Formula sheets, the key method steps for every topic and 6 practice problems, with full solutions at the back.
Why is the Lund and Browder chart preferred over the adult "rule of nines" for estimating burn size in children?
How is pain best assessed in a 10-year-old with severe cerebral palsy who cannot speak?
Practice exercise (made-up values, not clinical guidance). A bag contains 12 500 units of heparin in 250 mL. The order is 15 units/kg/h for a patient who weighs 61 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 patient who weighs 60 kg has an order for nitroglycerin at 5 mcg/min. The bag contains 50 mg in 250 mL. Find the pump rate R 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 bag was started at 09:15 and runs by pump at 150 mL/h. How many mL V are left in the bag at 12:45?
Answer: B · It adjusts for the larger head and smaller legs of young children
In young children the head makes up a larger share and the legs a smaller share of body surface area than in adults. The Lund and Browder chart adjusts for age, giving a more accurate estimate to guide fluid treatment.
Answer: A · With a behavioural tool such as revised FLACC, using the parents' knowledge of usual cues
Children with cognitive impairment are assessed with behavioural tools such as the revised FLACC, which can include the child's individual pain behaviours. Parents know the child's baseline and are key partners in pain assessment.
Answer: R = 18.3 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 = 1.5 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.
The order is per minute for the whole patient, so the weight is not needed.
Answer: B = 190 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: V = 475 mL
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.
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