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Acute Care Flashcards

1
Q

What is the definition of status epilepticus?

A

-continuous generalized tonic-clonic seizure activity with loss of consciousness for longer than 30 minutes or 2 or more discrete seizures without a return to baseline mental status

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2
Q

What is the mortality associated with status epilepticus?

A

2.7-8%

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3
Q

What are common aetiologies of status epilepticus?

A
  • CNS infection (meningitis, encephalitis)
  • metabolic derangement (hypoglycemia, hyperglycemia, hypoNa, anoxic injury)
  • antiepileptic durg noncompliance or withdrawal
  • antiepileptic drug overdose
  • non AED drug overdose
  • prolonged febrile seizure
  • cerebral migrational disorders (eg schizencephaly)
  • perinatal HIE
  • progressive neurodegenerative d/o
  • idiopathic
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4
Q

What are the objectives of acute management of status epilepticus?

A
  • maintain ABCs
  • terminate sz and prevent recurrence
  • identify and treat any life threatening causes
  • appropirate referral for ongoing care
  • management of refractory status
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5
Q

What are factors about status epilepticus that may make maintaining ABCs difficult? How can you overcome these?

A
  • clenched jaw
  • poorly coordinated respirations
  • lots of secretions
  • vomiting
  • hypoxia
  • suction
  • jaw thrust
  • 100% O2 by facemark
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6
Q

What are the common vital sign derrangements in a seizing patient?

A

hypoxia
high BP
high HR

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7
Q

Why do we want to treat seizures early?

A

Because seizures longer than 5-10 minutes are at high risk for continuing for at least 30 minutes

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8
Q

What are your prehospital options for managing status epilepticus in terms of meds?

A

Lorazepam buccal/PR 0.1mg/kg (max 4 mg)
Midaz buccal 0.5 mg/kg (max 10 mg)
Midaz intranasal 0.2 mg/kg (max 5 mg/nostril)
Diazepam PR 0.5 mg/kg (max 20 mg/dose)

CHECK GLUCOSE

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9
Q

Once you have an IV, what are your options for IV meds for a seizing patient?

A
  • Lorazepam IV 0.1 mg/kg (max 4 mg) give over 30-60 sec
  • Midaz IV 0.1 mg/kg (max 10 mg)
  • Diazepam IV 0.3 mg/kg (max 5mg if 5 yrs), give over 2 mins
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10
Q

If still seizing after 2-3 doses of benzo what is your next line?

A

Fosphenytoin IV 20mg PE/kg over 5-10 mins (max 1000mg)
Phenytoin IV 20 mg/kg over 20 mins
Phenobarb 20 mg/kg IV over 20 mins

*all of the above have a max of 1000mg

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11
Q

If still refractory seizures despite benzos and being loaded what is your next step?

A
  • if loaded with Phenytoin then give phenobarb and vice versa
  • next step RSI
  • midazolam continuous infusion (0.15mg/kg bolus then 2 microgram/kg/min) increase as needed q5mins (max is 24 microgram/kg/min)
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12
Q

If are on a midaz infusion and still seizing at max doses what is your next step?

A

Thiopental or pentobarbital bolus and infusion

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13
Q

What critical labs should draw in a patient with status epilepticus?

A
  • electrolytes
  • glucose
  • gas
  • calcium
  • consider CBC, AED levels, LFTs, tox screen, metabolic screen (lactate, ammonia) and BCx
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14
Q

What should you choose preferentially as your loading anti epileptic and why?

A

Forphenytoin is preferred, otherwise phenytoin unless the pt is already on phenytoin maintenance or is a neonatal patient in which case consider phenobarb to load first

-Fosphenytoin has decreased side effects compared to phenytoin, less resp depression

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15
Q

In kids

A

Intravenous pyridoxine (Vitamin B6) 100mg initially then 50 mg IV/PO bid

b/c pyridoxine-dependent epilepsy can be an undiagnosed metabolic condition

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16
Q

What are are the side effects of benzos?

A
  • hypotension
  • resp depression
  • sedation
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17
Q

What are the side effects of phenytoin?

A
  • hypotension
  • bradycardia
  • arrythmia
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18
Q

If a patient is already on phenytoin or phenobarb maintenance but you want to load them how should you proceed?

A

Give 5 mg/kg and then subsequent doses based on anticonvulsant levels

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19
Q

What other medication that we almost never use is also on the status epilepticus algorithm and what are the side effects?

A

Paraldehyde 400mg/kg PR (max 10g); dilute 1:1 in oil

s/e: mucosal irritation

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20
Q

If you measure a glucose in a seizing kid at what level should you bolus and how much?

A

bolus with glucose below 2.6

Give 2-4ml/kg of D25 or 5ml/kg of D10
Recheck in 3-5 minutes

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21
Q

What is the fastest and most effective way to deliver anti epileptics in a seizing kid?

A

IV but if not available intranasal is th next best choice

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22
Q

Which benzo is our first line in hospital and why?

A

Lorazepam b/c longer lasting and less resp depression than diazepam

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23
Q

After how many doses of benzos do you start to see resp depression?

A

more than 2

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24
Q

When do we consider status epilepticus to be refractory?

A

-when it is unresponsive to 2 different anti epileptic medications (e.g. bento + phenytoin)

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25
Q

In refractory status epilepticus if you start a barbiturate (thiopental or pentobarbital) what do you need to do with the other anti seizure drugs?

A
  • stop midazolam and phenobarbital

- maintain phenytoin at therapeutic serum levels

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26
Q

What is bronchiolitis?

A

-viral LRTI characterized by obstruction of small airways due to acute inflammation, deem and necrosis of the epithelial cells and increased mucus production

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27
Q

What is your risk of getting bronchiolitis if you’ve had it already?

A
  • primary infection does not give protective immunity

- can continue to get reinfected although these are usually milder

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28
Q

How do you diagnose bronchiolitis?

A

clinically

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29
Q

How does bronchiolitis typically present and progress?

A

first episode wheeze before 12 months

  • 2-3 days of viral prodrome, fever, cough, rhinorrhea
  • progresses to tachypnea, wheeze, crackles and varying degrees of resp distress
  • risk of dehydration
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30
Q

What is the Ddx for bronchiolitis?

A
  • asthma
  • other pulmonary infections (e.g. pneumonia)
  • laryngotracheomalacia
  • FB aspiration
  • GER
  • CHF
  • vascular ring
  • allergic rxn
  • CF
  • mediastinal mass
  • TEF
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31
Q

What diagnostic studies need to be done for bronchiolitis and why or why not?

A
  • usually don’t need any
  • CXR nonspecific, patchy hyperinflation with atelectasis (can be misinterpreted as consolidation)
  • Nasal aspirates not helpful for dx but can be useful for infection control and cohering
  • CBC not useful in predicting serious bacterial infections
  • BCx not routinely recommended
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32
Q

What are some key things that might help you decide whether to admit?

A
  • severe resp distress (indrawing, grunting, RR>70)
  • supplemental O2 needed to keep sats >90%
  • dehydration or hx of poor fluid intake
  • cyanosis or hx of apnea
  • at risk for severe disease
  • family unable to cope
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33
Q

Which groups are at highest risk for severe disease from bronchiolitis?

A

-prems

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34
Q

What are the treatments in bronchiolitis that are supported by evidence?

A
  • oxygen (to keep sats > 90%)

- hydration (support frequent feeds and breastfeeding; NG and IV are equally effective)

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35
Q

What conditions suggest that a baby with bronchiolitis may not be safe to feed orally?

A

-RR>60 +/- nasal congestion

b/c increased risk of aspiration

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36
Q

For which treatments in bronchiolitis is the evidence equivocal?

A
  • epi nebs (only use if clear evidence it causes improvement)
  • nasal suctioning
  • 3% hypertonic saline neb (theory is that it increases mucociliary clearance and rehydrates airway surface liquid; Cochrane review showed it may reduce LOS by 1 day for admissions >3days)
  • epi and dex combined
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37
Q

For which interventions is there no evidence in bronchiolitis?

A
  • ventolin
  • corticosteroids
  • antivirals
  • chest physio
  • cool mist therapies or NS neb
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38
Q

What are the recommendations around continuous monitoring and bronchiolitis?

A
  • continuous monitoring may prolong LOS
  • ECG monitoring is to detect episodes of apnea
  • ECG monitoring useful for high risk patients in acute phase of illness but not for majority of patients
  • continuous versus intermittent O2 sat monitoring is controversial
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39
Q

What discharge criteria should be used in patients with bronchiolitis?

A
  • tachypnea and WOB improved
  • maintain sats >90% without supplemental O2 or if on home O2 are back to baseline
  • adequate PO feeding
  • education provided and follow up is arranged
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40
Q

What is a traumatic brain injury?

A

-symptoms and signs that result from trauma to the brain itself which may or may not be associated with findings of injury on imaging

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41
Q

Why are kids more likely to develop an intracranial lesion due to head trauma?

A
  • larger head to body size ratio
  • thinner cranial bone
  • less myelinated neural tissue

*also more commonly develop diffuse axonal injury and secondary cerebral edema compared to adults

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42
Q

Which types of injuries are more frequently associated with intracranial injury?

A
  • falls from height above 3 feet (91 cm) or twice the length of the person
  • involvement in a MVC
  • impact from a high-velocity projectile
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43
Q

What are some signs and symptoms of head trauma?

A
  • headache
  • amnesia
  • impaired or loss of LOC
  • confusion
  • vomiting
  • blurred vision
  • seizures
  • lethargy
  • irritability
  • *higher chance of intracranial injury with:
  • prolonged LOC or impaired LOC
  • disorientation or confusion
  • worsening h/a
  • repeated or persistent vomiting
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44
Q

What is a mild, moderate or severe head trauma?

A

mild: GCS 14-15
moderate: GCS 9-13
severe: GCS

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45
Q

What are all the components of the GCS for verbal kids?

A

Eye:
4 spontaneous, 3 to verbal stimuli, 2 to pain, 1 nothing
Verbal:
5 oriented, 4 confused, 3 inappropriate words, 2 incomprehensible sounds, 1 none
Motor:
6 follows commands, 5 localizes to pain, 4 withdraws to pain, 3 flexion to pain, 2 extension to pain, 1 nothing

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46
Q

What are all the components of the GCS for preverbal kids?

A

Eye:
4 spontaneous, 3 to verbal stimuli, 2 to pain, 1 nothing
Verbal:
5 coos/babbles, 4 irritable/cries, 3 cries to pain, 2 moans to pain, 1 none
Motor:
6 normal spontaneous movement, 5 withdraws to touch, 4 withdraws to pain, 3 abnormal flexion, 2 abnormal extension, 1 nothing

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47
Q

What secondary injury to the traumatized brain do you want to prevent?

A
  • hypoxia
  • hypotension
  • hyperthermia
  • raised ICP
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48
Q

In your ABCD management for head trauma what things in particular do you need to do or consider?

A 
A:
-consider cspine injury, maintain head and neck in neutral position
-immobilization
-cervical collar
B
-intubation with c-spine precautions
C
-HD instability unlikely from head injury alone but consider 2 large bore IVs
-bolus
D
-do GCS
-pupil size and reactivity to light
-tone, reflex, movement of limbs
-fontanelle
-signs of basal skull fracture
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49
Q

What are signs of a basal skull fracture?

A
  • periorbital ecchymosis
  • battle’s sign (bruising over mastoid)
  • obvious leakage of CSF from nose or ears
  • hemotympanum
  • if these are present do not put any tubes in the nose
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50
Q

Who should get a skull X-ray in head trauma?

A

-kids

51
Q

Who should get a CT scan for head trauma?

A
  • all pts with moderate or severe trauma
  • patients who fit the CATCH rule
  • focal neuro deficit
  • clinically suspected open or depressed skull #
  • there are a list of relative indications as well
52
Q

What is the CATCH rule?

A

CT head for all kids with minor head injury (injury in the past 24 hrs with witnessed LOC, definite amnesia, persistent vomiting or irritability) plus any ONE of the following:

HIGH RISK
-GCS 3ft or down 5 stairs, falling from bicycle without a helmet)

53
Q

When can patients with a minor head trauma (GCS 14 or 15) go home?

A
  • if asymptomatic and reliable family
  • need to observe for a period if there is headache or repeated vomiting, hx of LOC at time of trauma
  • if no improvement pt needs to be admitted
  • if persistent symptoms after 18-24 hrs then may need CT if haven’t already had one
54
Q

Which skull fractures need follow up and why?

A

-widened or diastatic skull fracture (>4mm) increases risk of developing a leptomeningeal cyst

55
Q

What measures should be put in place to maintain a normal ICP and cerebral perfusion pressure?

A
  • continous end tidal monitoring if possible
  • normal oxygenation and ventilation
  • normal core temp
  • giving sedation and analgeseia esp with procedures and transport
56
Q

When do post-traumatic seizures usually occur?

A

most within first 24 hrs but can be up to 7 days

57
Q

What risk factors increase risk for post-traumatic seizures?

A
  • younger age

- severe head trauma (GCS

58
Q

How do you manage post-traumatic seizures?

A
  • as you would any other seizures
  • patients with a seizure at the time of the event or shortly after but who are otherwise normal with normal CT are at low risk of further complications
59
Q

Should you prophylax against post-traumatic seizures?

A

-not proven effective but is still used prequently

60
Q

What are indicators of poor prognosis in patients with documented intracranial head injury?

A

-severity at initial presentation (esp GCS

61
Q

What are the management objectives in the emergency department for acute asthma exacerbations?

A
  • immediate and objective assessment of severity
  • prompt and effective Rx to decrease resp distress and improve O2
  • appropriate disposition after ED Rx
  • Arrange f/u
62
Q

What objective measures can you use to assess asthma in the ED? What are the difficulties with this?

A
  • spirometry is objective measure of airway obstruction

- difficult to perform in kids

63
Q

What tests should you do for kids with asthma exacerbation?

A
  • none routinely
  • CXR if suspect pneuma, pneumonia, FB or not improving
  • gas only if not improving (normal CO2 with resp distress suggests IMPENDING RESP FAILURE)
64
Q

What are the treatment steps and recommendations for regular asthma exacerbation?

A
  • oxygen to keep sats greater than or equal to 94%
  • Ventolin (better as MDI than neb b/c less likely to provoke hypoemia and tachycardia); give NP o2 while using MDI
  • if super severe give continuous neb
  • Atrovent only evidence for this if used in the first hour
  • steroids give ASAP for moderate or severe
  • consider MgSO4
65
Q

What are the side effects of ventolin?

A
  • tachycardia
  • hypokalemia
  • hyperglycemia
66
Q

When do you consider MgSO4 in a patient with an asthma exacerbation?

A

-in the first 1-2 hours if incomplete response to other treatments

67
Q

What options are there if have failed management on the ward/ED?

A

aminophylline-bronchodilator -used in ICU if failed max Rx (cautions inhaled B2 agonist, IV steroids)
heliox - in PICU
-intubation - last resort b/c +++adverse effect

68
Q

What are the complications relating to intubating an asthmatic?

A
  • pneumo
  • impaired venous return
  • CV collapse due to increased intrathoracic pressure
  • risk of death
69
Q

How do you treat a mild asthma exacerbation?

A
  • Ventolin B2B x3, consider inhaled steroids

- if stay mild observe in ED for 2 hrs if no further tx needed then send home on ICS and f/u with MD

70
Q

How do you treat moderate asthma exacerbation?

A
  • Ventolin B2B
  • PO steroids
  • consider Atrovent B2B
  • reassess after 1 hour if still moderate continue with Ventolin q1h
  • if after 2 hours of treatment patient needs Ventolin more often than every 4 hrs then admit to hospital
71
Q

How do you treat severe asthma exacerbation?

A
  • consider O2 100%
  • Ventolin and Atrovent B2B
  • PO steroids, consider IV
  • consider continuous ventolin
  • Consider IV MgSO4
  • keep NPO
  • reassess
  • give ventolin q20mins until able to tolerate q1hr
  • admit
72
Q

How do you treat severe to impending resp failure in an asthma exacerbation?

A
  • nonrebreather with oxygen 100%
  • continuous ventolin and Atrovent B2B
  • NPO
  • IV access
  • continuous monitor
  • IV steroids
  • consider IV MgSO4, aminophylline or IV ventolin
  • draw gas and lights
  • consider submit epic
  • consider intubation if none of above are working
73
Q

What would a kid with a mild asthma attack look like?

A 
normal speech and activity
min retractions
moderate wheeze
minimal dyspena 
sats >94% on RA
peak flow >80% of personal best
74
Q

What would a kid with a moderate asthma attack look like?

A 
agitate
decreased activity or feeding
speaks in sentences
retractions
loud exsp and inspiratory wheeze
sats 91-94% on RA
peak flow 60-80% of personal best
75
Q

What would a kid with a severe asthma attack look like?

A 
agitated
infant stops feeding
speaks in words
signficant resp distress
hunched forward
paradoxical muscle use
wheezes might be audible without stethoscope
sats
76
Q

What would a kid with impending resp failure look like?

A
  • drowsy or confused
  • marked resp distress
  • absence of wheeze
  • bradycardia
77
Q

What are discharge criteria from the ED?

A
  • needs ventolin 94% on RA

- minimal or no resp distress

78
Q

Do ICS impair final adult height?

A

no

79
Q

Who should get ICS for asthma?

A
  • persistent asthma and/or who have a moderate or severe episode
  • if already taking then they should have the dose adjusted
80
Q

What are discharge medications and instructions for pts with asthma exacerbation?

A
  • PO steroids for 3-5 days
  • Ventolin q4h (0.3 puffs/kg) until exacerbation resolve and then prn
  • AAP
  • review puffer techniques
  • ensure f/u
81
Q

What is low/medium/high dosing for the various ICS?

A 
Beclamethasone dipropionate (QVAR), ciclesonide (AlvescO), Fluticasone (Flovent) for kids 6-11 yrs low is 400-500
For budesonide (pulmicort) low is 800

FOR KIDS 12 and UP
-it is similar except low doses for QVAR, alvesco and flovent is 250 (alvesco is 200) and pulmicoty is 400; high dose is >400-500 for the first 3 and >800 for pulmicort

82
Q 
What is the alternate name for each of these and for what ages are they approved?
Beclomethasone dipropionate HFA
Budesonide
Ciclesonide
Fluticasone
A

Beclomethasone dipropionate HFA = QVAR = 5 yrs and up
Budesonide = Pulmicort = 3 months and up
Ciclesonide = Alvesco = 6 yrs and up
Fluticasone = Flovent = 12 months and up

83
Q

What are the recommendations for AEDs and paramedics?

A
  • should have AED suitable for paediatric use if do not have a defibrillator
  • AEDs can be safely used in kids
84
Q

Can all paramedics do the same things?

A

no some are advanced care and some are BLS

85
Q

What is anaphylaxis?

A

-severe, acute, life-threatening condition due to systemic release of mediators from mast cells and basophils in response to an allergen

86
Q

What are the most common triggers of anaphylaxis?

A

1) food (peanuts, tree nuts, fish, milk)
2) hyemoptera venom (bee, wasp)
3) medications

87
Q

What systems can be affected by anaphylaxis and how does it manifest?

A

skin: urticaria, pruritis, angioedema, flushing
Resp: wheeze, cough, dyspnea, hoarseness, stridor, edema, rhinorrhea, sneezing
CVS: tachycardia, dizziness, hypotension, syncope
GI: nausea, vomiting, diarrhea, abdo pain
CNS: irritability, drowsiness, lethargy, sonmolence

88
Q

What is the criteria for anaphylaxis?

A

at least one of:

1) acute onset of illness (mins to hours) with involvement of skin and/or mucosal tissue (e.g.. hives, pruritus, angioedema) and at least one of: RESP or hypotension or end organ dysfunction (syncope, incontience)

2) after possible allergen exposure, 2 or more of occurring within mins to hours:
skin-mucosal; resp; CVS or GI sx

3) after a known allergen hypotension within mins to hours (low BP for age or >30% drop in sBP)

89
Q

What is the treatment for anaphylaxis?

A

0.01 mg/kg of IM epinephrine (1:1000) (max 0.5 mg) q 5-15 mins
supplemental O2
2 large bore IV
if hypotensive give NS boluses

90
Q

How does epinephrine act in anaphylaxis?

A

alpha adrenergic - increases SVR
beta1 adrenergic - positive chronotropic (HR) and inotropic (contractility) effects on heart
beta 2- bronchodilation

91
Q

What are some adjunct medications that can be used as adjuncts in anaphylaxis? What is their effect?

A
  • H1/H2 blockers: relieve cutaneous symtpoms
  • steroids: no benefit in acute, slow onset (4-6 h)
  • inhaled ventolin: give if wheezing; epi for stridor (no evidence)
92
Q

How do you treat anaphylaxis with refractory hypotension?

A

-if still hypotensive despite boluses start epic infusion 0.1 mcg/kg/min and titrate up

if pt taking beta blockers give gulag to reverse the effect of the beta blockers (bolus) then put on epi infusion

93
Q

When do biphasic reactions occur?

A

within 1-72 hours but most within 4-6 hours

94
Q

How long should you observe a pt in the ED after an anaphylactic reaction?

A

4-6 hours

95
Q

What do you need to do on discharge after an anaphylactic reaction?

A
  • prescribe epicene and tell them to fill script asap
  • educate about administration of epicene
  • 2 doses of epi available at all times, must be available at school
  • avoid trigger
  • medic alert bracelet
  • referral to allergist
  • can consider 3 day course of PO cetirizine and ranitidine and PO steroids (limited evidence)
96
Q

What is the definition of hyponatremia? severe hyponatremia?

A

hyponatremia = Na

97
Q

What contributes to hyponatremia in hospitalized kids?

A

-hypotonic maintenance IVF and ADH secretion

98
Q

What are signs of hyponatremia?

A
  • h/a, lethargy, seizures

- if severe risk of rap, cardiac arrest from herniation

99
Q

Why are kids at increased risk for complications from hyponatremia?

A

-increased brain/intracranial volume ratio

100
Q

Why is ADH secreted in hospitalized kids?

A

-due to nausea, stress, pain, pulmonary and CNS disordesr, surgical interventions, medications (morphine)

101
Q

What is are preferred maintenance fluid and how much Na is in it?

A

D5NS = 154 mmol/L of Na
- esp in kids for surgery, CNS or resp infections

*unless pt has impaired Na excretion, renal concentrating defect, significant water loss or prolonged fluid restriction

102
Q

What monitoring should be done for patients on IVF?

A 
daily lytes if high risk (euro or resp infections)
monitor ins and outs
daily weights
watch for signs of hypoNa
remember PO fluids are hypotonic
103
Q

Which kids are at particularly high risk for ADH secretion?

A
  • kids undergoing surgery

- kids with acute near or resp infections

104
Q

If a kid has a normal Na, and is not high risk for ADH secretion what fluids should you run?

A

D5NS preferred but D5 0.45NaCl is ok too

105
Q

If the Na is 145-154 what fluids should you run?

A

D5 0.45 NaCl and monitor sodium frequently

106
Q

Why don’t we usually use ringers as maintenance?

A

-no glucose and it contains lactate

Na content is 130

107
Q

For an asystolic cardiac arrest what is the order you do things?

A

CAB for both IN and OUT of hospital arrests

  • start CPR ASAP
  • avoids delays
108
Q

What are the recommended compression to ventilation ratios?

A

30:2 for single rescuer
15:2 for 2 rescuer
if have an advanced airway, do contiuous CPR with breaths throughout at rate of 8-10 per min do not stop CPR to bag

109
Q

What makes CPR high quality?

A
  • 1/3 AP diameter
  • rate of 100 per min
  • allow full recoil
  • minimize interruptions
  • avoid excessive ventilation
  • rotate compressors every 2 mins
  • limit pulse check to 10 seconds
110
Q

What is the recommendation if you com upon someone lying on the ground?

A
  • NO MORE look, listen, feel
  • if unresponsive and append or gasping start CPR right away
  • health professionals can check for a pulse for max 10 s
111
Q

What is the recommended method of defibrillating infants?

A

manually (2 J/kg to 4 J/kg), max is 10 J/kg

-if not available, use AED with peds dose attenuator, if not use adult

112
Q

What are the principles of post-arrest care?

A
  • hyperoxemia can be harmful
  • O2 to keep sats 94-99%
  • therapeutic hypothermia to temp 32-34 degrees may be considered for kids who remain comatose after rests in consultation with expert
113
Q

What is the definition of a wide complex tachycardia?

A

> 0.09s for QRS

114
Q

Which patients should not get adenosine?

A

those with known WPW if have a wide complex tachycardia

115
Q

What intubation/sedation medication should be avoided in paediatric septic shock and why?

A

Etomidate b/c adrenal suppression and associated with increased mortality

116
Q

Should you use cuffed or uncuffed ETT in septic shock?

A

either but cuffed might help decrease risk for aspiration

117
Q

What is the formula for uncuffed ETT?

A

2 yrs = 3.5 + (age/4)

for cuffed tubes go 0.5 mm higher

118
Q

What % of inhospital cardiac arrest patients die?

A

75%

119
Q

What is ondansetron and how quickly does it work?

A

-selective serotonin 5-HT3 receptor antagonist that is rapidly absorbed and reaches peak plasma concentrations in 1-2 hrs

120
Q

What are the main side effects of Ondansetron?

A

-mild diarrhea, does NOT cause drowsiness

121
Q

What is the evidence for ondansetron use in the ED?

A

-single dose is effective in reducing vomiting and IV fluid administration in kids 6-12 months with gastro and MAAY be effective in reducing hospitalization

122
Q

Who should get ondansetron in the ED?

A

-kids 6 mo to 12 years with acute gastro with mild to moderate dehydration OR who have failed ORT

123
Q

How soon after giving ondansetron should ORT resume?

A

15-30 mins after

CPS Statements (14 decks)

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