Weill Cornell University Medical College - New York Presbyterian
 

Help

for Emergency Medications and Drip-Rate Tables

 

Table of Contents

  1. Introduction
    1. Important Disclaimer
  2. Emergency Medications
  3. Drip-Rate Tables
  4. Frequently Asked Questions - FAQs
    1. What is the difference between "Flow-based" and "Dose-based" Tables?
    2. What is the difference between the "Weight-based Conc" button and the other two ("Flow-based Table" and "Dose-based Table")?
    3. How do I enter a drug name not on the drop-down list?
    4. How do I enter drug amount units different from those listed?
    5. How do I enter a diluent different from those listed?
    6. How do I enter an increment different from those listed?
  5. Calculations - Formulae
  6. Technical Stuff

1. Introduction Go to Top

This program is designed to quickly generate printouts to help the clinician in emergency and critical situations. It is actually several programs bound together by a data input form so that several printouts can be created quickly and without having to enter the same data repeatedly. The Emergency Medications program calculates dosages and volumes of common emergency medications based on age and weight. The Drip-Rate Tables program (actually three programs) generates tables that relate the flow rate (in cc/hr) of a medicated drip to a dosing rate (in units that are specified by the user). These tables can be either Flow-based or Dose-based if an a drug concentration (amount and volume) is specified. The Weight-based Concentration will calculate the amount of drug to be mixed in the specified volume so that a simple relationship exists between the flow rate and the dosing rate.

The References button will bring up a list of commonly used medicated drips and standard doing ranges. The Help button will bring up this window. The Reset button will clear all input fields and return the defaults. This is the recommended method for entering data for a different patient.

Important Disclaimer: All calculations must be confirmed. This program is not a substitute for clinical judgement. There are no claims, explicit or implied, of the accuracy of any of the data or information provided by this program.

2. Emergency Medications Go to Top

Instructions:

  1. Required Data. Enter the required data: patient's name, patient's weight, and the user's "signature." If the patient's weight is in pounds, select "lbs."
  2. Age. Enter the patient's age.
  3. Click on the "Emergency Meds" button, and another window will appear with a preview.
  4. If this is satisfactory, click on the "Print" button at the top of the window.
  5. After printing starts, close the window by clicking on the "x" at the window's top right corner.

3. Drip-Rate Tables Go to Top

Instructions:

  1. Required Data. Enter the required data at the top: patient's name, patient's weight, and the user's "signature." If the patient's weight is in pounds, select "lbs." The patient's age is not necessary.
  2. Drug Name. Enter the drug name by selecting it from the drop-down list. If you type the first letter, the list will skip to the listings beginning with that letter. If the drug name is not listed, enter "-" and the selection for "-- Other --" will appear. You will be asked for the drug name later.
  3. Amount & units. Enter the amount of drug that will go into the solution and select the units. If you pick "other" you will be prompted to type in the units later. If you select the Weight-based Concentration button, the "Amount" field is ignored.
  4. Volume & Diluent. The volume of the medicated solution to be mixed is entered next. The default is 100 mL. The type of diluent into which the medication is mixed may be entered here, but is entirely optional. The default is D5W. If the diluent is not listed, enter "-" and the selection for "-- Other --" will appear. You will be asked for the diluent name later.
  5. Table Units. Choose the units to be used. For example, for dopamine select mcg/kg/hr; for pancuronium select mg/kg/hr. If, at instruction #3 you had selected "units" or "other," you should select "units/kg/hr."
  6. Increments. Enter the increment you want between lines. For example, the following table uses increments of 1.
    cc/hr mcg/kg/min mcg/min
    1
    2
    3
    4
    = 0.89
    = 1.78
    = 2.67
    = 3.56
    26.67
    53.34
    80.01
    106.68

    Select the increments from among the list provided or type "-" and the selection for "-- Other --" will appear. If you select this, you will be prompted later for your entry.

  7. Buttons. Once you have entered the data, select one of the three buttons: Flow-based Table, Dose-based Table, or Weight-based Concentration. The above example is a Flow-based table, where the flow (cc/hr) is in regular increments. A Dose-based Table is virtually identical, but it is the dose (in mcg/kg/min or similar units) that is in regular increments. If you want the program to calculate the drip concentration that will create an easy-to-remember relationship between the flow and the dose, select the Weight-based Concentration. You would use this if, for example, you wanted 1 cc/hr to administer 1 mcg/kg/min of dopamine.
  8. If the preview is satisfactory, click on the "Print" button at the top of the window.
  9. After printing starts, close the window by clicking on the "x" at the window's top right corner.

4. Frequently Asked Questions Go to Top

1. What is the difference between Flow-based and Dose-based Tables?

The Drip-Rate Tables generate a table that relate three numbers: the infusion flow rate (mL/hr), the weight-based dosing rate (e.g. mcg/kg/min or mg/kg/hr), and the total dosing rate (e.g. mcg/min or mg/hr). Your choice of a Flow-based or Dose-based table will determine which column is in nice, round-number increments. For example:

Flow-based Dose-based
cc/hr mcg/kg/min mcg/min
1
2
3
4
= 0.89
= 1.78
= 2.67
= 3.56
26.67
53.34
80.01
106.68
cc/hr mcg/kg/min mcg/min
1.12
2.25
3.37
4.49
= 1.0
= 2.0
= 3.0
= 4.0
29.97
59.93
89.90
119.87

2. What is the difference between the "Weight-based Conc" button and the other two ("Flow-based Table" and "Dose-based Table")?

The Weight-based Concentration button calculates the amount of drug needed to be mixed in the specified volume so that a simple, easy-to-figure-out relationship exists between the flow rate (cc/hr) and the dose rate (mcg/kg/min, mg/kg/hr, or one of the others). That relationship is specified in the "Increments" field. Anything entered in the "amount" field causes a warning appear, informing the user that this entered value will be changed.

For example, enter the patient's weight, select "Dopamine," leave the default "volume" of 100cc, select "mcg/kg/min," and select an increment of 1. The program will calculate that you need 75 mg in the 100cc so that 1 cc/hr will deliver 1 mcg/kg/min, and will generate a table so that both the flow and the dose are nice, round-number increments.

3. How do I enter a drug name not on the drop-down list?

Enter the drug name by selecting it from the drop-down list. If you type the first letter, the list will skip to the listings beginning with that letter. If the drug name is not listed, enter "-" and the selection for "-- Other --" will appear. Alternatively, you can simply scroll down the list until you can select the "-- Other --" entry. After you select the table you want, you will be prompted to fill in the drug name in a pop-up window. Read the screen carefully!

4. How do I enter a drug amount units different from those listed?

Click the radio button for "other" next to the "Amount" field. After you select the table you want, you will be prompted to fill in the drug amount units in a pop-up window. Read the screen carefully!

At the "Table Units" radio buttons, click the "units/kg/hr" button.

5. How do I enter a diluent different from those listed?

Enter the diluent by selecting it from the drop-down list. If you type the first letter, the list will skip to the listings beginning with that letter. If the diluent is not listed, enter "-" and the selection for "-- Other --" will appear. Alternatively, you can simply scroll down the list until you can select the "-- Other --" entry. After you select the kind of table you want, you will be prompted to fill in the drug name in a pop-up window. Read the screen carefully!

6. How do I enter an increment different from those listed?

Enter the increment by selecting it from the drop-down list. If the increment is not listed, enter "-" and the selection for "-- Other --" will appear. Alternatively, you can simply scroll down the list until you can select the "-- Other --" entry. After you select the kind of table you want, you will be prompted to fill in the drug name in a pop-up window. Read the screen carefully!

5. Calculations - Formulae Go to Top

1. Emergency Medications

In many cases the doses calculated are arbitrary and institution-specific, even specific to a unit within an institution. The concentrations of drugs in a hospital formulary may also vary among institutions. It is the responsibility of the clinician using these calculators and references to confirm all data prior to use. The constants used in this program is subject to change without warning, though each new version of the program is generally well-indicated.

Medication Doses and Programmed Maximums
The maximum doses for many of the items is usually defined as the standard adult dose to avoid overdosing in larger patients, but some other maximum doses may be invoked. The following are the currently programmed maximums:
Item/Drug Initial Dose Program Max
ET tube Std formula 8.0 mm
Defibrillation 2 J/kg 200 J
Cardioversion 0.5 J/kg 100 J
Adenosine 0.1 mg/kg 6 mg
Amiodarone 5 mg/kg 150 mg
Atropine 0.02 mg/kg
(0.1 mg minimum)
1 mg >12 years
0.5 mg < 12 years
Bicarbonate 1 mEq/kg 50 mEq
Calcium Cl 0.25 mEq/kg 13.6 mEq
Dextrose 0.5 g/kg 25 g
Epinephrine 10 mcg/kg 1000 mcg
Flumazenil 5 mcg/kg -
Lidocaine 1 mg/kg 100 mg
Magnesium Sulfate 25 mg/kg 2000 mg
Mannitol 0.25 g/kg 12.5 mg
Naloxone 0.01 mg/kg 2 mg
Phenylephrine 5 mcg/kg -
Procainamide 15 mg/kg -
Vasopressin* 0.5 U/kg 4 U
Intubation Adjuncts
Etomidate 0.3 mg/kg -
Fentanyl 1 mcg/kg 100 mcg
Ketamine 1 mg/kg -
Midazolam 0.1 mg/kg 1 mg
Rocuronium 1 mg/kg -
Succinylcholine 1 mg/kg -
Thiopental Sodium 5 mg/kg -
Vecuronium 0.1 mg/kg -

* Pediatric dosing not established. Use with caution.

Note that the Program Maximum refers only to the initial dosing, and is usually the starting standard adult dose, not the absolute maximum dose allowed. For example, this program will not print a dose of adenosine above 6 mg, as this is the initial adult dose. Users must know how to use adenosine, that if the response to the initial dose is inadequate that the dose is doubled to an absolute maximum of 12 mg. Please refer to the disclaimer below.

Endotracheal Tubes
Endotracheal tube sizes are calculated by the formula:
Age + 16
4
For small infants less than 3 kg, the tube sizes are based on the patient's weight:
> 3000 gm 4.0 mm
2000 - 3000 gm 3.5 mm
1000 - 2000 gm 3.0 mm
< 1000 gm 2.5 mm
Maintenance Fluids
Maintenence fluids are based on the daily fluid requirements of 100 mL/kg for the first 10 kg, 50 mL/kg for the next 10 kg, and 20 mL/kg for the remaining body weight.

2. Drip Rate Tables

All calculations are rounded off to 3 significant digits.

6. Technical Stuff Go to Top

All calculations must be confirmed. This program is not a substitute for clinical judgement nor are the references a substitute for an understanding of the drugs. There are no claims, explicit or implied, of the accuracy of any of the data or information.

None of the data you enter on these forms are transmitted across the network or the Internet.

These calculators are written in JavaScript version 1.2 and is most compatible with the Netscape implementation of JavaScript in Navigator/Communicator 4.0 or higher.

Special thanks to Ken Tegtmeyer, MD and Lisa Polachek, RN

Copyright 2000.
Steven Pon, MD, Weill Medical College of Cornell University. All rights reserved.

Created: January 5, 2000. Edited: July 3, 2000.