This document is designed to give users unfamiliar with PDA programs a feel for the depth and practical functionality of ER Suite. By following these examples on your PDA device even non-medical professionals will see the value of this product in practice.

As such, these examples are just a fraction of the product�s capability, but will demonstrate how medical professionals can save time and reduce errors in their every day routine by using ER Suite.

ER Suite consists of 16 easy to navigate modules providing a vast array of information needed at the point of care:


1) ACLS: provides detailed up to date advanced cardiac life support protocols.

Wide Complex Tachycardia Example: A 37 year old male presents with a wide complex tachycardia with rate of 160 and a BP of 120/70 and no chest pain. The user selects the ACLS module, then selects Tachy(>100)/VF as the patient�s heart rate is 160.

The next selection is �Wide Tachycardia, Stable�. The text clearly displays the steps that the medical professional should undertake, including reminders to evaluate the ABC�s, confirm the rhythm and appropriate therapy for this condition.


2) Adult Drips: provides the drug information and weight based calculations for the 40 most commonly used drugs in critical or emergent care. This list includes anti-hypertensives, pressors, thrombolytics, antiarrhythmics, and diuretics.

Heart Failure Example: A 64-year-old male weighing 192 lbs with no contraindications to thrombolysis arrives at the ER with chest pain, shortness of breath, and promptly has a V-tach arrest. After being successfully defibrillated at 200 Joules, the patient is given Amiodarone via IVP then is placed on a drip.

a) Amiodarone via IVP Process:
Select Adult Drips; enter weight 192 lbs then select �Enter�.Select Amiodarone for VF/VT Arrest and select �Result�.The results page now displays your selection (which you should always double-check), both the mixing and Infusing instructions, a list of compatible drugs, and other relevant information on Amiodarone.
In this example, the results give these mixing instructions:
"6 mL of 50mg/mL (300 mg) of Amio into syringe. Fill to 20 mL a 20 mL total volume with D5W or NS. If repeat bolus is given, use 3mL (150mg) of Amio in 10mL total volume"
The Infusion Instructions are:
"Give 300mg (20mL) IVP. If indicated repeat with 150mg (10mg) IVP in 3-5 minutes. If patient responds to bolus, start standard drip of 1mg/min x 6 hours then 0.5 mg/min x 18 hours"

b) Amiodarone Drip Process:
From the Amiodarone IVP results page, press the "Back" button and select Amiodarone (Cordarone) and press �Result�.The results page for Amiodarone (Cordarone) will now give the correct dose and procedure for mixing for both bolus and drip. * Note the patient�s weight of 192 lbs automatically remains selected.

c) TNKASE:
After the Amiodarone drip has been administered, an emergent EKG then shows a large anterolateral acute MI and following normal CXR, you order Aspirin and Lopressor (via hospital protocol), TNKase with Enoxaparin both intravenously and Subcutaneously.

Again press back, select Tenecteplase and the relevant information will be supplied. Note the product offers standard dosing for either Heparin or Enoxaparin (Lovenox) with no additional need for selections.

d) Heart Failure: 
The patient has successful thrombolysis, but appears to have extensive myocardial damage and develops heart failure and hypotension. Lasix, Dopamine, Dobutamine, and Natrecor are needed sequentially to treat this heart failure following admission to the ICU.

The user selects Dopamine and two additional selectors appear, one detailing the common rates for the drug; the other listing the common concentrations.
In this example Select a moderate does of 10 mcg/kg/min, and the 3200 mcg/mL solution (as the patient should be fluid restricted). Then Press Result.

In addition to the usual weight based mixing and infusion recommendations on the results page, you may need to check Dopamine�s compatibility with other commonly infused drugs. That list includes Diltiazem, Dobutamine, Epinephrine, Esmolol, Lidocaine, Morphine Sulfate, Nitroglycerin, Norepi, Pancuronium, and Vecuronium.You would then hit the Drugs button to return to the drugs list, where you follow a similar process for both Dobutamine and Natrecor. (Noting that as per the compatible infusion drugs list, Natrecor cannot be infused through the same line as Dopamine).

In this example Adult drips was used six times to make calculations and to check on the relevant drug information.

3) Emergency Meds: includes dosing recommendations and dosage calculations for drugs used in emergencies such as conscious sedation medications, paralytics, and anti-hypertensives and many other medications that are administered via intravenous push. For example, if the previous patient needed to be paralyzed for intubation and Succinylcholine was needed:
Select Emerg Meds, the previously entered weight of 192 will be present, press �Enter�.Select Succinylcholine and the relevant information will display.

4) Fluid Wizard: covers calculations and information for IV Maintenance, Bolus, and Burn related for both adult and Pediatric patients (based upon the Parkland Formula).
Burn Victim Example: A 154lb woman arrives at ER 2 hours after suffering 34% burns in a car accident. The patient received 250mL of NS during the 30 minute Ambulance trip to the hospital.
Select Fluid Wizard
Select Burn Fluids
Enter 154 and select Pounds and press �Enter�.Select 34% on the BSA Burned.Select 2 hrs on Hours Since Burn Press the �C� to the Right of the mL of Fluid Already Given and select 250.Press �Result�The results suggest a deficit of fluids exists and that consideration of infusing 990mL/hr for the next 4Hours, then resume the recommended rate from the time of the burn, which in this case is 700mL/hr from 1- 8 hrs, then 410mL/hr from 9-24hrs after the initial burn. The results also display the details of the calculations and other relevant recommendations.

5) Infusion Calc: is a generic infusion calculator that basically solves the unknown factor of either needed mL/hr or actual mcg/kg/min (whichever one of the two you don�t know). This is most commonly used in transferring patients (e.g. when ER receives a patient from Paramedics, or the ICU dept receives a patient from ER).Patient Transfer Example: The ICU receives a 79kg patient with a solution hanging that is mixed at 250mcg/ml and infusing at 30ml/hr and the mcg/kg/min needs to be confirmed.
Select Infusion Calc
Select 79 then Kilograms then press �Enter�Press the C to the Right of Solution Conc and enter 250Select from �Select Desired Calculation�, the Calc. current mcg/kg/min.Press the �C� to the Right of �Enter current mL/hr and enter 30 and press the �Result� button.The result is displayed as 1.6 mcg/kg/min.

6) Pregnancy Calculator: calculates the important dates for pregnant patients. Quantitative Beta HCG ranges are also included.

Whether you know the either the 1st Day LMP, the number of weeks pregnant, or due date, this module will quickly calculate the other two. For example if your patient told you their 1st Day LMP, by entering that date you will be told the number of weeks currently pregnant and the due date, plus the expected B-HCG range. Simply play with this module as it is self explanatory.

7) RSI Wizard: provides information and calculations on dosing of drugs for intubation for both adult and pediatric patients.

Head Injury Example: A head injured male weighing 70 kgs arrives at ER with diminished mental status. The decision is made that he should be intubated prior to head CT. There is papilledema on a fundoscopic exam so both Lidocaine and Mannitol are desired as adjuncts, Versed for sedative, Morphine for Narcotic, and Succinylcholine for paralytic.

Select RSI Wizard, then enter 70, select Kilograms and press �Enter�.Select Lidocaine & Mannitol from the Adjunct menu
Select Versed (Midazolam) from Sedation
Select Morphine from Narcotic
Select Succinylcholine from the Paralytic menu
Select the �Result� button.The results page displays both the standard dosing range for both mL of drug and the mg amount. Importantly, if your patient is a child the results also recommend the Broselow Drawer by the color, along with estimated tube size for everything from ET Tube to urinary catheter size. E.g. 20 kg:
"Tube Size Info: Color Code = Blue; ETT 5.0-5.5; Laryngoscope: 2 Miller/Mac; Stylet: 14 French, ETT Depth Insertion 15-16.5 cm, LMA 2.5 Max air in cuff = 14ml, Suction Cath: 10 French, IV Cath: 18-20, Butterfly: 21-23, NG Tube: 12-14 French, Urine Cath: 10-12 French, Chest Tube 24-32 French."

This module makes a stressful situation less stressful, allowing more focus on patient care rather than spending precious time calculating drug doses. 

8) Toxicology: provides information on most common poisonings with the ability to calculate antidote dosing, plus provides all local poison center numbers throughout the United States.

Antifreeze Poisoning Example: An 8-year-old weighing 34 kg presents with his mother 2 hours after drinking approximately 8 ounces of antifreeze.
Select Toxicology, and then select the Poisoning/Ingestions/Bites section.
Select Ethylene Glycol (Antifreeze).

The most pertinent information is then provided including mechanism of the toxicity, clinical findings, laboratory findings, recommended laboratory tests to be taken, recommended treatment/antidote detailing both oral and intravenous methods of treating this poisoning, along with useful tips and management information.

In this example, after following the recommended urine test you decide the child will require an antidote. You would note that options for treatment include Fomepizole or Ethanol. You opt for Fomepizole so would then proceed to our antidote section to calculate dosing.

Select the �Back� button, then enter the Antidote sectionSelect 34 then Kilograms, then Press �Enter�Select Fomepizole (Antizol)The results then display the calculated result, with the standard Dosing, mixing instructions, and Infusion
instructions. 

In this case you would note that initial dosing should be 15 mg/kg, followed by 10mg/kg q12 hrs x 4 doses, then 15mg/kg q12 hrs. This should be mixed 1 gram in 100mL of NS or D5W and be infused over 30 minutes IV, and should be continued until ethylene glycol levels are below 20 mg/dL.

With all poisonings you should consider consultation with your regional poisoning center for both initial and continuing management. To find the phone number of the local Poison Center, press the �Back� button, then select the Phone Number section and select your state.

9) PALS: This section details the Pediatric Advanced Life Support protocols just as the ACLS section demonstrated above. This should be explored by the user. 

10) PediCode: provides all you need to know about over 30 emergency drugs and interventions often needed for the treatment of critically ill children.

Sepsis Example: An average sized infant of 9 months presents with no measurable blood pressure and diminished mental status. The parents indicate the child has had a couple of hours of decreased alertness, fever, and 1 episode of vomiting.

You attach the child to a monitor and find a heart rate of 300 with a narrow complex consistent with SVT. A peripheral line is not readily available.
Select PediCode

Select the MeanWt from the Calculator Pad and choose �9 Mos 8.9 kg"Select Cardioversion as the initial treatment for unstable SVT is synchronized cardioversion.

The program will then show you the result for Cardiovert at 0.5, 1.0 and 2.9J/kg. A single synchronized shock is delivered at 5 Joules and the SVT resolves.

The skin signs and mental status remain poor and the BP is now 50/p.
It is decided that you may also be dealing with a septic condition and so want to see the infant�s response to a 20mL/kg NS bolus and other sepsis treatment.From the drop down selector, select �Sepsis�Items needed for a septic child are automatically displayed, including fluid bolus and much more.After some improvement in pressure to 70/p, mental status remains poor and petechiea are noted on the extremities.

Your concern for Sepsis and meningococcemia increases so you want to treat accordingly.

The results now give comprehensive recommendations for this condition based on the patients weight including fluids, drips, antibiotics, and all relevant tube sizes and catheters. In this example, you want to administer Ceftriaxone and Ampicillin and unfortunately need to intubate the child and place a Foley catheter to evaluate for urinary source (tube sizes are listed on this single screen).

11) PediDrips: calculates critical care drips commonly needed for Pediatric patients.
So in the example we just used, the infant is transferred to the PICU and despite fluid boluses requires triple pressors to maintain minimal blood pressure. Epinephrine, Dopamine and Dobutamine are sequentially added via continuous infusion.
Go to the drop down module list (Right upper corner) select PediDrips

Press Enter on the Weight Entry as 8.9 Kilograms is still displayed from prior entry in PediCode.

Select Epinephrine and choose the desired dosing and concentration. In this case, we initiate therapy with 1 mcg/kg/min using a 32 mcg/mL solution. After selections are made, press the �Result� button.The results page now displays the confirmation of the selections made. Mixing, Infusing and compatibility information are easily available by pressing the appropriate buttons on the screen. You would follow a similar process for Dopamine then Dobutamine.

It is important to note that the "Rule of 6�s" calculations are automatically made and appear on the Infusion screen for those who prefer to use rule of 6�s rather than fixed concentration. This is available for Dopamine, Dobutamine, Epinephrine and Terbutaline.

12) PediDrugs: Provides dosing calculations for a wide variety of Pediatric IV, PO, IM medications from antibiotics to cardiac medications.

Otitis Media Example: A 28-month-old 15.4 kg child presents with otitis media. You opt for Cefzil for treatment.

Select PediDrugs, then enter 15.4 then Kilograms, then select �Enter�Select Abx PO CephalosporinsSelect Cefzil (2nd Gen Cefprozil) then press the �Next� button.This screen displays relevant items on the bottom part of the screen regarding dosing and duration. You note that Otitis Media is listed and 30mg/kg/d div BID is suggested. So select 30mg/kg/d on the Left section and BID on the Right, Select concentration of 250 mg/mL then select 10 days duration and press the �Result� button.Like all Medical Wizards Results Pages, the text at the top confirms your selections (which you should always double-check). The program has calculated 4.5mL (220mg) BID for 10 days of the 250 mg/5mL suspension. The result also gives you information such as total amount to be dispensed, the flavor, standard price (per Drugstore.com), and additional items relevant to your older patients including tablet and chewable forms of the drug. 

13) Pedifever: provides rapid weight based calculations of Acetaminophen and Ibuprofen dosing for febrile children.

14) PediGrowth: calculates percentile for length/height, weight, head circumference and BMI (body mass index) for infants and children up to the age 18 based upon the year 2000 CDC data.

Select PediGrowth, then enter Child Age, then GenderEnter the current weight, length and head circumference (if 3 years of age or younger).

Select the �Result� button.You can choose to skip any of the measurements. The percentiles will be displayed for all the measurements you provide.

15) PediInfo: provides a substantial collection of hard to remember Pediatric information in eleven easy to navigate categories such as Burns, EKG, Immunizations, Lab Normals, Murmurs, Rashes, and Tubes.

Vitals by Age Example: You want to check the normal range of vital signs for a 7-month-old child.
Select PediInfo
Select Vitals by Age then 6-11 Months.

16) PediOTC: Is a guide to most commonly used over-the-counter medications that parents purchase for their children and includes manufacturer recommendations.