Clinical Liability Med Reference

🚁 CLINICAL LIABILITY ✈️

MED REFERENCE · the PCGs

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⚠ UNOFFICIAL · PERSONAL USE
Built off-shift, blessed by no one. Tap for fine print.

NO DRUGS MATCH

PCG P27 — Push dose pressors: your bridge when the BP is trying to leave the building. Mix it right, label it, and have the drip running concurrently. These are buying time — not writing prescriptions.

⚡ WHICH AGENT?

▸TRAUMA / Hemorrhagic Shock → Epinephrine push dose

▸NON-TRAUMA / Vasodilatory Shock → Phenylephrine push dose

▸If bradycardia is contributing → Epinephrine preferred (has chronotropic effect)

Epinephrine (Push Dose)

Target concentration: 10 mcg/mL — for TRAUMA / bradycardia

MIXING — USING 1:10,000 (0.1 mg/mL)

Draw up 1 mL of Epinephrine 1:10,000 (0.1 mg/mL) into a 10 mL syringe

Add 9 mL of 0.9% NS → total 10 mL

Final: 0.1 mg / 10 mL = 10 mcg/mL

✓ 10 mL syringe at 10 mcg/mL — label before use

DOSING

Patient	Dose	Volume	Interval
Adult	10 mcg	1 mL	q 3–5 min PRN
Pediatric	1 mcg/kg (max 10 mcg)	0.1 mL/kg	q 3–5 min PRN

CLINICAL NOTES

Bridge ONLY — initiate vasopressor infusion concurrently

Onset: 1–2 min. Duration: 5–10 min

Do NOT use 1:1,000 concentration for push dose — verify vial

Phenylephrine (Push Dose)

Target concentration: 100 mcg/mL — for NON-TRAUMA vasodilatory shock

MIXING — USING 10 mg/mL VIAL

Draw up 1 mL phenylephrine 10 mg/mL

Add 99 mL NS → 100 mL total

Final: 10 mg / 100 mL = 100 mcg/mL

✓ 100 mL at 100 mcg/mL

DOSING

Patient	Dose	Volume	Interval
Adult	100–200 mcg	1–2 mL	q 2–5 min PRN
Pediatric	5–10 mcg/kg	0.05–0.1 mL/kg	q 3–5 min PRN

CLINICAL NOTES

Pure α₁ agonist — no chronotropy. Reflex bradycardia possible

Avoid if cardiac output already reduced — may worsen

Bridge ONLY — initiate norepinephrine infusion concurrently

Vasopressin Infusion Quick Mix

Per PCG M15 — adjunct vasopressor

Mix 25 units Vasopressin in 250 mL D5W or NS → 0.1 units/mL

Initiate at 0.03 units/min → Rate = 18 mL/hr

Obtain consult for dose titration. Typical range 0.01–0.04 units/min

Rate formula: [Dose (units/min) × 60] ÷ 0.1 (units/mL) = mL/hr
0.03 units/min → 18 mL/hr

Y-site compatibility for IV meds + common fluids. Tap any matrix cell to highlight a pair, or use the search/dropdowns. Slamming incompatibles down one line is how you get mystery precipitate and a very bad day.

QUICK PAIRS:

AGENT A

AGENT B

IV COMPATIBILITY MATRIX — TAP CELL TO SELECT

Compat

Conflict

No Data

Incompat

Sources: Trissel's Handbook on Injectable Drugs, King's Guide, Stabilis, manufacturer PI. Always verify with pharmacy when in doubt — published data ≠ your specific concentrations.

⚡ DRIP RATE CALCULATOR

Drug

Weight

Dose

mL / hr

⚠ Always verify calculations independently. Does not replace clinical judgment.

🩺 MEAN ARTERIAL PRESSURE (MAP)

SBP (mmHg)

DBP (mmHg)

mmHg MAP

Goal MAP: ≥65 mmHg for septic shock · ≥80 for TBI · Stroke: do not lower SBP >15% from baseline

🧪 ANION GAP

Na⁺ (mEq/L)

Cl⁻ (mEq/L)

HCO₃⁻ (mEq/L)

Albumin (g/dL)

Anion Gap

Corrected AG (if albumin entered)

Interpretation

Normal AG: 8–12 mEq/L · Corrected AG: + 2.5 for every 1 g/dL albumin below 4.0

❄️ WINTER'S FORMULA (Metabolic Acidosis)

HCO₃⁻ (mEq/L)

Actual PaCO₂

Expected PaCO₂

Interpretation

Formula: Expected PaCO₂ = (1.5 × HCO₃) + 8 ± 2
Actual < Expected = additional respiratory alkalosis
Actual > Expected = additional respiratory acidosis

⚖️ IDEAL BODY WEIGHT (IBW)

Sex

Height

Actual Wt

IBW

Adjusted BW (if obese)

BMI Category

IBW (M): 50 + 2.3 × (inches > 60) · IBW (F): 45.5 + 2.3 × (inches > 60)
Adjusted BW = IBW + 0.4 × (Actual − IBW) — use for obese pts (BMI > 30) for drug dosing

💧 PEDIATRIC MAINTENANCE FLUIDS (4-2-1 Rule)

Weight (kg)

Maintenance Rate

Daily Volume

Calculation

4 mL/kg/hr × first 10 kg + 2 mL/kg/hr × next 10 kg + 1 mL/kg/hr × remainder
Standard fluid: D5 0.45%NS + 20 mEq/L KCl (verify with orders)

📐 RATE FORMULAS

Weight-based (mcg/kg/min):
mL/hr = [Dose × Wt (kg) × 60] ÷ Conc (mcg/mL)

Fixed dose (mcg/min):
mL/hr = [Dose (mcg/min) × 60] ÷ Conc (mcg/mL)

Fixed dose (mg/hr):
mL/hr = Dose (mg/hr) ÷ Conc (mg/mL)

Units-based (units/min):
mL/hr = [Dose (units/min) × 60] ÷ Conc (units/mL)

RASS — Richmond Agitation-Sedation Scale

⌄

Combative

Overtly combative, violent, immediate danger to staff

Very Agitated

Pulls or removes tubes/lines, aggressive

Agitated

Frequent non-purposeful movement, fights ventilator

Restless

Anxious, apprehensive, not aggressive

Alert & Calm

Spontaneously alert and calm ✓ TARGET

–1

Drowsy

Sustained awakening (eye contact) to voice >10 sec ✓ TARGET

–2

Light Sedation

Brief awakening to voice, eye contact <10 sec

–3

Moderate Sedation

Movement or eye opening to voice, no eye contact

–4

Deep Sedation

No response to voice, movement to physical stimulation

–5

Unarousable

No response to voice or physical stimulation

GCS — Glasgow Coma Scale

Total 3–15 · Intubate consideration ≤8 · Severe TBI ≤8

⌄

EYES (E)

Spontaneous

To voice

To pain

None

VERBAL (V)

Oriented

Confused

Words

Sounds

None

MOTOR (M)

Obeys

Localizes

Withdraws

Flexion

Extension

None

E + V + M =

3–15

≤8 = Severe (consider airway) · 9–12 = Moderate · 13–15 = Mild

CPOT — Critical Care Pain Obs. Tool

Non-verbal/intubated · Score 0–8 · ≥3 = treat pain

⌄

FACIAL EXPRESSION (0–2)

Relaxed, neutral

Tense

Brow lowering, orbit tightening

Grimacing

All above + eyelid tightly closed

BODY MOVEMENTS (0–2)

Absence of movements

Protection

Slow cautious movements, touching pain site

Restlessness

Pulling tubes, thrashing, attempting to sit up

MUSCLE TENSION (0–2)

Relaxed

Tense & rigid

Very tense or rigid

COMPLIANCE / VOCALIZATION (0–2)

Tolerating vent / Normal speech

Coughing / Sighing, moaning

Fighting vent / Crying out

TOTAL SCORE

0–8

≥3 = Treat pain · Goal: <3

CIWA-Ar — Alcohol Withdrawal Scale

Max 67 · <8 Minimal · 8–15 Mild · 16–20 Moderate · >20 Severe

⌄

CIWA-Ar Score / 67

Minimal / No withdrawal

Minimal — observe, thiamine, PO diazepam PRN

8–15

Mild — PO or IV diazepam, monitor closely

16–20

Moderate — IV diazepam, seizure risk

>20

Severe — high seizure/DT risk, aggressive IV treatment

Shock Index Calculator

HR ÷ SBP · ≥0.9 = higher mortality / transfusion need (PCG T9)

⌄

Enter HR and SBP above

<0.6

Normal

0.6–0.9

Mildly elevated — monitor

0.9–1.2

↑ Mortality risk — prepare blood products

>1.2

High mortality — activate MTP, aggressive resuscitation

Pediatric Weight Estimator

Broselow-based · Enter age (years) OR known weight (kg)

⌄

ENTER AGE (1–10 yrs) OR KNOWN WEIGHT (kg)

COMMON PEDS DRUG DOSES

Age formula: (Age × 2) + 8 for 1–10 yrs · Cuffed ETT: (age/4) + 3 rounded to nearest 0.5 · Verify with Broselow tape

NIH Stroke Scale — Interactive Scoring

Mild <5 · Moderate 5–9 · Severe ≥10 · Max 42

⌄

NIHSS Total / 42

Enter scores above

BP Goals: Non-thrombolytic <220/110 · Thrombolytic candidate <180/105
Do not lower SBP >15% from baseline (M16/M17)