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Lectures / Presentations > Code Cart and RSI (Kayvan) > Flashcards

Code Cart and RSI (Kayvan) Flashcards

1
Q

What agents potentially reverse adenosine?

A
  1. Caffeine
  2. Theophylline
  3. Via adenosine receptor block
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2
Q

Why should adenosine be used with caution in Wolff-Parkinson White?

A
  1. Increased risk of VF

2. AV node block with adenosine can lead to wide complex arrhythmias and VF

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3
Q

What consideration should be made with adenosine use in heart transplant patients?

A

More sensitive to adenosine

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4
Q

What drug interaction occurs with adenosine and dipyridamole?

A

Increases adenosine levels

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5
Q

What are ADRs to adenosine?

A
  1. Asystole / Bradycardia
  2. Flushing
  3. Chest pain
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6
Q

What is the diluent for amiodarone?

A

D5W

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7
Q

What is a simple way to differentiate doses of amiodarone in ACLS?

A
  1. No pulse = 300mg IV bolus; may repeat 150mg in 3-5 mins

2. Pulse = 150mg IV over 10 min (in 50-100mL of D5W)

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8
Q

What is a common amiodarone drip dose and titration in ACLS?

A

1 mg/min for 6 hours
Then 0.5 mg/min for ~18 hours
Average total 24 hrs

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9
Q

What administration equipment is needed for IV amiodarone?

A

0.22 micron in-line filter

Use of non-PVC bags

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10
Q

What is the pharmacologic class of atropine?

A

Anticholinergic

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11
Q

What is the dose of atropine in bradycardia? Max dose?

A

0.5 mg IV Q3-5min

Max dose = 3mg

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12
Q

Why is atropine considered prior to intubation in pediatrics? Dose?

A

May help prevent a drop in heart rate

0.02 mg/kg IV

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13
Q

What are side effects of atropine?

A
  1. Anticholinergic
  2. Dry mouth
  3. Constipation
  4. Urinary Retention
  5. Tachycardia
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14
Q

What type of heart block is atropine not used?

A

Mobitz type II

3rd degree

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15
Q

When is calcium chloride 10% used during codes?

A
  1. Hyperkalemia
  2. Beta-blocker or Calcium Channel blocker toxicity
  3. Magnesium toxicity
  4. Hypocalcemia
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16
Q

What is the dose for calcium chloride 10% in ACLS? Duration?

A

1-2 g IV Q5min

Should last ~60 min

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17
Q

What is the mechanism of how calcium chloride 10% helps in hyperkalemia?

A
  1. Increases threshold potential of myocytes

2. Prevents arrhythmias

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18
Q

Should calcium chloride be used in digoxin toxicity?

A

No

Could cause possible harm

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19
Q

What is an administration consideration of calcium chloride 10%?

A

Can cause severe necrosis if infused through a small vein

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20
Q

What is the osmolarity of calcium chloride 10% syringe?

A

2050 mosm/L

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21
Q

What drugs can precipitate when given with calcium chloride 10%

A
  1. Phosphate

2. Ceftriaxone

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22
Q

What dextrose syringe is available in the code cart? How much dextrose?

A

Dextrose 50%
1 amp = 25 grams
1/2 amp = 12.5 grams

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23
Q

What is the osmolarity of dextrose 50% syringe?

A

2500 mosm/L

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24
Q

What is the dose of epinephrine for anaphylaxis?

A
  1. SubQ/IM = 0.2-0.5 mg (1:1,000; Epipens come in 0.3 mg)
  2. IV = 0.1 mg Q15min (1:10,000)
  3. The ratio strength is different
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25
Q

When is an epinephrine drip utilized in ACLS? Dose?

A

Symptomatic bradycardia (2nd line after trying atropine)

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26
Q

What is a typical concentration of epinephrine drip?

A

4 mg/250mL NS

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27
Q

What strength of epinephrine of in the code cart (Abboject)?

A
  1. 0.1 mg/mL

2. 1 mg total/10mL

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28
Q

What is the ratio strength of IV epinephrine (abboject)? What does this mean?

A
  1. 1:10,000
  2. 1g = 10,000mL
  3. You can calculate this to know that there is 1 mg in 10 mL
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29
Q

How is epinephrine supplied for IM or SubQ injection in an accudose?

A
  1. Ampule

2. 1 mg/mL

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30
Q

What is the ratio strength of IM or SubQ epinephrine? What does this mean?

A
  1. 1:1,000
  2. 1 g = 1,000mL
  3. You can calculate this out to know 1mg / 1mL
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31
Q

What is flumazenil used for? (2)

A
  1. Reversal of benzodiazepine

2. Reversal of zolpidem

32
Q

What is the MOA for flumazenil?

A

Block GABA/BZD receptor complex

33
Q

What is the onset for flumazenil?

A

1-3 minutes

34
Q

What is the duration for flumazenil?

A

~1 hour

35
Q

What is the dose for flumazenil? Frequency? Rate? Max?

A
  1. 0.2-0.5 mg IV
  2. Repeat Q1min
  3. Over 15-30 seconds
  4. Max 3mg/hr
36
Q

What is a risk of using benodiazepines for long term?

A

Seizures

37
Q

What is an alternative for cardiac arrest (VF / pulseless vtach) if amiodarone is unavailable?

A

Lidocaine

38
Q

What is the dose of lidocaine in VF/ pulseless vtach? Max?

A
  1. 1-1.5 mg/kg IV or IO
  2. Q5-10 mins
  3. 0.5-0.75 mg/kg for repeat doses
  4. Max 3 mg/kg
39
Q

What is a drip rate for lidocaine in VF/pulsless vtach if wanted?

A

1-4 mg/min IV

40
Q

What is another situation lidocaine may be used (weak evidence)?

A

Prevent ICP increase during intubation

41
Q

What are toxicities associated with lidocaine?

A
  1. CNS = confusion, sedation, seizure
  2. Cardiac = Hypotension
  3. Respiratory = Arrest
42
Q

What patient sign should lead to an immediate stop of lidocaine?

A

CNS = Slurred speech, excess sedation, seizures

43
Q

When should magnesium be used in ACLS? Why?

A
  1. Torsades de pointes

2. It improves response to shock

44
Q

What is the dose of magnesium sulfate? Dilution? Rate?

A
  1. 1-2 g IV/IO
  2. Diluted in 10 mL (NS or D5W)
  3. Over 5-20 minutes
45
Q

What are side effects to magnesium sulfate? (2)

A

Flushing

Hypotension

46
Q

What is the MOA for naloxone?

A

Opioid antagonist

Reversal agent for opioids

47
Q

What is the onset of action for naloxone?

A

2 minutes

48
Q

What are routes for naloxone?

A

IV
IM
SubQ
ET

49
Q

What is the duration for naloxone?

A

30-120 minutes

60 minutes

50
Q

What is the dose for naloxone? Rate? Frequency?

A
  1. 0.4-2 mg IV
  2. Over 30 seconds
  3. Q3min PRN
51
Q

What is a typical naloxone drip concentration?

A

2mg / 500mL (NS or D5W)

52
Q

What is a dosing pearl for administering naloxone?

A

Reversal will lead to pain return

53
Q

What are situations where sodium bicarbonate is used in ACLS?

A
  1. Acidosis
  2. Hyperkalemia
  3. TCA or aspirin overdose
54
Q

What is the dose of sodium bicarbonate for acidosis? For TCA overdose?

A

2-5 mEq/kg IV over 4-8 hours

1-2 mEq/kg IV

55
Q

What is the dose of sodium bicarbonate for hyperkalemia?

A

1 mEq/kg IV over 5 minutes

56
Q

What is the mechanism of why sodium bicarbonate is used for hyperkalemia?

A

Shifts K+ into cells

57
Q

What a typical sodium bicarbonate drip concentration? Rate?

A

150 mEq in 1000mL of D5W

25-250 mL/hr

58
Q

What is an IV administration consideration for sodium bicarbonate?

A
  1. Extravasation

2. High sodium load

59
Q

What is the osmolarity of 8.4% sodium bicarbonate syringe?

A

2000 mosm/L

60
Q

What is the dose of vasopressin in ACLS?

A

40 units IV/IO

To replace the 1st or 2nd dose of epinephrine

61
Q

What are the depolarizing neuromuscular blockers?

A

Succinylcholine

62
Q

What are the non-depolarizing neuromuscular blockers?

A

Rocuronium (Zemuron)

Vecuronium (Norcuron)

63
Q

What is the dosing for succinylcholine for RSI?

A

1-2mg/kg IV (peds and adults)

64
Q

What are the side effects of succinylcholine?

A
  1. Bradycardia (muscarinic stimulation)
  2. Hyperkalemia
  3. Malignant hyperthermia
  4. Increased intracranial pressure (ICP)
65
Q

What is the dosing for rocuronium (Zemuron) in RSI?

A
  1. 0.6-1.2mg/kg IV

2. “Rock ‘em hard 1mg/kg” (compared to vec)

66
Q

What is the dose for vecuronium (Norcuron) in RSI?

A

0.08 - 0.1 mg/kg IV

67
Q

Which non-depolarizing agent needs to be reconstituted?

A

Vecuronium

68
Q

What is the reversal agent for rocuronium or vecuronium?

A
  1. Glycopyrrolate (anticholinergic) 0.2mg per 1mg of neostigmine (acetylcholinesterase inhibitor)
  2. Give glycopyrrolate and neostigmine
69
Q

What is the dose for etomidate (Amidate) in RSI?

A

0.2-0.6mg/kg IV

70
Q

What are the side effects of etomidate (Amidate)?

A
  1. Hypotension

2. Shock (inhibits cortisol synthesis)

71
Q

What is the dosing of propofol (Diprivan)? Infusion?

A 
Bolus = 1-2mg/kg
Infusion =  5-50mcg/kg/min
72
Q

What are side effects of propofol (Diprivan)?

A
  1. Hypotension

2. Propofol infusion syndrome (rhabdomyolysis, renal failure, heart failure)

73
Q

What is the onset and duration of succinylcholine?

A

Onset = 0.5-1 minute
Duration = 5-10 minutes
(Shorter than roc and vec)

74
Q

What is the onset and duration of rocuronium (Zemuron)?

A

Onset = 1-2 minutes
Duration = 10-30 minutes
(~20 minutes, shorter than vec)

75
Q

What is the onset and duration of vecuronium (Norcuron)?

A

Onset = 1-5 minutes
Duration = 25-40 minutes
(~30 minutes, longer than roc)

76
Q

What is the onset and duration for etomidate (Amidate)?

A

Onset = 1 min
Duration = 3-5 minutes
(Shortest)

77
Q

What is the onset and duration for propofol (Diprivan)?

A

Onset = 30-45 seconds
Duration = 20-75 minutes
(~45 minutes)

Lectures / Presentations (10 decks)

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