Conditions and Treatments

Question 1

Thyrotoxicosis

Answer 1

1) Propranolol 1mg IV (titrate to HR and BP)
2) IV hydrocortisone or dex
3) PTU 600 to 1200 mg PO or by NG (inhibits synthesis and conversion)
4) Sodium Iodine 1g IV one hour AFTER PTU (inhibits secretion)

Rapid cooling, IV fluids (don’t make pulm edema worse), find cause; dilt for a.fib

Question 2

Myxedema Coma

Answer 2

• Thyroxine (T4) 500mcg IV
• IV hydrocortisone/dex
• volume resus, correct hypoglycemia
• abx often at first
• airway management

Question 3

Hypoglycemia

Answer 3

1) 1 amp D50 adults
2cc/kg D25<1
2cc/kg D10 newborn
2) Glucagon 1mg IM or SQ Can give if no IV access
3) Octreotide for DMII or sulfonylurea OD (suppresses insulin secretion)
4) Start a drip of D5, D10 or D25
5) Watch the K+

Question 4

Hyperkalemia

Answer 4

ADULTS PEDS
CaCl 10cc, 1g Caglu 10-20mg/kgCaCl, 0.5-1ml/Kg Cagluc
D50X2+10U insulin 0.2U/kg PLUS D10 10ml/kg
Albuterol 10-20mg albuterol 2.5-5mg
Nabicarb if acidotic 1meq/kg if acidotic
IVF
+/- 50g kayexelate 1g/kg

Question 5

Non-variceal Upper GI Bleed

Answer 5

Pantoprazole 80mg over 10 minutes (protonix)

Question 6

Suspected Variceal Bleed

Answer 6

1) Secure Airway
2) Vasoactive agent
Octreotide 50mcg IV bolus, then 50mcg/hr
OR
Somatostatin 250ug bolus then 500 ug/hr

  Vasopressin .4u/min 3) Transfusion-goal BP 100, HR 100, HCT 21 
 May need to activate massive transfusion protocol
 May need to reverse anticoagulation 3) ceftriaxone 1g 4) Blakemore tube 5) Call GI, MICU-endscopy, TIPS

Question 7

Aortic Dissection

Answer 7

Resuscitate w/IVF if very hypotensive (avoid pressors)
Esmolol 500ug/kg then 50-200ug/kg/min titrate HR60
Nicardipine 5mg/hr
(HR Goal 60, BP goal 100-120 systolic)
Consider pseudohypotension if BP very low but pt OK (dissecting into arm)
Consult surgery (for both type A and B; A are surgical)

Question 8

Massive PE

Answer 8

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Question 9

Heart Failure

Answer 9

.

Question 10

CO pOisoning

Answer 10

.

Question 11

Ectopic Pregnancy

Answer 11

· Opening gamut with two large bore IV and/or cordis

· Initial bolus of IVF

· Trauma or type specific PRBC’s after 2 liters of IVF’s

· Bedside ultrasound

· Urine pregnancy + S-Bhcg

· Early consultation with Ob/Gyn

· Ask for senior resident or attending Ob/Gyn

Question 12

SAH

Answer 12

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Question 13

TTP

Answer 13

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Question 14

Tumor Lysis Syndrome

Answer 14

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Question 15

A.fib

Answer 15

.

Question 16

Massive Transfusion Protocol at Vandy

Answer 16

Our Massive Transfusion Protocol is 6 units PRBC, 4 units FFP, 2 units platelets with the goal of maintaining a MAP of 60-65, mental status and systolic up to 90

Question 17

Intubating Child

Answer 17

ETT Size (age/4)+4, depth is ETTX3; newborn ETT 3.5

Pre-treat with atropine if <10yo 0.01 mg/kg (0.1-1mg)
Induce: ketamine 2-4mg/kg
Roc: 1mg/kg

Post-intubation:
CXR
Fentanyl 1mcg/kg/dose
Versed/vec 0.1mg/kg/hr

Question 18

Neonatal Emergencies-Differential

Answer 18

THE MISFITS

Trauma
Heart Disease
Endocrine (CAH, thyrotoxicosis)
Metabolic (electrolytes)
Inborn errors of metabolism 
Sepsis
Formula Mishap
Intestinal Catastophes
Toxins
Seizures

For inborn errors, get lactate, ammonia, ketones
CAH-suspect if hypotensive and unresponsive fluids
Hyperoxia test for heart disease (100% 02 should make non-cardiac cause of hypoxia go up 10%)
Sepsis-can give inotropes IV if can’t get central line or IO

Question 19

Approach to neonate w/possible congenital heart disease (cyanotic infant)

Answer 19

4 extremity BP
Pre and post-ductal O2 sat
CXR
EKG
Hyperoxia Test-put 100% on baby and see if O2 sat increases (or ABG)

If cyanotic:
-ABCs, gentle fluid 10cc/kg, O2 only to keep sats>75, PGE (0.05mcg/kg/min), bicarb (1meq/kg) if very acidotic
CALL CARDS

If acyanotic in heart failure:
-ABCS
-lasix 1mg/kg
dopamine,dobutamine
PGE (new presentation ductal dependent lesion)

*functional closure of ductus in 1st 10-14hrs, anatomic closure not until 2-3 weeks