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ONTARIO

ONTARIO. QUIT. BASE HOSPITAL GROUP. ADVANCED ASSESSMENT Medical Math. 2007 Ontario Base Hospital Group. QUIT. ADVANCED ASSESSMENT Medical Math. REVIEWERS/CONTRIBUTORS Rob Theriault EMCA, RCT(Adv.), CCP(F) Peel Region Base Hospital Donna L. Smith AEMCA, ACP Hamilton Base Hospital.

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  1. ONTARIO QUIT BASE HOSPITAL GROUP ADVANCED ASSESSMENTMedical Math 2007 Ontario Base Hospital Group

  2. QUIT ADVANCED ASSESSMENTMedical Math REVIEWERS/CONTRIBUTORS Rob Theriault EMCA, RCT(Adv.), CCP(F) Peel Region Base Hospital Donna L. Smith AEMCA, ACP Hamilton Base Hospital AUTHOR Tim Dodd AEMCA, ACP Hamilton Base Hospital 2007 Ontario Base Hospital Group

  3. MENU QUIT START AT THE BEGINNING METRIC SYSTEM WORKING WITH FRACTIONS HOW MUCH DRUG TO ADMINISTER WEIGHT VS. VOLUME DRUG CONCENTRATIONS INTRAVENOUS THERAPY CONCEPTS POUNDS TO KILOGRAMS OTHER “MUST KNOWS” REVIEW OF EQUIVALENTS • have paper and pen/pencil for notes and/or solving equations • use a calculator to confirm your answers

  4. MENU QUIT Medical Math holds people back Flattens their learning curve Paralyzes the professional from doing their job with confidence

  5. MENU QUIT Medical Math does not have to be this way! Our goal is to change this!

  6. The metric system must be fully understood to accurately deliver various volumes of fluid and various weights of drugs MENU QUIT Metric System • These are usually given based on the patients weight • Basic metric units of measurement are: • 1. Length - Meter • 2. Volume - Liter • 3. Weight - Gram

  7. MENU QUIT Basic Metric Units VOLUME LIQUID MASS CUBIC CENTIMETER cc MILLILITER ml GRAM G Not all slides have sound

  8. subdivisions of these basic units are made by moving the decimal point to the left multiples of the basic units are indicated by moving the decimal point to the right MENU QUIT Metric System

  9. MENU QUIT Metric System Based on the Decimal system or multiples of 10 • primary unit of weight is the GRAM • smaller unit of weight is the MILLIGRAM • larger unit of weight is the KILOGRAM • 1 GRAM is equal to 1,000 MILLIGRAMS • 1 KILOGRAM is equal to 1,000 GRAMS

  10. MENU QUIT BASE UNITS

  11. MENU QUIT Metric System Micro-------Milli----Centi----Deci-----BASE-----Deka----Hecto---Kilo .000001 .001 .01 .1 METER 10 100 1000 .000001 .001 .01 .1 LITER 10 100 1000 .000001 .001 .01 .1 GRAM 10 100 1000 Note: When documenting a drug dose that is less than 1, always place a “0” before the decimal point so that the dosage isn’t mistaken for a larger one. e.g. 0.3 mg epinephrine SC (not .3 mg epinephrine, as this may appear on the chart as “3” mg which would be an excessive dose)

  12. gram(G)milligram(mg)microgram(mcg) MENU QUIT Metric System Click to see answer = = 0.00001 G 1.0 mcg 0.001 mg = = 0.001 G 1.0 mg 1,000 mcg = = 1.0 G 1,000 mg 1,000,000 mcg next slide

  13. WEIGHTS 1000 900 800 700 600 500 400 300 200 100 10 Milligrams 10 mg 90 19 79 89 29 49 39 99 69 59 48 18 28 98 68 78 38 88 58 67 57 77 47 97 17 87 27 37 46 56 26 76 86 16 66 36 96 45 75 15 95 85 55 35 25 65 44 34 84 24 64 14 94 54 74 33 53 93 43 83 73 23 13 63 42 32 52 22 12 62 92 82 72 41 91 51 31 61 21 11 81 71 80 70 60 50 40 30 20 10 9 8 7 6 5 4 3 2 1 GRAM MENU QUIT 9 mg 8 mg 7 mg 6 mg 5 mg 4 mg 3 mg 2 mg 1 mg

  14. WEIGHTS 1000 900 800 700 600 500 400 300 200 100 1 gm 90 1 gm 39 49 59 19 69 29 79 89 99 18 28 68 78 38 48 58 98 88 27 67 97 17 37 87 57 77 47 36 86 96 46 26 76 56 66 16 45 25 35 55 65 95 85 15 75 34 54 64 44 74 94 24 84 14 63 13 73 93 43 83 23 33 53 62 12 32 22 92 72 52 42 82 31 81 21 41 11 71 61 91 51 80 1 gm 70 1 gm 60 1 gm 50 1 gm 40 1 gm 30 1 gm 20 1 gm 10 9 8 7 6 5 4 3 2 1gm 1 Kilogram MENU QUIT 1000 Grams

  15. WEIGHTS 70 Kilograms 10 9 8 7 6 5 4 3 2 1kg . MENU QUIT

  16. 1 Litre VOLUME 1000 900 800 700 600 500 400 300 200 100 91ml 90 81ml 49 89 69 39 79 99 59 19 29 18 28 98 58 88 68 48 38 78 37 27 97 57 77 47 67 17 87 46 36 26 16 76 96 86 56 66 25 55 85 95 65 15 75 35 45 54 44 24 34 74 94 64 14 84 53 43 63 33 73 23 83 13 93 42 32 52 22 12 82 62 92 72 51 71 91 41 61 31 11 81 21 80 71ml 70 61 ml 60 51ml 50 41ml 40 31ml 30 21ml 20 11ml 10 9 8 7 6 5 4 3 2 1000 Milliletres MENU QUIT 1mL

  17. kilogram Kg (= 1,000 G) gram G milligram mg microgram mcg (= 0.001 mg) liter L milliliter ml MENU QUIT ABBREVIATIONS

  18. MENU QUIT WORKING WITH FRACTIONS…. The return to school.

  19. MENU QUIT MULTIPLYING FRACTIONS 1 2 1 4 x 10 5 12 7 x 4 9 21 3 1 3 2 3 4 27 = = Try creating your own fractions and use the same procedure

  20. 1/9 3/18 MENU QUIT DIVIDING FRACTIONS 4/5 4/15 1 3 2 1 x 18 9 3 4 x 15 5 4 = = 1 1 1 3 2 3 = =

  21. x5 1 x5 1 MENU QUIT X +10 = 5 5 Treat both sides of the = sign the same X+10 = 5 5 Use the opposite function if you move across an ‘=’ sign X+10 = 25 X+10-10 = 25- 10 X= 15

  22. MENU QUIT Where will I apply medical math????

  23. MENU QUIT MEDICAL MATH • Calculators and medication tables are more than welcome, only if you intend on using them in your practice. • You are encouraged to use the formulas supplied. If you have your own method and it works for you, do it your way.

  24. WANT ---------- = AMOUNT TO HAVE ADMINISTER MENU QUIT HOW MUCH TO ADMINISTER?

  25. protocols i.e. 0.3mg Epi. 1:1,000 SC verbal orders by patch phone written orders on patient chart MENU QUIT WANT HAVE WANT = GIVE

  26. Concentration of the Drug Nitro, Salbutamol, Glucagon, Lidocaine Contents of the IV Bag Amount in a given Ampoule or Vial MENU QUIT WANT HAVE HAVE = GIVE

  27. MENU QUIT WEIGHT vs. VOLUME REMEMBER: Weight and Volume are not the same thing Weight is the amount of a drug -5.0mg of Ventolin Volume is the amount of fluid the drug is dissolved in - 2.5 ml Nebule

  28. MENU QUIT REMEMBER: Always document drug administration by weight – e.g. 2.5 mg never 2.5 ml

  29. MENU QUIT WANT HAVE = GIVE HAVE = CONCENTRATION Weight Concentration = Volume

  30. mol/L G/L G% or % mg% Eq/L m/Eq/L mg/ml mcg/ml moles per litre grams per litre grams/100mL mg per 100 mL equivalents/ L milliequivalents per litre milligrams/millilitre micrograms/millilitre MENU QUIT CONCENTRATION

  31. Click to see answer MENU QUIT CONCENTRATION Reduce the Volume to 1 ml which will make the math easier mg/ml 100 mg in 20 ml = 5 mg/ml 250 mg in 100 ml = 2.5 mg/ml 60 mg in 15 ml = 4 mg/ml next slide

  32. Click to see answer MENU QUIT CONCENTRATION EXAMPLE mg/ml 100 mg in 5 ml = 20 mg/ml next slide

  33. Click to see answer MENU QUIT CONCENTRATION EXAMPLE mg/ml 50 mEq in 50 ml = 1 mEq/ml next slide

  34. Click to see answer MENU QUIT CONCENTRATION EXAMPLE mg/ml 25 g in 50 ml = 500 mg/ml next slide

  35. MENU QUIT INJECTION - ml Amount Ordered (want) = Amount to administer (ml) Concentration (have) 50 mg 0.3 mg = 10 ml = 0.3 ml 5 mg/ml 1 mg/ml 0.3 mg 1.25 mg = 0.625 ml = 0.12 ml 5mg/2ml 5 mg/2.5ml Reduce to 2.5mg/ml Reduce mg per ml

  36. 20 mcg/min = 200 mcg/ml MENU QUIT INFUSION - ml/min Amount Ordered = Amount to Administer (ml/min) Concentration 1 mcg/min = 0.1 ml/min 10 mcg/ml 15 mg/min 3 mg/min = 3 ml/min = 0.3 ml/min 10 mg/ml 5 mg/ml

  37. Two concepts: 1. Flow rate: the rate at which IV fluid is given. 2. The drip factor: the number of drops per mL determined by the administration set. MENU QUIT IV CONCEPTS

  38. Are constructed to deliver a specific number of drops per milliliter. This is called the DRIP FACTOR and can be found on the package containing the set. MENU QUIT I.V ADMINISTRATION SETS Some examples: • 10 drops/ml ---(or 10 gtts/ml) Baxter • 13drops/ml---Mcgaw • 15 drops/ml---Abbot • 20 drops/ml---Cutter • 60 drops/ml---Micro (delivery of Rx infusion)

  39. The line scribed on the drip chamber denotes 1 ml of fluid MENU QUIT I.V ADMINISTRATION SETS • 60 gtt set: takes 60 gtts of the fluid to reach the line. • 10 gtt set: takes only 10 gtts, because the drops are much bigger.

  40. MENU QUIT INFUSION = ml/hr Calculate the drip rate when the Physician Orders - 400 ml/hr using a 10 gtts/ml drip set 400 ml/hr x 10 gtts/ml 400 ml/hr ÷ 60 min/hr 4000 gtts/hr ÷ 60 min/hr or 6.667 ml/min ÷ 60 sec/min 66.67 gtts/min ÷ 60 sec/min 0.111 ml/sec x 10 gtts/ml = 1 gtt/sec = 1 gtt/sec

  41. MENU QUIT INFUSION - gtt/min Amount Ordered X drip factor =Amount to Administer (gtt/min) Concentration 20 mcg/min = 0.1ml/min x 60 gtt/ml = 6 gtt/min 200 mcg/ml 15 mg/min 3 mg/min = 180gtt/min = 18gtt/min 5 mg/ml 10 mg/ml

  42. MENU QUIT POUNDS TO KILOGRAMS Some medications: like Lidocaine and Dopamine, are administered based on body weight. Once you determine the Pt.’s weight in lbs., simply divide by 2.2 170 Lb = 77 kg 2.2 Lb/ kg

  43. Click to see answer MENU QUIT Pounds to Kilograms Exercise work it out by hand or using a calculator, then... 1. 39 Lb = how many kg? = 18 kg 2. 120 Lb = how many kg? = 55 kg 3. 22 Lb = how many kg? = 10 kg 4. 88 Lb = how many kg? = 40 kg 5. 280 Lb = how many kg? = 127 kg next slide

  44. Click to see answer MENU QUIT HOW MUCH ?/KILOGRAM 1. 3mg/kg of Lidocaine to a 75 kg Patient = 225 mg 2. 5mcg/kg of Dopamine to a 80 kg Patient = 400 mcg 3. 1mg/kg of Lidocaine to a 220 lb Patient = 100 mg 4. 0.05mg/kg of Epi 1:1000 to a 110 lb Patient = 2.50 mg 5. 12mg/kg of Chocolate to a 110 kg Patient = 1320 mg next slide

  45. MENU QUIT WEIGHT BASED INFUSION Amount Ordered x Weight = Amount to administer (ml/min) Concentration 10 mcg/kg/min x 80 kg = 1ml / min =1 x 8 80 800 mcg/ml If drop/ minute are required multiply by drop factor = 60 gtt/min x 60 gtt/ml

  46. mcg/min 800 400 200 100 50 gtts/min 60 30 15 7.5 3.75 MENU QUIT Single Strength Dopamine Chart

  47. mcg/min 1600 800 400 200 100 50 gtts/min 60 30 15 7.5 3.75 1.875 MENU QUIT Double Strength Dopamine Chart

  48. 1. Estimate the patients weight in kg and round to nearest 10’s. 2. Multiply the (weight) x (order). 3. Use chart to add up drip rate. 4. Run IV at approximate rate or use an infusion pump. MENU QUIT Using the Chart System

  49. Parkland Burn Therapy a) total volume to be administered (ml)= 4 ml x weight (kg) x % of burn surface area(BSA) or [4ml x kg x % BSA] MENU QUIT PROBLEM • b) administer 1/2 of this volume in first 8 hours • c) administer second half over the next 16 hours

  50. 100 kg patient with 50 % BSA 4ml/kg x weight (kg) x % BSA = ml WORK THIS OUT! Click to see answer MENU QUIT PROBLEM (4 x 100 x 50)  2 20,000 ml or 20 litres in 24 hours = 10 litres in first 8 hours next slide

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