PICU medication dosages to memorize

[Annaiya, NP]

I want to put together a list of medications that are frequently used in the PICU that are either just especially dangerous or are frequently used in emergent situations where having the dosages memorized is a good idea. I'm new to the PICU so I don't have a good sense of which medications should go on the list. The ones that I've thought of so far are:

fentanyl

versed

ativan

morphine

dompamine

epinephrine

vecuronium

rocuronium

etomidate

adenosine

calcium chloride

calcium gluconate

potassium chloride

What else would you put on the list?

[Nursemommi]

Atropine, bicarb. Our staff is given a trifold orange "code card" its double sided. It has 5 pages for meds (1 for logo of course:)). Pg. 1 Epi anaphylaxis and code - concentrations and weight based chart. Pg. 2 Atropine - weight based chart. Pg 3 - intubation chart per age. Pg. 4 Safe ranges for emergency meds like dopamine, milrinone, nipride etc. Misc med doses - adenosine, narcan etc. Pg 5 - NS bolus doses, defib doses and RS intubation order. Any questions let me know. We also get a card for analgesia doses in peds.

[kessadawn, BSN, RN]

acetaminophen and ibuprofen

[Redneckmedic63]

Two easy answers for this question!

1 - Get to know your emergency drugs intimately, including code drugs, RSI drugs, seizure meds, pressor and sedation gtts, etc... we carry a small, double-sided laminated card on our ID badges (about 2"x3"), but are absolutely expected to know those without looking.

2 - Best practice - look up EVERY med you give, no matter how many times you give it! You'll be pleased at how repetition makes life easier, and you'll soon know them MUCH better than your residents. I've been there for years and still try to do it all the time. ESPECIALLY if its a drug you can't rattle right off the top of your head!

Bonus answer (LOL):

Many places - ours included - have some type of EXCEL-type program by which we input the patient's age and weight, and it spits out a chart with all emergency drugs with specific weight based dosages and the volumes based on our formulary for that patient. We generate these on admit for every kid - usually in the first few minutes after they hit the floor. 2 copies are made - one posted in a specific place in the room, the other attached to the bed (so it is available if the patient goes off-unit). These stay with the patient through discharge home. We also put a color-coded Broslow sticker on each copy, as well as on the patient's armband. These take some of the brainwork out of codes should a less experienced person be first through the door.

Just some thoughts - hope it helps... PM me if you have questions!

JZ :)

[Annaiya, NP]

Thanks for the reply. All good advice. We have the preprinted "code sheets" as well for every patient. I just wish I was allowed to look up drugs in Lexi-comp on my iPhone. Trying to bring up Lexi-comp on our CoWs takes forever, which makes it impossible to look everything up before giving it. I always know what the drug is for before giving it, but I like to look at all of the details as well.

[GatorRN21]

Know your code drugs inside and out. I work in a CICU so I know the correct dose and how many mL to draw up of epi (1:100,000 vs 1:10,000), atropine, Cal gluconate, and bicarb (infant vs adult concentration). I know this off the top of my head because as a new nurse I was drilled by my preceptors to write up the emergency drug doses and calculations for each specific patient until it became second nature and I could just rattle it back to them easily. I am grateful that my preceptors made me do this each time and I highly recommend new nurses especially in the critical care environment to make this part of your daily routine. Code situations are chaotic, be as prepared as possible.

[Annaiya, NP]

Know your code drugs inside and out. I work in a CICU so I know the correct dose and how many mL to draw up of epi (1:100,000 vs 1:10,000), atropine, Cal gluconate, and bicarb (infant vs adult concentration). I know this off the top of my head because as a new nurse I was drilled by my preceptors to write up the emergency drug doses and calculations for each specific patient until it became second nature and I could just rattle it back to them easily. I am grateful that my preceptors made me do this each time and I highly recommend new nurses especially in the critical care environment to make this part of your daily routine. Code situations are chaotic, be as prepared as possible.

Thanks for the reply. I am definitely getting better with medications and dosages, but for some reason it just is not something that wants to stick in my head. Someday I'll have it all down, lol.