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c:\Documents\Medikit\MediKit TBARLINK Z:\SYSTEM\OPL\TOOLBAR.OPO MediKitO CONVERT& LOGO& PAED& ABOUT& RESULTS& STORED& RIGHT& LEFT& DOWN& PMLLOGO& BACK& SAVE& EDIT& DRUGEDIT& ACIDBASE& PATH$ USERPATH$ HLPTHRD& MACH$ SKIP% MACHTYPE% SCRWID% SCRHT% MENU% LASTCHOICE% TEMP2 TEMP$ SCREEN1% SCREEN2% SCREEN3% TITLEFONT% TITLEHT% SUBFONT% SUBHT% TOPSCRHT% GUIDESCREEN% RUNONCE% FROMPAED% RDAYS% VERSION VERSION$ VERDATE$ GLOBWT GLOBHT& GLOBAGE GLOBMAP% GLOBMPAP GLOBLAP GLOBSA GLOBCVP GLOBGCS% GLOBAADO2 GLOBSV% GLOBSEX% GLOBCO GLOBCI GLOBSI CMNTH CWT50 CWT97 CHT50 CHT97 PAEDWEIGHT PAEDAGE NUMRESULTS% RESULTS$ RESTIME$ NEWRESULT$ NEWTIME$ BUTTPRESSED% GUIDEL$ GUIDEL% SETVAR DISCL2 DISCL TOOLBAR BACKDROP TBWIDTH% +AThis program is protected under international copyright treaties. +:Reverse translation of this program is strictly forbidden. Error! +4Congratulations, you have found an error in MediKit. +7To help make this program a bug free zone, please write +7down the following lines and email me with full details +*of how the error happened. Many thanks!( MACHINETYPE% VERSION VERSION$ VERDATE$ TEMP$ MACH$ RUNONCE% GLOBSEX% NUMRESULTS% LASTCHOICE% GUIDEL$ MACHTYPE% SCRWID% SCRHT% TITLEFONT% TITLEHT% SUBFONT% SUBHT% Version + June 2000 O#|B[ MOVEFILES READINI WRITEINI WELCOME PAEDC NAGSCREEN OLDRESULTS4 PATH$ USERPATH$ TEMP$ PMLLOGO& SCREEN1% SCRWID% SCRHT% SCREEN3% SKIP% \System\Apps\Medikit\K \System\Apps\MedikitKW ErrorO +&Unable to locate the MediKit directory( +)Ensure that you have installed MediKit to +(either of the following two directories: 'C:\System\Apps\MediKit\...' 'D:\System\Apps\MediKit\...'( +;Read the readme.txt file for full installation instructions +"D:\System\Apps\MediKit\MediKit.iniW +"C:\System\Apps\MediKit\MediKit.iniW InitialisingO C:\System\Apps\Medikit\ D:\System\Apps\Medikit\ \System\Apps\Medikit\K Medikit.mbmK +)Medikit icon file (MEDIKIT.MBM) not found+ Please re-install MediKitW8 Registered to Unregistered copyO PAEDS STORED INFUSION PROCESS SCREEN3% Switching to Paediatric sectionO Switching to Stored ValuesO Switching to Infusion sectionO TBAROFFER% SCRHT% '{A`[ T{1\[ H{A\[ CMDTBDOWNC% WEIGHT HEIGHT STORED SHOWRESULTS OSMOLAL ANIONGAP ESTCRCL STANDCRCL CORRCA CORRNA TOTAL_HDL LDL_HDL ENERGY FREEWATER CONVERT1 CONVERT2 AAGRAD ACIDBASE SVRINDEX PVRINDEX STROKEW CARDIND LVSWI RVSWI CORRQT ECGRATE DRIPRATE CSF_WBC CSF_PROT BMIBSA RANSONS IMRIE ALVORADO CHILDP BISHOP APGAR CARDRISK BARTHEL APACHE POSSUM HAMILTON KOENIG PAEDS INFUSION PARACALC BURNS HEPARIN PREFS ABOUT PAEDR CHECKNUMB MENU% SCRWID% SCREEN3% LASTCHOICE% RUNONCE% TITLEFONT% TEMP$ O`{Ix O@{Ix File+ Go to Paediatric Section Close MediKitOe Cholesterol+ LDL cholesterolOj+ VLDL cholesterolOJ+ Total : HDL ratioO LDL : HDL ratioO Biochemistry+ Anion gapON+ Cholesterol>O Corrected calciumOO+ Corrected sodiumOE+ Free water deficitOF+ Plasma osmolalityOo Miscellaneous + Cardiac outputO Stroke volumeO Cardiac indexOI+ Corrected Q-TO Stroke work calculations+ Stroke work calculationsO Left cardiac work indexO LV stroke work indexO Right cardiac work indexO RV stroke work indexO Resistances+ Systemic vascular res.O + SVR IndexO Pulmonary vascular res.O + PVR IndexO + Pressures+ Mean arterial pressureO Mean PAPO Blood volumes+ Estimated blood volumeO Allowable blood lossO Cardiovascular+ Blood volumes>O Miscellaneous >O Pressures>O Resistances>O Stroke work calculations>O + Neurology+ Corrected CSF WBCO Corrected CSF proteinO Miscellaneous + Delivery dates (EDD/LMP)Ov+ Drip ratesOd+ Rate timer (BPM)OB+ Neurology>O Metabolic & Weight+ Body surface areaOb+ BMI, BSA, IBW, LWBOW+ Energy requirementsOY Renal+ Creatinine clearanceOl+ Estimated creatinine clearanceOL+ Standardised clearanceOGh+ Fractional excreted sodiumOT+ Renal failure indexOT Respiratory+ Predicted PEFROx+ A-a Oxygen differenceOK Metabolite units+ BiochemicalOu+ OthersOU Conversions+ WeightOw+ HeightOh+ TemperatureOt+ Metabolite units>O Calculations+ Acid-Base graphOa+ Biochemistry>O Cardiovascular>O Miscellaneous >O Metabolic & Weight>O Renal>O Respiratory>O Conversions>O Anaesthetics+ APACHE II scoreOq+ POSSUM scoresOQ Cardiovascular + Cardiovascular risksOz+ Cardiac risk indexOC Miscellaneous+ Bishop scoreO Barthel's indexO Psychiatric+ MTSOm+ MMSEOM+ Geriatric depressionOS+ Hamilton depressionOy+ Koenig depressionO Psychiatric+ Mental test score (MTS)Om+ Mini mental state examinationOM+ Geriatric depression scaleOS+ Hamilton depression scaleOy+ Koenig depression scaleO Surgical & Operative+ Alvorado scoreO Child-Pugh scoreOD+ Modified Imrie scoreOZ+ Ranson's criteriaOn Trauma+ Revised trauma scoreO Trauma scoreO Assessments+ Glasgow coma scale (GCS)Og+ Anaesthetics>O Cardiovascular >O Miscellaneous>O Psychiatric>O Surgical & Operative>O Trauma>O Management+ Drug infusions Paracetamol overdoseOP+ Heparin infusionOf+ BurnsOR Tools+ Stored ValuesOs+ Results logOr+ PreferencesOkh+ AboutOA+ HelpOH Tools+ Stored ValuesOs+ Results logOr+ PreferencesOkh+ AboutOA+ RegisterOX+ HelpOH +'Tap the screen or press 'Menu' to start PAEDS CHECKNUMB BUTTPRESSED% Not available in this section SHOWRESULTS Not available in this section STORED BUTTPRESSED% WEIGHT HEIGHT CONVERT1 CONVERT2 CHECKNUMB BUTTPRESSED% SCRWID% SCREEN2% FROMPAED% Not available in this section Convert WeightOw+ Convert HeightOh+ Convert TemperatureOt+ Metabolites: BiochemOu+ Metabolites: OthersOUWX Ow@[* TBARINIT TBARBUTT TBARSHOW TEMP$ PATH$ MACHTYPE% RIGHT& LEFT& DOWN& LOGO& PAED& ABOUT& STORED& CONVERT& BACK& SAVE& EDIT& DRUGEDIT& RESULTS& MedikitO Medikit.mbmK +)Medikit icon file (MEDIKIT.MBM) not found+ Please re-install MediKitW8 PaedsO MenuKO StoredO ValuesKO ConvertO PaedsO MenuKO StoredO ValuesKO ConvertO ResultsO LogKO TBARBUTT TBARSHOW BACK& PAED& EDIT& STORED& SAVE& CONVERT& MACHTYPE% DRUGEDIT& ABOUT& RESULTS& PaedsO MenuKO MainO MenuKO PaedsO MenuKO EditO DrugKO StoredO ValuesKO SaveO DrugsKO ConvertO EditO DrugsKO AboutO ResultsO LogKO MACHTYPE% SCRHT% SCRWID% SCREEN1% LOGO& TEMP2 VERSION$ SCREEN3% TOPSCRHT% SCREEN2% TITLEFONT% TEMP$ PMLLOGO& TIM:O O.hD[3 TIM:O OZOZOZ Copyright 2000 JJPerry Registered to Unregistered copy Copyright 2000 JJPerry Registered to Unregistered copy +'Tap the screen or press 'Menu' to start GETMACHINENAME$ SERIEW WINSW @\\[ GEOFOXW WINSW OSARISW WINSW REVOW WINSW NETBOOKW WINSW SERIEW WINSW TITLEFONT% TEMP$ SCRWID% SCRHT% Press ENTER to return {A\[ Ol{A\[ {A\[ GUIDEL% GUIDEL$ TEMP$ TEMP2 Guidelines O"|6`[* RefsOr( RefsOr( CancelO >> NextO CancelO >> NextO Guidelines O"|6`[* RefsOr( << BackOb+ << BackOb+ RefsOr( CancelO << BackOb+ >> NextO RefsOr( CancelO << BackOb+ >> NextO Guidelines O"8`[ RefsOr( << BackOb+ RefsOr( << BackOb+ O#|B[ GUIDEL$ TEMP$ TEMP2 References |6`[* CancelO >> NextO TITLEFONT% TEMP$ +!Guidelines: MediKit Abbreviations %GC[U THIS CALC.: +mDRUG FREQUENCY: stat = immediately, od = once per day, bd = 2 x per day, tds = 3 x per day, qds = 4 x per day +qDRUG ROUTE: po = oral, im = intramuscular, iv = intravenous, s/c = subcutaneous, pr = per rectum, neb = nebulised +pVOLUME: l = litres, dl = decilitres (100mls), ml = millilitres ENERGY: kJ : kiloJoules, kcal : kiloCalories +OWEIGHT: kg = kilograms, g = grams, mg / mgs = milligrams, mcg / g = micrograms +nOTHERS: soln = solution, min = minute, hr = hour, bpm = beats per minute, kPA = kilopascals, mmol = millimoles Press ENTER to returnO {A\[ {A\[ References Press ENTER to returnO {A\[ {A\[ TEMP$ .00C[ .000C[ TEMP2 TEMP2 TEMP2 Od|R* TEMP2 GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ TEMP$ Expected Date of Delivery Last Menstrual Period Enter detailsO Date:O Date is+ELMP (first day),Conception date,EDD,for Gestational age (enter below) Gestation (weeks)O only needed if calculating from current gestational age CancelO + Ignoring entered gestational ageO {UO-{1 M}WB} M}WB} Currently weeks, K days gestationK Result (Conception date: Result (LMP: EDD is EDD: GuidelinesOg( RepeatOr( Og@[[ LMP / EDD calculation Assumes a 28 day cycle {UO-{1 M}WB} M}WB} Currently weeks, K days gestationK Result (EDD: LMP was LMP: Conception date was GuidelinesOg( RepeatOr( Og@[[ LMP / EDD calculation Assumes a 28 day cycle WB}F[t Invalid gestational ageO Result (For gestational age: wks, K days)KO EDD is EDD: LMP was Conception date was GuidelinesOg( RepeatOr( Og@[[ LMP / EDD calculation Assumes a 28 day cycle GUIDENAG GUIDELINES RESULTS GLOBWT TITLEHT% TITLEFONT% SUBFONT% TEMP2 TEMP$ NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ Weight Conversion Using stored weight +(Enter values (either Imperial or Metric)O Imperial: +>Leave 'kg' field at 0 to convert St & Lb to kgs and vice versa + Stones:O + Pounds:O +>Leave 'kg' field at 0 to convert Lb & Oz to kgs and vice versa + Pounds:O + Ounces:O Metric: Kg:O OuncesOo+ CancelO PoundsOp+ CancelO Oo@[! Using ouncesO Using poundsO |B\[ Please enter a valueO |F`\[{ NoteO Either the metric or imperial values must be left at zero << BackO |VJ*Q^ stone K poundsK pounds)K pounds K ouncesK ounces)K Pounds Ounces Note the ' K+)' value you enterered was greater than 14K ResultO Metric: + Imperial: GuidelinesOg( RepeatOr( 16 ounces in 1 pound 14 pounds in 1 stone 2.2046 pounds in 1 Kg Od|R* Storing weight GUIDENAG GUIDELINES RESULTS GLOBHT& TITLEHT% TITLEFONT% SUBFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ TEMP2 Height Conversion Using stored height +ULeave 'Centimetres' field at 0 to convert Feet & Inches to centimetres and vice versa +(Enter values (either Imperial or Metric)O Imperial: Feet:O Inches:O Metric: Centimetres (cm):O CancelO |F`\[ NoteO Either the metric or imperial values must be left at zero << BackO ?JWB} feet K inchesK inches)K +9Note the 'inches' value you enterered was greater than 12 ResultO Metric: + Imperial: GuidelinesOg( RepeatOr( Og@[f 12 inches in 1 foot 1 metre = feet * 0.3046 Storing height STRIPZERO GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% SUBFONT% TEMP$ NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ Temperature Conversion +JLeave 'Celsius' field at 0 to convert Fahrenheit to Celsius and vice versa Enter valuesO Fahrenheit:( Celsius:( CancelO NoteO Either the Celsius or Fahrenheit values must be left at zero << BackO O |NO |RO |V O |RO |VO |J Result GuidelinesOg( RepeatOr( +/Fahrenheit to Celsius : C = ( ( F -32) *5) / 9 +/Celcius to Fahrenheit : F = ( ( C * 9) /5) +32 Or@[ GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% TEMP$ TEMP2 NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ Biochemical Units Conversion Select substance: CreatinineOc+ UreaOu+ GlucoseOg+ CholesterolOh+ TriglyceridesOt+ ProteinOp+ BilirubinOb+ CalciumOaWX mmoL/L mg/dL Serum value Oc@[( Creatinine mol/L Glucose Oh@[# Cholesterol Ot@[% Triglycerides Op@[, Protein Ob@[- + Bilirubin mol/L Calcium Units Conversion: +'Enter details, then select Units button CancelO to K to K O @[1 Result for conversionK = K+ = K+ = K+ = K+ GuidelinesOg( RepeatOr( Biochemical Units Conversion +!Creatinine: mol/1 88.4 = mg/dL Urea: mmol/L 0.357 = mg/dL +!Glucose: mmol/L 0.05551 = mg/dL +%Cholesterol: mmol/L 0.02586 = mg/dL +'Triglycerides: mmol/L 0.01129 = mg/dL Protein: g/L 10 = g/dL +!Bilirubin: mmol/L 17.1 = mg/dL Calcium: mmol/L 0.25 = mg/dL GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% TEMP$ TEMP2 NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ Non-biochemical Units Conversion Select substance: HaemoglobinOh+ EnergyOe+ Partial pressureOo+ pH / H+ concOpWX mmol/L mg/dL Serum value Oh@[4 Haemoglobin mg/dL mmol/L Oe@[6 Energy Oo@[5 Partial pressure Op@[= Hydrogen ions H+ conc (nmol/L) Units Conversion: +'Enter details, then select Units button CancelO to K to K |B\[* Must be greater than zero Result for conversionK = H+ conc: K+ nmol/LK = H+ conc: K+ nmol/LK = K+ = K+ + H+ conc: nmol/L = K+ pH: K + H+ conc: nmol/L = K+ pH: K = K+ = K+ GuidelinesOg( RepeatOr( Og@[E Metabolite Units Conversion +"Haemoglobin: g/dL * 0.621 = mmol/L +&Partial pressures: kPa * 7.502 = mmHg Energy: kJ x 4.184 =kcal +'pH = - log (hydrogen ion concentration) +) (log = log to base 10, H+ conc = mol/L) Units Conversion: GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% TEMP2 NEWRESULT$ SCREEN3% GUIDEL$ GUIDEL% mmol/L mmol/L mmol/L mEq/L mg/dL mg/dL Plasma Osmolality Enter plasma valuesO Sodium ( )KOF|( Urea ( Glucose( UnitsOu+ CancelO Ou@[P Using conventional unitsO Using SI unitsO *gfffff Od|NRJ Result is K K+ mOsmol/LKO K+ mOsmol/LK (normal: 280-305)O Corrected sodium is Ox|>[7 Corrected sodium is mmol/LK GuidelinesOg( RepeatOr( +<Plasma Osmolality (mOsmol/L) = glucose + urea + (2 x sodium) +MPlasma Osmolality (mOsmol/L) = ( glucose / 18 )+ (urea / 2.8 ) + (2 x sodium) +>The alterations to glucose & urea in the above formula convert +&the equation to that used for SI units Units: glucose ( K+ ), urea (K ), sodium (K +C Corrected sodium (for glucose) is calculated if glucose is raised +> See 'Corrected sodium' section for corrected sodium equation +,Marshall W. Clinical Chemistry. 2nd Edition, +'Gower Medical Publishing. 1992. Page 20 GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% TEMP2 NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ mmol/L *433333 mg/dL Corrected Calcium Calculation Enter plasma valuesO Total Calcium Albumin Standard values Reference Albumin UnitsOu+ CancelO Ou@[P Using conventional unitsO Using SI unitsO +(Result is negative! Review entry valuesO +(Albumin measurement is innacurate below ResultO Corrected (free) Calcium is (normal: 2.20-2.60)O (normal: 4.48-4.92)O Corrected Calcium: specimen ideally taken uncuffed, on a fasting patient GuidelinesOg( RepeatOr( +1(For use when ionised calcium test not available) +5Corrected calcium = Total calcium + ( [difference] x +3 [difference] = reference albumin - serum albumin Units: Calcium ( ), Albumin (K +-Reference albumin is usually 40 g/L (4 mg/dL) +,Marshall W. Clinical Chemistry. 2nd Edition, +(Gower Medical Publishing. 1992. Page 194 GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% TEMP2 NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ Corrected Sodium mmol/L mmol/L mEq/L mg/dL +! Calculation (for hyperglycaemia)K Enter plasma valuesO Sodium ( + Glucose ( UnitsOu+ CancelO Ou@[P Using conventional unitsO Using SI unitsO Glucose must be >150 Od|NROd|VJ Result is K GuidelinesOg( RepeatOr( +0Na (corrected) = Na + ( ( 1.6 * glucose ) / 100) Na = Sodium +6Glucose (mmol/L) is converted to mg/dL for calculation Na = Sodium + Glucose ( +8Jacobs D, Demott W, et al. Laboratory Test Handbook, 3rd +4edition. Lexi-Comp Inc. Hudson, Ohio. 1994. page 349 GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ + Anion Gap mmol/L mEq/L CalculationK Enter plasma values ( SodiumOF|( + PotassiumO Bicarbonate (HCO3 ChlorideO UnitsOu+ CancelO Ou@[P Using conventional unitsO Using SI unitsO Result is K (normal: 10-18)O GuidelinesOg( RepeatOr( +8Anion Gap = ( Potassium + Sodium ) - (Bicarb + Chloride) + (all: +-Kumar & Clark. Clinical Medicine, 2nd Edition + Balliere Tindall. 1990. Page 505 GUIDENAG GUIDELINES RESULTS GLOBAGE TITLEHT% TITLEFONT% TEMP2 NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ GLOBAADO2 +#Alveolar-arterial Oxygen Difference Using stored age Enter values: pressures in kPaO Inspired O2 %O Arterial pCO2O Arterial pO2O + Age (yrs)O age only required for normal values calculation Standard values Atmospheric pressureO UnitsOu+ CancelO Ou@[2 Units changed to mmHgO Enter values: pressures in mmHgO Inspired O2 %O Arterial pCO2O Arterial pO2O + Age (yrs)O age only required for normal values calculation Standard values Atmospheric pressureO UnitsOu+ CancelO Ou@[1 Units changed to kPaO RN*5^ RN*5^ |J*5^ *433333 ResultO A-a Difference is Alveolar pO2 is A-a Difference: Normal values (based on age yrs):K A-a difference: sitting alveolar pO2: supine alveolar pO2: GuidelinesOg( RepeatOr( +7A-a difference = (((Pb - 47) x FiO2) -pCO2 / 0.8) - pO2 +3Alveolar pO2 is = ((Pb - 47) x FiO2) - (pCO2 / 0.8) +*Normal A-a difference (mmHg) = (age/4) + 4 #30Normal Alveolar pO2 (mmHg) = sitting 104.2-(0.27 x age) @supine 103.5-(0.42 x age) +,Yentis S, Hirsch P, Smith G. Anaesthesia A-Z +$Butterworth Heinemann. 1993. Page 15 Storing age GUIDENAG GUIDELINES CHECKNUMB TBAROFFER% TEMP$ PATH$ MACHTYPE% ACIDBASE& SCRWID% SCRHT% TITLEFONT% SCREEN3% GUIDEL% GUIDEL$ TEMP2 SCREEN1% SCREEN2% Medikit.mbmK Enter arterial blood gas valuesO PaCO2* units+ kPa,mmHg GuidelinesOg( CancelO Acid-Base Graph +:The areas between the solid lines represent 95% confidence +=limits of hydrogen ion concentration / PaCO2 relationships in +;uncomplicated metabolic or respiratory acid-base disorders. +-Results outside these bands represent a mixed +!respiratory / metabolic disorder. +$The hatched box is the normal range. Out of rangeO +$PaCo2 must be between 0.1 and 20 kPa H+ conc: nmol/L PaCo2: mmHg +,Position plotted. Tap the graph to explore RepeatO {A\[ {A\[ {A\[ Or{A\[ H{5\O H{5\\[ H{5\O H{5\\[ H{5\O H{5\\[ RepeatO PaCo2: mmHg H+ conc: nmol/L GUIDENAG GUIDELINES RESULTS TEMP$ GLOBHT& GLOBSEX% GLOBAGE TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ TEMP2 +#Predicted Peak Expiratory Flow Rate height, K gender, K age, K , C[& Using stored CalculationK Enter valuesO Age (years)O Height (cm)O2{( Gender+ Male,Female Observed PEFR (l/min)O only required for % PEFR calculation CancelO R*?W[ }RN*gfffffM@ Result Predicted PEFR is l/minK VOd|R Observed PEFR is % of predicted PEFRK Adult PEFR: l/min (Observed PEFR = K % predicted)K l/minK GuidelinesOg( RepeatOr( +>Male: LN(PEFR)=(0.544*LN(age))-(0.0151*age)-(74.7/height)+5.48 +@Female: LN(PEFR)=(0.376*LN(age))-(0.0120*age)-(58.8/height)+5.63 +<% of predicted PEFR = ( actual PEFR / predicted PEFR ) * 100 +?LN = natural LOG, PEFR = Peak Expiratory Flow Rate (Litres/min) Age (years), Height (cm) +6NOTE: So-called "Normal" predicted PEFR is affected by +: *multiple* variables. These equations do not account for: +. smoking, occupation, race and other variables +>Nunn AJ. Gregg I. New regression equations for predicting peak +8expiratory flow in adults. BMJ. 298(6680):1068-70, 1989. Storing height, age, gender GUIDENAG GUIDELINES RESULTS GLOBSA TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ Using stored BSA mol/L mmol/L mg/dL mg/dL Creatinine Clearance +3Enter values (note the units used for creatinine)O Enter valuesO Serum Creatinine ( Urine Creatinine ( Urine volume (mls)O Urine collection time (hours)O Body surface area (m Leave 'BSA' at zero if unknown (used for standardised result) UnitsOu+ CancelO Ou@[P Using conventional unitsO Using SI unitsO O<|RRV mL/minK (BSA Adjusted: K ResultO is K mL/minK +$Standardised (BSA adjusted) CrCl is mL/minK Normal (males) : 94-140O (females) : 72-110O GuidelinesOg( RepeatOr( #30CrCl (mL/min) = (Urinary Cr ( ) x urine volume (mls) )K @/ (Plasma Cr ( ) x collection time (mins) )K +@Standardised CrCl = actual CrCl * ( 1.73/body surface area(m CrCl = Creatinine Clearance, Cr = Creatinine note plasma creatinine is converted from mol to mmol Use 'Estimated CrCl' section if urine collection unreliable. +51. Hope R et al. Oxford Handbook of Clinical Medicine +- Ed 3, Oxford University Press. 1993, p 633 +D2. Jacobs D, Demott W, et al. Laboratory Test Handbook, 4th edition. +4 Lexi-Comp Inc. Hudson, Ohio. 1996. Pages 117-118. +A(Segments of calculation coding supplied by Jan F Monkelbaan, MD) Storing BSA GUIDENAG GUIDELINES RESULTS TEMP$ GLOBWT TEMP2 GLOBAGE GLOBSEX% TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ Estimated Creatinine Clearance weight, K age, K gender, K , C[& Using stored mol/L mg/dL Enter valuesO Weight (kg)O Age (years)O Gender+ Male,Female Serum Creatinine Serum Creatinine UnitsOu+ CancelO Ou@[P Using conventional unitsO Using SI unitsO RV*333333 Result is K mL/minK mL/minK +#(normal adult range: 94-140 mL/min)O +#(normal adult range: 72-110 mL/min)O GuidelinesOg( RepeatOr( +)Estimated Creatinine Clearance (mL/min) = +4 ( (140 - age) * weight (kg) ) / (72 * Cr (mg/dL) ) +$For females, multiply result by 0.85 +/Serum creatinine ( mol/L) is converted to mg/dL @by dividing by 88.4 Use 'actual' CrCl whenever possible, estimated CrCl should +3 only be used when urine collection is unreliable. Gives unreliable results with cachexic patients, or those ++ with a rapidly changing serum Creatinine. Equation gives more reliable results if IDEAL BODY WEIGHT +7 is used, especially with obese or oedematous subjects +(Cockroft & Gault, Nephron, 1976 16:31-41 Storing weight, age & gender GUIDENAG GUIDELINES RESULTS GLOBSA TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ +!Standardised Creatinine Clearance Using stored BSA Enter valuesO Creatinine Clearance (ml/min)O Body Surface area (m Standard Values Standard BSA (m CancelO ml/minK ResultO is K mL/minK Normal (males) : 94-140O (female) : 72-110O GuidelinesOg( RepeatOr( #30Standardised Cr Cl = +%actual Cr Cl x (standard body surface +"@area / actual body surface area ) +*Standard body surface area is usually 1.73 +9Units: Cr Cl = Creatinine Clearance (ml/min), BSA (m +AJacobs D, Demott W, et al. Laboratory Test Handbook, 4th edition. +1Lexi-Comp Inc. Hudson, Ohio. 1996. Pages 117-118. Storing BSA GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ TEMP2 +/Fractional Excreted Sodium, Renal Failure Index mmol/L mmol/L mmol/L mmol/L mEq/L mg/dL mEq/L mg/dL +*Enter values (concentrations, not amounts)O Plasma Sodium ( Plasma Creatinine ( Urinary Sodium ( Urinary Creatinine ( leave plasma sodium at zero to only calculate RFI UnitsOu+ 24hr UrineO ValuesKOt+ CancelO UnitsOu+ CancelO Ot@[ Ou@[P Using conventional unitsO Using SI unitsO ResultO Fractional Excreted Sodium is FeNa: <1 suggests a prerenal causeO >1 suggests a renal cause (ATN)O Only calculating RFI Renal Failure Index is RFI: K <1 suggests a prerenal causeO >1 suggests a renal cause (ATN)O GuidelinesOg( RepeatOr( Og@[Y FeNa, Renal Failure Index +)FeNa = ( (uNa * pCr) / (uCr * pNa) ) *100 RFI = (uNa) / (uCr / pCr) +<FeNa = Fractional excreted sodium, RFI = Renal failure index +)uNa = urinary sodium, pNa = plasma sodium +1uCr = urinary creatinine, pCr = plasma creatinine all concentrations in mmol/L +& serum Cr: (mmol/L) = ( mol/L) /1000 ) +7Conventional Units: Sodium (mEq/L), Creatinine (mg/dL) +51. Hope R et al. Oxford Handbook of Clinical Medicine +- Ed 3, Oxford University Press. 1993, p 385 +4Fractional Excreted Sodium: Calculate concentrations Enter 24 hour urine valuesO Urinary Sodium (mmol)O (normal: 50-250) Urinary Creatinine (mmol)O (normal: 5-15) 24h urine volume (mls)O CancelO Concentrations calculated. GUIDENAG GUIDELINES RESULTS GLOBWT TITLEHT% TITLEFONT% TEMP2 NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ Using stored weight mmol/L mEq/L +4Free Water Deficit / Excess in Hyper / Hyponatraemia Enter valuesO Sodium ( Weight (kg)O Standard values Target Sodium ( UnitsOu+ CancelO Ou@[P Using conventional unitsO Using SI unitsO V*433333 RR*433333 Result +$Free Water Deficit in Hypernatraemia Free Water Deficit is litresKO Free Water Deficit: litresK +"Free Water Excess in Hyponatraemia Free Water Excess is litresKO Free Water Excess is litresK GuidelinesOg( RepeatOr( Free Water Deficit +2FWD = [ ((measured Na / target Na) x TBW ) - TBW ] +3TBW = Total body water (l) = 0.6 x body weight (kg) +'FWD = Free Water Deficit (l) (Na = If free water deficit is negative, free +. water excess is calculated for hyponatraemia +>Ewald G, McKenzie C (editors). Manual of Medical Therapeutics, +928th edition. Little, Brown and Company. 1995. page 49-50 Storing weight GUIDENAG GUIDELINES RESULTS TEMP$ GLOBWT GLOBHT& GLOBAGE GLOBSEX% TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ TEMP2 Energy Requirements weight, height, K age, K gender, K , C[& Using stored Enter valuesO Weight (kg)O Height (cm)O + Age (yrs)O Gender+ Male,Female Activity+ Bedrest,Ambulatory Injury+!Minor surgery,Trauma,Sepsis,Burns + If Obese:+ Adjust weight,Don`t adjust CancelO *333333 Od|V*333333 ?ZR*C Od|VO |ZVRN O2|*gfffff Od|V* C@RO<|NRJ X|VRN F@*gfffff Od|V* C@RO<|NRJ R:\[Z + Weight adjusted for obesity (to kg)KO *gfffff+@RJ |RJ*433333 *433333#@RJ + kcal/dayK *433333 *433333 + kcal/dayK g/dayK ResultO Basal Energy Expenditure is Resting Energy Expenditure is +"(estimated protein requirement is BSA: BMI: IBW: LBW: , REE K , Protein: K Show BMI etcOb( GuidelinesOg( RepeatOr( Og@[$ #30B.E.E. = +-MEN: 66 + (kg*13.7) + (cm*5) - (6.8*age(yrs)) +2@WOMEN: 655 + (kg*9.6) + (cm*1.8) - (4.7*age(yrs)) #31R.E.E. = +%BEE x activity factor x injury factor +,Estimated protein requirement = 1.5 g/kg/day B.E.E. = Basal Energy Expenditure (kcal/day) R.E.E. = Resting Energy Expenditure (kcal/day) +3Actual energy needs may be 10-15% of this estimate +7Weight classified as obese if >125% [ideal body weight] +$and adjusted for BEE calculation as: +1adjusted body weight (kg) = (ideal body weight) + +; (0.025 * ((actual body weight) - (ideal body weight))) +=[the adjustment is required as fat is metabolically inactive] See "BMI, BSA, IBW, LBW" calculation for these four equation definitions +@Veldee MS, Chapter 20: Nutrition, pages 1240-1242; IN: Burtis C, +A Ashwood E. Tietz Textbook of Clinical Chemistry, Second edition. W.B. Saunders Company. 1994. Or@[ +$Storing height, weight, age & gender GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% TEMP2 NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ mmol/L mg/dL LDL Cholesterol calculationK Enter serum values ( Total cholesterol* HDL cholesterol* Enter EITHER 'Triglycerides' OR 'VLDL' TriglyceridesO TriglyceridesO VLDL cholesterolO UnitsOu+ CancelO Ou@[\ mmol/L mg/dL Units changed to |B\[5 Enter triglycerides OR VLDLO |F\[. Enter triglycerides OR VLDLO +"Result is negative! Recheck inputsO Result is K (normal: 1.55-4.4)O (normal: <130)O GuidelinesOg( RepeatOr( +$LDL = total cholesterol - VLDL - HDL +9LDL = total cholesterol - ( HDL + (triglycerides / 2.2) ) Units: all mmol/L If using mg/dL, triglycerides is divided by 5 Serum triglycerides must be <4.5mmol/L (<400mg/dL) (The Friedwald Formula) +,Marshall W. Clinical Chemistry. 2nd Edition, +(Gower Medical Publishing. 1992. Page 229 GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% TEMP2 NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ mmol/L mg/dL VLDL Cholesterol calculationK Enter serum values ( Total cholesterol* LDL cholesterolO HDL cholesterol* UnitsOu+ CancelO Ou@[\ mmol/L mg/dL Units changed to +"Result is negative! Recheck inputsO Result is K GuidelinesOg( RepeatOr( +%VLDL = total cholesterol - LDL - HDL Units: all mmol/L (The Friedwald Formula) +,Marshall W. Clinical Chemistry. 2nd Edition, +(Gower Medical Publishing. 1992. Page 229 GUIDENAG GUIDELINES RESULTS GLOBSEX% TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ +*Total Cholesterol to HDL Cholesterol ratio Using stored gender. calculationK Enter serum valuesO Total cholesterol* HDL cholesterol* Gender+ Ignore,Male,Female Gender only used for risk calculation CancelO no gender specified *433333 (No data available) 50% of average *433333#@2[ average L7@2[ 2 times average 3 times average *gfffff (No data available) 50% of average average 2 times average 3 times average ResultO is K +!Risk of coronary artery disease: GuidelinesOg( RepeatOr( +!Total cholesterol to HDL ratio = +4 (total cholesterol / HDL cholesterol) +'(Both values must be in the same units) ++Correlated risk of coronary artery disease: #25HDL ratio: MALE / FEMALE Correlated risk #263.4-4.9 / 3.3-4.3 50% of average #275.0-9.5 / 4.4-6.9 average #289.6-23.3 / 7.0-10.8 2 times average #29>23.3 / >10.8 3 times average +<Grover SA, Coupal L, Hu XP. Identifying Adults at Increased +2Risk of Coronary Disease. JAMA. 1995; 274:801-806. Storing gender. GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ +(LDL Cholesterol to HDL Cholesterol ratio calculationK Enter serum valuesO LDL cholesterol* HDL cholesterol* CancelO (No data available) low risk moderate risk + high risk ResultO is K Cardiovascular disease risk: GuidelinesOg( RepeatOr( LDL cholesterol to HDL ratio = ++ (LDL cholesterol) / (HDL cholesterol) +'(Both values must be in the same units) Correlated risk: #30Ratio Cardiovascular Disease Risk #310.5-3.0 Low risk #323.0-6.0 Moderate risk #33>6.0 + High risk +;Wallach J. Interpretation of laboratory tests, 6th edition, +(Little Brown and Company. 1996. page 482 GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% TEMP2 NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ +*CSF WBC correction for blood contamination +'For use with blood contamination of CSF( Normal blood RBC & WBC?O (ie no anaemia or leucocytosis)K+ Yes,No CancelO Enter valuesO CSF WBC (white cells / mm CSF RBC (red cells / mm CancelO << BackOb+ Enter valuesO CSF WBC (white cells / mm CSF RBC (red cells / mm +"Blood WBC (white cells x10^9 / l )O +!Blood RBC (red cells x10^12 / l )O CSF WBC (white cells / CSF RBC (red cells / +#Blood WBC (white cells x10^3 / +!Blood RBC (red cells x10^6 / UnitsOu+ CancelO << BackOb+ Ob@[ Ou@[P Using conventional unitsO Using SI unitsO Corrected CSF WBC = white blood cells / K +$Negative result! Review input valuesO ResultO GuidelinesOg( RepeatOr( 1. If blood count is normal: +0 corrected CSF WBC = CSF WBC - ((CSF RBC)/700) 2. If blood count is abnormal: corrected CSF WBC = += CSF WBC - ( (Blood WBC) * ( (CSF RBC) / (Blood RBC) ) ) +;CSF = Cerebrospinal fluid. WBC = white blood cells per +(RBC = red blood cells per L, 1mm +AJacobs D, Demott W, et al. Laboratory Test Handbook, 4th edition. +0Lexi-Comp Inc. Hudson, Ohio. 1996. page 309-310. GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ +,CSF Protein correction for blood contaminatn For use with blood contamination of CSF( Normal blood RBC & protein?+ Yes,No CancelO >> NextO Enter valuesO CSF RBC (red cells / mm CSF protein (g/L)* CSF RBC (red cells / CSF protein (mg/dL)* ?zOd{ +!Blood RBC (red cells x10^12 / l )O Blood protein (g/L)O +!Blood RBC (red cells x10^6 / Blood protein (g/dL)* ?zOd{ UnitsOu+ CancelO << BackOb+ Ob@[ Ou@[P Using conventional unitsO Using SI unitsO |ROd|R Corrected CSF protein = g/LK Corrected CSF protein = mg/dLK +$Negative result! Review entry valuesO ResultO (Normal: 0.15-0.45 mg/dL)O (Normal: 15-45 mg/dL)O GuidelinesOg( RepeatOr( If blood protein and RBC are normal: +" (corrected CSF total protein) = +1 (CSF total protein) - ( (CSF RBC) / 1000) If blood protein and RBC are abnormal: +" (corrected CSF total protein) = +5 (blood protein) x ( (CSF RBC) / (blood RBC) ) +9CSF = Cerebrospinal fluid. RBC = red blood cells per +@CSF protein (mg/dL), blood protein (mg/dL), RBC (red cells / +9Protein: 1 g/L = 10 mg/dL RBC: 1 cell/ l = 1 cell / mm +AJacobs D, Demott W, et al. Laboratory Test Handbook, 4th edition. +0Lexi-Comp Inc. Hudson, Ohio. 1996. page 309-310. GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ GLOBMAP% +'Mean Arterial Pressure & Pulse Pressure calculationK Enter values (mmHg)O Systolic BPO Diastolic BPO CancelO Result Mean Arterial Pressure is mmHgK Pulse Pressure is mmHgK MAP: mmHg, PP: K mmHgK GuidelinesOg( RepeatOr( Og@[N Mean arterial pressure (mmHg) = +9 [ ( systolic BP + (2 x diastolic BP) ) /3 ] (mmHg) +9Pulse pressure (mmHg) = systolic BP - diastolic BP (mmHg) +,Yentis S, Hirsch P, Smith G. Anaesthesia A-Z +,Butterworth Heinemann. 1993. Pages 289 & 377 Storing MAP GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ GLOBMPAP + Mean Pulmonary Arterial Pressure Enter values (mmHg)O +!Pulmonay artery systolic pressureO (normal 15-30) +!Pulmary artery diastolic pressureO (normal 5-13) CancelO Result is K mmHgK (normal 10-18)O MPAP: mmHgK GuidelinesOg( RepeatOr( Og@[j +#MPAP = [ ( PASP + (2 x PADP) ) /3 ] +%MPAP = mean pulmonary artery pressure +)PASP = pulmonary artery systolic pressure +*PADP = pulmonary artery diastolic pressure all pressures in mmHg +&Rodriguez A. Mediformulas, 1st edition Rodram Corporation. 1998. Page9 Storing MPAP GUIDENAG GUIDELINES RESULTS TEMP$ GLOBMAP% GLOBCO GLOBCVP TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ TEMP2 Sytemic Vascular Resistance MAP, K CO, K CVP, K , C[& Using stored Enter valuesO Mean Arterial Pressure (mmHg)O Central Venous Pressure (mmHg)O h|Od| Cardiac Output (l/min)O CancelO VOP|Ry Result SVR is dynae s/cm^5K SVR: dynae s/cm^5K (normal: 1000-1500)O GuidelinesOg( RepeatOr( +-SVR = [ ( MAP - CVP ) / cardiac output ] x 80 +1SVR = Systemic vascular resistance (dynae s/cm^5) +#MAP = Mean arterial pressure (mmHg) +$CVP = Central Venous Pressure (mmHg) +! (Right atrial pressure) Cardiac Output (l/min) +,Yentis S, Hirsch P, Smith G. Anaesthesia A-Z +%Butterworth Heinemann. 1993. Page 428 +!Storing MAP, CVP & Cardiac output GUIDENAG GUIDELINES RESULTS TEMP$ GLOBMAP% GLOBCI GLOBCVP TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ TEMP2 +"Systemic Vascular Resistance Index MAP, K CI, K CVP, K , C[& Using stored CalculationK Enter valuesO Mean Arterial Pressure (mmHg)O Central Venous Pressure (mmHg)O h|Od| Cardiac IndexO (normal: 2.5-4.2 l/min/m CancelO NOP|R Result SVR Index is dynae s/cm^5/m SVR Index: dynae s/cm^5/m (normal: 1970-2390)O GuidelinesOg( RepeatOr( +)SVR Index = ( ( MAP - CVP ) * 80 ) / CI ) +;SVRI = Systemic vascular resistance index (dynae s/cm^5/m +#MAP = Mean arterial pressure (mmHg) +$CVP = Central Venous Pressure (mmHg) +! (Right Atrial Pressure) CI = Cardiac Index (l/min/m +5Barash P, Cullen B, Stoelting R. Clinical Anaesthesia +(J.B.Lippincott Company. 1989. Table 21-6 Storing MAP & Cardiac Index GUIDENAG GUIDELINES RESULTS TEMP$ GLOBMPAP GLOBCO GLOBLAP TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ TEMP2 Pulmonary Vascular Resistance MPAP, K CO, K LAP, K , C[& Using stored CalculationK Enter valuesO Mean Pulmonary Artery Pressure* (normal: 10-15 mmHg) Left Artrial Pressure* (normal: 2-10 mmHg) Cardiac Output (l/min)* CancelO VOP|Ry Result PVR is dynae s/cm^5K PVR: dynae s/cm^5K (normal: 20-120)O GuidelinesOg( RepeatOr( +"PVR = [ ( MPAP - LAP ) * 80 ] / CO +3PVRI = Pulmonary vascular resistance (dynae s/cm^5) +!LAP = Left atrial pressure (mmHg) +, (Pulmonary capillary wedge pressure) +,MPAP = Mean pulmonary artery pressure (mmHg) CO = Cardiac output (l/min) +"Miller R. Anaesthesia, 3rd Edition +5Churchill Livingstone Inc. 1990. Table 16-5, Page 565 +"Storing MPAP, LAP & Cardiac output GUIDENAG GUIDELINES RESULTS TEMP$ GLOBMPAP GLOBCI GLOBLAP TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ TEMP2 +#Pulmonary Vascular Resistance Index MPAP, K CI, K LAP, K , C[& Using stored CalculationK Enter valuesO Mean Pulmonary Artery Pressure* (normal: 10-15 mmHg) Left Artrial Pressure* (normal: 2-10 mmHg) Cardiac Index* + (normal: 2.5-4.2 (l/min/m CancelO NOP|R Result PVR Index is dynae s/cm^5/m PVR Index: dynae s/cm^5/m (normal: 30-240)O GuidelinesOg( RepeatOr( +"PVRI = ( (MPAP - LAP ) x 80 ) / CI +;PVRI = Pulmonary vasular resistance index (dynae s/cm^5/m +,MPAP = Mean pulmonary artery pressure (mmHg) +#LAP = Left arterial pressure (mmHg) +- (Pulmonary capillary wedge pressure) CI = Cardiac Index (l/min/m +5Barash P, Cullen B, Stoelting R. Clinical Anaesthesia +(J.B.Lippincott Company. 1989. Table 21-6 +!Storing MPAP, LAP & Cardiac Index GUIDENAG GUIDELINES RESULTS TEMP$ GLOBSA GLOBCO TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ TEMP2 GLOBCI *433333 Cardiac Index surface area, K CO, K , C[& Using stored Enter valuesO Cardiac Output (l/min)O Body Surface Area (m CancelO Result is K K+ l/min/m K+ l/min/m (normal: 2.5-4.2)O GuidelinesOg( RepeatOr( Cardiac Index (l/min/m +? [ Cardiac Output (l/min) / Body Surface area (m +,Yentis S, Hirsch P, Smith G. Anaesthesia A-Z +$Butterworth Heinemann. 1993. Page 77 +4Storing surface area, cardiac output & cardiac index GUIDENAG GUIDELINES RESULTS TEMP$ GLOBMAP% GLOBCI TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ TEMP2 Left Cardiac Work Index MAP, K CI, K , C[& Using stored CalculationK Enter valuesO Mean Arterial Pressure (mmHg)O Cardiac IndexO (normal: 2.5-4.2 l/min/m CancelO LCWI is kg*m/m Result (normal: 3.4-4.2)O GuidelinesOg( RepeatOr( Og@[3 LCWI = MAP * CI * 0.0144 +(LCWI = Left cardiac work index (kg*m/m CI = Cardiac Index (l/min/m +#MAP = Mean arterial pressure (mmHg) +&Rodriguez A. Mediformulas, 1st edition + Rodram Corporation. 1998. Page 8 Storing MAP & Cardiac Index GUIDENAG GUIDELINES RESULTS TEMP$ GLOBMPAP GLOBCI TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ TEMP2 Right Cardiac Work Index MPAP, K CI, K , C[& Using stored CalculationK Enter valuesO +'Mean Pulmonary Arterial Pressure (mmHg)O (normal 10-18) Cardiac IndexO (normal: 2.5-4.2 l/min/m CancelO RCWI is kg*m/m Result (normal: 0.54-0.66)O GuidelinesOg( RepeatOr( Og@[@ RCWI = MPAP * CI * 0.0144 +)RCWI = Right cardiac work index (kg*m/m CI = Cardiac Index (l/min/m +.MPAP = Mean pulmonary arterial pressure (mmHg) +&Rodriguez A. Mediformulas, 1st edition + Rodram Corporation. 1998. Page 8 Storing MAP & Cardiac Index GUIDENAG GUIDELINES RESULTS TEMP$ GLOBMPAP GLOBCVP GLOBSI TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ TEMP2 +#Right Ventricular Stroke Work Index MPAP, K CVP, K Stroke Index, K , C[& Using stored CalculationK Enter valuesO +'Mean Pulmonary Arterial Pressure (mmHg)O (normal 10-18) Central Venous Pressure (mmHg)O h|Od| Stroke IndexO (normal: 30-50 mL/beat/m CancelO + RVSWI is g-m/m Result (normal: 5-10)O GuidelinesOg( RepeatOr( +"RVSWI = (MPAP - CVP) * SI * 0.0136 +4RVSWI = Right ventricular stroke work index (g-m/m SI = Stroke Index (mL/beat/m +.MPAP = Mean pulmonary arterial pressure (mmHg) +$CVP = Central Venous Pressure (mmHg) +"Miller R. Anaesthesia, 3rd Edition +5Churchill Livingstone Inc. 1990. Table 16-5, Page 565 + Storing MPAP, CVP & Stroke Index GUIDENAG GUIDELINES RESULTS TEMP$ GLOBMAP% GLOBLAP GLOBSI TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ TEMP2 +"Left Ventricular Stroke Work Index MAP, K LAP, K Stroke Index, K , C[& Using stored CalculationK Enter valuesO Mean Arterial Pressure (mmHg)O Left Artrial Pressure* (normal: 2-10 mmHg) Stroke IndexO (normal: 30-50 mL/beat/m CancelO + LVSWI is g-m/m Result (normal: 50-62)O GuidelinesOg( RepeatOr( +#LVSWI = ( MAP - LAP ) * SI * 0.0136 +3LVSWI = Left ventricular stroke work index (g-m/m SI = Stroke Index (mL/beat/m +#LAP = Left arterial pressure (mmHg) +- (Pulmonary capillary wedge pressure) +#MAP = Mean arterial pressure (mmHg) +5Barash P, Cullen B, Stoelting R. Clinical Anaesthesia +(J.B.Lippincott Company. 1989. Table 21-6 Storing MAP, LAP & Stroke Index GUIDENAG GUIDELINES RESULTS GLOBSV% TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ TEMP2 GLOBCO Cardiac Output Using stored stroke volume CalculationK Enter valuesO Heart rate /minO Stroke Volume (ml)* CancelO Result is K l/minKO l/minK GuidelinesOg( RepeatOr( +?Cardiac output (l/min) = heart rate (/min) Stroke volume (ml) +-Kumar & Clark. Clinical Medicine, 2nd Edition + Balliere Tindall. 1990. Page 563 +$Storing cardiac output & stroke vol. GUIDENAG GUIDELINES RESULTS GLOBCO TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ GLOBSV% TEMP2 Stroke Volume Using stored cardiac output calculationK Calculate Stroke volumeO Heart rate /minO Cardiac Output (l/min)* CancelO Result is K mlKO GuidelinesOg( RepeatOr( +>Stroke Volume (l) = cardiac output (l/min) / heart rate (/min) +-Kumar & Clark. Clinical Medicine, 2nd Edition + Balliere Tindall. 1990. Page 563 +&Storing stroke volume & cardiac output GUIDENAG GUIDELINES RESULTS TEMP$ GLOBMAP% GLOBSA GLOBLAP GLOBSV% TITLEHT% TITLEFONT% TEMP2 NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ GLOBSI Stroke Work MAP, surface area, K LAP, K stroke vol, K , C[& Using stored CalculationK Enter valuesO Stroke Volume (ml)O Mean Arterial Pressure (mmHg)O Left Atrial PressureO h{Od{ +; (Pulmonary Capillary Wedge Pressure. normal: 6-12 mmHg)( Body Surface Area (m required for Stroke Index & Stroke Work Index CancelO MQ}*` ResultsO Stroke Work is (normal: 60-80)( Stroke Work Index is (normal: 40-80)( Stroke Index is mL/beat/m (normal: 30-50)O g, K+ SW Index: K SI: K mL/beat/m Results Stroke Work is (normal: 60-80)O Stroke Work: GuidelinesOg( RepeatOr( Stroke Work (g) = +5 stroke volume (ml) x (MAP - LAP (mmHg) ) x 0.0136 +7Stroke Work Index = stroke work (g) / surface area (m Stroke Index (mL/beat/m +8 stroke volume (ml) / surface area (m MAP = Mean Arterial Pressure LAP = Left Atrial Pressure ++ Pulmonary Capillary Wedge Pressure +,Yentis S, Hirsch P, Smith G. Anaesthesia A-Z +*Butterworth Heinemann. 1993. Pages 421-422 Storing MAP & stroke volume +3Storing BSA, MAP, LAP, stroke volume & Stroke Index GUIDENAG GUIDELINES RESULTS TEMP$ GLOBWT GLOBSEX% GLOBHT& TITLEHT% TITLEFONT% SCREEN3% GUIDEL% GUIDEL$ NEWRESULT$ TEMP2 Estimated Blood Volume weight, K gender, K height, K EBV values, K , C[& Using stored CalculationK Enter valuesO Weight (Kg)O Gender+ Ignore,Male,Female Height (cm)O Leave 'height' at zero to calculate using weight only Select 'Edit ormula' to alter the equations EditO ormulaKOf+ CancelO +3Enter ormula values: as mls blood / Kg body weightO No gender specifed (min)O2{Od{ (ie 'unisex') (max)O Males: (min)O2{Od{ + (max)O Females: (min)O2{Od{ + (max)O only enter a maximum value to specify a 'from-to' range these figures are used if height is NOT entered select 'Guidelines' for more information ResetOr+ GuidelinesOg( CancelO +/Reset these figures to 'default MediKit values' NoOn( YesOy( Oy@[9 MediKit will only use these values if the 'height' field +. on the 'Enter Values' screen is left at zero If 'height' is supplied, EBV will be calculated according +4 to the surface area given by 'height' and 'weight' Use your preferred reference text to edit the 'mls of blood / Kg +3 body weight' values for male / females / 'unisex' To use an EBV 'range', eg x - y mls/kg, enter both 'min' & 'max' values To use a single figure, eg x mls/kg, leave the 'max' field at zero NB The values you enter will be saved to disc, and reloaded +" each time you use this section 'min' must be less than 'max' 'min' must be less than 'max' 'min' must be less than 'max' }*333333 *333333 ?ZR*D }*333333 *333333 + Select gender if height is known Result is K mlsK mls.K GuidelinesOg( RepeatOr( If height is NOT entered, EBV is calculated according to the +- values entered in the 'Edit ormula' screen +. Otherwise, the following equations are used: +#Male: EBV = (0.0236 * BSA ) - 1.229 +%Female: EBV = (0.0248 * BSA ) - 1.954 +>BSA = Body surface area (m ) = (height^0.725) * (weight^0.425) +*Units: EBV (mls), weight (Kg), height (kg) Note: these equations are valid for adults only. += Use the 'Paediatric Section' to calculate EBV for children. +4Svirbely J, Sriram M. The Medical Algorithms Project +3http://www.medal.org/index.html 1999 Chapt 02.08.01 weight, K height, K gender, K , C[& Storing GUIDENAG GUIDELINES RESULTS GLOBWT TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ TEMP2 Allowable Blood Loss Using stored weight CalculationK Enter valuesO + Hb (g/dL)O Hb (mmol/L)O Weight (Kg)O Standard values Minimum Hb (g/dL)O Minimum Hb (mmol/L)O Blood volume (mls blood/Kg)O2{Od{ UnitsOu( CancelO Ou@[f Hb units changed to mmol/LO Hb units changed to mg/dLO + Hb is already less than minimum!O ResultO is K mlsK( (estimated blood volume is mls)K Use the EBV section for a more comprehensive +$ estimated blood volume calculation mls, Est. blood vol.: K mlsK GuidelinesOg( RepeatOr( +.ABL = ( (actual Hb - minimum Hb) / actual Hb ) +3 * weight * (mls blood per Kg body weight) Estimated blood volume (mls) = +3 weight * (mls of blood per Kg body weight) +)Units: ABL (mls), weight (Kg), Hb (g/dL) +4 (Hb: mmol/L is converted to g/dL by 0.621 Use the 'Estimated blood volume' section for a +- more comprehensive blood volume calculation Storing weight GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% TEMP2 NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ Corrected Q-T Interval *433333 CalculationK Enter values (in seconds)O Q-T interval* R-R interval* 1 'large' square = 0.2 sec 1 'small' square = 0.04 sec CancelO Result is K secondsKO (normal 0.35 - 0.53)O secondsK GuidelinesOg( RepeatOr( Og@[j +>Corrected Q-T = (Q-T interval) / (square root of R-R interval) +, (Bazett's formula. All values in seconds) ECG paper 'square' times are based on an ECG speed of 25 mm/sec +,Yentis S, Hirsch P, Smith G. Anaesthesia A-Z +%Butterworth Heinemann. 1993. Page 378 GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ ECG Rate CalculationK Enter valuesO R-R interval ('large squares')* Recording rate must be 25mm/sec +- Each 'large square' on ECG paper = 0.2 sec CancelO Result is K bpmKO bpmK GuidelinesOg( RepeatOr( Rate = 300 / R-R interval +5R-R interval as 'number of large squares on ECG paper #30Assuming +!each 'large square' = 0.2 seconds @ECG rate = 25mm/s STRIPZERO GUIDENAG GUIDELINES RESULTS TEMP$ GLOBWT GLOBHT& GLOBSEX% TITLEHT% TITLEFONT% TEMP2 NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ GLOBSA h|B\[ weight, K h|B\[ height, K gender, K , C[& Using stored +"Body Mass Index, Body Surface Area +#Ideal Body Weight, Lean Body Weight Enter detailsO Weight (kg)* Height (cm)* Gender+ Male,Female CancelO *333333 *333333 Od|VO (Underweight) + (Normal) (Pre-obese) O#|2\[ (Obese class I) O(|2\[ (Obese class II) O(|>[ (Obese class III) |ZVRN O2|*gfffff Od|V* C@RO<|NRJ |ZVRN F@*gfffff Od|V* C@RO<|NRJ + kCal/dayK ResultsO Body Surface Area (BSA): Body Mass Index (BMI): Ideal Body Weight: Lean Body Weight: BMI: , BSA: K , IBW: K , LBW: K GuidelinesOg( RepeatOr( Og@[1 BMI, BSA, Ideal body weight Body Surface Area (m +9@( Weight(kg) ^ 0.425 ) x ( Height(m)^0.725 ) x 0.007184 Lean Body Weight (men) = +=@1.10 x Weight(kg) - 128 x ( Weight^2 / (100 x Height(m) )^2) Lean Body Weight (women) = +=@1.07 x Weight(kg) - 148 x ( Weight^2 / (100 x Height(m) )^2) +<Ideal Body Weight (men) = 50 + ( 2.3 x ( Height(in) - 60 ) ) +@Ideal Body Weight (women) = 45.5 + ( 2.3 x ( Height(in) - 60 ) ) BMI = Weight(kg) / Height(m)^2 BMI categories: #30<18.5 : underweight 30-34.9 : Obese class I #3120-24.0 : Ideal 35-39.9 : Obese class II #3225-29.9 : Pre-obese >40 : Obese class III +91. Dubois D, Dubois EF. Arch Intern Med. 1916: 17:863-871 +52. Hope R et al. Oxford Handbook of Clinical Medicine +- Ed 3, Oxford University Press. 1993, p 718 +83. Ewald G, McKenzie C.. Manual of Medical Therapeutics, +9 28th edition. Little, Brown and Company. 1995. Page 30 +%Storing height, weight, gender & BSA. STRIPZERO GUIDENAG GUIDELINES RESULTS TEMP$ GLOBWT GLOBHT& TITLEHT% TITLEFONT% TEMP2 NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ GLOBSA Body Surface Area weight, K height, K , C[& Using stored CalculationK Enter valuesO Height (cm)O Weight (Kg)O CancelO *333333 *333333 Result is K GuidelinesOg( RepeatOr( Og@[@ +7BSA = ( weight ^ 0.425 ) * (height ^ 0.725 ) * 0.007184 +)Units: BSA (m ), weight (Kg), height (cm) Some centres regard the result as being significant to only one decimal place +6Dubois D, Dubois EF. Arch Intern Med. 1916: 17:863-871 Storing weight, height, BSA GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% SUBFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ IV Infusion Drip Rates +1Note most IV giving sets vary drops/mL from 10-25 Enter desired volume & rateO Volume (mls)O Delivery time (hrs)*{ GUTT (drops/mL)O CancelO O<|RV ResultsO Drip rate (drops / min): Time between drops (s): Mls per hour: Drip rate: drops/min, K sec between dropsK GuidelinesOg( RepeatOr( Or@[ Og@[' Drip rate calculations +4Rate = ( Volume (mls) * GUTT ) / ( Time (hrs) * 60 ) +(Time between drops (sec) = ( 60 / Rate ) +(Mls per hour = Volume (mls) / Time (hrs) Rate = Drip rate (drops/min) +!GUTT = Drops per ml of giving set TBAROFFER% RESULTS SCRWID% TOPSCRHT% TITLEFONT% MACHTYPE% TEMP$ SUBFONT% NEWRESULT$ SCREEN2% Beats Per Minute timerO Use <ENTER> to log a beat <DEL> to restart <ESC> to quit <C> to calculate CancelO |*gfffff Restart Log Beat + Calculate min K secK {A\`[ {A\`[ {A\`[ Oc{AO OC{A`\`[ Oc{AO OC{A`[ min K secK Last rate 0 beats 0 BPM |VO<|Ry |VWB}B[< beatsK 1 beat BPMK Calculate BPM: Enter DetailsO BeatsO SecondsO CancelO VO<|R ResultO beats in K secondsK Rate = BPMK beats/minK GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% GLOBGCS% NEWRESULT$ SCREEN3% GUIDEL$ GUIDEL% Glasgow Coma Scale Enter Best Responses:O Eye opening:+!Nil,To pain,To speech,Spontaneous Motor:+GNo response,Extends,Abnormal Flexion,Withdraws,Localises,Obeys commands Verbal:+[No response,Incomprehensible (moans),Innappropriate (words),Confused (sentences),Orientated CancelO / 15K Result GCS is GCS: (E:K GuidelinesOg( RepeatOr( See references +2Hope R et al. Oxford Handbook of Clinical Medicine +*Ed 3, Oxford University Press. 1993, p 718 GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% SUBFONT% NEWRESULT$ SCREEN3% GUIDEL$ GUIDEL% Children's Coma Scale + : (<4yrs)K +=Note: Verbal: score the best 'CRYING' OR 'INTERACTS' response Enter Best Responses:O Eye opening:+)Nil,To pain,To speech / shout,Spontaneous Motor:+ No response,Limb extension to pain,Abnormal limb flexion to pain,Withdraws to pain,Localises to pain,Obeys commands / Moves spontaneously Verbal:+ CRYING: No response / INTERACTS: No response,CRYING: Inconsolable / INTERACTS: Irritable,CRYING: Variably consolable / INTERACTS: Moaning,CRYING: Consolable / INTERACTS: Inappropriate,Orientated to sounds (fixes & follows objects) CancelO / 15K Result is K (E:K GuidelinesOg( RepeatOr( +!For use in children under 4 years ++Advanced Life Support Group 1993, "Advanced Paediatric Life Support", BMA GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL$ GUIDEL% Mental Test Score + QuestionsO Date of Birth? Time? Year? Place? Recogises nurse / doctor etc? Dates of WW I/II? Name of monarch? Count from 20 to 1? Address recall? ResetOr( CancelO Or@[ / 10K Result MTS is MTS: GuidelinesOg( RepeatOr( Og@[7 Mental Test Score +(Also known as `Mini` or `Abbreviated` or +!`Hodkinson`s` `Mental Test Score` +BQureshi KN, Hodkinson HM. Evaluation of a ten-question mental test +?in the institutionalised elderly. Age Ageing. 1974; 3: 152-157. GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% SCRHT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ +(Ranson's criteria for Acute Pancreatitis At PresentationO Age > 55 ? WCC > 16 x10^9/L ? Glucose > 11 mmol/L ? LDH > 350 iu/L ? AST > 250 iu/L ? Age > 55 ? WCC > 16,000 per Glucose > 200 mg/dL ? LDH > 350 iu/L ? AST > 250 iu/L ? UnitsOu+ ResetOr( CancelO >> NextO Or@[ Ou@[` Units changed to ConventionalO Units changed to SIO During the first 48hrsO Haematocrit fall > 10% ? Urea rise > 10 mmol/L ? Calcium < 2 mmol/L ? +#Base deficit greater than 4 mEq/L ? Arterial PaO2 < 8 kPa ? +%Estimated fluid sequestration > 6 l ? Haematocrit fall > 10% ? Urea Nitrogen rise > 10 mg/dL ? Calcium < 8 mg/L ? +#Base deficit greater than 4 mEq/L ? Arterial PaO2 < 60 mmHg ? +%Estimated fluid sequestration > 6 l ? UnitsOu+ CancelO << BackOb+ Ob@[ Ou@[\ Displaying conventional units Displaying SI units / 11 K ResultO Ranson's Score: Ranson's Score: Correlated Mortaility: GuidelinesOg( RepeatOr( Og@[l Ranson's Criteria #29Score : Predicted Mortality #30<=2 : 2% #313-4 : 15% #325-6 : 40% #33>=7 : 100% +=Ranson JHC. Etiological and prognostic factors in human acute +4pancreatitis. Am J Gastroenterol. 1982, 77 : 633-638 GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% SCRHT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ Goldman Cardiac Risk Index Enter valuesO 3rd heart sound / raised JVP? MI within last 6/12? Ventricular ectopics >5/min ? Not in sinus rhythm? Age >70 yrs? Emergency operation? Severe aortic stenosis? Poor medical condition? +$Abdominal or intra-thoracic operatn? ResetOr( CancelO Or@[ ResultO Cardiac risk index is Cardiac risk index: Correlated incidence of death, K incidenceK +&of severe cardiovascular complications GuidelinesOg( RepeatOr( Cardiac Risk Index #29Score ++: Incidence of death, Incidence of severe +* cardiovascular complications #30>=26 : 56%, 22% #31<26 : 4%, 17% #32<6 : 0.2%, 0.7% "Poor medical condition": bedridden due to noncardiac cause, +< chronic liver disease, abnormal AST, Creatinine > 3 mg/dL, +1 BUN > 50 mg/dL, K+ < 3 mEq/L, HCO3- < 20 mEq/L, +" pO2 < 60 mm Hg, pCO2 > 50 mm Hg) +AGoldman L, Caldera L, et al. Multifactorial Index of Cardiac Risk +>in Noncardiac Surgical Procedures. N Engl J Med. 1977; 297:845 GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% SCRHT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ +1Glasgow Prognostic Criteria in Acute Pancreatitis Age >55 years ? White cell count >15 x10^9/L ? Urea >16 mmol/L ? Glucose >10 mmol/L ? Albumin <32 g/L ? Uncorrected calcium <2 mmol/L ? LDH >600 IU/L ? Arterial pO2 on air <8 kPa ? Age >55 years ? +!White cell count >15,000 per Urea nitrogen >45 mg/dL ? Glucose >180 mg/dL ? Albumin <3.2 g/dL ? Uncorrected calcium <8 mg/dL ? LDH >600 IU/L ? Arterial pO2 on air <60 mmHg ? UnitsOu+ CancelO Ou@[` Units changed to ConventionalO Units changed to SIO unlikely likely Result Modifed Imrie score is Modified Imrie score is Severe pancreatitis is GuidelinesOg( RepeatOr( Modified Imrie Score #29Score +#: Likelyhood of severe pancreatitis #30<3 : Unlikely #31>3 + : Likely Positive findings to be marked if present + anytime within the first 48hrs +1Blamey SL, Imrie CW, et al. Prognostic factors in ++acute pancreatitis. Gut 1984, 25: 1340-1346 GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% SCRHT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ +$Alvorado Score in Acute Appendicitis +(Migration of pain to right iliac fossa ? Anorexia, or acetone in urine ? Nausea & vomiting ? +!Tenderness in right iliac fossa ? Rebound tenderness ? Temperature >37.3 WCC >10 x10^3/ Left shift (>75% neutrophils) ? ++Migration of pain to right lower quadrant ? Anorexia, or acetone in urine ? Nausea & vomiting ? +$Tenderness in right lower quadrant ? Rebound tenderness ? Temperature >37.3 WCC >10,000 / Left shift (>75% neutrophils) ? UnitsOu+ CancelO Ou@[` Units changed to ConventionalO Units changed to SIO Acute appendicitis unlikely +"Compatible with acute appendicitis O |2[' Probable acute appendicitis + Very probable acute appendicitis evaluate for other causes observe appendicectomy indicated ResultO Appendicitis score is Appendicitis score is Management suggestion: GuidelinesOg( RepeatOr( Og@[@ #25Score +#: Likelyhood of acute appendicitis #26<=4 : Unlikely #275 / 6 : Compatible #287 / 8 : Probable + #299 / 10 : Very probable #30Score : Suggested management #31<=4 : Evaluate for other causes #325 / 6 : observe #33>= 7 : appendicectomy indicated +5Alvorado A. A practical score for the early diagnosis +>of acute appendicitis. Annals Emerg Medicine 1986: 15: 557-564 GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ Child-Pugh Classification for Grading Hepatic CirrhosisK Enter valuesO Bilirubin ( mol/L):+ <35,35 - 50,>50 Albumin (g/dL):+ >35,28 - 35,<28 Prothrombin time (secs):+H<14 (prolonged by 1-4s),15-17 (prolonged by 4-6s),>18 (prolonged by >6s) Encephalopathy (grade):+ none,mild (1-2),severe (3-4) Ascites:+ none,mild,severe (tense) Bilirubin (mg/dL):+ <2,2 - 3,>3 Albumin (g/dL):+ >3.5,2.8 - 3.5,<2.8 Prothrombin time (secs):+H<14 (prolonged by 1-4s),15-17 (prolonged by 4-6s),>18 (prolonged by >6s) Encephalopathy (grade):+ none,mild (1-2),severe (3-4) Ascites:+ none,mild,severe (tense) UnitsOu+ CancelO Ou@[` Units changed to ConventionalO Units changed to SIO Grade A (Score /15)K O |6[8 moderate Grade B (Score /15)K Grade C (Score /15)K Result is K is K Operative risk is GuidelinesOg( RepeatOr( #25Score : Grade : Operative Risk #265-6 : A : Good #277-9 : B : Moderate #2810-15 : C : Poor +(Goldman, Caldera, Nussbaum et al (1977), NEJM 297:845-50 GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL$ GUIDEL% Apgar Score + Virginia Record Best Responses:O Pulse:+ 0,<100,>100 Resp. Effort:+(Nil,Gasping / Irregular,Regular / Crying Muscle Tone:+!Flaccid,Some tone,Active movement Colour:+ All blue / white,Blue limbs,Pink On Stimulation:+ Nil,Grimace,Cry / cough CancelO / 10K Result is K GuidelinesOg( RepeatOr( See references +9Collier J et al. Oxford Handbook of Clinical Specialities +*Ed 4, Oxford University Press. 1995, p 230 GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ Paediatric Croup Score Record features:O Inspiratory stridor+6None,When agitated,On / off at rest,Continuous at rest Retractions+ None,Mild,Moderate,Severe + Air entry+8Normal,Decreased,Moderately decreased,Severely decreased Cyanosis+ None,When crying,At rest + Alertness+!Alert,Restless anxious,Depressed CancelO / 15K + very mild mild to moderately severe severe croup ResultO Croup score is Croup score : Interpretation: GuidelinesOg( RepeatOr( Or@[ #25Score : Interpretation #26<2 : Very mild #272 - 9 : Mild - moderately severe #28>9 : Severe croup +0Prendergast M et al, Am J of Emergency Medicine, 1994 12(6):613-6 GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% TEMP$ NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ Syracuse Croup Score O<|:[ INFO: Syracuse Croup ScoreO The age you entered in the paediatric section was greater than 5 years. The Syracuse Croup Score did not include children >60 months. +5 Bear this in mind when using this assessment scale. +9 Don't show this information screen again CancelO Current age is >60 monthsO Record features: ( K+ months, K kg patient)K Inspiratory stridor+DNone,Audible on close examination or with stethescope,Easily audible Cyanosis+=None,Minimal (nailbeds &/or perioral mucosa),Obvious cyanosis Sternal retraction+ None,Present Respiratory rate+ <35,36 - 40,41 - 45,>45 Respiratory rate+ <30,31 - 35,36 - 40,>40 Respiratory rate+ <20,21 - 24,25 - 30,>30 Heart rate+ <150,151 - 165,166 - 190,>190 Heart rate+ <130,131 - 145,146 - 170,>170 Heart rate+ <120,120 - 135,136 - 150,>150 O%|2[6 Heart rate+ <110,111 - 125,126 - 140,>140 Heart rate+ <90,91 - 100,101 - 120,>120 CancelO / 11K Low risk for airway obstruction + High risk for airway obstruction ResultO + Score is Syracuse Croup score : Interpretation: GuidelinesOg( RepeatOr( Or@[ Og@[: #25Score : Interpretation #26<=5 +": Low risk for airway obstruction #27>5 +#: High risk for airway obstruction Choices presented depend on age and weight. +@ Age & weight are taken from data entered in the Paeds. section Respiratory rate choices are different for the following weights: (kg): <=5, 5.1-10, >10 Heart rate choices are different for the following ages +' (months): <3, 3-6, 7-12, 13-36, 37-60 Evaluation to be done at presentation & every 12 hrs until discharge. This score did not assess children >60 months +AJacobs S et al, Validation of a croup score & its use in triaging +2children with croup. Anaesthesia, 1994 49: 903-906 GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL$ GUIDEL% Modified Bishop`s Score Record Values:O Cervical dilatation (cm):+ 0,1-2,3-4 Length of cervix (cm):+ >2,1-2,<1 +*Station of head (cm above ischial spines):+ -3,-2,-1 Cervical consistency:+ Firm,Medium,Soft Position of cervix:+ Posterior,Middle,Anterior CancelO / 10K Result is K Bishop Score: GuidelinesOg( RepeatOr( See references +9Collier J et al. Oxford Handbook of Clinical Specialities ++Ed 4, Oxford University Press. 1995, p 110. GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL$ GUIDEL% +-Barthel's index of activities of daily living Enter Values (Page 1 / 2)O Bowels:+AIncontinent (or needs enema),Occasional accident (1/wk),Continent Bladder:+TIncontinent or catheterised,Occasional accident (max 1/day),Continent (for > 1 week) Toilet:+@Dependant,Needs some help but can go alone,Fully independent (on( offK( wipingK( dressing)K Bathing:+ Dependent,Independent (in( outK( washing unsupervised)K Feeding:+ Unable,Needs help in cutting( K+8 spreading butter etc,Independent (if food within reach)K ResetOr( CancelO >> NextO Or@[ Enter Values (Page 2 / 2)O + Grooming:+ Needs help with face( hairK( teethK( shaving,IndependentK + Dressing:+LDependent,Needs help but can do about half unaided,Independent (incl buttons( zipsK( laces)K + Transfer:+=Unable (no sitting balance),Major help (physical: 1-2 people)( K+4 can sit,Minor help (verbal or physical),IndependentK Mobility+hImmobile,Wheelchair independent incl. corners etc,Walks w/ help 1 person (verbal / physical),Independent Stairs:+ Unable,Needs help (verbal( K+ physicalK( K+& carrying aid),Independent (up & down)K CancelO << BackOb+ Ob@[ / 20K Result Barthel's Score is Barthel's Score: GuidelinesOg( RepeatOr( Barthel`s Index See references +2Hope R et al. Oxford Handbook of Clinical Medicine +)Ed 3, Oxford University Press. 1993, p 67 ENTERCONT GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% TEMP$ SCRWID% SCRHT% SCREEN2% TOPSCRHT% NEWRESULT$ SCREEN3% GUIDEL$ GUIDEL% Mini-Mental State Examination MMSE Page 1O +$Does the patient know the following: Day of the week? Day of the month? Month? Year? Season? ResetOr( CancelO >> NextO Or@[ MMSE Page 2O Does the patient know: Name of this country? Name of this town? Name of two nearby streets? +(What floor of this building they are on? +&Name of this building OR this address? CancelO << BackOb+ >> NextO Ob@[ MMSE Page 3O +;Say: "I am going to give you a piece of paper, when I do so+ ++ take the paper in your right hand, +/ fold the paper in half with both hands +- and put the paper down on your lap." +7Say: "Write a complete sentence on this sheet of paper"+ +; Sentence makes sense and contains a verb? CancelO << BackOb+ >> NextO Ob@[ MMSE Page 4O +'Recognises (and can name) pen / pencil? +%Recognises (and can name) wristwatch? +0Say: "I am going to say something and I want you +5 to repeat it after me: No ifs, ands or buts." +? Correct first time? CancelO << BackOb+ >> NextO Ob@[ Close your eyes Command obeyed? CancelO << BackOb+ >> NextO Ob@[ |RWBO TOKL( |RWBiO MMSE Page 6 +2Say: "Here is a drawing, please copy the drawing." CancelO << BackOb+ Hide this dialogO Ob@[3 MMSE Page 6O +%Intersecting five sided figures drawn with all angles preserved? CancelO << BackOb+ >> NextO Ob@[ MMSE: Page 7O +5Say: "I am going to name three objects. After I have +: finished saying all three, I want you to repeat them. +5 Remember what they are because I am going to ask +. you to name them again in a few minutes."( +; Apple +; Table +; Penny +:Score on first attempt and then repeat list until learned. CancelO << BackOb+ >> NextO Ob@[ MMSE Page 8O +1Say: "I would like you take 7 away from 100. Now +5 take 7 away from the number you get. Continue +- subtracting until I tell you to stop."( += 93 += 86 += 79 += 72 += 65 CancelO << BackOb+ >> NextO Ob@[ MMSE Page 9O +)Say: "What were the three objects I asked +* you to repeat a little while ago?"( +( Apple +( Table +( Penny CancelO << BackOb+ >> NextO Ob@[ / 30K ResultO MMSE Score for this patient is MMSE: Score suggests dementia( Borderline score( Score does not suggest dementia( Always consider acute confusional state 13% of over-75s in the general population score <25 GuidelinesOg( RepeatOr( << BackOb+ + Folstein See references +2Hope R et al. Oxford Handbook of Clinical Medicine +)Ed 3, Oxford University Press. 1993, p 72 Or@[ GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% GLOBGCS% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ Trauma Score Record features:O Respiratory Rate (/min)+">= 36,24 - 35,10 - 24,0 - 9,absent Respiratory Expansion+ Normal,Shallow,Retractive Systolic BP (mmHg)+(>=90,70 - 89,50 - 69,0 - 49,absent pulse Capillary return+ Normal,Delayed,None Glasgow Coma Score+"14 - 15,11 - 13,8 - 10,5 - 7,3 - 4 + CalculateO GCSKOg+ CancelO Og@[t Using GCS of / 16K *gfffff ResultO is K Probability of survival: GuidelinesOg( RepeatOr( Or@[ Og@[) Interpretation of result: +&Trauma Score (Probability of Survival) +8 16 (0.99), 15 (0.98), 14 (0.95), 13 (0.91), 12 (0.83), +5 11 (0.71), 10 (0.55), 9 (0.37), 8 (0.22), 7 (0.12), +: 6 (0.07), 5 (0.04), 4 (0.02), 3 (0.01), 2 (0.0), 1 (0.0) +61. Champion, Sacco et al, Trauma Score. Crit Care Med. 1981; 9:672-676 +;2. Wilberget JE. The multiply injured patient. Page 15.9 IN +> Rengarchy SS et al: Priniples of Neurosurgery. Wolfe. 1994 GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% GLOBGCS% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ Revised Trauma Score Record features:O Respiratory Rate (/min)+ 10 - 29,>29,6 - 9,1 - 5,0 Systolic BP (mmHg)+ >89,76 - 89,50 - 75,1 - 49,0 Glasgow Coma Score+ 13 - 15,9 - 12,6 - 8,4 - 5,3 + CalculateO GCSKOg+ CancelO Og@[t Using GCS of / 12K not indicated + indicated ResultO is K Treatment at trauma centre: GuidelinesOg( RepeatOr( Or@[ Og@[* Interpretation of result: #30Score <=11 : +"Potentially important trauma which +&@should be treated at a trauma centre. +6Champion, Sacco et al, A revision of the trauma score. J Trauma. 1998: 29;623-629 GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ Paediatric Trauma Score Record features:O + Body size+ >=20 kg,10 - 20 kg,<10 kg Systolic BP+ >=90 mmHg,50 - 90 mmHg,<50 mmHg Airway+"Normal,Maintainable,Unmaintainable Consciousness+-Awake,Obtunded; unconscious,Coma decerebrate Open wounds+ None,Minor,Major penetrating + Fractures+>None,Single closed fracture,Open fractures multiple fractures CancelO / 12K + indicated not indicated ResultO is K +'Treatment at paediatric trauma centre: GuidelinesOg( RepeatOr( Or@[ Og@[p Interpretation of result: + Minimum score = -6, Maximum = 12 Scores <8 should be managed at a paediatric trauma centre +01. Ford EG. Chapt 4: Trauma Triage. pages 95-117 +72. IN Nelson WE, et al. Nelson Textbook of paediatrics, +" 15th edition. WB Saunders. 1996 AAGRAD GUIDELINES GUIDENAG RESULTS GLOBAGE GLOBMAP% TITLEHT% TITLEFONT% GLOBGCS% GLOBAADO2 GUIDEL% GUIDEL$ NEWRESULT$ SCREEN3% APACHE II Score Using stored age O,|6[ O6|6[ O@|6[ OJ|6[ Using stored MAP. Using stored age & MAP. + Age (yrs)+!<=44,45 - 54,55 - 64,65 - 74,>=75 Temperature - rectal ( C)+I>=41,39 - 40.9,38.5 - 38.9,36 - 38.4,34 - 35.9,32 - 33.9,30 - 30.9,<=29.9 Mean arterial pressure (mmHg)+/>=160,130 - 159,110 - 129,70 - 109,50 - 69,<=49 Heart rate (/min)+7>=180,140 - 179,110 - 139,70 - 109,55 - 69,40 - 54,<=39 Respiratory rate (/min)+->=50,35 - 49,25 - 34,12 - 24,10 - 11,6 - 9,<5 Inspired O2+ >=50%,<50% + Calc. MAPOm( `+ Calc. GCSOg( CancelO >> NextO MAP calculated On|>[ OF|>[ Og@[$ GCS calculated A-a O2 difference (kPa)+ >67,47 - 66.9,27 - 46.9,<27 PaO2 (kPa)+ >9.3,8.1 - 9.3,7.3 - 8.0,<7.3 Arterial pH+E>7.7,7.6 - 7.69,7.5 - 7.59,7.33 - 7.49,7.25 - 7.32,7.15 - 7.24,<=7.15 Haematocrit (%)+0>=60,50 - 59.9,46 - 49.9,30 - 45.9,20 - 29.9,<20 WCC (x10^9/L)+,>=40,20 - 39.9,15 - 19.9,3 - 14.9,1 - 2.9,<1 Serum sodium (mmol/L)+G>=180,160 - 179,155 - 159,150 - 154,130 - 149,120 - 129,111 - 119,<=110 Serum potassium (mmol/L)+6>=7,6 - 6.9,5.5 - 5.9,3.5 - 5.4,3 - 3.4,2.5 - 2.9,<2.5 Serum creatinine ( mol/L)+%>301,170 - 300,130 - 169,50 - 129,<50 Acute renal failure? A-a O2 difference (mmHg)+ >500,350 - 499,200 - 349,<200 PaO2 (mmHg)+ >70,61 - 70,55 - 60,<55 Arterial pH+E>7.7,7.6 - 7.69,7.5 - 7.59,7.33 - 7.49,7.25 - 7.32,7.15 - 7.24,<=7.15 Haematocrit (%)+0>=60,50 - 59.9,46 - 49.9,30 - 45.9,20 - 29.9,<20 WCC (x10^9/L)+,>=40,20 - 39.9,15 - 19.9,3 - 14.9,1 - 2.9,<1 Serum sodium (mmol/L)+G>=180,160 - 179,155 - 159,150 - 154,130 - 149,120 - 129,111 - 119,<=110 Serum potassium (mmol/L)+6>=7,6 - 6.9,5.5 - 5.9,3.5 - 5.4,3 - 3.4,2.5 - 2.9,<2.5 Serum creatinine (mg/dL)+&>=3.5,2 - 3.4,1.5 - 1.9,0.6 - 1.4,<0.6 Acute renal failure? Change UnitsOu+ CalculateO A-adO2KOa( CancelO << BackOb+ >> NextO UnitsOu+ CancelO << BackOb+ >> NextO Ou@[` Units changed to ConventionalO Units changed to SIO Ob@[ Oa@[i OC|>[ O/|>[ A-a O2 difference calculated +0Severe organ insufficiency or immunocomprimised? +( (click "C.H.P." for a full description)O +TNo,Yes: Elective post-op admission,Yes: Non-operative or emergency post-op admission C.H.P.Oc( CancelO << BackOb+ Ob@[ Chronic Health points Any of the following must have been evident PRIOR to this hospital admission: +81. LIVER: Prior hepatic failure / encephalopathy / coma. +* Proven cirrhois and portal hypertension +62. CARDIOVASCULAR: New York Heart Association Class IV ++ (inability to perform physical activity) +<3. RESPIRATORY: Chronic restrictive / obstructive / vascular +@ disease resulting in severe exercise limitation or documented +8 chronic hypoxia, hypercapnea, 2 polycythemia, severe pulmonary hypertension +-4. RENAL: Chronic peritoneal or haemodialysis +85. IMMUNOCOMPRIMISED: Received immunosuppressing therapy +6 (eg recent / long term steroids, DXT, chemotherapy, +* immonosuppression). Or has an advanced +; immunosuppressive disease (eg AIDS, leukaemia, lymphoma) 43101234 432024 4320234 4310124 4310234 43210234 4310234 43202 421024 421024 02356 ResultO APACHE II Score is Acute Physiology Score: Age points: Chronic health points: APACHE II Score: GuidelinesOg( RepeatOr( See references +5Hinds C, Watson D. Intensive Care, A Concise Textbook Ed 2, 1993, p 11 Saunders GUIDENAG GUIDELINES RESULTS GLOBAGE TITLEHT% TITLEFONT% GLOBGCS% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ POSSUM Scores Using stored age OG|>[ O=|>[ Physiological Score (Page 1/3)O + Age (yrs)+ >71,61 - 70,<=60 Cardiac signs+^Normal (no failure),Cardiac drugs,Oedema / Warfarin / ? cardiomegaly,Raised JVP / cardiomegaly Resiratory signs+RNormal,SOBOE / mild COAD,SOB stairs / moderate COAD,SOB at rest / RR>30 / fibrosis Systolic BP (mmHg)+0>=171,131 - 170,110 - 130,100 - 109,90 - 99,<=89 Heart rate (/min)+->=121,101 - 120,81 - 100,50 - 80,40 - 49,<=39 ECG+6Normal,AF (rate 60 - 90),Other abN rhythm / MI changes 15,12 - 14,9 - 11,<=8 ResetOr( `+ Calc. GCSOg( CancelO >> NextO Or@[ Og@[X GCS calculated Physiological Score (Page 2/3)O Hb (g/100 ml)+D>=18.1,17.1 - 18.0,16.1 - 17.0,13 - 16,11.5 - 12.9,10.0 - 11.4,<=9.9 WCC (x 10^12/L)+)>=20.1,10.1 - 20.0,4 - 10,3.1 - 4.0,<=3.0 Urea (mmol/L)+#>=15.1,10.1 - 15.0,7.6 - 10.0,<=7.5 Sodium (mmol/L)+ >=136,131 - 135,126 - 130,<=125 Potassium (mmol/L)+=>=6.0,5.4 - 5.9,5.1 - 5.3,3.5 - 5.0,3.2 - 3.4,2.9 - 3.1,<=2.8 CancelO << BackOb+ >> NextO +#Operative Severity Score (Page 3/3)O Operative severity+ Minor,Moderate,Major,Major + No. of previous ops+ 1,2,>2 Periop blood loss (mls)+ <=100,101 - 500,501 - 999,>=1000 Peritoneal soiling+ENone,Minor (serous fluid),Local pus,Free pus / blood / bowel contents Malignancy+4None,Primary only,Nodal metastases,Distal metastases Surgery timing+CElective,<24h / Emergency resus >2h poss,<2h / Emergency (no resus) CancelO << BackOb+ >> NextO 421248 842128 8421248 42124 8421248 |RJ*R |RJ*{ G!"@j* ResultO Physiological POSSUM Score is Operative POSSUM Score is POSSUM Mortality risk is P-POSSUM Mortality risk is Morbidity risk is POSSUM Scores: Physiological: , Operative: K GuidelinesOg( RepeatOr( Or@[ +0" Physiological and Operative Severity Score for +, the enUmeration of Mortality & morbidity " Mortality risk is calculated using both the original +* POSSUM and the revised Portsmouth-POSSUM +! (P-POSSUM) regression equations (see references) +<1. Copeland GP, Jones D, Walters M. POSSUM: A scoring system +3 for surgical audit. BJ Surgery 1991; 78: 355-60 +@2. Whiteley M et al. POSSUM and Portsmouth POSSUM for predicting +, mortality. BJ Surgery 1998; 85: 1217-1220 +>3. Wijesinghe L et al. Comparison of POSSUM and the Portsmouth +5 predictor equation.. BJ Surgery 1998; 85: 209-212 GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ +!INFO: Cardiovascular Risk ProfileO Using equations derived from the Framingham populations You are strongly advised to read the articles referenced +9 in the 'Guidelines' screen of this section before using +* these calculations in a clinical setting Use the 'Setup' button to choose which risk-profile(s) +< you wish to calculate, in addition to other entry options.( +6 Don't show this information screen again Cardiovascular Risk Profile Calculate cardiovascular risk Calculate stroke risk +(Calculate cardiovascular and stroke risk Enter detailsO Enter detailsO Enter details ( 1 / 2 )O Gender+ Male,Female Age (years)O7{OT{ Age (years)O Systolic BP (mmHg)O2{(, Diastolic BP (mmHg)O Total cholesterol* HDL cholesterol* Total / HDL cholesterol ratio* Smoker Diabetes LVH on ECG Years to predictO Years to predictO SetupOs+ CancelO SetupOs+ CancelO >> NextO Enter details ( 2 / 2 )O Smoker Diabetes LVH on ECG Atrial Fibrillation Hypertensive Treatment +!History of Cardiovascular disease 3+ Reset allOr+ CancelO << BackOb+ Or@[- Enter detailsO Enter detailsO Gender+ Male,Female Age (years)O7{OJ{ Systolic BPO2{(, Hypertensive Treatment Diabetes Smoker +!History of Cardiovascular disease LVH on ECG Atrial Fibrillation Years to predictO SetupOs+ Reset allOr+ CancelO Os@[ Or@[- X9&@* RN*C> OJ|VW |ZRJ*" X9&@*X9 RN*J{ OJ|VW |ZRJ* ?JWB} ?JWB} CV Risk: 5 yr: K+ %, 10 yr:K ?JWB} yr CV risk = K h"lx RRJ*c RJ*`vO ?JWB} ?JWB} CVA risk: 5yr:K %, 10yr:K O |B[ O |B[ Od|R* yr CVA risk = K ResultO Coronary heart disease risk: 5 year risk: %, 10 year risk: K year risk is K Risk of stroke: 5 year risk: %, 10 year risk: K year risk is K GuidelinesOg( << BackOb+ Ob@[+ Og@[j The stroke and coronary heart disase risk assessments equations +0 function with several significant limitations. Click the 'References' button to view details of the articles +G users are advised to read if using this section in a clinical setting The equations and tables used to calculate the these risks are detailed in these references To use the equations, all requested patient data must be available Entered 'Total cholesterol' & 'HDL cholesterol' must be in the same units +71. Anderson KM et al, An updated coronary risk profile. +C A statement for health professionals. Circulation 1991;83:356-62 +<2. Wolf PA et al. Probability of stroke: a risk profile from +- the Framingham study. Stroke 1991;22:312-8 +"SETUP: Cardiovascular risk profileO +(Select from the following entry options: Calculate:+6Coronary heart disease risk only,Stroke risk only,Both Risk period:+9Calculate 5 & 10 year risk,Enter specific number of years Blood pressure:+ Use Systolic BP,Use Diastolic BP Cholesterol:+)Enter total & HDL values,Enter ratio only Save this setup CancelO + Stroke risk requires Systolic BPO GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ Hamilton Depression Scale Enter Values (Page 1 of Depressed mood:+ Absent,Indicated only on questioning,Spontaneously reported verbally,Communicated non-verbally,Virtually only expressed: verbal & non-verbal Suicide:+|Absent,Feels life not worth living,Wishes were dead/thoughts of deaths to self,Suicidal ideas or gesture,Attempts at suicide Insomnia early:+INo difficulty falling asleep,Occasional difficulty,Difficulty every night Insomnia middle:+dNo difficulty,Restless & disturbed during the night,Waking in night/getting out of bed (not voiding) Insomnia late:+eNo difficulty,Early morning waking (but falls back to sleep),Unable to fall asleep if gets out of bed SetupOs+ CancelO >> NextO Enter Values (Page 2 of Feelings of guilt: Absent,Self reproach - feels has let people down,Ideas of guilt / rumination over past errors or sinful deeds,Delusions of guilt (present illness is a punishment),Hears accusatory voices & or threatening visual hallucinations Work & interests No difficulty,Thoughts & feelings of incapacity fatigue or weakness,Loss of interest-directly reported OR indirect in listlessness indecision,Decrease in time spent in activities / decreased productivity,Stopped working because of present illness +@Retardation: Psychomotor (Slowness of thought & speech, impaired +M concentration, decreased motor activity) +|Normal speech & thought,Slight retardation at interview,Obvious retardation at interview,Interview difficult,Complete stupor CancelO << BackOb+ >> NextO Ob@[ Enter Values (Page 3 of Agitation:+yNone,Figetiness,Playing with hands hair etc,Moving about can't sit still,Hand wringing nail / lip biting hair pulling Anxiety (Psychological):+ No difficulty,Subjective tension and irritability,Worrying about minor matters,Apprehensive attitude in face or speech,Fears expressed without questioning Anxiety (Somatic):+*Absent,Mild,Moderate,Severe,Incapacitating +I (Physiological / autonomic effects: 'butterflies', indigestion, stomach +? cramps, belching, diarrhoea, palpitations, hyperventilation, +H paraesthesia, sweating, flushing, tremor, headache, urinary frequency) +C Avoid asking about drug side effects (ie dry mouth, constipation) CancelO << BackOb+ >> NextO Ob@[ Enter Values (Page 4 of +$Somatic Symptoms (Gastrointestinal): +=None,Loss of appetite,Difficulty eating without others urging Somatic Symptoms (General): +SNone,Heaviness in limbs back or head. Back / head / muscle aches,Clear-cut symptom +4Genital Symptoms: (eg loss of libido, impared sexual +> performance, menstrual disturbances) +8Absent ,Mild,Severe CancelO << BackOb+ >> NextO Ob@[ Enter Values (Page 5 of Hypochondriasis: Not present,Self-absorption (bodily),Preoccupation with health,Frequent complaints requests for help etc,Hypochondriacal delusions Weight loss:+rNone,Probable weight loss associated with current illness,Definate (according to patient) weight loss,Not assessed Insight+oAcknowledges being depressed & ill,Acknowledges but attributes to food/climate/work etc,Denies being ill at all Diurnal Variation: +ZSymptoms don't vary with time of day,Symptoms are worse in a.m.,Symptoms are worse in p.m. + Severity:+ No diurnal variation,Mild,Severe CancelO << BackOb+ >> NextO CancelO << BackOb+ Ob@[ Enter Values (Page 6 of +BDepersonalisation & Derealisation (Such as: feelings of unreality; nihilistic ideas):+:Absent ,Mild,Moderate,Severe,Incapacitating Paranoid symptoms: +GNone,Suspicious,Ideas of reference,Delusions of reference & persecution +$Obsessional and compulsive symptoms: +'Absent ,Mild,Severe CancelO << BackOb+ Ob@[ ResultO Hamilton Depression Score is Hamilton Depression Score: GuidelinesOg( << BackOb+ Or@[ See references +;Hedlung & Vieweg, The Hamilton rating scale for depression, +1J of Operational Psychiatry, 1979; 10(2): 149-165 + SETUP: Hamilton Depression ScaleO +!Select the scale you wish to use:+ 17 item scale,23 item scale You can access this screen in the future +) by selecting 'Setup' on the next screen CancelO GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ Koenig Brief Depression Scale +6Record answers relating to the last week (Page 1 of 2)O Do you often get bored ? +%Do you often get restless or figety ? Do you feel in good spirits ? +(Do you feel you have more problems with O memory than most people ?K +4Can you concentrate easily when reading the papers ? +*Do you prefer to avoid social gatherings ? ResetOr( CancelO >> NextO Or@[+ +6Record answers relating to the last week (Page 2 of 2)O +(Do you often feel downhearted and blue ? +$Do you feel happy most of the time ? Do you often feel helpless ? +2Do you feel worthless and ashamed about yourself ? +!Do you often wish you were dead ? CancelO << BackOb+ Ob@[ / 11K ResultO Koenig depression score is Koenig depression score: Score 3 or more:+*83% sensitive, 77% specific for depression Score 4 or more:++100% sensitive, 85% specific for depression GuidelinesOg( << BackOb+ +6A rapid and simple questionairre, for use in emergency +9situations when dealing with the elderly or medically ill +D1. Koenig H et al. A brief depression scale for use in the medically +. ill. Int J Psychaitry Med 1992; 22: 183-195 +B2. Meldon S et al. Depression in geriatric ED patients. Prevalence +3 & recognition. Ann Emerg. Med. 1997; 30: 141-145 GUIDENAG GUIDELINES RESULTS TITLEHT% TITLEFONT% NEWRESULT$ SCREEN3% GUIDEL% GUIDEL$ Geriatric Depression Scale +6Record answers relating to the last week (Page 1 of 3)O +,Are you basically satisfied with your life ? +8Have you dropped many of your activities and interests ? +%Do you feel that your life is empty ? Do you often get bored ? +*Are you in good spirits most of the time ? ResetOr( CancelO >> NextO Or@[+ +6Record answers relating to the last week (Page 2 of 3)O +4Are you afraid that something bad is going to happenO to you ?K +"Do you feel happy most of the time Do you often feel helpless +4Do you prefer to stay at home, rather than going outO and doing new things ?K +.Do you feel you have more problems with memoryO than most ?K CancelO << BackOb+ >> NextO Ob@[ +6Record answers relating to the last week (Page 3 of 3)O +.Do you think it is wonderful to be alive now ? +2Do you feel pretty worthless the way you are now ? Do you feel full of energy ? +-Do you feel that your situation is hopeless ? +1Do you think that most people are better off thanO you are ?K CancelO << BackOb+ Ob@[ / 15K ResultO is K ++Scores >10 almost always signify depression +'Scores >5 are suggestive of depression: + Follow up interview is warranted +%Score is not suggestive of depression GuidelinesOg( << BackOb+ A basic screening measure for depression in older adults Differing sensitivities and specificities have been obtained += across studies. For clinical purposes, >5 is suggestive of +4 depression & should warrant a follow-up interview. +) Scores >10 are almost always depression +?1. Yesavage JA et al. Development and validation of a geriatric +8 depression rating scale. J Psych Res. 1983; 17: 37-49 +62. Sheikj JI, Yesavage JA. Geriatric Depression Scale: +8 recent evidence and development of a shorter version. +! Clin Gerontol. 1985; 5:165-172 GUIDENAG GUIDELINES GLOBWT GUIDEL$ TITLEHT% TITLEFONT% SUBFONT% SCRHT% SCREEN3% GUIDEL% TEMP2 h|B\[$ Using stored weight +2Hope R et al. Oxford Handbook of Clinical Medicine +.Ed 3, Oxford University Press. 1993, p 758-759 Fluid Management for Burns Enter DetailsO Weight (kg)O Burn Area (% BSA)O Which Formula?+!Muir & Barclay (UK),Parkland (US) Rule ofO Nines?KOr( CancelO Rule of NinesO Head=9% Front=18% Back=18% +0Arm=9% Leg=18% Palm=1% Genitals=1%( Children: Head=14% Leg=14% mls over first 12 hours (K mls/hr)K mls over next 12 hours (K mls/hr)K mls over final 12 hours (K mls/hr)K PLUS mls 5% Dextrose per day (K mls/hr)K Muir & Barclay Formula Results for a kg patient with K % burnsKO +3Additional fluid required (Colloid: eg Haemaccel GuidelinesOg( RepeatOr( Muir & Barclay Formula +51 x fluid unit [mls] = body weight [kg] x % burn) / 2 #301st 12 hours: give 3 x fluid unit #312nd 12 hours: give 2 x fluid unit #323rd 12 hours: give 1 x fluid unit +6Plus normal daily losses as 5% Dextrose (40 mL/kg/day) % burn = burn percentage of Body Surface Area mls over first 8 hours (K mls/hr)K mls over next 16 hours (K mls/hr)K Parkland Formula+ (normal fluid requirement: K mls/day = K mls/hr)K Results for a kg patient with K % burnsKO +(Additional fluid required (Hartmann's GuidelinesOg( RepeatOr( Parkland Formula +6Weight [kg] x 4 x % burn = mls Hartmann's over 24 hrs +0Half of the above to be given in the first 8 hrs % burn = burn percentage of Body Surface Area Storing weight INFO: Notes on burnsO Replace fluid from time of burn, not from time of admission Do not forget to add normal daily fluid requirements Rates should be adjusted according to response & urine output % Burn assessment methods are different in children( +< Don't show this information screen again RepeatOr( DRAWTOOLBAR GUIDENAG GUIDELINES CHECKNUMB STRIPZERO DRAWARROWS TBAROFFER% USERDRUG WEIGHT HEIGHT CONVERT1 CONVERT2 INFUSION STORED PREFS SHOWRESULTS CHILDCOMA APGAR CROUP1 CROUP2 PHAEM ABOUT RESULTS CENTMALE CENTFEMALE PAEDUSERD GLOBAGE GLOBWT TITLEFONT% TEMP$ TITLEHT% SCREEN2% SCREEN3% GUIDEL% GUIDEL$ TEMP2 CWT97 SUBFONT% SUBHT% SCRWID% MACHTYPE% MENU% FROMPAED% TOPSCRHT% NEWRESULT$ GLOBHT& GLOBSEX% CMNTH CWT50 CHT50 CHT97 PAEDAGE PAEDWEIGHT 2 (3 (] ( INFO: Paediatric SectionO The next screen lets you enter the age and weight for the child you are dealing with.( Select 'Under 1 year' or enter age as less than 1 (eg 0.5) and +> you will then be asked for the age in months / weeks / days.( Leave the 'weight' field at zero and MediKit will estimate the +; child's weight using inbuilt formulas (see 'Guidelines').( Use this section with care and clinical judgement. +< Don't show this information screen again h|B\[M h|B\[# Using stored age & weight Using stored age h|B\[0 h|B\[ Using stored weight h|B\[ h|B\[ Paediatric Section Enter age and weight of childO + Age (yrs)O Weight (kg)O leave weight at 0 to estimate GuidelinesOg( CancelO Under 1 yearOu+ New Child <N>O Ou@[ Weight Estimation #30Under 1 year: weight = (40 + age x 60) / 10 #311 - 8 years: weight = (2 x age) + 8.49 #329 years and over: weight = age x 3 Units: age (years), weight (kg) 'Out of centile range' checking is against the 97th male or +< female weight: using the value closest to the 50th centile INFO: NoteO +'For a child over 12yrs old, the 'Drugs' +'and 'Fluids' sections are not available +(Don't show this information screen again << BackOb+ O<|RJO O |2[/ ?JWB} WarningO +-MediKit is not suitable for premature infants Weight must be >= 2 Kg << BackO Entered weight is > 97 centileO Entered weight is < 3 centileO O<|RJO O<|RJO ?R2[ O |2[Y ?R2[ ?R2[ WarningO +(The weight you entered is less than 50% +)The weight you entered is more than 150% +0of the predicted weight for a child of that age. +-It is strongly recommended that you treat all +%results with caution. Look them up. << BackOb+ Paediatric Section Estimated weight Estimating weight at Known weight yearK yearsK monthK monthsK |6\[> dayK daysK weekK weeksK Calculating for: oldK Kg (ESTIMATED)K Preset Drugs <D> New Child <N> Preset Drugs <D>O Formulary DrugsO <ctrl-D>KO New Child <N>O Fluids <F>O Statistics <Z>O |*gfffff This copy of MediKit is |*gfffff UNREGISTERED |*gfffff UNREGISTERED |*gfffff O1@[D '{A`[ Od{A[ Oe{A[ H{A\[ {A\[( Od{A[ {5\\[] L{5\O |*433333 ?R>\O P{5\O Preset Drugs <D>O This item is not availableO Formulary DrugsO <ctrl-D>KO This item is not availableO New Child <N>O Fluids <F>O This item is not availableO Statistics <Z>O O`{Ix O@{Ix File+ Back to Main Menu Define Formulary drugs Close MediKitOe Metabolite units+ BiochemicalOu+ OthersOU Conversions+ WeightOw+ HeightOh+ TemperatureOt+ Metabolite units>O Calculations+ New ChildOnh+ StatisticsOz+ Blood countOlh+ Conversions>O Assessments+ APGAR scoreOV+ Children's coma scaleOG+ Paediatric trauma scoreOT+ Croup scoreOy+ Syracuse croup scoreOY Preset Drugs+ AnalgesiaOa+ AntibioticsOb+ Anti-convulsantsOc+ AsthmaOo+ Anti-emeticsOp+ Emergency drugsOq Management+ Formulary DrugsOd+ Preset Drugs>O FluidsOf+ Drug Infusions Preset Drugs+ AnalgesiaOa( AntibioticsOb( Anti-convulsantsOc( AsthmaOo( Anti-emeticsOp( Emergency drugsOq( Management+ Formulary DrugsOd( Preset Drugs>O FluidsOf( Drug Infusions Tools+ Stored ValuesOs+ Results logOr+ PreferencesOkh+ AboutOA+ HelpOH Oq@`[ Ow@[3 Oh@[$ Ot@[$ Ou@[$ OU@[$ Oi@[+ OG@[$ OT@[$ OV@[$ Oy@[$ OY@[L Ol@[& OE@[? + AnalgesiaOa+ AntibioticsOb+ Anti-convulsantsOc+ AsthmaOo+ Anti-emeticsOp+ Emergency DrugsOqWX Oa@[ Ob@[ Oc@[ Oo@[ Op@[ Preset Drugs <D>O |NRJy |NRJy mls/day or K mls/hrK OU|Ry OK|Ry OF|Ry Estimated blood volume is mlsK Fluids: Calculating for % dehydrationKO Normal fluid requirement is Pre-existing deficit: mlsK Thus IV fluids for first 24h: mls or K mls/hrK( fluids: K+ mls/24h. K % dehydn = K K+ mls/24h (K mls/hr)K +,Paediatric fluid requirements: Normal valuesO Normal fluid requirement is Normal fluid requirement is Estimated water losses:+ Urinary: *433333 mls/dayK Insensible: *433333 mls/dayK Faecal: * mls/dayK Minimum urine output: mls/hrK DehydrationOd( GuidelinesOg( Fluid Requirements Estimated blood volume (mls) : #26<10 days old: 85mls/kg #27<10 yrs old: 75mls/kg #28>=10 yrs old: 70mls/kg + #29Weight Requirement + #30<10 kg 100 mL/kg/day #3110-20 kg +(1000 ml + 50 x (weight(kg)-10) mL/kg/day + #32>20 kg +(1500 ml + 20 x (weight(kg)-20) mL/kg/day +&Minimum urine output: 0.5 - 1 mL/kg/hr Dehydration: +=Pre-existing deficit (mls) = % dehydration x weight (kg) x 10 +7Estimated daily water losses as % of fluid requirement: +< Urinary: 60%, Insensible: 30%, Faecal: 10% Water losses are approximate estimations and do not take +$ into account metabolic water gains +:1. Habel A. Synopsis of Paediatrics. Butterworth-Heinemann + Ltd. 1993. Pages 210 and 677. +<2. Collier J et al. Oxford Handbook of Clinical Specialities +0 Ed 4, Oxford University Press. 1995, Page 250 +73. Milner A, Hull D. Hospital Paediatrics. 2nd Edition. +' Churchill Livingstone.1992. Page 208 Calculation of fluid deficit Enter estimated % dehydrationO Signs ofO Dehydration?KOd( CancelO Estimating dehydrationO Mild+ : decreased urine output 5%+ : above + dry mucous membranes 10%+/: above + sunken fontanelle, decreased eyeball +$ pressure, tachycardia, hoarse cry >10%+): above + shock, drowsiness, hypotension Fluids <F>O height, gender, K , C[& Using stored +,Statistics: Enter gender and height of childO Gender+ Male,Female Height (cm)O leave height at 0 to estimate +*Note: height only used for BSA calculation +1Note: height only used for PEFR & BSA calculation CancelO 140 bpm (range: 115 to 165) 85 mmHg (range: 70 to 100) 30 /min (range: 22 to 38) 120 bpm (range: 100 to 140) 95 mmHg (range: 80 to 110) 27 /min (range: 23 to 32) 110 bpm (range: 90 to 130) 100 mmHg (range: 88 to 112) 25 /min (range: 21 to 29) 105 bpm (range: 85 to 125) 100 mmHg (range: 88 to 112) 23 /min (range: 20 to 26) 95 bpm (range: 80 to 110) 110 mmHg (range: 102 to 118) 20 /min (range:18 to 22) 80 bpm (range: 60 to 100) 110 mmHg (range: 100 to 128) 14 /min (range:12 to 16) O |B`[! O |2[ O |NO WB}B[! ratio= Height must be >20cmO WarningO Height entered is less than 75% of the 50th centile. << BackOb+ Ob@[ +$Entered height is below 3rd centile!O +%Entered height is above 97th centile!O estimated height known height Normal values for this child ( Heart rate: Systolic BP: Respiratory rate: + CENTILES:+ 3% 50% 97% Weight: kg |2\[I Height:+ ----- -----K( Height: cm *333333 *333333 Body surface area: Paeds: BSA: R*?W[ RN*gfffffM@ Using adult PEFR equationO Predicted PEFR: l/minK , Predicted PEFR: K l/minK + FBC / CBCOl+ GuidelinesOg( Ol@[2 + Paediatric Centiles & Statistics Pulse, BP and RR are based on standard data for the +5 following ages (irrespective of gender): Under 1yr, +- 1-2 yrs 2-3yrs, 4-9 yrs, 10-11 yrs, >12 yrs Centiles calulations are based on standard weight & +8 height data for the following ages: birth, 3/12, 6/12, +1 9/12, 12/12, 18/12 and then yearly, up to 18yrs Values for ages between the above are calculated +$ using a linear intermediate method +)PEFR (l/min) = (height (cm) x 5.27) - 427 +BIf height is not entered, 50th centile height is used based on age Body Surface Area (m +9 ( Weight(kg) ^ 0.425 ) x ( Height(m)^0.725 ) x 0.007184 + PEFR = Peak Expiratory Flow Rate +9Collier J et al. Oxford Handbook of Clinical Specialities +6Ed 4, Oxford University Press. 1995, pages 175 and 294 height, K gender, K , C[& Storing Statistics <Z>O mg tds po *K Not recommended ml 125/31 susp. tds poK 5 ml 125/31 susp. tds po 5 ml 250/62 susp. tds po mg tds ivK mg tds-qds ivK mg qds ivK mg tds ivK mg qds poK 125 mg qds po O |2[ 250 mg qds po 250-500 mg qds po mg qds iv *K 62.5-125 mg qds po 62.5-250 mg qds iv 125-250 mg qds po 125-500 mg qds iv 250-500 mg qds po 0.25-1 g qds iv mg tds ivK mg tds o/ivK 62.5 mg qds po 125 mg qds po 250 mg qds po not recommended 25 mg bd po 50 mg bd po 100 mg bd po + mg bd ivK mg nocte poK +6Antibiotics (Page 1 / 2) (* = double dose if severe)O Amoxycillin: Augmentin: Benzylpenicillin: Cefuroxime: Cefalexin: Erythromycin: GuidelinesOg( CancelO >> NextO Og@[v Paediatric Antibiotics #1 +8AMOXYCILLIN: PO tds: If weight known or <1yr: 8.33mg/kg, + 1-5yr 125mg, 6-12yr: 259mg. ** +7AUGMENTIN: PO tds: 1/12->1yr: 0.266 mL/kg, 1-6yr: 5ml +) (125/31 susp), 6-12yr 5ml (250/62 susp) +$ IV: 25 mg/kg tds, tds-qds if >3/12 +!BENZYLPENICILLIN : IV 25mg/kg qds CEFUROXIME : IV 20mg/kg tds CEFALEXIN : PO 6mg/kg qds @** = double dose if severe ERYTHROMYCIN +2 PO qds: <2yr 125mg , 2-8yr 250mg, >8yr 250-500mg IV: 6-12.5mg/kg qds ** @** = double dose if severe Antibiotics (Page 2 / 2)O Flucloxacillin: Gentamicin: Metronidazole: Penicillin-V: Trimethoprim: UTI prophylaxis: GuidelinesOg( << BackOb+ Paediatric Antibiotics #2 +<FLUCLOXACILLIN: PO QDS: <2yo: 62.5-125mg , <10yo: 125-250mg, >10yo: 250-500mg +> IV QDS: <2yo: 62.5-250mg , <10yo: 125-500mg, >10 yo: 250-1g GENTAMICIN IV 2.5mg/kg tds +!METRONIDAZOLE O/IV 7.5mg/kg tds +CPENICILLIN V : PO QDS: <1yr: 62.5mg, 1-5yr: 125 mg , 6-12yrs: 250mg +8TRIMETHOPRIM : PO BD: 2-5month: 25mg, 6mnth - 5yr: 50mg, +" 6-12yrs: 100mg. IV 4mg/kg BD +% UTI prophylaxis: PO: 1-2mg/kg nocte mg tds slow ivK 20 mg tds slow iv 25 mg tds slow iv/po not recommended po *333333 5-10 mg bd-tds po/pr *333333 mg bd-tds po/prK not recommended im 6.25 mg 8 hrly deep im mg tds - K *333333 mg bd iv/im/poK mg od slow iv/imK 4 mg od slow IV/im AntiemeticsO Cyclizine: Metoclopramide: Prochlorperazine: Ondansatron: GuidelinesOg( Paediatric Anti-emetics +7CYCLIZINE: PO: 6-12yrs: 25mg tds. IV TDS: <2yo;1mg/kg, 2-5yo: 20mg, >6yo:25mg +4PROCHLOPERAZINE (Stemetil): PO (if >10kg): 0.15-0.25 +; mg/kg 8 hrly (5-10mg tds). Deep IM (if >5yo): 6.25mg tds METOCLOPRAMIDE (Maxolon): +' PO/IM/IV: 0.15mg/kg bd - 0.1mg/kg tds +-ONDANSATRON: 0.1 mg/kg slow IM/IV OD, max 4mg (dose for post-op n&v only) ?>\[m 60-100 mg qds po/pr 120-250 mg qds po/pr 250-500 mg qds po/pr mg qds po/prK Not recommended mg tds poK 400 mg tds po Not recommended mg tds po/prK Not recommended mg tds poK mg 4 hourly po/imK mcg 4 hourly sc/imK mcg 4 hourly sc/imK 2.5-5 mg 4 hourly sc/im 5-10 mg 4 hourly sc/im mg 4 hourly iv slowK + AnalgesiaO Paracetamol: Ibuprofen: Codeine: Diclofenac: Pethidine: + Morphine: GuidelinesOg( Og@[P Paediatric Analgesia +9PARACETAMOL: PO/PR QDS: <3/12 or known weight: 10-15mg/kg +4 If weight estimated & >=3/12 old: <1yo: 60-100 mg, +& <6yo: 120-250 mg, 6-12yo: 250-500 mg +6IBUPROFEN: PO TDS: <7kg OR <1/12: N/A, else 6.66 mg/kg +4DICLOFENAC: PO/PR TDS: <1yo: N/A, else 0.333-1 mg/kg +'CODEINE: PO TDS: <1yo: N/A, else 1mg/kg +&PETHIDINE: PO/IM 4 hourly: 0.5-2 mg/kg +,MORPHINE: SC/IM 4 hourly: <1/12: 150 mcg/kg, +2 <1yr: 200mcg/kg, <6yo: 2.5-5 mg, 6-12yo: 5-10 mg +) IV: 1yr & over: 0.1mg/kg 4 hourly slow Check formulae 2.5 mg neb stat 5 mg neb stat 125 mcg neb stat 250 mcg neb stat 500 mcg neb stat mg IV / 30minK mg IV / 30min. Then K mg/hr IVIK mg IV / 5minsK |RO(|>[ mg po od initiallyK estimated weight known weight AsthmaO Salbutamol: + Atrovent: Aminophylline: Prednisolone: Hydrocortisone: GuidelinesOg( W7Og@[ Paediatric Asthmatic Drugs +0SALBUTAMOL: 6/12 - 5yr: 2.5mg NEB, >5yr: 5mg neb +2ATROVENT (Iprotroprium Bromide) NEB: <1yr: 125mcg, 1-5yr: 250 mcg, >5yr: 500mcg +"AMINOPHYLLINE: 5mg/kg / 30 min IV, +# then (if over 1/12) 1mg/kg/hr IVI +$PREDNISOLONE: 2mg/kg PO OD initially +$HYDROCORTISONE: 4mg/kg IV over 5mins mcg (K mls 1 in 1000 soln) IM/SCK ml 1 in 1,000 soln IM/SCK mcg (K mls 1 in 10,000 soln) IVK Od|R( Od|RO mcg (K mls 1 in 1,000 soln) IVK mg (K mls 1 in 1,000 soln) IVK 100 mcg mcgK ml 50% soln (K g) IVK mmol (K mls 4.2% soln) slow IVK mmol (K mls 8.4% soln) slow IVK mg (K mls 10% soln) IVK |6\[L mcg (K mls 20 mcg/mL soln) IVK mcg (K mls 400 mcg/mL soln) IVK joulesK joulesK (uncuffed) 3.0-3.5 18-21 7.5-8.0 (cuffed) mg (K mls 1% soln) IVK O2|RO mcg IV every 2 minsK Emergency Drugs (Page 1 / 2)O Adrenaline (initial): subsequent CPR loops: + Atropine: Adenosine: Bicarbonate: Calcium Chloride: Lignocaine: GuidelinesOg( CancelO >> NextO Paediatric Emergency Drugs #1 +>ADRENALINE (CPR): 10mcg / kg (0.1 mL/kg 1 in 10,000 solution), +2 then 100mcg / kg (0.1mL/kg 1 in 1,000 solutn) IV +-ATROPINE: 20mcg / kg (min 100 mcg, max 3g) IV +*ADENOSINE: 50 mcg/kg IV bolus every 2 mins +.BICARBONATE: 1 mmol/kg (1 mL/kg 8.4% solution) +% (Dilute to 4.2% in infants) slow IV +5CALCIUM CHLORIDE: 10 mg/kg (0.1 mls/kg 10% solutn) IV +-LIGNOCAINE: 1 mg/kg (0.1 mls/kg 1% solutn) IV Emergency Drugs (Page 2 / 2)O Initial DC defibrillation: (VF / pulseless VT)K (VT / SVT with shock)K( Adrenaline (anaphalaxis): Glucose: + Naloxone: Fluid bolus in shock: mls IVK ET Tube : Oral length: K cm. Int. diameter: K GuidelinesOg( << BackOb+ Ob@[ Og@[V Paediatric Emergency Drugs #2 #25Initial DC shock: +!VF / pulseless VT: 2 joules / kg. +%@SVT / VT with shock: 0.5 joules / kg +"ADRENALINE (in anaphalaxis): SC/IM +B Age(yr) : mls (1 in 1,000 solution): <1yr: 0.05mls, 1yr: 0.1mls, += 2yrs: 0.2mls, 3-4yrs: 0.3mls, 5yrs: 0.4mls, 6-12yrs: 0.5mls +.GLUCOSE: 0.5-1 g/kg OR 1-2 mL/kg 50% solutn IV +3NALOXONE: 10 mcg/kg (0.025 mls/kg 400 mcg/mL solutn +- (Neonates: 0.5 mls/kg 20 mcg/mL solutn)) IV +<Initial IV FLUID BOLUS in haemodynamic shock: 20 mls / kg IV +7 (crystalloid or colloid according to local protocols) ENDOTRACHEAL TUBE SIZES: +#Age: Oral length, Internal diameter #260-3mnth: 10cm, 3.0-3.5mm 4-6yr: 15cm, 5.5mm #273-6mnth: 12cm, 3.5mm 6-8yr: 16cm, 6.0mm #286mnth-1yr: 12cm, 4.0mm 8-10yr: 17cm, 6.5mm #291-2yr: 13cm, 4.5mm 10-12yr: 18cm, 7.0mm #302-4yr: 14cm, 5.0mm >12yr: 18-21cm, 7.5-8.0mm +8ET tubes should be UNCUFFED, unless oral length 18-21 cm + 2.5 mg PR 5 mg PR 5-10 mg PR mg IV / PR (rpt after 10 mins)K mg/hr IVIK mg IV / 5 minsK |VO2|:[9 + mg IV / K |RO2|VO minsK mg IV / 20 - 30 minsK mg /?24h IVIK *333333 mls PR (in arachis oil)K mls PR (in arachis oil)K O2|R( mg IV. Then KO mcg/hr IVIK O2|RO mcg IV. Then KO mcg/hr IVIK O2|R( mg PR / IVK O2|RO Od|RO mcg PR / IVK OP|RO mcg/min IVI for first 2-4 hrsK +3Anti-convulsants (* = see BNF for cautions)O + Diazepam: (dose is based on age only)K * infusion: Paraldehyde: Phenobarbitone: Phenytoin: * Clonazepam: * Chlormethiazole: Lorazepam: GuidelinesOg( W7Og@[ Paediatric Anti-Epileptic Drugs +=DIAZEPAM: IV / PR: 400mcg/kg (rpt after 10 min) (Diazemuls +% IV infusion: 0.1 - 0.4 mg/kg/hr IVI +< Based on age only: PR <1yr:2.5mg, 1-3yr:5mg, 4-12yr:5-10mg +7PARALDEHYDE: Over 6/12 old: 0.2mls/kg, under 6/12 old: 0.15mls/kg PR in arachis oil +8PHENYTOIN: 18mg/kg IV over 20-30 mins, max rate 50mg/min CLONAZEPAM: 50 mcg/kg IV bolus. Infusion: 10 mcg/kg/hr IVI +4CHLORMETHIAZOLE: 80 mcg/kg/min IVI for first 2-4 hrs + LORAZEPAM: 50 - 100 mcg/kg IV/PR +0PHENOBARBITONE (if under 1yr): 15 mg/kg / 5 mins Preset Drugs <D>O O4|R* +$Under 1 year old: Enter age & weightO +)Enter age in ONE of the following fields: MonthsO WeeksO DaysO DOBO Weight (kg)O leave weight at 0 to estimate GuidelinesOg( CancelO Over 1 yearOo+ New Child <N>O ?JWB} Weight Estimation #30Under 1 year: weight = (40 + age x 60) / 10 #311 - 8 years: weight = (2 x age) + 8.49 #329 years and over: weight = age x 3 Units: age (years), weight (kg) 'Out of centile range' checking is against the 97th male or +< female weight: using the value closest to the 50th centile DOB = over 18 years!O OA|2[ |VWB} |:`[D Enter only ONE value for ageO Formulary DrugsO <ctrl-D>KO Formulary DrugsO <ctrl-D>KO |F\[' weight, K height, K age, K gender, K , C[& Storing Returned to main menuO DRAWTOOLBAR TBAROFFER% ABOUT PREFS ASSIGNUNIT ASSIGNFREQ SCRWID% TOPSCRHT% SCREEN3% USERPATH$ MACHTYPE% SUBFONT% BUTTPRESSED% SUBHT% TITLEHT% TEMP$ TITLEFONT% SCRHT% VERSION TEMP2 SCREEN2% INFO: Edit Paediatric FormularyO +;This section allows you to add your own drug definitions to +"the paediatric section of MediKit. +<Up to 80 drugs can be defined: a total of 8 categories, each +=containing up to 10 drugs. Definitions can vary from simple +1to highly complex: experimenting will reveal all! +:Don't forget to save the drugs you define and MediKit will +8then load them automatically from the paediatric screen. See 'Formulary Drugs' in the Help file for more information( +9 Don't show this information screen again HelpOh+ +'Edit Paediatric Formulary: UNREGISTEREDO +4The registered version of MediKit allows you to save +/up to 80 drug definitions within your fomulary.( +3With this unregistered copy, only the first 5 drugs +.within category 1 can be saved for future use.( +6Register MediKit to gain full access to the formulary. +- Don't show this information screen again PaedsDrugsK _*433333 D[O { .oldKW WarningO +$MediKit was only able to find an old version of the 'Drugs File'. This file will now be opened CancelO .oldK Drug file not foundO Category RenameO CategoryK Category 8 Paediatric Formulary Paediatric Formulary +%Select a category above & click twice +$on the drug that you wish to define. Press MENU for furthur options. O>O>O> Nothing to saveO H{A\[ {A\[0 Oc{AO O {A`[ O0{9O O;{1\[A O0{A[ '{A`[ {A\[ {5\\[ _{A\[ _{A\[ _{A\[ _{A\[ _{1\O {A\[s ?RN:O ?RN2\[ {A\[s ?RN:O ?RN2\[ O`{Ix O@{Ix More+ Revert to savedO ( Erase all drugsO More+ Revert to savedO + Erase all drugsO File+ Save FormularyOs( More>O Return to Paediatric Menu Close MediKitOe File+ Save FormularyOs+ More>O Return to Paediatric Menu Close MediKitOe + UndefinedC\[Q Drug+ Edit currentO DeleteOd( CutOx( CopyOc( PasteOv( + UndefinedC |F\[M Drug+ Edit currentO DeleteOd( CutOx( CopyOc( PasteOv + UndefinedG\[E Drug+ Edit currentO DeleteOdh+ CutOx+ CopyOc+ PasteOv( Drug+ Edit currentO DeleteOdh+ CutOx+ CopyOc+ PasteOv SelectO Category+ RenameOr+ Select>O View+ Zoom inOm+ Zoom outOM Tools+ Stored ValuesO Results logO PreferencesOkh+ AboutOA+ HelpOH tZOc@[ tZOx@[ tZOv@[ tZOd@[ tZOs@[* Nothing to saveO tZOr@[ tZOm@[ tZOM@[ tZOk@[ tZOp@[ Return to Paediatric menu +%Do you want to save the changes made? CancelO NoOn( YesOy( tZO @[ No changes madeO Confirm the loss of all changes ('Yes' discards all changes) YesOy( NoOn( Oy@[ WarningO +/Selecting this option will erase ALL drug data, replacing it with blank fields( Are you sure ?O YesOy( NoOn( Oy@[# All data resetO tZOA@[ tZOH@[ tZOe@[ Warning: Unsaved data Current file has not been savedO +&Are you sure you want to quit MediKit? NoOn( YesOy( CopyO PasteO + UndefinedC[ Nothing to copyO CopiedO Nothing to pasteO + UndefinedG[t Overwrite existing drug ' NoOn( YesOy( AbortedO Record replacedO + UndefinedC[ Nothing to deleteO Delete this record? (' NoOn( YesOy( AbortedO + Undefined Record deletedO RenameO CategoryKO Rename Category: lX+ New name:O CancelO RenameO CategoryKO You must specify a nameO Category renamedO + UndefinedG[ New drug Define new drug (Category : Drug K Y+81. Do you need different doses for different age groups? +2 (eg 'under 1 year: 10mg/kg, over 1yr: 20mg/kg')( Y++2. Do you need 'minimum and maximum' values +% for any doses? (eg '10-20 mg/kg') CancelO >> NextO +(Enter drug details (multiple age groups)O + Drug NameO Dose+ (Enter in next page) No. of different age groups+ 1,2,3,4,5,6 Units for Dose+8g/kg,mg/kg,mcg/kg,mL/kg,g,mg,mcg,ml,(Enter in next page) q=+ Frequency+DStat,qd,bid,tid,qid,5x/day,6x/day,7x/day,8x/day,(Enter in next page) q=+ Frequency+CStat,od,bd,tds,qds,5x/day,6x/day,7x/day,8x/day,(Enter in next page) Admin. RouteO Additional NoteO CancelO << BackOb+ >> NextO CancelO >> NextO Ob@[ + UndefinedC[( Invalid nameO New drug U[+}0,1 month,3 months,6 months,9 months,1 year,2 years,3 years,4 years,5 years,6 years,7 years,8 years,9 years,10 years,11 years U[+#g/kg,mg/kg,mcg/kg,mL/kg,g,mg,mcg,ml U[+/Stat,qd,bid,tid,qid,5x/day,6x/day,7x/day,8x/day U[+.Stat,od,bd,tds,qds,5x/day,6x/day,7x/day,8x/day O @[) Dose (O Enter age groups and dosesO Range 1: Lower age limitO MbP?( Range 2: Lower age limitO MbP?( Range 3: Lower age limitO MbP?( CancelO << BackOb+ >> NextO Ob@[ Dose (O Enter age groups and dosesO Range 4: Lower age limitO MbP?( Range 5: Lower age limitO MbP?( Range 6: Lower age limitO MbP?( CancelO << BackOb+ >> NextO Ob@[ Enter age groups and doses Range 1: Lower age limitO Dose (min)* MbP?( (max)O Range 2: Lower age limitO Dose (min)* MbP?( (max)O CancelO << BackOb+ >> NextO Ob@[ |F\[< +''Max' dose must be more than 'Min' doseO +!6OR |F\[< +''Max' dose must be more than 'Min' doseO Enter age groups and doses Range 3: Lower age limitO Dose (min)* MbP?( (max)O Range 4: Lower age limitO Dose (min)* MbP?( (max)O CancelO << BackOb+ >> NextO Ob@[ |F\[< +''Max' dose must be more than 'Min' doseO O&6OR |F\[< +''Max' dose must be more than 'Min' doseO Enter age groups and doses Dose (O Range 5: Lower age limitO Dose (min)* MbP?( (max)O Range 6: Lower age limitO Dose (min)* MbP?( (max)O CancelO << BackOb+ >> NextO Ob@[ |F\[< +''Max' dose must be more than 'Min' doseO s+6OR |F\[< +''Max' dose must be more than 'Min' doseO +%Enter age groups and dose informationO Range 1: Lower age limitO Dose* MbP?( Units for DoseO Units for DoseO q=+ FrequencyO + FrequencyO Range 2: Lower age limitO Dose* MbP?( Units for DoseO Units for DoseO >+ FrequencyO + FrequencyO CancelO << BackOb+ >> NextO Ob@[ +%Enter age groups and dose informationO Range 3: Lower age limitO Dose* MbP?( Units for DoseO Units for DoseO >+ FrequencyO + FrequencyO Range 4: Lower age limitO Dose* MbP?( Units for DoseO Units for DoseO c?+ FrequencyO + FrequencyO CancelO << BackOb+ >> NextO Ob@[ +%Enter age groups and dose informationO Range 5: Lower age limitO Dose* MbP?( Units for DoseO Units for DoseO @+ FrequencyO + FrequencyO Range 6 Lower age limitO Dose* MbP?( Units for DoseO Units for DoseO @+ FrequencyO + FrequencyO CancelO << BackOb+ >> NextO Ob@[ +%Enter age groups and dose informationO Range 1: Lower age limitO Dose (min)* MbP?( (max)O Units for DoseO Units for DoseO q=+ FrequencyO + FrequencyO CancelO << BackOb+ >> NextO Ob@[ |F\[< +''Max' dose must be more than 'Min' doseO +%Enter age groups and dose informationO Range 2: Lower age limitO Dose (min)* MbP?( (max)O Units for DoseO Units for DoseO >+ FrequencyO + FrequencyO CancelO << BackOb+ >> NextO Ob@[ +!6OR |F\[< +''Max' dose must be more than 'Min' doseO +%Enter age groups and dose informationO Range 3: Lower age limitO Dose (min)* MbP?( (max)O Units for DoseO Units for DoseO >+ FrequencyO + FrequencyO CancelO << BackOb+ >> NextO Ob@[ |F\[< +''Max' dose must be more than 'Min' doseO +%Enter age groups and dose informationO Range 4: Lower age limitO Dose (min)* MbP?( (max)O Units for DoseO Units for DoseO c?+ FrequencyO + FrequencyO CancelO << BackOb+ >> NextO Ob@[ O&6OR |F\[< +''Max' dose must be more than 'Min' doseO +%Enter age groups and dose informationO Range 5: Lower age limitO Dose (min)* MbP?( (max)O Units for DoseO Units for DoseO @+ FrequencyO + FrequencyO CancelO << BackOb+ >> NextO Ob@[ |F\[< +''Max' dose must be more than 'Min' doseO +%Enter age groups and dose informationO Range 6: Lower age limitO Dose (min)* MbP?( (max)O Units for DoseO Units for DoseO @+ FrequencyO + FrequencyO CancelO << BackOb+ >> NextO Ob@[ s+6OR |F\[< +''Max' dose must be more than 'Min' doseO +@Error: The age ranges you entered do not run in increasing orderO The 'lower age range' for each group must less than the +( 'lower age range' for the next group. Click 'Back' to view and adjust the age ranges. << BackO U[+}0,1 month,3 months,6 months,9 months,1 year,2 years,3 years,4 years,5 years,6 years,7 years,8 years,9 years,10 years,11 years U[+}0,1 month,3 months,6 months,9 months,1 year,2 years,3 years,4 years,5 years,6 years,7 years,8 years,9 years,10 years,11 years U[+#g/kg,mg/kg,mcg/kg,mL/kg,g,mg,mcg,ml U[+/Stat,qd,bid,tid,qid,5x/day,6x/day,7x/day,8x/day U[+.Stat,od,bd,tds,qds,5x/day,6x/day,7x/day,8x/day Birth 1 month infancy (<1/12) 3 months 2 months 6 months 5 months 9 months 8 months ^+ 11 months yrsK yrsK +#Confirm the data entered for drug 'OR + Age range+ Dose( + and over to O - KOR + and over to O - KOR + and over to O )3:[; - KOR + and over to O - KOR + and over to O M8:[; - KOR + and over - KOR Note: 'OR CancelO << BackOb+ U[+}0,1 month,3 months,6 months,9 months,1 year,2 years,3 years,4 years,5 years,6 years,7 years,8 years,9 years,10 years,11 years U[+}0,1 month,3 months,6 months,9 months,1 year,2 years,3 years,4 years,5 years,6 years,7 years,8 years,9 years,10 years,11 years U[+#g/kg,mg/kg,mcg/kg,mL/kg,g,mg,mcg,ml U[+/Stat,qd,bid,tid,qid,5x/day,6x/day,7x/day,8x/day U[+.Stat,od,bd,tds,qds,5x/day,6x/day,7x/day,8x/day New drug +*Enter drug details (one dose for all ages)O + Drug NameO Dose (min)* MbP?( (max)O Dose* MbP?( Units for Dose+#g/kg,mg/kg,mcg/kg,mL/kg,g,mg,mcg,ml Admin. RouteO q=+ Frequency+/Stat,qd,bid,tid,qid,5x/day,6x/day,7x/day,8x/day q=+ Frequency+.Stat,od,bd,tds,qds,5x/day,6x/day,7x/day,8x/day Additional NoteO CancelO << BackOb+ CancelO Ob@[ + UndefinedC[( Invalid nameO New drug Saving FormularyO .oldKW .oldK .oldK + UndefinedG[ OQ|B[ DDRUGNUM% DDRUG$ DTYPE% DDOSE1 DDOSE2 DDOSE3 DDOSE4 DDOSE5 DDOSE6 DDOSE11 DDOSE12 DDOSE13 DDOSE14 DDOSE15 DDOSE16 DAGE1 DAGE2 DAGE3 DAGE4 DAGE5 DAGE6 DUNIT$ DFREQ1% DFREQ2% DFREQ3% DFREQ4% DFREQ5% DFREQ6% DROUTE1$ DNOTE1$ Insufficient disc spaceO +#Try closing any other open programs or delete any unnecessary files and retry saving. DDRUG$' MediKit Paediatric Drug Data DDOSE1& + UndefinedG[ Writing drug DDRUG$' + DDRUGNUM%$ DTYPE%$ DDOSE1& DDOSE2& DDOSE3& DDOSE4& DDOSE5& DDOSE6& DDOSE11& DDOSE12& DDOSE13& DDOSE14& DDOSE15& DDOSE16& DAGE1& DAGE2& DAGE3& DAGE4& DAGE5& DAGE6& DUNIT$' DFREQ1%$ DFREQ2%$ DFREQ3%$ DFREQ4%$ DFREQ5%$ DFREQ6%$ DROUTE1$' DNOTE1$' YOQ|B[I + DDRUGNUM%$ Writing categoriesO + UndefinedG[ O |B[ DDRUG$' DFREQ1%$ O |B[ drugs savedKO O2@[ Reading FormularyO DDRUGNUM% DDRUG$ DTYPE% DDOSE1 DDOSE2 DDOSE3 DDOSE4 DDOSE5 DDOSE6 DDOSE11 DDOSE12 DDOSE13 DDOSE14 DDOSE15 DDOSE16 DAGE1 DAGE2 DAGE3 DAGE4 DAGE5 DAGE6 DUNIT$ DFREQ1% DFREQ2% DFREQ3% DFREQ4% DFREQ5% DFREQ6% DROUTE1$ DNOTE1$ +!Error loading Pediatric Formulary Error opening file Error message: 'W MediKit will now delete this file CancelO File deleted + Undefined OQ|B[ Y+ DDRUGNUM% DDRUG$# DTYPE% DDOSE1" DDOSE2" DDOSE3" DDOSE4" DDOSE5" DDOSE6" DDOSE11" DDOSE12" DDOSE13" DDOSE14" DDOSE15" DDOSE16" DAGE1" DAGE2" DAGE3" DAGE4" DAGE5" DAGE6" DUNIT$# DFREQ1% DFREQ2% DFREQ3% DFREQ4% DFREQ5% DFREQ6% DROUTE1$# DNOTE1$# YOQ|B[G DDRUG$# DFREQ1% O |B[ P[L|O drug slots free.KO + Undefined YOQ|B[ lX+ Category O |B[ +$Register to define more than 5 drugsO TEMP$ mg/kg mcg/kg mL/kg TEMP$ 5x/day 6x/day 7x/day 8x/day 5x/day 6x/day 7x/day 8x/day STRIPZERO PAEDAGE PAEDWEIGHT USERPATH$ TEMP$ SCREEN3% PaedsDrugsK .oldKW WarningO +$MediKit was only able to find an old version of the 'Drugs File'. This file will now be opened CancelO NoteO +"No Formulary Drugs file was found. +)To set up your own drug protocols, select +-'Define formulary drugs' from the 'File' menu Loading FormularyO DDRUGNUM% DDRUG$ DTYPE% DDOSE1 DDOSE2 DDOSE3 DDOSE4 DDOSE5 DDOSE6 DDOSE11 DDOSE12 DDOSE13 DDOSE14 DDOSE15 DDOSE16 DAGE1 DAGE2 DAGE3 DAGE4 DAGE5 DAGE6 DUNIT$ DFREQ1% DFREQ2% DFREQ3% DFREQ4% DFREQ5% DFREQ6% DROUTE1$ DNOTE1$ +!Error loading Pediatric Formulary Error opening file Error message: 'W MediKit will now delete this file CancelO File deletedO + Undefined OQ|B[ + DDRUGNUM% DDRUG$# DTYPE% DDOSE1" DDOSE2" DDOSE3" DDOSE4" DDOSE5" DDOSE6" DDOSE11" DDOSE12" DDOSE13" DDOSE14" DDOSE15" DDOSE16" DAGE1" DAGE2" DAGE3" DAGE4" DAGE5" DAGE6" DUNIT$# DFREQ1% DFREQ2% DFREQ3% DFREQ4% DFREQ5% DFREQ6% DROUTE1$# DNOTE1$# OQ|B[F DDRUG$# DFREQ1% O |B[ NoteO +1No drug definitions found within formuluary file. +)To set up your own drug protocols, select +&'Define formulary drugs' from the menu user-defined drugs in memoryKO O |B[ PO L| + UndefinedG[ + UndefinedG PO L| PO L| |B`\[h ^WB} 5x/day 6x/day 7x/day =O @[ 8x/day 5x/day 6x/day 7x/day =O @[ 8x/day Not recommended (User defined, Screen 1 / 2)KO CancelO >> NextO (User defined)KO CancelO PO L| + UndefinedG[< (User defined, Screen 2 / 2)KO << BackOb+ (User defined)KO CancelO + UndefinedG[@ using drawbuttons Preset Drugs <D>O Formulary DrugsO <ctrl-D>KO New Child <N>O Fluids <F>O Statistics <Z>O RIGHT& LEFT& CMNTH CWT50 CWT97 CHT50 CHT97 *433333 O |B[? *gfffff *433333'@ *gfffff'@ *gfffff,@ *gfffff$@ *gfffff)@ *gfffff/@ *433333'@ *gfffff-@ O |B[2 CMNTH CWT50 CWT97 CHT50 CHT97 *433333 *433333 O |B[9 *gfffff!@ *gfffff *433333#@ *433333+@ *433333#@ *gfffff&@ *433333,@ *gfffff1@ O |B[2 GUIDENAG GUIDELINES TEMP2 SCREEN3% GUIDEL% GUIDEL$ GLOBSEX% he[@J Enter gender of child Gender:+ Male,Female CancelO Haematology + 6-26 [11] 0.02-0.8 0.4-3.1 + 6-26 [11] 0.02-0.8 0.4-3.1 + 6-26 [11] 0.02-0.8 0.4-3.1 1.5-10 [5] 0.07-0.1 0.3-2.7 + 1-9.5 [4] 2-17 [6] 0.07-0.1 0.2-2.4 + 1-9.5 [4] 2-17 [6] 0.07-0.1 0.2-2.4 1-9.5 [4]) 2-17 [6] 0.07-0.1 0.2-2.4 + 1-9.5 [4] 2-17 [6] 0.07-0.1 0.2-2.4 + 11.5 (>9) 88 (>80) + 1-9.5 [3] 2-17 [6] 0.07-0.1 0.2-2.4 + 11.5 (>9) 77 (>70) + 1-9.5 [3] 2-17 [6] 0.07-0.1 0.2-2.4 + 11.5 (>9) 78 (>72) + 1-9.5 [3] 2-17 [5] 0.07-0.1 0.2-2.4 + 11.5 (>9) 78 (>74) + 1-9.5 [3] 2-17 [5] 0.07-0.1 0.2-2.4 12.2 (>10) 80 (>75) + 1-9.5 [4] 2-17 [4] 0.07-0.1 0.2-2.4 13.0 (>10.4) 82 (>75) 1-9.5 [4.2] 2-17 [3.8] 0.07-0.1 0.2-2.4 13.8 (>11) 83 (>76) 1-9.5 [4.9] 2-17 [3.1] 0.07-0.1 0.2-2.4 84 (>77) + 1-9.5 [5] 2-17 [3] 0.07-0.1 0.2-2.4 14.2 (>12) 14 (>11.5) 85 (>78) + 2-7.5 [5] 1.3-3.5 30-36 0.8-2 0.04-0.4 0.2-0.8 14.8 (>12) 14 (>11.5) 85 (>78) + 2-7.5 [5] 1.3-3.5 30-36 0.8-2 0.04-0.4 0.2-0.8 15 (>13) 14 (>11.5) +#Normal haematology reference valuesO Hb: g/dLK MCV: flK+ MCHC: Reticulocytes: Platelets: 150-400 x 10^9/L( WCC: K+ x 10^9/LK Neutrophils: K+ x 10^9/LK+ Eosinophils: K+ x 10^9/LK Lymphocytes: K+ x 10^9/LK+ Monocytes: K+ x 10^9/LK +,Figures in square brackets = [median values]O GuidelinesOg( +,Blood results are based on standard data for the following ages: Days: 1, 4, 5 + Weeks: 1-2, 2-3, 4-5, 6-7, 8-9 Months: 3, 6, 12 +, Years: 2, 4, 6, 12, 14(M&F), 16(M&F) 18(M) M=male, F=Female Reference values provided as a general guide - +' check them with your local laboratory +9Collier J et al. Oxford Handbook of Clinical Specialities +*Ed 4, Oxford University Press. 1995, p 292 Storing gender PAEDI MACH$ SCREEN3% he[@J C:\System\Apps\MediKit\Regdat SCREEN3% MACH$ TEMP$ he[@J Registration errorO +8Registration information exists which was not entered on this particular machine. +%This information will now be deleted.( +9Please re-enter your registration code from your records. +7If you have forgotten your code then email JJ@Perry.net C:\System\Apps\MediKit\Regdat medikitmyn O`{A[ OI{A[ PAEDI SCREEN3% TEMP$ he[@J Registered to Information Program already registered! +"Enter MediKit registration detailsO + User nameO Registration codeO CancelO Unsuccesful RegistrationO +*The information you entered was incorrect. +)Please ensure that the name and code were entered EXACTLY as supplied. C:\System\Apps\MediKit\Regdat c:\System\Data\ISP_142g.DAT c:\System\Data\Timescr.dat Registered to Succesful Registration!O +!Thank you for registering MediKit +'and supporting the concept of shareware( +$Don't hesitate to contact me for any support or suggestions. GUIDENAG GUIDELINES TITLEHT% TITLEFONT% SUBFONT% TEMP$ SCRWID% GLOBWT SCRHT% SCREEN3% GUIDEL% GUIDEL$ TEMP2 he[@J *433333 Paracetamol Overdose +3Can only advise if hours since ingestion >4 and <24 +%This section 1997 Medi-Cal Software +%This section 1997 Medi-Cal Software h|B\[$ Using stored weight mmol/l Enter valuesO Weight (kg)O Hours since ingestionO Serum Paracetamol ( UnitsOu+ CancelO Ou@[< Using mg/L Using mmol/l +7- Check Creatinine & PT Time at 24 hrs post ingestion - +<- Check Creatinine & PT Time at 24 & 48 hrs post ingestion - High Risk Patient? Is this patient at high riskO of hepatic damage?( CancelO Don'tO knowKOd( KOy( KOn( High Risk PatientsO +-1. Those taking hepatic enzyme inducing drugs +( (eg Carbamazepine, phenobarbitone, +) phenytoin, rifampicin and alcohol) 2. Malnourished patients +$ (alcoholism, anorexia, HIV+ve) On@`[ On@[C Ow|:\[ Of|:\[ OQ|:\[ OD|:\[ O;|:\[ O1|:\[ O)|:\[ O#|:\[ |:\[ Oy@[= Oc|:\[ OT|:\[ OE|:\[ O;|:\[ O1|:\[ O)|:\[ O"|:\[ O |:\[ |:\[ +$Acetylcysteine infusion NOT REQUIRED RepeatOr( mg K+ mls*)K+& in 200ml of 5% Dextrose over 15 mins K mg K+ mls*)K+$ in 500ml of 5% Dextrose over 4 hrs K mg K+ mls*)K+& in 1000ml of 5% Dextrose over 16 hrs K + Acetylcysteine infusion REQUIREDO ++*: mls = mls of 200mg/mL Parvolex ampoules( GuidelinesOg( RepeatOr( Or@[ Og@[f If Acetylcysteine required +21. Give 150mg/kg in 200ml 5% dextrose over 15 mins +22. Then 50 mg/kg in 500ml 5% dextrose over 4 hours +93. Then 100mg/kg in 1l 5% dextrose over 16 hours (all IV) Acetylcysteine supplied as Parvolex : 10ml ampoules containing 2 grams (200mg/mL Paracetamol levels are compared against 22 derivative +4 levels from a treatment thresholds graph (in mg/L) Serum paracetamol units: 150 mmol/l = 1 mg/l PT = Prothrombin time + British National Formulary, 1997 Storing weight GUIDELINES TITLEHT% TITLEFONT% SUBFONT% GUIDEL% GUIDEL$ he[@J Heparin Infusion +2To calculate APTT ratio, leave ratio field at zero Rate CalculationO +$Current infusion rate (Units / 24h):O APTT ratioO or APTT (patient)O APTT (control)O CancelO |B\[o +8You must enter either the APTT ratio, or the APTT values CancelO |F\[| +7You must enter either the APTT ratio OR the APTT values CancelO *gfffff *gfffff (` |N *433333 *433333 HmmmO +(Predicted new infusion rate is negative! Review initial parameters. CancelO << BackO Increase Decrease Units / 24hrK infusion rate to K Units / 24hrK (Therapeutic) Continue with Units / 24hrK + (Low) (High) +.Results (aiming for an APTT ratio of 1.5-2.5)O Current APTT ratio: Current Infusion rate: Stop infusion for 30-60 mins( Recheck APTT in 4 hrs time( Recheck APTT in 24 hrs time( Recheck APTT in 10 hrs time( GuidelinesOg( RepeatOr( Or@[ Heparin infusion #25APTT Ratio : Action #26 >7.0: +,Decr rate by 12000 U/24h, stop for 30-60mins #275.1 - 7.0: Decrease rate by 12000 U/24h #284.1 - 5.0: Decrease rate by 7200 U/24h #293.1 - 4.0: Decrease rate by 2400 U/24h #302.6 - 3.0: Decrease rate by 1200 U/24h #311.5 - 2.5: + No change #321.2 - 1.4: Increase rate by 4800 U/24h #33 <1.2: Increase rate by 9600 U/24h Target APTT ratio 1.5-2.5 +"APTT = Activated prothrombin ratio +*APTT ratio = patient's APTT / control APTT +6Based on 1992 Drugs and Therapeutics Guidelines, using 24h infusion rates. STRIPZERO RESULTS USERPATH$ FROMPAED% SCRWID% GLOBWT TITLEHT% TITLEFONT% SUBFONT% TEMP$ TEMP2 NEWRESULT$ SUBHT% SCREEN3% he[@J + InfusionsK Using current paediatric weight Using stored weight IV Infusion Calculation iviKW + InfusionsK O<|R( IV Infusion Calculation Using standard infusion: +(Enter Infusion Parameters for solution: Weight (kg)*{ Rate of infusion ( MbP?( Solution details for mg of K in K mls of solutionK mg of K in mls of solutionK Note: Enter Infusion ParametersO Weight (kg)*{ Amount of drug (mgs)* MbP?( Volume of solution (mls)O Rate of infusion* MbP?( Units for Rate+ mcg/kg/min,mcg/kg/hr,mg/kg/hr StandardO K+ InfusionsKOs( CancelO Os@[ mcg/kg/min + mcg/kg/hr mg/kg/hr O<|V( O<|RO O<|R( mg of drug in K mls of solutionK for a kg pt, requested rate K .00C[ mg/mLK mL/hrK mL/hrK VO<|R ResultsO Drug concentration: 1 mL/hr: 1 mcg/kg/min: Required infusion rate: |F\[# O<|2[F +& Infusion will run out after minsK( O<|VWB}B[K +& Infusion will run out after O<|VO hrsK( O<|VWB}NO<|R +& Infusion will run out after O<|VO K+ hrs and K mins.K( RepeatOr( ResultsO Required infusion rate: Infusion rate: DetailsOd( RepeatOr( + Results: To infuse for a K kg ptK Required infusion rate: Infusion rate: DetailsOd( RepeatOr( Or@[ Reading infusion data DDRUG$ DDOSE DRATE DUNIT% DNOTE$ Error Error opening file +!MediKit will now delete this file CancelO DDRUG$# DDOSE" DVOL" DRATE" DUNIT% DNOTE$# Using default values Adrenaline pre-programmed data Dobutamine pre-programmed data Dopamine +&pre-programmed: renal vasodilator dose Noradrenaline pre-programmed data Define your own! undefined data IV Infusion Calculation Select infusion type +`The values returned are of predefined standard available infusions, with the usual starting dose +,Enter all the infusion data for calculation h+*Define your own 'Standard Infusions' data Exit Infusion section Od@[ mcg/kg/min + mcg/kg/hr mg/kg/hr IV Infusion Calculation Enter standard infusion data +>You must register to allow standard infusion data to be saved. INFO: Changing infusion dataO +1This section allows you to customise the infusion +!names and details for five drugs.( +,Enter or change the data for each infusion. +0After completing the fifth infusion, you will be +1given the option to save the data for future use.( +(Don't show this information screen again + Edit values for infusion number + Drug nameO + Amount of drug in solution (mgs)* MbP?( Volume of solution (mls)O Usual initial rate* MbP?( Units for Rate+ mcg/kg/min,mcg/kg/hr,mg/kg/hr Additional notesO CancelO >> NextO CancelO << BackOb+ SaveO Final record CancelO << BackOb+ >> NextO +)Do you want to save these values to disc? No: Use initialO MediKit valuesKOm+ No: Keep theO current fileKOn( YesOy( +-Selecting this option will overwrite all data ++you have previously entered, and replace it ++with the values that came with this program( CancelO ConfirmOc( W7Oc@[ NoteO +1The ability to define your own drug infusion data +0is limited to the registered version of MediKit.( You must register MediKit to obtain this feature CancelO Writing dataO DDRUG$ DDOSE DRATE DUNIT% DNOTE$ DDRUG$' DDOSE& DVOL& DRATE& DUNIT%$ DNOTE$' Storing weight GUIDELINES RESULTS SCREEN2% NEWRESULT$ GUIDEL% GUIDEL$ he[@J O1|RWBI} Result + Numbers: Six numbers: GuidelinesOg( RepeatOr( Or@[ Lottery Numbers +9Select integers generated from proven winning random seed +3Arthur et al, "Numbers That'll Come Up Eventually", I.J.C.: 1992: 16,1325-1328 LISTBOXLINK DLControls SEARCH1O LISTBOXCREATE% LISTBOXADDROW% LISTBOXVISIBLE LISTBOXCLOSE LISTBOXPOINTEREVENT% LISTBOXKEYEVENT% LISTBOXFINDROW% LISTBOXCURRENTROW% PAEDS LB_SHADOW% LB_SHOW% LBACTIONPGDN% LBACTIONPGUP% LBACTIONEND% LBACTIONHOME% LBACTIONDN% LBACTIONUP% TEMP$ LB_IGNORECASE% MENU% SCREEN2% he[@J Creating list MediKit Index HO-LO<O CancelO HO-LO<O SelectO Enter Find: O~O~O~ + ERROR: Could not create ListBox!+ CloseW8 +'ERROR: Could not add record to ListBox!+ CloseW8 DLControls OA{=\ {5\[ enter {A\[^ CancelO SelectO A-a oxygen difference (AaDO2) Acid-base graph Allowable blood loss Alvorado score + Anion gap APACHE II score APGAR score Barthel`s index Basal energy expenditure (BEE) Bishop score Body mass index (BMI) Body surface area (BSA) Burns Cardiac index Cardiac output Cardiac risk index (Goldman) Cardiovascular risks Centiles (paediatric) Child Pugh score Children`s coma scale Cockroft & Gault formula +!Coronary heart disease (CHD) risk Corrected calcium Corrected CSF protein +%Corrected CSF white blood count (WBC) Corrected Q-T interval Corrected sodium Creatinine clearance (CrCl) Croup score Delivery dates (EDD / LMP) Drip rates Drug infusions Energy requirements Estimated blood volume Estimated creatinine clearance Estimated protein requirement +!Fractional excreted sodium (FeNa) Free water deficit Glasgow coma scale (GCS) +1Glasgow prognostic criteria in acute pancreatitis Goldman cardiac risk index Hamilton depression scale Height conversion Heparin infusion Ideal body weight (IBW) Imrie score + Infusions Koenig depression scale LDL : HDL cholesterol ratio LDL cholesterol Lean body weight (LBW) Left cardiac work index +"Left ventricular stroke work index Maximum allowable blood loss Mean arterial pressure (MAP) +'Mean pulmonary arterial pressure (MPAP) Mental test score (MTS) +$Mini mental state examination (MMSE) Osmolality (plasma) Paediatric body surface area Paediatric blood count Paediatric fluids Paediatric section Paediatric trauma score Paracetamol overdose +*Peak expiratory flow rate (predicted PEFR) POSSUM score Preferences +#Pulmonary vascular resistance (PVR) +*Pulmonary vascular resistance index (PVRI) Ranson`s criteria Renal failure index (RFI) + Resting energy expenditure (REE) Results log Revised trauma score Right cardiac work index +#Right ventricular stroke work index +!Standardised creatinine clearance Stored values Stroke risk Stroke volume Stroke work (SW) calculations Syracuse croup score +"Systemic vascular resistance (SVR) +)Systemic vascular resistance index (SVRI) Temperature conversion Total : HDL cholesterol ratio Trauma score Units conversion (Biochemical) +"Units conversion (non-biochemical) VLDL cholesterol Weight conversion DLControls h{A[# GLOBWT GLOBHT& GLOBMPAP GLOBSA GLOBAGE GLOBCO GLOBCI GLOBSI GLOBSEX% GLOBMAP% GLOBSV% GLOBLAP GLOBCVP TEMP2 he[@J INFO: Stored ValuesO MediKit remembers the results from calculations and uses them +G in other sections of the program as initial values. (Eg. a previously +5 converted weight is passed to the BMI/BSA section.) Use this section to edit these common values directly, so that +( they are used for future calculations. Use the 'Preferences' menu option to prevent MediKit 'storing' +, these values from other calulation inputs.( +? Don't show this information screen again No values stored Stored Values (Page 1 of 2)O Weight (kg)O Height (cm)O Age (years)O Gender+ Select,Male,Female Body Surface Area (m Enter paediatric age & weight using the +- 'New Child' button on the Paediatric screen Values left at zero will not be stored + Reset allOr+ CancelO >> NextOn+ StoreO No changes made Or@[ Stored Values (Page 2 of 2)O Mean Arterial Pressure (mmHg)O +'Mean Pulmonary Arterial Pressure (mmHg)O Cardiac Output (l/min)O Stroke Volume (ml)O Left Atrial Pressure (mmHg)O h|O2| +"Right Atrial Pressure (CVP) (mmHg)O h|O2| Cardiac Index (l/min/m Stroke Index (mL/beat/m + Reset allOr+ CancelO << BackOb+ StoreO No changes made Or@[ Reset all 'Stored Values'? CancelO YesOy( Oy@[w All values reset No values stored Stored SCRHT% NEWTIME$ NUMRESULTS% RESULTS$ RESTIME$ NEWRESULT$ he[@J SCRWID% NUMRESULTS% TEMP2 RESTIME$ RESULTS$ he[@J Time : Previous resultO No results currently stored ResetOr+ SelectOs( Or@[m Delete all stored results? CancelO YesOy( Oy@[" Results deleted Showing result obtained at K Use 'ctrl+c' to copy the result to the clipboard. You can also add any additional comments to the text. DoneOd NextO ResultKOn+ DoneOd Od@`[ ABOUT3 ABOUT2 MACHTYPE% he[@J NAGSCREEN TEMP$ PATH$ SCREEN3% SCRWID% TBWIDTH% SCRHT% VERSION$ VERDATE$ TEMP2 SCREEN2% SKIP% he[@J Medikit.mbmK Registered to +)Clinical Assistant and Medical Calculator +%for Psion 5 & EPOC handheld computers +4Check http://www.palmaris.com for the latest version NOF|NO +,Email: jonathan@palmaris.com or JJ@Perry.net NOF|NO PLOFLO +#Select HELP for further information NOF|NO PLOFLO Copyright K+ JJ Perry & Palmaris Medical LtdK NOF|NO HelpO Ctrl+H Enter HO5L<[ {A\[ {A\[ OFL{=O OFLO2H{5\O H{=\O H{5\O OFL{=O OFLO2H{5\O O8H{=\O H{5\O {A\[ {A\[ {A\[0 NAGSCREEN TEMP$ PATH$ SCREEN3% SCRWID% TBWIDTH% SCRHT% VERSION$ VERDATE$ TEMP2 SCREEN2% SKIP% he[@J Medikit.mbmK Registered to +)Clinical Assistant and Medical Calculator +%for Psion 5 & EPOC handheld computers +4Check http://www.palmaris.com for the latest version NOF|NO +,Email: jonathan@palmaris.com or JJ@Perry.net NOF|NO PLOFLO +#Select HELP for further information NOF|NO PLOFLO Copyright K+ JJ Perry & Palmaris Medical LtdK NOF|NO HelpO Ctrl+H Enter HO5L<[ {A\[ {A\[ O:L{=O L{5\O OXL{=\O O@L{5\O O:L{=O L{5\O O-L{=\O L{5\O {A\[ {A\[ {A\[0 SCRWID% TBWIDTH% SCRHT% TEMP$ TEMP2 he[@J MediKit: Disclaimer While every effort has been made to ensure the accuracy of the contents of this software, +Nno liability or warranty for errors or omissions exists, expressed or implied. All results must be checked with established texts and local guidelines. Results should +Sbe interpreted in the context of the user's knowledge of medicine and common sense. Normal physiological and laboratory values are presented as general guides. +QIt is essential to validate these with reference texts and your local laboratory. For some calculations alternative formulas exist and may yield different results. You use this software at your own risk - exercise good clinical judgement at all times. +1I understand and agree to these conditions of use Enter {A\[ Oy{A\[ OY{A\[ ON{A\[ On{A\[ H{5\O H{5\O H{5\O H{5\O SCRWID% TBWIDTH% SCRHT% TEMP$ TEMP2 he[@J MediKit: Disclaimer While every effort has been made to ensure the accuracy of the contents of this software, +Nno liability or warranty for errors or omissions exists, expressed or implied. All results must be checked with established texts and local guidelines. Results should +Sbe interpreted in the context of the user's knowledge of medicine and common sense. Normal physiological and laboratory values are presented as general guides. +QIt is essential to validate these with reference texts and your local laboratory. For some calculations alternative formulas exist and may yield different results. You use this software at your own risk - exercise good clinical judgement at all times. +1I understand and agree to these conditions of use Enter {A\[ ON{A\[ On{A\[ H{5\O H{5\O H{5\O H{5\O PATH$ HLPTHRD& he[@J MediKit.hlpKW Help file not foundW8 Accessing help file MediKit.hlpK+ PATH$ TEMP$ VERSION$ he[@J c:\DocumentsW Initialising MediKit HistoryKW C:\Documents\MediKit HistoryW C:\Documents\MediKit History ++Unable to move History file to C:\Documents MediKit HistoryK+ C:\Documents\MediKit History ++Unable to move History file to C:\Documents c:\System\Data\W c:\System\Data\ c:\System\MediKit\ ISP_142g.DATKW ISP_142g.DATK Timesvr.datKW Timesvr.datK Welcome to MediKit +0The clinical calculator and reference source forO ++Psion 5 and EPOC handheld computer systems.( If you are a new MediKit user, read the 'Disclaimer' section of the +D 'Help File' which includes instructions on how to use the program. If you have just upgraded to MediKit , please read theK +H 'MediKit History' file for details of changes in this release version. +: (You can find this file in your '\Documents' directory.) +D (You can find this file in your '\System\Apps\MediKit' directory.) + Help FileOh+ TEMP$ he[@J :\System\Apps\MediKit\ Moving ini files to C drive C:\temp.dat C:\temp.dat Out of disc space MediKit.ini Regdat ErrorO +.MediKit was unable to move configuration files +.from drive D (external) to drive C (internal).( MediKit will now close TEMP$ he[@J :\System\Apps\MediKit\ Moving files from to K Paedsdrugs Paedsdrugs.old + Infusions +#Unable to delete original files on driveK ErrorO +&MediKit has found copies of the file " in the directory of bothK the 'C' AND 'D' drive.( +/You should delete the unwanted version and then retry the preferences option( +0MediKit will continue to use the files on drive ErrorO +"MediKit was unable to move program definition files from drive to K +)Your original settings have been retained WELCOME WRITEINI VERSION TEMP$ he[@J +"C:\System\Apps\MediKit\MediKit.ini DNOTE$ DVALUE Error Error opening .ini file +!MediKit will now delete this file CancelO DNOTE$# MediKit ini fileG[ DVALUE" InitialisingO DNOTE$ DVALUE DVALUE" DVALUE" DVALUE" DNOTE$# DVALUE" DNOTE$# DNOTE$# DNOTE$# WRITEINI he[@J Saving preferencesO TEMP$ VERSION he[@J C:\System\Apps\MediKit Error Unable to create the directory MediKit will now close \MediKit.iniK DNOTE$ DVALUE DNOTE$' MediKit ini file DVALUE& DVALUE& DNOTE$' DVALUE& DNOTE$' MOVEFILES2 WRITEINI2 PATH$ USERPATH$ TEMP$ he[@J MediKit PreferencesO Startup screen+9Main Menu,Paediatric Section,Stored values,Drug Infusions +*Log calculation entries to 'Stored Values' +$Set 'Units' for ALL calculations to:+!Keep Current,SI,Conventional (US) +$Reset all 'INFO Screens' to 'Unseen' Keep saved program files on:+&C Drive (internal),D Drive (removable) Paediatric PrefsOp+ CancelO SaveO C:\System\Apps\Medikit\ INFO: Stored FilesO Note that if you keep saved program files (eg for the +8 paediatric and infusion section) on drive D, they will +0 take longer to access than if saved on Drive C +2 Don't show this information screen again <<BackOb+ D:\System\Apps\Medikit\ Paediatric Preferences Default age for 'New child'+ Over 1 year old,Under 1 year old +*Paediatric formulary drug frequency labels+&UK (od tds..),US (qd tid..) +'Keep backup 'Paediatric Formulary' file CancelO PaedsDrugs.oldK NAGSCREEN SCREEN3% he[@J |VWB}B[ he[@J +,Please Register MediKit to access GuidelinesO NAGSIGNS RDAYS% SKIP% he[@J |RWBI} Oh|B[ +- Tedious Nag Screen MEDIKIT IS NOT FREE SOFTWAREO +6The program is the result of hundreds of hours of work( MEDIKIT IS NOT FREE SOFTWARE( To remove these tedious nag screens, please register MediKit( Registration allows you to view the 'Guidelines' screens += and lets you access the full paediatric formulary. You can +< also save your own standard drug infusions for future use.( For details of how to register, please read the MediKit help file HelpO File KOh+ RDAYS% he[@J Please Register!O Please Register!O RDAYS% he[@J c:\System\Data\W c:\System\Data\ c:\System\MediKit\ Clpboard.hstK NUM&! NUM&% TITLEFONT% TEMP$ SCRWID% TITLEHT% SUBFONT% RDAYS% he[@J +$This copy of MediKit is UNREGISTERED You are currently on day K+! of your 30 day evaluation periodK ++Your MediKit evaluation period has expired.O You have completed your 30 day trial of MediKit, hopefully you found the program useful! To unlock the full and unrestricted functionality of MediKit, +8 visit www.palmaris.com for details of how to register.( If you don`t intend to register, you should remove the +7 program from your system using the EPOC control panel `Add/Remove Software`. If you do continue to use the program unregistered, the +3 nagscreen delays will become longer and longer... O<8[] +FDon't you think it's a little unfair that you haven't registered yet?? WB}B[Z +CPlease support the work that has gone into this program & register! +=Your evaluation period has expired. Please register MediKit. +;For details of how to register, select 'Help' from the menu |*333333 NAGSIGNS WRITEINI SCREEN3% HLPTHRD& he[@J Closing MediKitO START1 MEDIKITy SETVAR INITB PROCESSF CMDP% CMDA% CMDR%<( CMDTBDOWNC% TOOLBAR DRAWTOOLBAR BACKDROP MACHINETYPE% GETMACHINENAME$'8 ENTERCONT GUIDELINESg: ABBREV STRIPZERO`H DEC1=J EDD}K WEIGHT%X HEIGHTpa CONVERT1 CONVERT2Lu OSMOLALB~ CORRCAt CORRNAV ANIONGAP AAGRAD ACIDBASE4 ESTCRCLu STANDCRCL FREEWATER[ ENERGY TOTAL_HDL LDL_HDL> CSF_WBC CSF_PROT MPAP' SVRINDEX PVRINDEX CARDINDQ1 RVSWI LVSWI STROKEW MABLAl CORRQTMs ECGRATE BMIBSA DRIPRATE CHILDCOMA RANSONS< CARDRISK IMRIE ALVORADO CHILDP{ APGAR' CROUP1 CROUP2 BISHOP BARTHELw MMSEZ APACHE POSSUM<( CVRSu8 HAMILTON KOENIG BURNSB{ PAEDSK USERDRUG ASSIGNUNITY{ ASSIGNFREQP| N= PAEDUSERDF~ DRAWBUTTONS! DRAWARROWS} CENTMALE CENTFEMALE PHAEM PAEDC PAEDI PAEDR PARACALC HEPARIN INFUSIONm SEARCH! SEARCH1] STORED RESULTS SHOWRESULTSF ABOUT ABOUT3 ABOUT2 DISCL DISCL2V; HELPqB WELCOMEKC )K MOVEFILES MOVEFILES2uJ READINIfN L WRITEINI2RT WRITEINI PREFSLW eM CHECKNUMB`] GUIDENAG M NAGSCREENA^ NAGSIGNSta OLDRESULTS4tb DAYSuc SYSTEM\