- All Saints
Healthcare
WheatonFranciscan
Physicians
RacineEmergency
CareCenter
Emergency
CareerDiscoverySolutionsProgram
October2010
History
Marcus is a 12 year old boy who was brought into the EmergencyCare Centerby his father and
mother. His parentsreportedto staffthat Marcus hasbecomeincreasinglymore ill over the past 710 days.
lnitially their son reportedmild cold symptomswith nonproductivecough,clear rhinorhea,mild
pharyngitis,and low gradefever of 37.2" Celsius. Over the past 24-48hours,however,Marcus was
appearingmuch more ill. Coughinghad increasedand becomeproductiveof yellow phlegm with
associateddyspneaand shortnessof breath. He was now experiencingnauseaand vomiting, as well
as posttussiveemesis. His appetitewas poor"oral fluid intake minimal with resultantminimal
by chills, diaphoresisand
micturation.His lasttemperature
at homewas 39.1' Celsiusaccompanied
rigors. He had last receivedacetaminophen
two (2) hoursPTA. He was not given any Ibuprofen.
Current Vital Signs:
1)
Temperature
Pulse
2)
3)
Respiration
4)
Weight
39.3" Celsius (normal37" Celsius)
136 (normal 60- 74 beatsper minute)
(normal 12 respirationsper minute)
30
I l0 pounds
Through clinical assessment,
laboratorystudiesand medical imagingMarcus was diagnosedwith:
1)
Fever
2)
Dehydration
3)
Pneumonia
Medical managementand interventionwas initiatedin the emergencycare centerwith the child
being stabilizedand eventuallyadmittedto the pediatricunit where recoverycontinuedand
eventuallydischargedhome after 72 hours.
WheatonFranciscan
Healthcare
- All Saints
RacineEmergency
Physicians
Emergency
CareCenter
CareerDiscovery SolutionsProsram
Octo6er2010
ProblemsStatement
Utilizing your math skills and the medical information / formulas provided, pleaseanswer the
following questionsregarding the treatment provided Marcus in the emergencycare center.
l.
To correctMarcus' dehydration,how many liters of IV fluid (SodiumChloride) were
orderedbolus?
2.
After the bolus, how many milliliters of IV fluid were orderedper hour?
(maintenanceIV)
3.
The antiemetic,Zofran,was orderedIV - how much was given?
4.
What is Marcus' temperaturein Fahrenheit?
5.
Was an antipyreticmedicationrequiredin treatingMarcus?
6.
If so, what antipyreticand what dosagewere ordered?
7.
Marcus requirestwo (2) antibioticsto treat his pneumonia.
The first antibiotic is Azithromycin - what is the daily IV dosage?
The secondantibiotic is Ceftriaxone- he is to receive1,000mg IV darly. How many
gramsare to be given daily?
WheatonFranciscanHealthcare- All Saints
RacineEmergencyPhysicians
EmergencyCare Center
CareerDiscoverv SolutionsProsram
Octoler 2010
Answers
1.
Becausethe metric systemis utilized in the delivery of medicationsand IV fluids, we
needto determineMarcus weight in kilograms
Marcusweight: 50 kg
I 10 poundsx's .45359: 49.89kg (50 kg)
IV Bolus: I liter
20 ml x's 50 ks: 1.000ml
1 , 0 0 0ml:
2.
1L
MaintenanceIV: 90 ml / hr
Marcusweights 50 kg
1".10kg of weight: 4 ml x's 10 kg I hr : 40 mI I hr
2"" l0 kg of weight: 2 ml x's l0 kg /hr:20 ml I hr
Finallythe remaining30 kg of weight: 1 ml x's 30 kg lhr:30 ml/ hr
Total maintenanceIV.
3.
Zofran dosage:
4.
102.7"Fahrenheit
5.
Yes, fever greater than 101.0oFahrenheit is treated with antipyretics
6.
Ibuprofen 500 mg
4 mg
90 ml / hr
BecauseMarcusweights more than 15 kg, the larger
Dosageof Zofran can be given.
(39.3"Celsiusx's 9) I 5 + 32: 102.74"Fahrenheit
10 mg x's 50 kg:500 mg
Tylenol was given 2 hours prior to arrival and can
only be given every 4 hours. Too much Tylenol is toxic
to the liver. It is the leadins causeof fatal overdosein
children.
7.
Azithromycin 500mgfV daily 10 mg x's 50 mg: 500 mg IV daily
Ceftriaxone I gm IV daily
1000mg: I gm
WheatonFranciscan
Healthcare
- All Saints
RacineEmergency
Physicians
EmergencyCareCenter
CareerDiscoverySolutionsProgram
October2010
Formulas
Conversions:
# of poundsx's .45359: # of kilograms(kg)
# of kilograms(kg) x's2.2 pounds: # of pounds
I liter (L) : 1,000milliliters(ml)
1 gram(gm): 1,000milligrams(mg)
(Celsiustemperaturex's 9/5) * 32: Fahrenheittemperature
(Fahrenheittemperature- 32) x's 519: Celsiustemperature
Pediatric
Intravenous (IV)
Fluids:
Bolus.
20 ml / kg
Maintenance:
4 ml /kg / hr for the l" lO kg
2 ml lkg lhr for the 2ndl0 kg
I ml / kg I hr for the remainingkg
or
20 ml x's # of kg patientweighs
The total of these3 equationsis the total ml per hour
Medications:
Tylenol
15 mg / kg per oral (p.o.)
every 4 hours if needed(prn) for fever greaterthan I 0 I
Ibuprofen
10 mg / kg per oral (p.o.)
every 6 hoursifneeded (prn) for fever greaterthan 101
Zofran
weight of 8-15 kg weight greaterthan 15 kg-
Azithromycin
10 mg / kg IV daily
give2 mg IV
give 4 mg IV
WheatonFranciscanHealthcare- All Saints
RacineEmergencyPhysicians
EmergencyCare Center
CareerDiscoverySolutionsProgram
October2010
Abbreviations
degrees
Fahrenheit
IV
intravenous(in a vein)
kg
kilogram
L
liter
mg
milligram
ml
milliliter
po
per oral (by mouth)
prn
as needed
PTA
prior to arrival
WheatonFranciscan
Healthcare- All Saints
RacineEmergency
Physicians
EmergencyCareCenter
CareerDiscovery Solutionsprogram
October2010
Vocabulary
Acetaminophen
Tylenol - medicationthat treatsfever
antiemetic
medication to stop nauseaand vomiting
antibiotic
medication that destrovsbacteria
antipyretic
medication to lower temperature
bolus
alarge quantity
celsius
temperaturescalein Europe/ most of the world
namedafter Swedishastronomer,AndersCelsius
dehydration
loss of body fluid in tissue/ organ
diaphoresis
sweating
dosage
amountof a medicationthat canbe given
dyspnea
painful to take big breaths
emesis
vomit
Fahrenheit
temperaturescalein the United Statesand few Caribbeancountries
namedafter physicist,Daniel Gabriel Fahrenheit
fever
temperaturegreaterthan l0l' F
Ibuprofen
Advil, Motrin - medication that treats fever
intervention
to spot a processor event from continuing
intravenous
by vein or in the vein
micturation
urination
WheatonFranciscanHealthcare- All Saints
RacineEmergencyPhysicians
EmergencyCare Center
CareerDiscoverySolutionsProgram
October2010
Vocabulary (continued)
nausea
feelingsickto your stomach
oral
by mouth
pediatric
refersto children
pharyngitis
sorethroat
pneumonia
lung infection
posttussive
after coughing
rhinorhea
runny nose
rigors
shakes
stabilization
to returnto normal