, Bu/Flu/TT 0 10 1 1 1 Panepinto 67 10 2-27 Bone marrow, peripheral blood stem cell, cord blood 5 Bu/Cy (63), other (4) 3 55 10 22 9 Adamkiewicz 3 6 3-12 4/6 Unrelated donor/umbilical cord blood 4 Bu/Cy/ATG 0 2 3 1 1 Abbreviations: ALG, antilymphocyte globulin; ATG, antithymocyte globulin; Bu

2014 eMedicine.com

188. Toxicity, Mercury (Diagnosis)

. Rec 32. WHO. 2003 Jun 11-12. 282-284. Environmental Protection Agency (EPA). Spills, Disposal and Site Cleanup. US Environmental Protection Agency. Available at . Accessed: March 30, 2009. Jao-Tan C, Pope E. Cutaneous poisoning syndromes in children: a review. Curr Opin Pediatr . 2006 Aug. 18(4):410-6. . Tezer H, Kaya A, Kalkan G, Erkocoglu M, Ozturk K, Buyuktasli M. Mercury poisoning: a diagnostic challenge. Pediatr Emerg Care . 2012 Nov. 28(11):1236-7. . Takaoka S, Kawakami Y, Fujino T, Oh-ishi (...) distress syndrome (ARDS) has been reported following elemental mercury inhalation. Vaccine-associated exposure Thimerosal is a mercury-containing preservative used in some vaccines and other products since the 1930s. No harmful effects have been reported from thimerosal at doses used in vaccines, except for minor reactions, such as redness and swelling at the injection site. However, in July 1999, the Public Health Service agencies, the American Academy of Pediatrics, and vaccine manufacturers agreed

2014 eMedicine Emergency Medicine

189. Toxicity, Mushroom (Diagnosis)

than 6 years. Mortality is higher in children because they absorb a larger dose of toxins per kilogram of body weight. Previous Next: Prognosis The primary factor determining the prognosis is the quantity of mushroom that was eaten. In some cases, ingestion of a single A phalloides mushroom can be lethal. However, variations in individual susceptibility to amatoxin have been reported, and as noted, children absorb proportionally higher doses of toxins than adults do and are more likely to die (...) and indications for emergency liver transplantation. J Hepatol . 2007 Mar;. 46(3):466-73. . Diaz JH. Evolving global epidemiology, syndromic classification, general management, and prevention of unknown mushroom poisonings. Crit Care Med . 2005 Feb. 33 (2):419-26. . Kaya E, Karahan S, Bayram R, Yaykasli KO, Colakoglu S, Saritas A. Amatoxin and phallotoxin concentration in Amanita phalloides spores and tissues. Toxicol Ind Health . 2015 Dec. 31 (12):1172-7. . Yilmaz I, Ermis F, Akata I, Kaya E. A Case Study

2014 eMedicine Emergency Medicine

190. Toxicity, Mushroom (Follow-up)

than 6 years. Mortality is higher in children because they absorb a larger dose of toxins per kilogram of body weight. Previous Next: Prognosis The primary factor determining the prognosis is the quantity of mushroom that was eaten. In some cases, ingestion of a single A phalloides mushroom can be lethal. However, variations in individual susceptibility to amatoxin have been reported, and as noted, children absorb proportionally higher doses of toxins than adults do and are more likely to die (...) and indications for emergency liver transplantation. J Hepatol . 2007 Mar;. 46(3):466-73. . Diaz JH. Evolving global epidemiology, syndromic classification, general management, and prevention of unknown mushroom poisonings. Crit Care Med . 2005 Feb. 33 (2):419-26. . Kaya E, Karahan S, Bayram R, Yaykasli KO, Colakoglu S, Saritas A. Amatoxin and phallotoxin concentration in Amanita phalloides spores and tissues. Toxicol Ind Health . 2015 Dec. 31 (12):1172-7. . Yilmaz I, Ermis F, Akata I, Kaya E. A Case Study

2014 eMedicine Emergency Medicine

191. Renal Failure, Acute (Follow-up)

) Group. Crit Care . 2004 Aug. 8(4):R204-12. . . Nee PA, Bailey DJ, Todd V, Lewington AJ, Wootten AE, Sim KJ. Critical care in the emergency department: acute kidney injury. Emerg Med J . 2015 May 12. . Uchino S, Bellomo R, Goldsmith D, Bates S, Ronco C. An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. Crit Care Med . 2006 Jul. 34(7):1913-7. . Ostermann M, Chang RW. Acute kidney injury in the intensive care unit according to RIFLE. Crit Care Med . 2007 Aug. 35(8 (...) in serum creatinine level, glomerular filtration rate (GFR), or urine output (UO). The RIFLE classification of ARF is as follows [ ] : Risk (R) - Increase in serum creatinine level X 1.5 or decrease in GFR by 25%, or UO < 0.5 mL/kg/h for 6 hours Injury (I) - Increase in serum creatinine level X 2.0 or decrease in GFR by 50%, or UO < 0.5 mL/kg/h for 12 hours Failure (F) - Increase in serum creatinine level X 3.0, decrease in GFR by 75%, or serum creatinine level ≥ 4 mg/dL with acute increase of >0.5 mg

2014 eMedicine Emergency Medicine

192. Renal Failure, Acute (Diagnosis)

) Group. Crit Care . 2004 Aug. 8(4):R204-12. . . Nee PA, Bailey DJ, Todd V, Lewington AJ, Wootten AE, Sim KJ. Critical care in the emergency department: acute kidney injury. Emerg Med J . 2015 May 12. . Uchino S, Bellomo R, Goldsmith D, Bates S, Ronco C. An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. Crit Care Med . 2006 Jul. 34(7):1913-7. . Ostermann M, Chang RW. Acute kidney injury in the intensive care unit according to RIFLE. Crit Care Med . 2007 Aug. 35(8 (...) in serum creatinine level, glomerular filtration rate (GFR), or urine output (UO). The RIFLE classification of ARF is as follows [ ] : Risk (R) - Increase in serum creatinine level X 1.5 or decrease in GFR by 25%, or UO < 0.5 mL/kg/h for 6 hours Injury (I) - Increase in serum creatinine level X 2.0 or decrease in GFR by 50%, or UO < 0.5 mL/kg/h for 12 hours Failure (F) - Increase in serum creatinine level X 3.0, decrease in GFR by 75%, or serum creatinine level ≥ 4 mg/dL with acute increase of >0.5 mg

2014 eMedicine Emergency Medicine

193. Therapeutic Injections for Pain Management (Diagnosis)

of the allowed radiation dose that an individual may receive without the risk of significant side effects. The annual whole body MPD limit for physicians is 50 mSv. The annual MPD for the lens of the eye is 150 mSv, and for the thyroid, gonads and extremities it is 500 mSv. The fluoroscopy's x-ray tube should be kept as far away from the patient as possible. Federal regulations limit the maximum output for C-arm fluoroscopy to 10 R/min at 12 in (30 cm) from the image intensifier. Beam collimation reduces (...) characteristics should be considered when choosing an LA. The latency of onset of anesthetic action is an important clinical property; however, concentration, total dose, distance between the injection site and target, and relative penetrance of the compound also should be considered. Penetrance depends on target-tissue characteristics, including the thickness of superimposed, fibrous, and other intervening tissues. Tissue penetrance of specific LAs determines latency of onset and intensity of induced

2014 eMedicine.com

194. Critical Care Considerations in Trauma

and requires immediate decompression. This is initially commonly accomplished with a 14-gauge catheter-over-needle assembly placed in the second intercostal space (ICS) midclavicular line (MCL). Patients treated in this way should have a tube thoracostomy placed to manage simple pneumothorax and to evacuate thoracic cavity blood when present. Life-threatening hemorrhage identified when placing a tube thoracostomy may be managed with a resuscitative thoracostomy. Circulation and hemorrhage control Emergent (...) over the past 20 years, largely from improvements in trauma systems, assessment, triage, resuscitation, and emergency care. However, an Institute of Medicine report identified a US crisis in access and distribution to emergency care that may impact trauma system efficiency and effectiveness. Similarly, a predicted deficit in critical care practitioners may similarly degrade the post-emergency department care of the critically injured patient. The American College of Surgeons Committee on Trauma

2014 eMedicine Surgery

195. Toxicity, Mushroom (Treatment)

than 6 years. Mortality is higher in children because they absorb a larger dose of toxins per kilogram of body weight. Previous Next: Prognosis The primary factor determining the prognosis is the quantity of mushroom that was eaten. In some cases, ingestion of a single A phalloides mushroom can be lethal. However, variations in individual susceptibility to amatoxin have been reported, and as noted, children absorb proportionally higher doses of toxins than adults do and are more likely to die (...) and indications for emergency liver transplantation. J Hepatol . 2007 Mar;. 46(3):466-73. . Diaz JH. Evolving global epidemiology, syndromic classification, general management, and prevention of unknown mushroom poisonings. Crit Care Med . 2005 Feb. 33 (2):419-26. . Kaya E, Karahan S, Bayram R, Yaykasli KO, Colakoglu S, Saritas A. Amatoxin and phallotoxin concentration in Amanita phalloides spores and tissues. Toxicol Ind Health . 2015 Dec. 31 (12):1172-7. . Yilmaz I, Ermis F, Akata I, Kaya E. A Case Study

2014 eMedicine Emergency Medicine

196. Renal Failure, Acute (Treatment)

) Group. Crit Care . 2004 Aug. 8(4):R204-12. . . Nee PA, Bailey DJ, Todd V, Lewington AJ, Wootten AE, Sim KJ. Critical care in the emergency department: acute kidney injury. Emerg Med J . 2015 May 12. . Uchino S, Bellomo R, Goldsmith D, Bates S, Ronco C. An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. Crit Care Med . 2006 Jul. 34(7):1913-7. . Ostermann M, Chang RW. Acute kidney injury in the intensive care unit according to RIFLE. Crit Care Med . 2007 Aug. 35(8 (...) in serum creatinine level, glomerular filtration rate (GFR), or urine output (UO). The RIFLE classification of ARF is as follows [ ] : Risk (R) - Increase in serum creatinine level X 1.5 or decrease in GFR by 25%, or UO < 0.5 mL/kg/h for 6 hours Injury (I) - Increase in serum creatinine level X 2.0 or decrease in GFR by 50%, or UO < 0.5 mL/kg/h for 12 hours Failure (F) - Increase in serum creatinine level X 3.0, decrease in GFR by 75%, or serum creatinine level ≥ 4 mg/dL with acute increase of >0.5 mg

2014 eMedicine Emergency Medicine

197. Toxicity, Mushrooms - Amatoxin (Overview)

than 6 years. Mortality is higher in children because they absorb a larger dose of toxins per kilogram of body weight. Previous Next: Prognosis The primary factor determining the prognosis is the quantity of mushroom that was eaten. In some cases, ingestion of a single A phalloides mushroom can be lethal. However, variations in individual susceptibility to amatoxin have been reported, and as noted, children absorb proportionally higher doses of toxins than adults do and are more likely to die (...) and indications for emergency liver transplantation. J Hepatol . 2007 Mar;. 46(3):466-73. . Diaz JH. Evolving global epidemiology, syndromic classification, general management, and prevention of unknown mushroom poisonings. Crit Care Med . 2005 Feb. 33 (2):419-26. . Kaya E, Karahan S, Bayram R, Yaykasli KO, Colakoglu S, Saritas A. Amatoxin and phallotoxin concentration in Amanita phalloides spores and tissues. Toxicol Ind Health . 2015 Dec. 31 (12):1172-7. . Yilmaz I, Ermis F, Akata I, Kaya E. A Case Study

2014 eMedicine Pediatrics

198. Toxicity, Mercury (Overview)

. Rec 32. WHO. 2003 Jun 11-12. 282-284. Environmental Protection Agency (EPA). Spills, Disposal and Site Cleanup. US Environmental Protection Agency. Available at . Accessed: March 30, 2009. Jao-Tan C, Pope E. Cutaneous poisoning syndromes in children: a review. Curr Opin Pediatr . 2006 Aug. 18(4):410-6. . Tezer H, Kaya A, Kalkan G, Erkocoglu M, Ozturk K, Buyuktasli M. Mercury poisoning: a diagnostic challenge. Pediatr Emerg Care . 2012 Nov. 28(11):1236-7. . Takaoka S, Kawakami Y, Fujino T, Oh-ishi (...) distress syndrome (ARDS) has been reported following elemental mercury inhalation. Vaccine-associated exposure Thimerosal is a mercury-containing preservative used in some vaccines and other products since the 1930s. No harmful effects have been reported from thimerosal at doses used in vaccines, except for minor reactions, such as redness and swelling at the injection site. However, in July 1999, the Public Health Service agencies, the American Academy of Pediatrics, and vaccine manufacturers agreed

2014 eMedicine Pediatrics

199. Nutritional Requirements of Children Prior to Transplantation (Follow-up)

- 2.2 g/kg body weight Age 6-12 months - 2 g kg/body weight Age 1-3 years - 0.18 g/cm height Age 4-6 years - 0.21 g/cm height Age 7-10 years - 0.21 g/cm height Age 11-14 years - 0.29 g/cm height Age 15-18 years - 0.34 g/cm height Assessment of fluid requirements The daily fluid requirements of nonstressed pediatric patients are as follows: Premature neonates who weigh less than 2 kg - 150 mL/kg Neonates and infants who weigh 2-10 kg - 100 mL/kg for the first 10 kg Infants and children who weigh 10 (...) 12 1 300 1.8 14-18 65 1 1 14 1.2 400 2.4 19-30 75 1.1 1.1 14 1.3 400 2.4 31-50 75 1.1 1.1 14 1.5 400 2.4 51-70 75 1.1 1.1 14 1.5 400 2.4 >70 75 1.1 1.1 14 1.5 400 2.4 Pregnant women < 19 80 1.4 1.4 18 1.9 600 2.6 19-30 85 1.4 1.4 18 1.9 600 2.6 31-50 85 1.4 1.4 18 1.9 600 2.6 Lactating women < 19 115 1.4 1.6 17 2 500 2.8 19-30 120 1.4 1.6 17 2 500 2.8 31-50 120 1.4 1.6 17 2 500 2.8 * The allowances, expressed as average daily intakes over time, are intended to provide for individual variations

2014 eMedicine Pediatrics

200. Hematopoietic Stem Cell Transplantation (Follow-up)

. In addition, HSCT is used to allow patients with cancer to receive higher doses of chemotherapy than bone marrow can usually tolerate; bone marrow function is then salvaged by replacing the marrow with previously harvested stem cells. Examples of emerging indications for HSCT include replacement of marrow progenitors for the purpose of making normal red cells (eg, in hemoglobinopathies), making corrective enzymes (eg, in storage disorders), and mediating tissue repair (eg, in epidermolysis bullosa). HSCT (...) Vermylen 50 7.5 9-23 Sibling bone marrow 11 Bu/Cy ± TLI or ATG 2 42 (85) 20 10 5 Bernaudin 34 8 2-14 Sibling bone marrow 1 Bu/Cy ± TLI or ATG 3 31 9 2 1 Locatelli 11 5 1-20 Sibling cord blood 2 Bu/Cy ± ATG/ALG, Bu/Flu/TT 0 10 1 1 1 Panepinto 67 10 2-27 Bone marrow, peripheral blood stem cell, cord blood 5 Bu/Cy (63), other (4) 3 55 10 22 9 Adamkiewicz 3 6 3-12 4/6 Unrelated donor/umbilical cord blood 4 Bu/Cy/ATG 0 2 3 1 1 Abbreviations: ALG, antilymphocyte globulin; ATG, antithymocyte globulin; Bu

2014 eMedicine Pediatrics

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