Table of Contents
Cover image
Title Page
Tables for first two pages
Copyright Dedication
Preface
Part I Pediatric Acute Care
Chapter 1 Emergency Management
ICirculation-
IIAirway7-10
IIIBreathing27818
IVAllergicEmergencies(Anaphylaxis)19,20
VRespiratoryEmergencies
VINeurologicEmergencies
References
Chapter 2 Poisonings
IWebResources
IIInitialEvaluation
IIIToxidromes
IVIngestionandAntidotes
VAcetaminophenOverdose6-10
VILeadPoisonings11-13
References
Chapter 3 Procedures
IGeneralGuidelines
IIUltrasoundforProcedures
IIIVascularAccessandSampling
IVBodyFluidSampling
VImmunizationandMedicationAdministration4
VIBasicLacerationRepair3
VIIMusculoskeletalProcedures
References
Chapter 4 Trauma, Burns, and Common Critical Care Emergencies
IWebResources
IITrauma:Overview
IIISpecificTraumaticInjuries
IVCommonCriticalCareEmergencies
VAnimalBites
VIBurns3,26,36
VIIChildAbuse,,
References
Chapter 4: Color Plates
Part II Diagnostic and Therapeutic Information
Chapter 5 Adolescent Medicine
IWebResources
IIIntroductiontoAdolescentHealth
IIIAdolescentHealthMaintenance
IVSexualHealth
VMentalHealth
VITransitioningAdolescentsIntoAdultCare
References
Chapter 6 Analgesia and Procedural Sedation
IWebResources
IIPainAssessment
IIIAnalgesics14
ENonpharmacologicMeasuresofPainRelief1415
IVPatient-ControlledAnalgesia
VOpioidTapering4
VIProceduralSedation1410111219
References
Chapter 7 Cardiology
IWebResources
IIPhysicalExamination
IIIElectrocardiography
IVImaging
VCongenitalHeartDisease
VIAcquiredHeartDisease
VIIExerciseRecommendationsforCongenitalHeartDisease
VIIILipidMonitoringRecommendations
IXCardiovascularScreening
References
Chapter 8 Dermatology
IEvaluationandClinicalDescriptionsofSkinFindings
IIVascularAnomalies
IIIInfections
IVHairLoss:DiagnosisandTreatment(Figs 817to821,ColorPlates)
VAcneVulgaris
VICommonNeonatalDermatologicConditions(Fig 822;Figs 823to831,ColorPlates)
VIIAutoimmuneandAllergicLesions(Figs 832to841,ColorPlates)
VIIINailDisorders
IXDisordersofPigmentation
References
Chapter 8: Color Plates
Chapter 9 Development, Behavior, and Mental Health
IWebResources
IIDevelopmentalDefinitions1
IIIGuidelinesforNormalDevelopmentandBehavior
IVDevelopmentalScreeningandEvaluation
VMedicalEvaluationofDevelopmentalDisorders
VIDisordersofDevelopment
VIIDevelopmentalReferralandIntervention
VIIIDisordersofMentalHealth
IXMentalHealthReferralandIntervention
References
Chapter 10 Endocrinology
IWebResources
IIDiabetes
IIIThyroidFunction11-13
IVParathyroidGlandFunctionandVitaminD
VAdrenalFunction21-23
VIPosteriorPituitaryFunction
VIIGrowth-
VIIISexualDevelopment-
IXNeonatalHypoglycemiaEvaluation44
XAdditionalNormalValues
References
Chapter 11 Fluids and Electrolytes
IOverallGuidanceinFluidandElectrolyteManagement
IIMaintenanceRequirements
IIIDeficitRepletion1,11,12
IVOngoingLosses
VSerumElectrolyteDisturbances
VIAcid–Base/OsmolarGapDisturbances
References
Chapter 12 Gastroenterology
IWebResources
IIGastrointestinalEmergencies
IIIConditionsoftheGITract(Esophagus/Stomach/Bowel)
IVConditionsoftheLiver
VPancreatitis23-25
VIMiscellaneousTests
References
Chapter 13 Genetics
IWebResources
IIThePedigree
IIIMetabolism
IVDysmorphology-
VDiagnosticGeneticTestingandClinicalConsiderations
References
Chapter 14 Hematology
IWebResources
IIAnemia
IIIHemoglobinopathies
IVNeutropenia
VThrombocytopenia
VICoagulation
VIIBloodComponentReplacement
VIIIInterpretingBloodSmears
References
Chapter 14: Color Plates
Chapter 15 Immunology and Allergy
IAllergicRhinitis(AR) 1-6
IIFoodAllergy7-12
IIIDrugAllergy13-14
IVEvaluationofSuspectedImmunodeficiency
VImmunoglobulinTherapy24-27
VIImmunologicReferenceValues
VIIComplementPathway
References
Chapter 16 Immunoprophylaxis
IWebResources
IIImmunizationSchedules
IIIImmunizationGuidelines
IVImmunoprophylaxisGuidelinesforSpecialHosts
VImmunoprophylaxisGuidelinesforSpecificDiseases,
References
Chapter 17 Microbiology and Infectious Disease
IMicrobiology
IIInfectiousDisease
References
Chapter 18 Neonatology
IWebResources
IIFetalAssessment
IIINewbornResuscitation
IVRoutineNewbornCareofaTermInfant
VNewbornAssessment
VFluids,Electrolytes,andNutrition
VICyanosisintheNewborn
VIIRespiratoryDiseases
VIIIApneaandBradycardia
IXCardiacDiseases
XHematologicDiseases
XIGastrointestinalDiseases
XIINeurologicDiseases
XIIIRetinopathyofPrematurity(Rop)
XIVCongenitalInfections
XVCommonlyUsedMedicationsintheNeonatalIntensiveCareUnit
References
Chapter 19 Nephrology
IWebResources
IIUrinalysis,UrineDipstick,andMicroscopy
IIIEvaluationandManagementofUrinaryTractInfections3
IVKidneyFunctionTests
VAcuteKidneyInjury10 11
VIHematuriaandAssociatedDisorders14,15
VIIProteinuriaAndAssociatedDisorders1516
VIIITubularDisorders
IXChronicKidneyDisease
XChronicHypertension21-23
XINephrolithiasis24-26
References
Chapter 20 Neurology
IWebResources
IINeurologicExamination
IIIHeadaches-
IVParoxysmalEvents
VHydrocephalus
VIAtaxia
VIIStroke-
References
Chapter 21 Nutrition and Growth
IWebResources
IIAssessmentofNutritionalStatus
IIIEstimatingEnergyNeeds
IVDietaryReferenceIntakesforIndividuals
VBreastfeedingandtheUseofHumanMilk
VIEnteralNutrition
VIIParenteralNutrition
References
Chapter 22 Oncology
IWebResources
IIPresentingSignsandSymptomsofPediatricMalignancies(Tables221and222)
IIIFeaturesofaPathologicLymphNode
IVGeneralManagementofNewlyDiagnosedPediatricBrainTumors
VCommonlyUsedChemotherapeuticDrugsandAssociatedAcuteToxicities
VIOncologicEmergencies-
VIIHematopoieticStemCellTransplantation(HSCT),
VIIICommonComplicationsofBoneMarrowTransplantation
IXCommonChemotherapyComplicationsandSupportiveCare
XAntimicrobialProphylaxisinOncologyPatients(Table225)
XIBeyondChildhoodCancer:TreatingaCancerSurvivor
References
Chapter 23 Palliative Care
IWebResources
IIPalliativeCare
IIICommunicationandDecisionMaking
IVLegacyandMemoryMaking
VDecisionstoLimitInterventions
VIBody,Mind,andSpiritChangesasDeathApproaches
VIILastHours:MedicationandManagement
VIIIDeathPronouncement
IXAfterDeath Bereavement
References
Chapter 24 Pulmonology
IWebResources
IIRespiratoryPhysicalExamination
IIIEvaluationofPulmonaryGasExchange
IVPulmonaryFunctionTests
VBriefResolvedUnexplainedEvent(BRUE)-
VIAsthma
VIIBronchiolitis
VIIIBronchopulmonaryDysplasia(BPD)-
IXCysticFibrosis(CF)-
XObstructiveSleepApneaSyndrome(OSAS)-
XIChildhoodSleepProblems,
XISuddenInfantDeathSyndrome,
References
Chapter 25 Radiology
IWebResources
IIGeneralPediatricPrinciples
IIIChoosingtheRightStudy(Table251)
IVHead2
VEyes7
VISpine
VIIAirway8
VIIIChest6,8,9
IXHeartandVessels8
XAbdomen8,9,10
XIGenitourinaryTract8
XIIExtremities810
References
Chapter 26 Rheumatology
IWebResources
IICommonRheumatologicDiseases
IIILaboratoryStudies
References
Part III Reference
Chapter 27 Blood Chemistries and Body Fluids
IReferenceValues
IIEvaluationofBodyFluids
IIIConversionFormulas
References
Chapter 28 Biostatistics and Evidence-Based Medicine
IWebResources
IIEvidence-BasedMedicine
IIIBiostatisticsforMedicalLiterature
References
Part IV Formulary
Chapter 29 Drug Dosages
INotetoReader
IISampleEntry
IIIExplanationofBreastfeedingCategories
IVExplanationofPregnancyCategories
VBodySurfaceNomogramandEquation
VIDrugIndex
Acetaminophen
Acetazolamide
Acetylcysteine
Acth
Acyclovir
Adapalene±BenzoylPeroxide
Adderall
Adenosine
Albumin,Human
Albuterol
Allopurinol
AlmotriptanMalate
Alprostadil
Alteplase
AluminumHydroxide
AluminumHydroxideWithMagnesiumHydroxide
AmantadineHydrochloride
AmikacinSulfate
AminocaproicAcid
Aminophylline
AmiodaroneHcl
Amitriptyline
Amlodipine
AmmoniumChloride
Ammonul
Amoxicillin
Amoxicillin-ClavulanicAcid
Amphetamine
AmphotericinB(Conventional)
AmphotericinBLipidComplex
AmphotericinB,Liposomal
Ampicillin
Ampicillin/Sulbactam
AntipyrineandBenzocaine(Otic)
ArginineChloride InjectablePreparation
Aripiprazole
ArnuityEllipta
AscorbicAcid
Aspirin
Atenolol
Atomoxetine
Atovaquone
AtropineSulfate
Auralgan
Azathioprine
Azelastine
Azithromycin
Aztreonam
Bacitracin±PolymyxinB
Baclofen
BeclomethasoneDipropionate
BenzoylPeroxide
BenztropineMesylate
Beractant
Betamethasone
Bicitra
Bisacodyl
BismuthSubsalicylate
BrompheniramineWithPhenylephrine
Budesonide
BudesonideandFormoterol
Bumetanide
Butorphanol
CaffeineCitrate
Calcitonin Salmon
Calcitriol
CalciumAcetate
CalciumCarbonate
CalciumChloride
CalciumCitrate
CalciumGlubionate
CalciumGluconate
CalciumLactate
CalciumPhosphate,Tribasic
Calfactant
Captopril
Carbamazepine
CarbamidePeroxide
Carbinoxamine
Carnitine
Carvedilol
Caspofungin
Cefaclor
Cefadroxil
Cefazolin
Cefdinir
Cefepime
Cefixime
Cefotaxime
Cefotetan
Cefoxitin
CefpodoximeProxetil
Cefprozil
CeftarolineFosamil
Ceftazidime
Ceftibuten
Ceftriaxone
Cefuroxime(Iv,Im)/CefuroximeAxetil(Po)
Celecoxib
Cephalexin
Cetirizine±Pseudoephedrine
Charcoal,Activated
Chloramphenicol
ChloroquinePhosphate
Chlorothiazide
ChlorpheniramineMaleate
Chlorpromazine
Cholecalciferol
Cholestyramine
CholineMagnesiumTrisalicylate
Ciclesonide
Cidofovir
Cimetidine
Ciprofloxacin
CitrateMixtures
Clarithromycin
Clindamycin
Clobazam
Clonazepam
Clonidine
Clotrimazole
Corticotropin
CortisoneAcetate
Co-Trimoxazole
Cromolyn
Cyanocobalamin/VitaminB12
Cyclopentolate
CyclopentolateWithPhenylephrine
Cyclosporine,CyclosporineMicroemulsion,CyclosporineModified
Cyproheptadine
Dantrolene
Dapsone
DarbepoetinAlfa
DeferoxamineMesylate
DesmopressinAcetate
Dexamethasone
Dexmedetomidine
Dexmethylphenidate
Dextroamphetamine±Amphetamine
Diazepam
Diazoxide
DicloxacillinSodium
Digoxin
DigoxinImmuneFab(Ovine)
Diltiazem
Dimenhydrinate
Dimercaprol
Diphenhydramine
DivalproexSodium
Dobutamine
Docusate
Dolasetron
Dopamine
DornaseAlfa/Dnase
DoxapramHcl
Doxycycline
Dronabinol
Droperidol
Edetate(Edta)CalciumDisodium
EdrophoniumChloride
Emla
EnalaprilMaleate(Po),Enalaprilat(Iv)
Enoxaparin
EpinephrineHcl
Epinephrine,Racemic
EpoetinAlfa
Ergocalciferol
ErgotamineTartrate±Caffeine
Ertapenem
ErythromycinPreparations
Erythropoietin
Escitalopram
EsmololHcl
Esomeprazole
Etanercept
EthambutolHcl
Ethosuximide
Famciclovir
Famotidine
Felbamate
Fentanyl
FerricGluconate
FerrousSulfate
Fexofenadine±Pseudoephedrine
Filgrastim
FlecainideAcetate
Fluconazole
Flucytosine
FludrocortisoneAcetate
Flumazenil
Flunisolide
Fluoride
FluoxetineHydrochloride
FluticasoneFuroate+Vilanterol
FluticasonePreparations
FluticasonePropionateandSalmeterol
Fluvoxamine
FolicAcid
Fomepizole
Formoterol
Foscarnet
Fosphenytoin
Furosemide
Gabapentin
Ganciclovir
Gatifloxacin
Gcsf
Gentamicin
GlucagonHcl
Glycerin
Glycopyrrolate
Granisetron
Griseofulvin
Guanfacine
Haloperidol
HeparinSodium
Hyaluronidase
HydralazineHydrochloride
Hydrochlorothiazide
Hydrocortisone
HydromorphoneHcl
Hydroxychloroquine
Hydroxyzine
Ibuprofen
ImipenemandCilastatin
Imipramine
ImmuneGlobulin
Indomethacin
InsulinPreparations
Iodide
Iohexol
IpratropiumBromide±Albuterol
IronDextran
IronSucrose
Iron InjectablePreparations
Iron OralPreparations
Isoniazid
Isoproterenol
Isotretinoin
Itraconazole
Ketamine
Ketoconazole
Ketorolac
Labetalol
Lacosamide
Lactulose
Lamivudine
Lamotrigine
Lansoprazole
Levalbuterol
Levetiracetam
Levocarnitine
Levofloxacin
Levothyroxine(T4)
Lidocaine
LidocaineandPrilocaine
Lindane
Linezolid
Lisdexamfetamine
Lisinopril
Lithium
Lodoxamide
Loperamide
Loratadine±Pseudoephedrine
Lorazepam
Losartan
LowMolecularWeightHeparin
Lucinactant
MagnesiumCitrate
MagnesiumHydroxide
MagnesiumOxide
MagnesiumSulfate
Mannitol
Mebendazole
Medroxyprogesterone
MefloquineHcl
Meropenem
Mesalamine
Metformin
MethadoneHcl
Methimazole
Methyldopa
MethyleneBlue
MethylphenidateHcl
Methylprednisolone
Metoclopramide
Metolazone
Metoprolol
Metronidazole
MicafunginSodium
Miconazole
Midazolam
Milrinone
MineralOil
Minocycline
Minoxidil
MometasoneFuroate±FomoterolFumarate
MometasoneFuroate:
MometasoneFuroate+FomoterolFumarate(Dulera):
Montelukast
MorphineSulfate
Mupirocin
Mycophenolate
Nafcillin
Naloxone
Naproxen/NaproxenSodium
Neo-PolymycinOphthalmicOintment
Neo-PolycinHc
NeomycinSulfate
Neomycin/PolymyxinBOphthalmicProducts
Neomycin/PolymyxinB+Gramicidin:
Neomycin/PolymyxinB+Hydrocortisone:
Neomycin/PolymyxinB+Bacitracin+Hydrocortisone:
Neomycin/PolymyxinB±Bacitracin
Neomycin/PolymyxinB+Bacitracin:
NeosporinOphthalmicSolution
Neostigmine
Nevirapine
Niacin/VitaminB3
Nicardipine
Nifedipine
Nitrofurantoin
Nitroglycerin
Nitroprusside
NorepinephrineBitartrate
NortriptylineHydrochloride
Nystatin
OctreotideAcetate
Ofloxacin
Olanzapine
Olopatadine
Omeprazole
Omnipaque
Ondansetron
OseltamivirPhosphate
Oxacillin
Oxcarbazepine
OxybutyninChloride
Oxycodone
OxycodoneandAcetaminophen
OxycodoneandAspirin
Oxymetazoline
Palivizumab
Pancrelipase/PancreaticEnzymes
PancuroniumBromide
Pantoprazole
ParomomycinSulfate
Paroxetine
PenicillinGPreparations AqueousPotassiumandSodium
PenicillinGPreparations Benzathine
PenicillinGPreparations PenicillinGBenzathineandPenicillinGProcaine
PenicillinGPreparations Procaine
PenicillinVPotassium
PentamidineIsethionate
Pentobarbital
Permethrin
PhenazopyridineHcl
Phenobarbital
PhentolamineMesylate
PhenylephrineHcl
Phenytoin
PhosphorusSupplements
PhysostigmineSalicylate
Phytonadione/VitaminK1
PilocarpineHcl
Pimecrolimus
PiperacillinWithTazobactam
Polycitra
PolyethyleneGlycol ElectrolyteSolution
PolymyxinBSulfateandBacitracin
PolymyxinBSulfateandTrimethoprimSulfate
PolymyxinBSulfate,NeomycinSulfate,HydrocortisoneOtic
PolytrimOphthalmicSolution
Polysporin
PoractantAlfa
PotassiumIodide
PotassiumSupplements
PralidoximeChloride
Prednisolone
Prednisone
PrimaquinePhosphate
Primidone
Probenecid
Procainamide
Prochlorperazine
Promethazine
Propranolol
Propylthiouracil
ProstaglandinE1
ProtamineSulfate
Pseudoephedrine
Psyllium
PyrantelPamoate
Pyrazinamide
PyrethrinsWithPiperonylButoxide
PyridostigmineBromide
Pyridoxine
Pyrimethamine
Quetiapine
Quinidine
QuinupristinandDalfopristin
RanitidineHcl
Rasburicase
Rho (D)ImmuneGlobulinIntravenous(Human)
Ribavirin
Riboflavin
Rifabutin
Rifampin
Rimantadine
Risperidone
RizatriptanBenzoate
Rocuronium
Rufinamide
Salmeterol
ScopolamineHydrobromide
SeleniumSulfide
Senna/Sennosides
SertralineHcl
Sildenafil
SilverSulfadiazine
Simethicone
Sirolimus
SodiumBicarbonate
SodiumChloride InhaledPreparations
SodiumPhenylacetateandSodiumBenzoate
SodiumPhosphate
SodiumPolystyreneSulfonate
Spironolactone
StreptomycinSulfate
Succimer
Succinylcholine
Sucralfate
SulfacetamideSodiumOphthalmic
Sulfadiazine
SulfamethoxazoleandTrimethoprim
Sulfasalazine
SumatriptanSuccinate
Surfactant,Pulmonary/Beractant
Surfactant,Pulmonary/Calfactant
Surfactant,Pulmonary/PoractantAlfa
Tacrolimus
Tazarotene
Terbutaline
TetracyclineHcl
Theophylline
Thiamine
Thioridazine
Tiagabine
Tiotropium
Tobramycin
Tolnaftate
Topiramate
Trazodone
Tretinoin TopicalPreparations
Triamcinolone
Triamterene
Trifluridine
Trilisate
TrimethobenzamideHcl
TrimethoprimandSulfamethoxazole
Ursodiol
Valacyclovir
Valganciclovir
ValproicAcid
Valsartan
Vancomycin
Varicella-ZosterImmuneGlobulin(Human)
Vasopressin
VecuroniumBromide
Verapamil
Vigabatrin
Vitamina
VitaminB1
VitaminB2
VitaminB3
VitaminB6
VitaminB12
VitaminC
VitaminD2
VitaminD3
VitaminE/α-Tocopherol
VitaminK
Voriconazole
Warfarin
Zidovudine
ZincSalts,Systemic
Zolmitriptan
Zonisamide
Bibliography
Chapter 30 Drugs in Renal Failure
IDoseAdjustmentMethods
IIAntimicrobialsRequiringAdjustmentinRenalFailure
IIINonantimicrobialsRequiringAdjustmentinRenalFailure
References
Index
Algorithm 1
Algorithm 2
Algorithm 3
Algorithm 4
(mcg/kg/min)
Alprostadil (prostaglandin E1) 0 05–0 1
0 01–0 2, up to 1 in severe circumstances
Lidocaine, post resuscitation 20–50
Phenylephrine 0 05–2, up to 5 in severe circumstances
Terbutaline 0 1–4 (up to 10 has been used) 0
Vasopressin (pressor) 0 5–2 milliunits/kg/min 6 milliunits/kg
*Standardizedconcentrationsarerecommendedwhenavailable Foradditionalinformation,seeLarsenGY,ParkHBet al Standarddrugconcentrationsandsmart-pumptechnologyreducecontinuous-medication-infusionerrorsinpediatricpatients
Pediatrics 2005;116(1):e21-e25
RESUSCITATIONMEDICATIONS
Adenosine
Supraventricular tachycardia
Amiodarone
Ventricular tachycardia
Ventricular fibrillation
Atropine
Bradycardia (increased vagal tone)
Primary AV block
Calcium chloride (10%)
Hypocalcemia
0 1 mg/kg IV/IO RAPID BOLUS (over 1-2 sec), Flush with 10 mL normal saline
May repeat at 0 2 mg/kg IV/IO, then 0 3 mg/kg IV/IO after 2 min
Max first dose 6 mg, max subsequent dose 12 mg
Administer using a 3-way stopcock attached to a 10 ml NS flush
5 mg/kg IV/IO
No Pulse: Push Undiluted
Pulse: Dilute and give over 20-60 minutes
Max first dose 300 mg, max subsequent dose 150 mg
Monitor for hypotension
Strongly consider pretreating with IV calcium in patients with a pulse to prevent hypotension
0.02 mg/kg IV/IO/IM, 0.04–0.06 mg/kg ETT
Max single dose 0 5 mg
Repeat in 5 minutes if needed (up to twice) to max total dose 1 mg
20 mg/kg IV/IO
Max dose 1 gram
Calcium Gluconate (10%) 60 mg/kg IV/IO
Dextrose
Epinephrine
Pulseless arrest
Bradycardia (symptomatic)
Anaphylaxis
Insulin (Regular or Aspart)
Hyperkalemia
Magnesium sulfate
Torsades de pointes
Hypomagnesemia
Naloxone
Opioid overdose Coma
Sodium Bicarbonate (8 4% = 1 mEq/mL)
Administer only with clear indication:
Metabolic acidosis
Hyperkalemia
Max dose 3 grams
<5 kg: 10% dextrose 10 mL/kg IV/IO
5-44 kg: 25% dextrose 4 mL/kg IV/IO
≥45 kg: 50% dextrose 2 mL/kg IV/IO, max single dose 50 grams = 100 mL
0 01 mg/kg (0 1 mL/kg) 1:10,000 IV/IO every 3–5 min (max single dose 1 mg)
0 1 mg/kg (0 1 mL/kg) 1:1000 ETT every 3–5 min (max single dose 2 5 mg)
Anaphylaxis: 0 01 mg/kg (0 01 mL/kg) of 1:1000 IM (1 mg/mL) in thigh every 5-15 min PRN; max single dose 0 5 mg
Standardized/Autoinjector:
<10 kg: no Autoinjector, see above
10-30 kg: 0.15 mg IM
>30 kg: 0 3 mg IM
0.1 units/kg IV/IO with 0.5 gram/kg of dextrose Max single dose 10 units
50 mg/kg IV/IO No Pulse: Push Pulse: Give over 20-60 minutes Max single dose 2 grams
Monitor for hypotension/bradycardia
Respiratory Depression: 0 001-0 005 mg/kg/dose IV/IO/IM/Subcut (max 0 1 mg first dose, may titrate to effect) Full Reversal/Arrest Dose: 0.1 mg/kg IV/IO/IM/Subcut (max dose 2 mg) ETT dose 2–3 times IV dose May give every 2 min PRN
Tricyclic antidepressant overdose 1 mEq/kg IV/IO
Dilute 8 4% sodium bicarbonate 1 : 1 with sterile water for patients <10 kg to a final concentration of 4 2% = 0 5 mEq/mL
Hyperkalemia: Max single dose 50 mEq
Vasopressin 0 4 units/kg/dose IV/IO
Max single dose 40 units
ETTMeds(NAVEL:naloxone,atropine,vasopressin,epinephrine,lidocaine) dilutemedsto5mLwithNS,followwithpositivepressureventilation
SpecialthankstoLeAnnMcNamara,ClinicalPharmacySpecialist,andElizabethA Hunt,MD,MPH,PhD,fortheirexpert guidancewithIVinfusionandresuscitationmedicationguidelines
AdaptedfromHuntEA,Nelson-McMillanK,McNamaraL TheJohnsHopkinsChildren'sCenterKidsKard,2016andtheAmerican HeartAssociation,PALSPocketCard,2010
Copyright
1600 John F. Kennedy Blvd. Ste 1800
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THE HARRIET LANE HANDBOOK, 21ST EDITION
INTERNATIONAL EDITION
ISBN: 978-0-323-39955-5
ISBN: 978-0-323-47373-6
Copyright © 2018 by Elsevier, Inc. All rights reserved.
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Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility
With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.
Previous editions copyrighted 2015, 2012, 2009, 2005, 2002, 2000, 1996, 1993, 1991, 1987, 1984, 1981, 1978, 1975, 1972, and 1969.
Library of Congress Cataloging-in-Publication Data
Names: Harriet Lane Service (Johns Hopkins Hospital), author | Hughes, Helen (Helen Kinsman), editor. | Kahl, Lauren, editor.
Title: The Harriet Lane handbook : a manual for pediatric house officers / The Harriet Lane Service at The Charlotte R Bloomberg Children's Center of The Johns Hopkins Hospital ; editors, Helen Hughes, Lauren Kahl
Description: Twenty-first edition. | Philadelphia, PA : Elsevier, [2018] | Includes bibliographical references and index.
Identifiers: LCCN 2016048390 | ISBN 9780323399555 (pbk : alk paper) | ISBN 9780323473736 (international edition)
Subjects: | MESH: Pediatrics | Handbooks
Classification: LCC RJ48 | NLM WS 29 | DDC 618 92 dc23 LC record available at https://lccn loc gov/2016048390
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Printed in United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
HERVEY WILLETTS
CHAPTER I HAPPY-GO-LUCKY
If Hervey Willetts were lacking many qualities which a scout ought to have (and it is to be feared he was), he certainly had one quality truly scoutish; he had nerve. It was not the sort of nerve commonly recommended to scouts, but it was one kind.
And indeed Hervey had all kinds. He was always brave, he was often reckless, he was sometimes blithely heroic. But he was always wrong. His bizarre courage never paid him any interest because, somehow or other, it was always mixed up with disobedience. Thoughtful boys saw this and were sorry for him. More, they had a sneaking admiration for him.
Once, in the wee hours of the night, Hervey saved a boy from drowning. He should have had the gold medal for that; but you see he had no right to be out swimming in the middle of the night. And there you are.
All his spectacular deeds went to waste so far as scout advancement was concerned. The deed was always clouded by the escapade. And sometimes, as you shall see, there was an escapade containing none of the ingredients of heroism. Hervey’s heroic deeds were always byproducts.
He did not fit into Temple Camp at all. Why he had ever chosen it as the theatre for his stunts of glory was a puzzle. Many scouts, captivated by his effrontery, said kindly that Temple Camp did not fit into him. Assuredly there was misfit somewhere.
To give you an example of his nerve (and it is the episode on which this whole story hinges) he went back to Temple Camp the season following his summary expulsion therefrom. To appreciate the magnitude of his effrontery you must know something of the circumstance of his dismissal.
During that summer which had ended so ingloriously for him, he had pursued a course as free as life on the ocean wave. He was always in hot water. He would come strolling in late for meals, his outlandish little rimless hat at a rakish angle, swinging a stick or doing stunts with it for his own amusement as he ambled past the group assembled for camp-fire, or the after dinner stragglers lolling on the pavilion porch.
They seldom asked him where he had been. They knew he was on friendly terms with every farmer in the neighborhood, a crony at every rural wayside garage, the volunteer comrade of wandering pedlers, of gypsies, and even of tramps who made camp in secluded hollows and regaled him with dubious reminiscences. There was something about Hervey....
Yes, that was the worst of it; there was something about him. Tom Slade was under the spell, and if Tom Slade liked you, you could go a long way along the trail of disobedience. It was not that Hervey was popular, in the sense that Roy Blakeley was popular. He did not grace the camp with his presence enough to be popular.
But was it not an amazing thing that he was so much liked even though he was so seldom among the big camp family? He had no friends, yet everybody was his friend. If ever a boy was a host unto himself, as they say, Hervey Willetts was that boy. Certainly he was never lonesome.
You know him; he was slender and good looking, with a kind of dancing deviltry in his eyes. When they reprimanded him he looked at them as if he just did not understand. He was hopeless. There was an unconscious effrontery about him. The woods belonged to him. You could not scold him any more than you could scold a squirrel.
He certainly was not without feeling for he held in deep affection his little rimless hat cut full of holes and decorated with every sort of campaign and advertising button which had ever come his way. These little celluloid trinkets did not proclaim Hervey’s principles. One of them said Keep to the Right, a thing which Hervey never did. Another (I know not its origin, nor did he) said Be good and you’ll be happy.
Well, at all events, he was happy.
CHAPTER II
THE SENTENCE
Even the powers that be at Temple Camp were considerate of Hervey. They did not dismiss him as they might have done after any one of his unruly escapades. They bided their time, and as the season approached its end they became the more lenient. There was something ominous about their leniency; a kind of grimness about the way Mr. Benson greeted our hero upon his return after an all night absence. “Well, my boy, did you have a good time?” he asked with portentous cordiality.
Hervey was too guileless to read the handwriting on the wall. Another boy, conscious of his own delinquencies, would have recognized this sudden immunity from reprimand as too good to be true. But Hervey accepted it as in the natural order of things. He had never resented reprimands; he had ignored and forgotten them. He bore nobody any malice, not even the trustees. He went upon his way rejoicing. If he had any thought about the management at all, it was probably that it had at last come round to his own way of thinking. But probably he had no thought about these things at all.
Then came the end of the season with its boat races and swimming matches and distribution of awards. Against the background of these honors and festivities, Hervey seemed a lonely figure. But he was not lonely. It was his fate to arouse much sympathy which he neither deserved nor desired. There was really nothing pathetic about his being an outsider at camp. It was the camp that was the outsider, not Hervey.
Yet there was a certain pity expressed for him when little Harold Titus, the tenderfoot office boy from Administration Shack, came running down to the diving board where Hervey had condescended to grace a loitering group with his presence. These idle, bantering
groups bespoke the closing of the season; they were significant of diminishing numbers and the end of pleasurable routine.
“You’re wanted in the office, Hervey Willetts,” Harold panted. “You got to go up there right away.” Perhaps the breathless little tenderfoot felt a certain pride of triumph that he had been able to locate Hervey at all; it was a sort of scout stunt. Significant glances passed between the loiterers as Hervey departed.
He ambled in that way he had made familiar to all toward the somewhat pretentious rustic bungalow where the business of Temple Camp was conducted. He seemed never to proceed with any purpose; there was something delightfully casual about him. He was a natural born explorer. A secreted, chirping cricket could detain him, and on this occasion he paused and accommodatingly laid his trusty stick against the ground so that an aimless caterpillar might ascend it.
The small tenderfoot glanced back, aghast at Hervey’s leisurely progress toward his doom. “You better hurry up, it’s serious,” he called. And, imbued with a sense of his responsibility, he waited while our hero shot the caterpillar up into the foliage by a dextrous snap of his stick.
His ambling progress bringing him to Administration Shack, Hervey conceived the novel idea of ascending the steps on one leg. The tenderfoot messenger was appalled by the delay and by Hervey’s thus casually pulling a stunt at the very portal of the holy sanctum.
There being several steps, Hervey found his bizarre ascent difficult, but his resolution increased with repeated failures. He often made use of a couplet which had detained him many times and interfered with the camp schedule:
Start a stunt and then get stuck, Twenty days you’ll have bad luck.
He was so engrossed with this present acrobatic enterprise (to the unspeakable dismay of the little boy who had summoned him) that he did not at first perceive Councilor Wainwright standing in the doorway smiling down upon him. Indeed he was not aware of the
councilor until, triumphant, he hopped breathless into the official’s very arms. The tenderfoot was appalled.
“Well, you succeeded, Hervey?” Mr. Wainwright commented pleasantly. “Suppose we step inside. I see you never give up.”
“When I start to do a thing, I do it,” said Hervey.
“Only sometimes you start to do the wrong things,” the councilor commented sociably. “Well, Hervey,” he added, dropping into a chair and inviting the boy to do the same, “here we are at the end of the season. How many rules do you suppose you’ve broken, Hervey?”
“I don’t like a lot of those rules,” said Hervey.
“No, I know you don’t,” laughed Mr. Wainwright, “but you see this isn’t your camp. If you want to have rules of your own you ought to have a camp of your own.”
“That’s true, too,” said Hervey.
“You see, Hervey, the trouble is you don’t seem to fit. You’re not bad; I never heard of you doing anything very bad. But you don’t seem to work in harness. You’re pretty hard to handle.”
“You don’t have to handle me, because I’m not around so much,” said Hervey.
“Well, now, my boy,” Mr. Wainwright pursued in a way of coming to the point, “of course, this kind of thing can’t go on. There have been a dozen occasions this season when you might have been—when you ought to have been summarily expelled. That this wasn’t done speaks well for your disposition. It’s surprising how well you are liked by those who seldom see you. I suppose it’s what you might call the triumph of personality.”
Here was a glowing truth. And because it was true, because he really did have a certain elusive charm, Hervey seemed baffled at this declaration of his own quaint attractiveness. He did not know what a hard job poor Mr. Wainwright was having trying to pronounce sentence.
“A fellow wanted to hike to Westboro with me yesterday,” said Hervey, “but I told him he’d better ask the keepers; I wouldn’t get any fellow in trouble—nix on that.”
“But you got yourself in trouble.”
“That’s different,” said Hervey.
CHAPTER III THE LAST STUNT
“Well, Hervey,” said Mr. Wainwright, “being one of the keepers, as you call us⸺ ”
“I’ve got nothing against you,” said Hervey.
“Thank you. Now, Hervey, we’ve been talking over your case for some time and it was lately decided that since the end of the season was close at hand there was no need of putting on you the stigma of dismissal. Tom Slade was responsible for that decision; he seems to like you.”
“He knows I wouldn’t take a dare from anybody,” said Hervey; “I don’t care what it is.”
“Hmph; well, he seems to like you. So you’re going home Saturday just like all the other boys. You will have finished the season. No disgrace. I don’t know whether you have any regrets or not. You have been a great trial to the management. We who have the camp in charge feel that we can’t again take the responsibility which your presence here entails. If you were with a troop and scoutmaster perhaps it would be different; perhaps you would have made a better showing under such influence. But you are a born free lance, if you know what that is, and this camp is no place for free lances, however picturesque they may be.”
“I have a lot of fun by myself,” said Hervey. “I stood on my hands on a merry-go-round horse in a carnival in Crowndale. I bet you couldn’t do that.”
Councilor Wainwright looked at him with an expression of humorous despair. “No, I don’t suppose I could,” he said.
“Isn’t that a scout stunt?” Hervey demanded.
“Why no, it isn’t, Hervey. Not when you follow a traveling carnival all the way to Crowndale and stay away for two days and identify
yourself with wandering acrobats and such. Of course, there’s no use talking about those things now. But if you’re asking me, that isn’t a scout stunt at all.”
“Gee williger!” Hervey ejaculated in comment on the unreasonableness of all councilors and camp regulations.
“That’s just it, you don’t understand,” said Mr. Wainwright. “Scouting doesn’t consist merely in doing things that are hard to do. If that were so, I suppose every lawless gangster could call himself a scout.”
“I know a gangster that’s a pretty nice fellow,” said Hervey. “He did me a good turn; that’s scouting, isn’t it?”
The camp councilor looked serious. “Well, you’d better keep away from gangsters, my boy.”
“You say a good turn isn’t scouting?”
“We won’t talk about that now, because you and I don’t see things the same way. The point is—and this is why I sent for you—you must never again at any time return to Temple Camp. You are leaving as the season closes and you are not openly disgraced. But you must tell your father ”
“It’s my stepfather,” said Hervey
Mr. Wainwright paused just a second. “Well, your stepfather then,” he said. “You must tell him that your leaving camp this season has all the effects of a dismissal. Councilor Borden wanted to write to your father—your stepfather—and tell him just how it is. But for your sake we have overruled him in that. You may tell your stepfather in your own way
⸺ ”
“Standing on my head, hey?” said Hervey.
“Standing on your head if you wish. The point is that you must tell him that you are forbidden to return to Temple Camp. And of course, you will have to tell him why. No application from you will be considered another season. Now do you understand that, Hervey?”
It was characteristic of Hervey that he never talked seriously; he seemed never impressed; it was impossible to reach him. It was not that he was deliberately flippant to his superiors. He was just utterly carefree and heedless. He talked to the camp officials exactly the same as he talked to other boys. And he did not talk overmuch to
any one “Bet you can’t do this,” was a phrase identified with him. “Do you dare me to jump off?” he would say if he happened to find himself one of a group assembled on the balcony above the porch of the “eats” shack. He could not just talk.
And now, in his disgrace (or what would have been disgrace to another boy) he only said, “Sure, what you say goes.”
“You understand then, Hervey? And you’ll explain to your— stepfather?”
“Leave it to me,” said Hervey.
Well, they left it to him. And thereby hangs a tale. This breaking the news was about the hardest job that Mr. Wainwright had ever done. If Hervey, the stunt specialist, had only known what a stunt it was, and how the other “keepers” had been disinclined to perform it, his sympathy, even affection, might have gone out to Mr. Wainwright on professional grounds. Even Tom Slade, afraid of nothing, found his presence necessary across the lake while Hervey was being “let down.”
At all events if any sympathy was in order, it was for the young councilor, not Hervey. The wandering minstrel ambled forth after the encounter and, pausing before the large bulletin board, took occasion to alter one of the announcements which invited all scouts to attend camp-fire that evening and listen to a certain prominent scout official “who has seen many camps and brings with him several interesting books which he will use in narrating how he caught weasels and collected oriental bugs in the Mongolian jungle.”
When Hervey got through with this it read, “Who has seen many vamps and brings with him several interesting crooks which he will use in narrating how he caught measels and collected oriental rugs in the Mongolian bungle.” The misspelling of measles did not trouble him.
Having thus revised the announcement he went upon his way kicking his trusty stick before him and trying to lift it with his foot so that he could catch it in his hand.
He felt that the morning had not been spent in vain.
