EZDrips est une application permettant de faciliter l’administration de médicaments en situation critique. Notre mission est de proposer des “recettes” simples permettant une administration médicamenteuse rapide et sécuritaire. Ces recettes ont été élaborées pour être le plus simples possible avec du matériel disponible en salle d’urgence. Nos recommandations se basent toujours sur un tableau clinique de réanimation où nous devons donner une première dose le plus rapidement possible.

Dans un souci de simplicité et ainsi diminuer le risque d’erreur, chaque recette a été établie pour avoir le moins d’étapes possible. Par exemple, nous recommandons d’ajouter la dose de médicament au diluant sans retirer de volume.

Exemple :
Norepinéphrine
Ajouter 4mg (4ml) à 250ml de NaCl 0.9% (Volume total 254ml)
Concentration de la préparation : 0.01574803 mg/ml

Nous croyons que cette approche est supérieure à celle de retirer du volume, car elle limite le nombre de manipulations du produit. La pratique de retirer du volume a été établie principalement pour avoir des concentrations plus faciles à calculer manuellement. Ceci ne représente pas un obstacle puisque l’application fait le calcul pour vous !

N’oubliez pas qu’EZDrips n’est PAS une référence complète sur chacun des médicaments ni un substitut pour votre jugement clinique.

Revue de Littérature

Les doses et modes d’administrations de chaque médicament ont été vérifiés avec les ressources suivantes :
> UpToDate [Internet]. Waltham, MA.: Lexicomp Inc.; Disponible: www.uptodate.com
> Micromedex Healthcare Series [Internet]. Greenwood Village, Colo: Thomson Micromedex; Disponible: www.micromedex.com
> Trissel LA: Handbook on injectable drugs, 17 edn: Amer Soc of Health System; 2013.
> Mario Bédard AM, Marilyn Emily Morris, Sangeeta Prasad: Manuel sur la pharmacothérapie parentérale de L'Hôpital d'Ottawa: Hôpital d'Ottawa; 2013.
> ACLS - PALS Guidelines

Une revue de littérature exhaustive a été conduite pour chacun des médicaments pour déterminer la dose et le mode d’administration le plus pertinent pour une situation de soins critique. La dose et le mode d’administration final pour chaque médicament ont été déterminés en comité interdisciplinaire (Médecin, Pharmacien, Infirmier).

Les références disponibles dans le logo “Référence” de chacun des médicaments de l’application représentent les études principales supportant le choix final.

Revue de Littérature

Les doses et modes d’administrations de chaque médicament ont été vérifiés avec les ressources suivantes :
> UpToDate [Internet]. Waltham, MA.: Lexicomp Inc.; Disponible: www.uptodate.com
> Micromedex Healthcare Series [Internet]. Greenwood Village, Colo: Thomson Micromedex; Disponible: www.micromedex.com
> Trissel LA: Handbook on injectable drugs, 17 edn: Amer Soc of Health System; 2013.
> Mario Bédard AM, Marilyn Emily Morris, Sangeeta Prasad: Manuel sur la pharmacothérapie parentérale de L'Hôpital d'Ottawa: Hôpital d'Ottawa; 2013.
> Taketomo CK: Pediatric & Neonatal Dosage Handbook, 23 edn: Lexi-Comp, Inc.; 2017.
> Gahart’s Intravenous Medications, 34 edn : Elsevier Inc. ; 2018.
> ACLS - PALS Guidelines
> VIHA IV monograph, Vancouver Island Health Authority, Victoria: BC
> Les antidotes en toxicologie d'urgence. INSPQ. Disponible: www.inspq.qc.ca
> Racicot J, Huot H, Vachon A. Guide d'administration intraveineuse des médicaments critiques. Institut Universitaire de cardiologie et de pneumologie de Québec - Université Laval. 8e edition.
> Monographies des produits

Une revue de littérature exhaustive a été conduite pour chacun des médicaments pour déterminer la dose et le mode d’administration le plus pertinent pour une situation de soins critique. La dose et le mode d’administration final pour chaque médicament ont été déterminés en comité interdisciplinaire (Médecin, Pharmacien, Infirmier).

Les références disponibles dans le logo “Référence” de chacun des médicament de l’application représentent les études principales supportant le choix final.

Estimation du poids

Idéalement, le poids exact de l’enfant devrait être entré dans l’application pour un calcul plus précis des différentes doses.

Si l’âge est choisi, le calcul est fait selon “Best Guess Method”
< 12 mois : poids (kg) = ( âge en mois +9) / 2
1-5 ans : poids(kg) = (2 x âge en année) +10
5-14 ans : poids(KG)= 4 x âge en année

Si la longueur est choisie, le calcul sera fait selon “Broselow-Luten Tape system”
À noter que cette règle à tendance à sous-estimer le poids des patients en pays développés

Particularités Pédiatriques

Nous avons dû faire certains choix éditoriaux par rapport aux différences de pratique entre la salle d’urgence et les soins intensifs pédiatriques. Pour limiter la quantité de volume infusé chez les enfants de petits poids, il est pratique courante aux soins intensifs d’utiliser des “microperfuseurs”. Ces appareils ne sont malheureusement pas disponibles dans toutes les salles d’urgence, particulièrement dans les régions éloignées.
Nous avons donc établi des recettes sécuritaires en diluant les doses dans des petits volumes (25ml). Il faut garder en tête que l’administration de plusieurs médicaments chez un patient de petit poids peut représenter un volume considérable. Le jugement clinique doit toujours primer.

Références

1.Abdel-Rahman SM, Paul IM, James LP, Lewandowski A. Evaluation of the Mercy TAPE: performance against the standard for pediatric weight estimation. Annals of emergency medicine. 2013;62(4):332-9.e6.
2.Ackwerh R, Lehrian L, Nafiu OO. Assessing the accuracy of common pediatric age-based weight estimation formulae. Anesthesia and analgesia. 2014;118(5):1027-33.
3.Cattermole GN, Graham CA, Rainer TH. Pediatric weight estimation. Annals of emergency medicine. 2013;62(1):101.
4.DuBois D, Baldwin S, King WD. Accuracy of weight estimation methods for children. Pediatric emergency care. 2007;23(4):227-30.
5.Garcia CM, Meltzer JA, Chan KN, Cunningham SJ. A Validation Study of the PAWPER (Pediatric Advanced Weight Prediction in the Emergency Room) Tape--A New Weight Estimation Tool. The Journal of pediatrics. 2015;167(1):173-7.e1.
6.Kelly AM, Kerr D, Clooney M, Krieser D, Nguyen K. External validation of the Best Guess formulae for paediatric weight estimation. Emergency medicine Australasia : EMA. 2007;19(6):543-6.
7.Marikar D, Varshneya K, Wahid A, Apakama O. Just too many things to remember? A survey of paediatric trainees' recall of Advanced Paediatric Life Support (APLS) weight estimation formulae. Archives of disease in childhood. 2013;98(11):921.
8.Thompson MT, Reading MJ, Acworth JP. Best Guess method for age-based weight estimation in paediatric emergencies: validation and comparison with current methods. Emergency medicine Australasia : EMA. 2007;19(6):535-42.
9.Tinning K, Acworth J. Make your Best Guess: an updated method for paediatric weight estimation in emergencies. Emergency medicine Australasia : EMA. 2007;19(6):528-34.
10. Based on World Health Organization (WHO) Child Growth Standards (2006) and WHO Reference (2007) and adapted for Canada by Canadian Pediatrics Society, Canadian Pediatric Endocrine Group, College of Family Physicians of Canada, Community Health Nurses of Canada and Dietitians of Canada.
11.Lubitz DS, Seidel JS, Chameides L, Luten RC, Zaritsky AL, Campbell FW. A rapid method for estimating weight and resuscitation drug dosages from length in the pediatric age group. Ann Emerg Med 1988;17(6):576–81, http://dx.doi.org/10.1016/s0196-0644(88)80396-2.
12. Hughes G, Spoudeas H, Kovar IZ, Millington HT. Tape measure to aid prescription in paediatric resuscitation. Arch Emerg Med 1990;7(1):21–7.
13. The accuracy of the Broselow tape as a weight estimation tool and a drug-dosing guide – A systematic review and meta-analysis Mike Wells∗, Lara Nicole Goldstein, Alison Bentley, Sian Basnett, Iain Monteith Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, South Africa

Général

EZdrips permet d’améliorer le calcul des médicaments chez les obèses. Si toutes les informations sont entrées, l’application reconnaît que le patient est obèse et calcul la dose de médicament appropriée selon le poids total, idéal ou ajusté. Cette fonctionnalité n’est présentement disponible que pour la portion adulte de l’application

Cette fonctionnalité n’aurait pas été possible sans l’apport de nos 2 experts en pharmacie chez l’obèse, auteurs du premier livre publié sur le sujet : “Demystifying Drug Dosing in obese patients”
https://store.ashp.org/Default.aspx?TabID=251&productId=484986422

Définitions

Définition Obésité : IMC > 30
Calcul du Poids Idéal :
Nous avons décidé d’utiliser la formule de Robinson, puisque celle-ci est dérivée de données factuelles et non empirique (Pai & al. 2000). Elle donne des résultats très similaire à l’équation de Devine et Miller.

Homme : 51.65 + 1.85 x (Hauteur Pouce - 60)
Femme : 48.67 + 1.65 x (Hauteur Pouce - 60)

Revue de littérature

Pour chaque médicament, une revue de littérature a été effectuée pour déterminer le mode d’administration optimal chez la population obèse. Lorsqu’il n’y avait pas de littérature disponible, nous nous sommes penchés vers l’avis de nos experts, basés sur les propriétés pharmacocinétiques des différentes molécules.
Références 1. Brunette DD: Resuscitation of the morbidly obese patient. Am J Emerg Med 2004, 22(1):40-47.
2. Cella M, Knibbe C, Danhof M, Della Pasqua O: What is the right dose for children? British journal of clinical pharmacology 2010, 70(4):597-603.
3. Erstad BL: Which weight for weight-based dosage regimens in obese patients? American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists 2002, 59(21):2105-2110.
4. Erstad BL: Dosing of medications in morbidly obese patients in the intensive care unit setting. Intensive care medicine 2004, 30(1):18-32.
5. Honiden S, McArdle JR: Obesity in the intensive care unit. Clinics in chest medicine 2009, 30(3):581-599, x.
6. Ingrande J, Lemmens HJ: Dose adjustment of anaesthetics in the morbidly obese. British journal of anaesthesia 2010, 105 Suppl 1:i16-23.
7. Kendrick JG, Carr RR, Ensom MH: Pediatric Obesity: Pharmacokinetics and Implications for Drug Dosing. Clin Ther 2015, 37(9):1897-1923.
8. Martin JH, Saleem M, Looke D: Therapeutic drug monitoring to adjust dosing in morbid obesity - a new use for an old methodology. British journal of clinical pharmacology 2012, 73(5):685-690.
9. Matson KL, Horton ER, Capino AC: Medication Dosage in Overweight and Obese Children. The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG 2017, 22(1):81-83.
10. Medico CJ, Walsh P: Pharmacotherapy in the critically ill obese patient. Critical care clinics 2010, 26(4):679-688.
11. Pai MP, Paloucek FP: The origin of the "ideal" body weight equations. The Annals of pharmacotherapy 2000, 34(9):1066-1069.
12. Robinson JD, Lupkiewicz SM, Palenik L, Lopez LM, Ariet M: Determination of ideal body weight for drug dosage calculations. American journal of hospital pharmacy 1983, 40(6):1016-1019.
13. Rowe S, Siegel D, Benjamin DK, Jr.: Gaps in Drug Dosing for Obese Children: A Systematic Review of Commonly Prescribed Emergency Care Medications. Clin Ther 2015, 37(9):1924-1932.
14. Young KD, Korotzer NC: Weight Estimation Methods in Children: A Systematic Review. Annals of emergency medicine 2016, 68(4):441-451.e410.

EZDrips is an application to facilitate drug administration in critical situations. Our mission is to offer simple "recipes" allowing rapid and safe drug administration. These recipes have been developed to be as simple as possible, with the equipment available in the emergency room. Our recommendations are always based on a clinical picture of resuscitation where we must give the first dose as fast as possible.

For the sake of simplicity and thus reduce the risk of error, each recipe has been established to have the least possible step. For example, we recommend adding the dose of medication without removing the diluent volume.
Example:
Norepinephrine
Add 4 mg (4ml) in 250ml of NaCl 0.9% (total volume 254ml)
Concentration: 0.01574803 mg / ml

We believe that this approach is superior to removing the volume because it limits the number of handling. The practice of removing the volume has been established primarily for easier mental calculation. This does not represent an obstacle because the application does the math for you!

Remember that EZDrips is NOT a comprehensive reference on each drug, nor a substitute for your clinical judgment.

Literature review

Doses and administration modes of each drug were reviewed with the following resources:
> UpToDate [Internet]. Waltham, MA .: Lexicomp Inc .; Available:www.uptodate.com.
> Micromedex Healthcare Series [Internet]. Greenwood Village, Colo Thomson Micromedex; Available:www.micromedex.com
> LA Trissel: Handbook on Injectable Drugs, 17th edn: Amer Soc of Health System; 2013.
> Mario Bédard AM Marilyn Emily Morris, Sangeeta Prasad Manuel Parenteral Drug Therapy of The Ottawa Hospital: The Ottawa Hospital; 2013. > ACLS - PALS Guidelines
> VIHA IV monograph, Vancouver Island Health Authority, Victoria: BC
> Les antidotes en toxicologie d'urgence. INSPQ. Disponible: www.inspq.qc.ca
> Racicot J, Huot H, Vachon A. Guide d'administration intraveineuse des médicaments critiques. Institut Universitaire de cardiologie et de pneumologie de Québec - Université Laval. 8e edition.
> Product monograph

An extensive literature review was conducted for each drug to determine the dose and the best method of administration in a critical care situation. The dose and the final mode of administration for each drug were determined in interdisciplinary committee (Doctor, Pharmacist, Nurse).

References available in the logo "Reference" of each of the drug application represents the main studies supporting the final choice.

Literature review

Doses and administration modes of each drug were reviewed with the following resources:
> UpToDate [Internet]. Waltham, MA .: Lexicomp Inc .; Available:www.uptodate.com.
> Micromedex Healthcare Series [Internet]. Greenwood Village, Colo Thomson Micromedex; Available:www.micromedex.com
> LA Trissel: Handbook on Injectable Drugs, 17th edn: Amer Soc of Health System; 2013.
> Mario Bédard AM Marilyn Emily Morris, Sangeeta Prasad Manuel Parenteral Drug Therapy of The Ottawa Hospital: The Ottawa Hospital; 2013.
> Taketomo CK: Pediatric & Neonatal Dosage Handbook, 23 edn: Lexi-Comp, Inc .; 2017.
> Gahart's Intravenous Medications, 34 edn: Elsevier Inc; 2018.
> ACLS - PALS Guidelines
> VIHA IV monograph, Vancouver Island Health Authority, Victoria: BC
> Les antidotes en toxicologie d'urgence. INSPQ. Disponible: www.inspq.qc.ca
> Racicot J, Huot H, Vachon A. Guide d'administration intraveineuse des médicaments critiques. Institut Universitaire de cardiologie et de pneumologie de Québec - Université Laval. 8e edition.
> Product monographbr>

An extensive literature review was conducted for each drug to determine the dose and the best method of administration in a critical care situation. The dose and the final mode of administration for each drug were determined in interdisciplinary committee (Doctor, Pharmacist, Nurse).
References available in the logo "Reference" of each of the drug application represents the main studies supporting the final choice.

Estimated weight

Ideally, the exact weight of the child should be entered in the application for a more accurate dosing.

If the age is chosen, the calculation is made according to "Best Guess Method"
<12 months: Weight (kg) = (age in months +9 ) / 2
1-5 years: Weight (kg) = (2 x age in years) + 10
5-14: weight (KG) = 4 x age in years
If the length is selected, the calculation will be made according to "Broselow-Luten Tape system"
Note that this rule tends to underestimate the weight of patients in developed countries

Pediatric Particularities

We had to make some editorial choices concerning differences in practice between the emergency room and pediatric intensive care. To limit the amount of volume infused in children with a small weight, it is common practice in intensive care to use a specialized infusion pump. These devices are unfortunately not available in all emergency rooms, particularly in remote regions.
We then established safe recipes diluting doses in small volumes (25ml). Keep in mind that the administration of several drugs in a neonate can represent a considerable volume. Clinical judgment must always take precedence.

References

1.Abdel Rahman SM, IM Paul James LP, Lewandowski A. Evaluation of the Mercy TAPE: Against the performance standard for pediatric weight estimate. Annals of emergency medicine. 2013; 62 (4): 332-9.e6.
2.Ackwerh R, L Lehrian, Nafiu OO. Assessing the accuracy of common pediatric age-based Formulas weight estimate. Anesthesia and analgesia. 2014; 118 (5): 1027-1033.
3.Cattermole GN, Graham CA, Rainer TH. Pediatric weight estimate. Annals of emergency medicine. 2013; 62 (1): 101.
4.DuBois D, S Baldwin, King WD. Accuracy of weight estimation methods for children. Pediatric emergency care. 2007; 23 (4): 227-30.
5.Garcia CM, Meltzer JA, Chan KN, SJ Cunningham. A Validation Study of the PAWPER (Pediatric Advanced Weight Prediction in the Emergency Room) Tape - A New Weight Estimation Tool. The Journal of Pediatrics. 2015; 167 (1): 173-7.e1.
6.Kelly AM, Kerr D, M Clooney, Krieser D Nguyen K. External validation of the Best Guess formulas for pediatric weight estimate. Emergency Medicine Australasia: EMA. 2007; 19 (6): 543-6.
7.Marikar D Varshneya K Wahid A Apakama O. Just too many things to remember? A survey of pediatric trainees' recall of Advanced Pediatric Life Support (APLS) weight Formulas estimate. Archives of disease in childhood. 2013; 98 (11): 921.
8.Thompson MT Reading MJ, Acworth JP. Best Guess method for age-based weight estimation in pediatric emergencies: validation and comparison with current methods. Emergency Medicine Australasia: EMA. 2007; 19 (6): 535-42.
9.Tinning K Acworth J. Make your Best Guess: an updated method for pediatric weight estimate in emergencies. Emergency Medicine Australasia: EMA. 2007; 19 (6): 528-34.
10. Based on World Health Organization (WHO) Child Growth Standards (2006) and WHO Reference (2007) and adapté for Canada by Canadian Pediatrics Society, Canadian Pediatric Endocrine Group, College of Family Physicians of Canada, Community Health Nurses of Canada and Dietitians of Canada .
11.Lubitz DS, JS Seidel, Chameides L Luten RC, Zaritsky AL, Campbell FW. A rapid method for estimating weight and resuscitation drug dosages from length in the pediatric age group. Ann Emerg Med 1988; 17 (6): 576-81 http://dx.doi.org/10.1016/s0196-0644(88)80396-2.
12. Hughes G, H Spoudeas, Kovar IZ, Millington HT. Tape measure to aid prescription in pediatric resuscitation. Arch Emerg Med 1990; 7 (1): 21-7.
13. The accuracy of the Broselow tape as a weight estimation tool and a drug-dosing guide - A systematic review and meta-analysis Mike Wells*Lara Nicole Goldstein, Alison Bentley, Sian Basnett Iain Monteith Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, South Africa

General

EZdrips improves drug dosing in obese patient. If all the information is entered, the application recognizes that the patient is obese and calculate the appropriate drug dosage based on the total weight, ideal body weight or adjusted body weight. This feature is currently available only for the adult portion of the application

This feature would not have been possible without the contribution of our two experts in drug dosing in obese patient. They are the authors of the first book published on the subject: "Demystifying Drug Dosing in obese patients"
https://store.ashp.org/Default.aspx?TabID=251&productId=484986422

Definitions

Obesity definition BMI > 30
Calculation of Ideal Weight:
We decided to use the Robinson formula, since the latter is derived from evidence and not empirical (Pai et al. 2000). It gives very similar results to the Devine and Miller equation.
Man: 51.65 + 1.85 x (Height Inches - 60)
Female: 48.67 + 1.65 x (Height Inches - 60)

Literature review

For each drug, a literature review was conducted to determine the optimal method of administration in the obese population. When there was no literature available, we looked to the opinion of our experts, based on the pharmacokinetic properties of the different molecules.
References 1.Brunette DD: Resuscitation of the morbidly obese patient. Am J Emerg Med 2004, 22 (1): 40-47.
2.Cella M, Knibbe C, Danhof M, Della Pasqua O: What is the right dose for children? British Journal of Clinical Pharmacology 2010, 70 (4): 597-603.
3.Erstad BL: Which weight for weight-based dosing regimens in obese patients? American journal of health-system pharmacy: AJHP: official journal of the American Society of Health-System Pharmacists, 2002, 59 (21): 2105-2110.
4.Erstad BL: Dosing of medications in morbidly obese patients in the intensive care unit setting. Intensive care medicine 2004, 30 (1): 18-32.
5.Honiden S McArdle JR: Obesity in the intensive care unit. Clinics in chest medicine, 2009, 30 (3): 581-599, x.
6.Ingrande J, Lemmens HJ: Dose adjustment of anesthetics in the morbidly obese. British journal of anesthesia 2010, 105 Suppl 1: i16-23.
7.Kendrick JG Carr RR Ensom MH: Pediatric Obesity: Pharmacokinetics and Implications for Drug Dosing. Clin Ther 2015, 37 (9): 1897-1923.
8.Martin JH, M Saleem, Looke D: Therapeutic drug monitoring to adjust dosing in morbid obesity - a new use for an old methodology. British Journal of Clinical Pharmacology, 2012, 73 (5): 685-690.
9.Matson KL Horton ER Capino AC: Medication Dosage in Obese and Overweight Children. The journal of pediatric pharmacology and therapeutics: JPPT: the official journal of cMYP 2017, 22 (1): 81-83.
10.Medico CJ, Walsh P: Pharmacotherapy in the Critically ill obese patient. Critical care clinics 2010, 26 (4): 679-688.
11.Pai MP palouček FP: The origin of the "ideal" body weight equations. The Annals of pharmacotherapy 2000 34 (9): 1066-1069.
12.Robinson JD Lupkiewicz SM Palenik L, Lopez LM, Ariet M: Determination of ideal body weight for drug dosage calculations. American journal of hospital pharmacy in 1983, 40 (6): 1016-1019.
13.Rowe S, D Siegel Benjamin DK Jr .: Gaps in Drug Dosing for Obese Children: A Systematic Review of Commonly Prescribed Medications Emergency Care. Clin Ther 2015, 37 (9): 1924-1932.
14.Young KD Korotzer NC Weight Estimation Methods in Children: A Systematic Review. Annals of Emergency Medicine 2016, 68 (4): 441-451.e410.