1 How to use this book
Preparation before using the book
• Verify all the information that has been presented and familiarize yourself with the layout of the book! If you have checked it yourself you will have learnt a lot about emergency drug doses and reassured yourself that the content is sound (we really hope you don’t find any errors).
• Check which doses have been presented, as a higher or lower dose may be appropriate for different clinical scenarios. In general the most commonly used dose that is known to be effective has been selected, or one that is found in a high-profile source. If a drug has more than one use, such as agents employed in procedural sedation for example, make sure that you know which dose is to be found in the EDDC book. We encourage you to read up on the doses and agents contained in this book as they all form a core part of paediatric emergency practice.
• Check which formulation has been used for the dilution. This is a perennial problem as comprehensive paediatric formularies do not exist. If your local preparation differs from the one that we have used then be sure to note the necessary changes in your book.
• Use the Broselow® tape or PAWPER tape (see p. 5) to determine the patient’s weight. Flip to that weight section in this book: everything that is needed will be on those pages, from drug doses to equipment sizes to information for emergency infusion initiation. Everything is alphabetical to help making navigating around the book easier.
• Make sure that you have read the pharmacology chapter in this book so that you can decide how best to tailor or adapt your drug doses based on age as well as body weight (total/ideal/adjusted body weight or according to the age of your patient).
• Select the drug or equipment that you need and read off the dose or size. If you have an accurate weight, then use that weight as the reference. It may be necessary to interpolate between doses if a patient’s weight falls between the reference weights in the book. If you are not sure how to interpolate then read the following examples. In general, however, the reference weights have been selected such that there is a small increase in volume to administer (such as 1 mL).
• As a general rule give all medications slowly unless there is a specific reason not to (such as with adenosine)! Some drug doses may need to be repeated for appropriate clinical results. Monitor the effect and move on to the next appropriate management step.
• Keep the book with you whenever it might be needed – it will do you no good if it is in your car/your bag/your study and you are up to your elbows in trouble in the ED, ICU or paediatric ward.
• This book is meant to provide assistance to a TEAM and not just the doctor, so make sure that your team knows how to use it too. This applies especially to the team members who will be preparing and administering the drug dilution.
Guide to using the bolus drug dose tables
1. Turn to the page of the book with the correct weight, or the closest weight if that exact weight is not presented. Whether you use the closest higher or lower weight depends on the drugs you wish to use, but in general use the closest higher weight to ensure that the dose that you administer is effective. Interpolation may be necessary at the higher end of the weight spectrum.
2. This is the generic drug name, with an indication of the route of administration if more than one is presented.
3. This is the dose that was selected to be presented in this book because it was considered to be the most appropriate and the safest to ensure efficacy while avoiding overdosage or toxicity.
