Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
Which finding is an early sign of shock in a child?
A 2-year-old has had three febrile urinary tract infections. Which underlying condition should be considered?
Practice exercise (made-up values, not clinical guidance). A bag contains 20 000 units of heparin in 500 mL. The order is 20 units/kg/h for a patient who weighs 80 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.
Practice exercise (made-up values, not clinical guidance). A bag contains dobutamine 500 mg in 250 mL. The order is 5 mcg/kg/min for a patient who weighs 71 kg. At what rate R do you set the pump, in mL/h? Round to one decimal place.
Practice exercise (made-up values, not clinical guidance). The record shows a patient's intake and output for one 8-hour shift. The IV infusion ran at the rate shown for the whole shift. Find the fluid balance B = intake − output in mL (a negative answer means a net loss).
Practice exercise (made-up values, not clinical guidance). A 1000 mL infusion starts at 08:00 at 100 mL/h. After 3 hours the rate is changed to 150 mL/h and is not changed again. How many hours t after the start will the bag be empty? Round to one decimal place.
Answer: C · A fast heart rate with a prolonged capillary refill
Children maintain their blood pressure until late in shock. Early signs include tachycardia, prolonged capillary refill, cool peripheries, reduced urine output and changes in behaviour.
Answer: C · Vesicoureteral reflux
Vesicoureteral reflux allows urine to flow back from the bladder into the ureters and kidneys, causing recurrent UTIs and possible kidney scarring. Children with repeated febrile UTIs are investigated with imaging.
Answer: R = 40 mL/h
Heparin and insulin infusions: concentration = units in the bag/bag volume (units/mL). Pump rate (mL/h) = units per hour/concentration, and units per hour = mL/h × concentration. For a weight-based order, units/h = units/kg/h × weight first. A bolus volume = units needed/vial strength. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Answer: R = 10.7 mL/h
Titrated drips: first find the concentration in mcg/mL (mg × 1000/mL). For a weight-based order, mcg/min = mcg/kg/min × weight. Then mL/h = mcg/min × 60/concentration. Working backwards, mcg/kg/min = mL/h × concentration/(60 × weight). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Answer: B = 290 mL
Intake and output: intake counts everything that goes in (oral fluids, IV infusions, IV medications and flushes, tube feeds); ice chips count as half their volume. Output counts urine, drains, vomit and other losses. Balance = total intake − total output; a negative balance is a net loss. The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
Positive: more fluid went in than came out.
Answer: t = 7.7 h
Infusion time: time (h) = volume to infuse (mL)/rate (mL/h); use the volume still left in the bag, not the bag size. Volume infused = rate × time. Convert decimal hours to hours and minutes with the fraction × 60 (0.5 h = 30 min, not 50 min). The numbers are for practice only; at the bedside always follow local protocols and have high-risk doses double-checked.
That is about 7 h 40 min, so the bag runs out at about 15:40.
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