A: Enviro And Metabolic

Question 1

MDSO: Fever: Meds and Dosing

Answer 1

Short Answer:

TYLENOL : 975 - 1000 mg q 4 hrs (above 60 kg)
IBUPROPHEN: 400 mg ( > 40 kg) - long list of rule out

Other dosing for Tylenol if < 60 kg = 15mg/kg

Question 2

MDSO: Anaphylaxis, meds, considerations, patch, dosing

Answer 2

1) EPI IM 0.01 mg/kg to max 0.5 mg q 5 x 1(IP)

2) Salbutamol (5mg or 8 puffs) q 5- 15 min x 3 (IP)

3) Benadryl 50mg IV/IM (no patch)

PATCH::::

4) METHYLPREDNISOLONE (SOLUMEDROL) 125 mg IV/I0 (MP)

5) For Persistent Hypotension - 20mL/kg (Max 1 L) - (IP) I may do that up front

6) EPI INFUSION (MP) - usual dose 0-0.5 mcg/kg/min

***extra, in clinical considerations, consider adding another histamine antagonist like Ranitidine.

Question 3

MDSO: Adult Hypoglycemia : Drugs, Dose, Patch, Considerations

Answer 3

1) 1 mg IM Glucagon (if no IV access ) (IP), OR

2) 25 g (1 Amp D50W)

After #1 or #2 - Start D10W infusion at 100mL/hr

3) MIX: D10W = 250 NS - 50 cc + 1 Amp D50W (50 mL) (IP)

4) Thiamine (Vit B1) (if suspect malnutrition or alcoholism) - 100 mg IVP or IM (No Patch)

Question 4

MDSO: HyperKalemia : Drugs, Dose, Considerations

Answer 4

1) NS @ 10 mL/kg Bolus
2) Calcium (IP)
20 mg/kg (MAX 1 g)
** 1 g CaCl > 20 min PIV, > 5 min CVL, or
** 1 g Ca Gluc > 2-3 min
**Max 40 mg/kg (2 g) - ask TMP about second dose.
3) NaHCO3 (IP) - for the acidosis
- 1 mEq/kg (but usually 1 Amp ie 50 mEq)
4) Dextrose (IP)
- 1 amp (25 g), repeat 1 x if needed
5) Humulin R (IP)
-10 units IV/IO
6) Salbutamol (IP)
- double the SOB
- 16 puffs q 5-15 x 2. Or 10 mg NEB q 5-15 x 2

Question 5

MDSO / FLowchart : HyperKalemia : Define Mild, Modeerate and Severe and list the treatments that come with each.

Answer 5

Mild: 5.5-6.5
asymptomatic / general weakness
Tx: 10 cc/kg NS, 1 Amp Dextrose, 10 units of Humulin, test BGT q `5 min, Salbutamol 16puffs or 10 mg x 2

Moderate: 6.5 - 7.5
Weakness, Fatigue, Peaked T
Start with 20 cc/kg NS, Calcium Cl 1 g > 20 min PIV, 1 amp Bicarb….then continue with Dextrose and other as above.

Severe > 7.5
S/S = wide QRS. Peaked T, progression of ECG
Bradycardia, Hypotension, decreased LOA, Syncope, SOB, Arrhythmia
TX: Same as Moderate, consider need to intubate as you are treating the underlying…..consider other MDSO / Mechanism - ex: BRASH (Bradycardia, Renal Failure, AV blockage, Shock, Hyperkalemia) - - - TOX ? SPESIS- Renal Failure and on BBBlockers ? Etc)))

Question 6

MDSO / Flowchart : Hyper K - Considerations: Does Peaked T by itself warrant Ca ?

Answer 6

NO, want to see wide QRS before considering Ca++ (note on flowchart)

Question 7

MDSO / Flowchart : Hyper K : Digoxin and Ca++ in HyperK

Answer 7

If Dig Tox suspected, hold Ca++ until Digibind is given.

If not suspecting TOX, just at normal doses, and Severe HyperK, then may give Ca++