Clinical Pearls

Question 1

Treatment for toxic alcohol ingestion? Duration of treatment? Level?

Answer 1

Fomepizole, 15 mg/kg loading dose, then 10 mg/kg Q12 hours until level goes below 20 (for both Methanol and Ethanol).

Question 2

STEMI Criteria

Age differences?

Answer 2

1 mm in two contiguous leads anywhere other than V2/V3

2.5 mm in male under 40
2 mm in male older than 40
1.5 mm for woman

Question 3

Dosing for Atropine? Indications? Side effects?

Answer 3

0.5-1 mg Q3-5 minutes for symptomatic bradycardia. 3 mg max. Organophosphate poisoning. 1 mg each dose. Can double dose up to 6 mg per dose until secretions dry out. Can cause tachydysrhythmias. Pediatric dosing is 0.02 mg/kg IV/IO. Max dose of 0.5 mg.

Question 4

Dosing for NAC (N-acetylcysteine). SE’s?

Answer 4

IV- 150 mg/kg in 200ml D5W over 1 hour, 50 mg/kg in 500ml D5W over 4 hours,
100 mg/kg in 1 liter D5W over 16 hours (21 total hours, may need to continue until LFTs and
APAP level normalize). PO is good efficacy as well, less hypersensitivity reaction, but longer duration (72 versus 21 hours)

Question 5

Dosing for amiodarone in refractory ventricular arrest? In wide complex stable tachycardia? SE?

Answer 5

300 mg IV push, can repeat with 150 mg IV push. 150 mg over 10 minutes in stable patient. Can cause hypotension, dysrhythmia.

Question 6

Dosing of Calcium gluconate? Chloride?

Answer 6

1 gram of either. 1 gram is contained in 10 ml. Okay to keep redosing or to give higher amount. Gluconate preferred in pt with pulse.

Question 7

Dosing of diltiazem?

Answer 7

0.25 mg/kg x 1. Then rate of 5-15 mg/hr.

Question 8

Dosing of Norepinephrine (Levophed)?

Answer 8

Start at 2-5mcg/min. Can titrate up to 30 mcg. Higher than 10 should think about central accesss quickly.

Question 9

Dosing of dobutamine? SE?

Answer 9

Start a 5 mcg/kg/min. (appx. 250 mcg/min) Concern for hypotension. Need to use with Levophed is BP is borderline.

Question 10

Dosing of Epinephrine? SE. Push dose dosing. How to make it? Anaphyaxis/asthma dose in peds?

Answer 10

Can start at 2-5 mcg/min. Crash dose epi is 1 mg in 10 cc vial. Take out 1 cc of this and mix in a flush of saline. Have 10 mcg/cc of Epi. Label well and can push 1 cc (10 mcg) every 3-5 min as needed.
Dose is 0.01 mg/kg IM in asthma or anaphyaxis. 0.3 mg max.

Question 11

Dosing of phenylephrine? SE?

Answer 11

50-200 mcg per push. Can have reflex bradycardia give pure alpha effect.

Question 12

Dosing of dopamine? SE?

Answer 12

5-20 mcg/kg/min. Can start at 250 mcg/min and titrate. Tachydysrhythmias.

Question 13

Enoxaparin/Lovenox dosing?

Answer 13

1 mg/kg sc Q12. Watch out in renal impaired patients. Dose actual body weight up to 150 kg.

Question 14

Esmolol dosing? Indication?

Answer 14

500 mcg/kg bolus (35-50 mg typical) . Then drip of 100 mcg/kg/min. Aortic dissection or ventricular storm.

Question 15

Etomidate dosing? SE?

Answer 15

0.3mg/kg. Usually 20 mg. Myoclonus is common.. Adrenal suppression.

Question 16

Fosphenytoin dosing?

Answer 16

15 mg/kg IV loading for status.

Question 17

Glucagon dosing? indications? SE?

Answer 17

1 mg IV for hypoglycemia (or IM). 1 MG IV for food impaction. 5 mg IV for B-blocker toxicity. SE if GI (vomiting).

Question 18

Dosing of haloperidol? Droperidol? SE?

Answer 18

5-10 mg IM or IV. Droperidol is 2.5-5 mg IV or IM. EP SE. Long QT.

Question 19

Dosing of Heparin? For DVT/PE? ACS? Reversal agent?

Answer 19

80 mg/kg once. 18 mg/kg/hr after. 60 mg/kg for ACS. 12 mg/kg/hr after. Protamine sulfate is reversal agent (also for lovenox).

Question 20

Dosing of hydrocortisone for adrenal insufficency in shock? Status asthmaticus?

Answer 20

100 mg IV. 125 mg IV in COPD or asthma.

Question 21

Dosing of insulin in DKA? HyperK? CCB overdose?

Answer 21

0.1 unit/kg drip. 5-10 units in HyperK (supplement with glucose. 1 unit/kg in CCB overdose (Supplement with glucose)

Question 22

Ketamine dosing. IM dosing in agitated delirium?

Answer 22

0.1 mg/kg - 0.3 mg/kg for subdissociative (pain dosing). Procedural sedation or RSI 1 mg/kg (can do 2 mg/kg for RSI). 4 mg/kg IM in agitated delirium (300-400 in large male).

Question 23

Labatelol dosing?

Answer 23

20 mg IV push.

Question 24

Mannitol dosing?

Answer 24

1 gram/kg IVP once.

Question 25

Dosing of Methylprednisolone? Other same?

Answer 25

1 mg/kg. Often 125 mg in asthmatics. Salumedrol.

Question 26

Dosing of octreotide? Indication?

Answer 26

50 mcg push then 50 mcg/hr. Bleeding variceas or sulfonyurea toxicity.

Question 27

Dose of olanzapine for agitation? Trade name?

Answer 27

5-10 mg IM or ODT. Zyprexa. Don’t give it IV.

Question 28

Phenobarbital dose? Indication?

Answer 28

20 mg/kg IV. 130-260 mg per dose for ETOH withdrawal. Half life is 100 hour. Status epilepticus or ETOH withdrawal.

Question 29

Propofol dosing? For procedural sedation? RSI?

Answer 29

1 mg/kg in procedural sedation, then repeat with 0.5 mg/kg. RSI can do 2 mg/kg.

Question 30

Rocuronium dosing?

Answer 30

1 mg/kg.

Question 31

Reversal agent for heparin? Dosing.

Answer 31

Protamine sulfate. 1 mg per 100 units of heparin. Max dose of 50 mg.

Question 32

Uses for sodium bicarbinate? Dosing?

Answer 32

Hyperkalemia or metabolic acidosis (only helpful in acidosis with HyperK)- 50 mEq (1 amp). Salicylate toxicity, 3 amps in 1 liter of D5W as a bolus, then drip with goal of urine ph of 7.5-8.

Question 33

Diazepam taper for mild withdrawal?

Answer 33

Prescribe 10 mg PO valium. Allow up to 4 tablets day 1, then 3, then 2, then 1. Given an extra tab. Total of 11 tablets. Need to trust the patient. Only for people who are not opiate dependent, Never had seizures or severe withdrawal.