Details

Question 1

Crotalid Envenomation (Pit Vipers)

Answer 1

CroFab 4-6 vials till initial control envenomation syndrome

– in 250ml NS over 60 min

Question 2

Glaucoma Meds

Answer 2

1) Acetazolamide 500mg IV
2) Timolol 0.5% 1-2 drops q10 min (x 3 doses) until IOP <20
3) Mannitol 20%, 1g/kg over 30 min
4) Pilocarpine 2% 1 drop q30min till pupil constricted

HOURLY IOP checks

Question 3

Toxic ASA level

Answer 3

30 mg/dL

• Dialysis:
  
  • acute > 100 mg/dL
  • chronic > 60 mg/dL

Question 4

ASA overdose Mngmnt

Answer 4

1) Multi dose charcoal 1mg/kg if w/in 2 hours
2) Sodium Bicarb 1mgEq/kg IV bolus
3) Sodium Bicarb drip, 3 amps into 1 L D5W, running at 2 ml/kg/h + 40 mEq KCl rider
4) Consider Hemodialysis

5) Check q2 hours:
- urine/serum pH (keep ~ 7.5)
- K levels
- ASA level (want < 20 mg/dL)

Question 5

Lithium Overdose Mngmnt

Answer 5

1) WBI 250 ml/hr polyethylene glycol (Peds) or 2 L/hr (adult)

2) Hemodialisis
- AMS/seizures/coma/renal impairment/CV toxicity
- Acute level > 4 mEq/L
- Chronic level > 2.5 mEq/L

3) Measure Levels q2 hr

Question 6

Iron Overdose Mngmnt

Answer 6

1) WBI 250 ml/hr polyethylene glycol (Peds) or 2 L/hr (adult)
2) Deferoxamine 5-15 mg/kg/h (shock, acidosis, serum iron> 350 mg/dL)
3) Rpt Iron levels q4h until peak and start decreasing

Question 7

Anion Gap

Answer 7

Na - (Cl + HCO3)

Normal - 8-12 mEq/L

Question 8

Causes high anion gap acidosis

Answer 8

ACAT MUDPILE
Alcoholic ketoacidosis
Cyanide, CO
Aspirin
Toluene
Methanol, Metformin
Uremia
Dka
Paraldehyde
Iron, Isoniazid
Lactic acidosis 
Ethylene Glycol

Question 9

Serum Osmolarity

Answer 9

2 (Na) + BUN + Glu + EtOH
2.8 18 4.6

Normal < 10

Question 10

Sodium Bicarb Drip

Answer 10

3 amps of 50 mEq NaHCO3 into 1 L D5W, run at 2 ml/kg/h + 40 mEq KCl rider

Question 11

Methanol Antidote

Answer 11

Fomepizole

Question 12

Ethylene Glycol Antidote

Answer 12

Fomepizole

Question 13

Carbon Monoxide Antidote

Answer 13

Oxygen / HBO

Question 14

Anticholinergic Antidote

Answer 14

Physostigmine

Question 15

Organophosphate Antidote

Answer 15

1) Atropine
- 0.5mg up to 100mg
- repeat freq titrate to secretions/bronchospasm/bronchorrhea)
2) Pralidoxime
- 2g bolus followed by 250 mg/hr infusion

Question 16

Cyanide Antidote

Answer 16

1) Sodium Nitrite
2) Sodium Thiosulfate
3) Vitamin B12

Question 17

Methemoglobinema Antidote

Answer 17

Methylene Blue 1mg/kg IV

Symptoms with level >15%

Question 18

Arsenic / Lead Antidote

Answer 18

Peds level > 70 ug/dL
1) BAL 300 IM divid q4h
2) CaNaEDTA 1000 IV (start
4 hours after BAL)

Adult level > 100
1) BAL 450 IM divid q4h
2) CaNaEDTA 1000 IV (start
4 hours after BAL)

Question 19

Acetaminophen Tox Mngmt

Answer 19

Toxic dose 140 mg/kg
Toxic level @ 4 hr 150 mg/mL

N-acetylcysteine (NAC)

1) 140 mg/kg PO first dose
2) 70 mg/kg PO q4h x 17 doses

Question 20

Digoxin Tox Mngmt

Answer 20

Dig level >10 ng/mL at 6 hours
(or ingestion of 10 mg in adult or 4 in child

Digoxin-specific antibodies
- Empiric dose 10 - 20 vials

Question 21

Ped tube size

Answer 21

[16 + age] / 4

Question 22

RSI Litany

Answer 22

I will intubate the patient using RSi
I will gather my equipment, preoxygenate the patient, premeditate with x, wait 3 minutes, sedate and paralyze with etomidate (0.3mg/kg) and succinylcholine (1.5 mg/kg), place the ETT, confirm tube calorimeter, placement with CO2 auscultation, and CXR.

Question 23

Intubation Premedication meds

Answer 23

Increased ICP

1) Lidocaine 1.5 mg/kg bolus
2) Fentanyl 0.3ug/kg over 30s

Peds < 10yo
1) Atropine 0.02 mg/kg (min dose 0.1mg, max 0.5mg)

Question 24

Peds Sedation meds

Answer 24

1) Etomidate 0.3 mg/kg
2) Ketamine 1mg/kg
3) Midazolam 0.2 mg/kg

Question 25

Peds Paralytic

Answer 25

1) Succinylcholine 2 mg/kg

2) Rocuronium 1 mg/kg

Question 26

Peds Epi Dose

Answer 26

1) 0.01 mg/kg (1:10,000) IV or IO
2) 0.1 mg/kg (1:1,000) via ET tube
3) 0.1 ug/kg/min continuous infusion

Question 27

Pulseless VF/VT Peds

Answer 27

1) Defib with 4 j/kg
2) Epi 0.01 mg/kg (1:10,000)
3) Magnesium 25 mg/kg over 10 min
4) Amiodarone 5mg/kg IV over 10-60 min (max dose 15 mg/kg/d)

CARDS CONSULT

Question 28

Peds Septic Arthritis Abx

Answer 28

0-2 months

1. Nafcillin and
2. Gentamicin

> 2 months

1. Nafcillin
2. Ceftriaxone
3. +/- Vancomycin