The sophistication of simplicity... Optimizing emergency dosing

Abstract

The barriers to safe and effective dosing are principally logistic and have less relevance to nonemergent dosing. To maximize dosing safety and efficiency, precalculated doses and critical dosing information should be available for immediate access at the point of care. Instead of relying on an estimated weight, formulas requiring estimation of age, or any formula that requires calculation, the dose based on an estimate of IBW can be quickly accessed from a single rapid length measurement utilizing one of several published or commercial sources.19,20,33 Alternatively, the ideal (50th percentile weight for age) may be readily obtained using a common centimeter measuring tape and a growth chart. Length-based estimated weight, which correlates well with IBW, can be modified by estimating habitus if judged necessary. During an emergency, time spent managing logistic issues should be minimized and effort focused on critical clinical issues. Considering the wide therapeutic range of most medications, there is currently no evidence that for most resuscitation medications, giving a dose based on actual body weight is superior to giving an IBW dose and titrating to clinical effect if necessary. Indeed, using the actual weight could increase the risk of toxicity in certain clinical situations. Further study of the pharmacology of emergent dosing is needed. © 2008 by the Society for Academic Emergency Medicine.