Real-World Secnarios

Scenario: Pediatric Sepsis Patient Requiring Fluid Resuscitation, Antibiotics, and Maintenance Fluids

A 7-year-old child weighing 45 lb is admitted to the Pediatric ICU with sepsis. The child requires aggressive fluid resuscitation, antibiotic therapy, and maintenance fluids. Orders are as follows:

1. Fluid Resuscitation: Administer a bolus of Normal Saline (NS) at 20 mL/kg IV over 30 minutes.
2. Antibiotic Therapy: Administer ceftriaxone 50 mg/kg IV. The pharmacy has provided a vial of ceftriaxone 1 gram reconstituted with 10 mL of sterile water, yielding a concentration of 100 mg/mL.
3. Maintenance Fluids: After the fluid bolus, start maintenance IV fluids of D5 ½ NS with 20 mEq KCl/L at 4 mL/kg/hr.

Question

Using dimensional analysis, answer the following:

1. Fluid Bolus Volume: How many milliliters of NS will you administer for the fluid bolus?
2. Ceftriaxone Dose and Volume: a. What is the required dose of ceftriaxone in milligrams for this child? b. How many milliliters of the prepared ceftriaxone solution will you administer?
3. Maintenance Fluids Rate and Bag Change Timing: a. What is the hourly infusion rate for the maintenance fluids in mL/hr? b. If the infusion starts at 1400 (2:00 PM) and you are using a 1,000 mL bag, at what time will the bag need to be replaced?

Scenario: 69-Year-Old Male with Chest Pain

A 69-year-old male presents to the emergency department with chest pain. The following orders are provided:

Orders:

• Admit to ICU
• IV Nitroglycerine: 10 mcg/min, increase infusion rate by 10 mcg/min every 10 minutes until pain relief
  • Stock Supply: 50 mg/250 mL D5W
• Labs: CK, CK-MB, Troponin at 1, 6, and 10 hours; CBC, CMP, ABG’s
• Oxygen: O₂ via nasal cannula
• Pain Management:
  • ASA: 160 mg PO now
  • Morphine: 2.5 mg IV q5 min until pain subsides, NTE (not to exceed) 20 mg/24 hours
    • Stock Concentration: 5 mg/mL, diluted with 5 mL sterile water
• Diagnostic Tests: Chest X-ray; ECG at 6 and 10 hours
• Vitals:
  • q15 min for 1 hour
  • q30 min for 1 hour
  • q2 hours until stable
• Accurate I&O’s

Questions

1. IV Nitroglycerine Pump Rate: What is the IV pump rate (mL/hr) for nitroglycerine at an infusion rate of 10 mcg/min?
2. Current Nitroglycerine Infusion Rate: If the patient is receiving 15 mL/hr of nitroglycerine, how many mcg/min is the patient receiving?
3. Morphine Fluid Volume: If the patient received 20 mg of morphine over 24 hours, how many mL of fluid did they receive?