Details Flashcards
Crotalid Envenomation (Pit Vipers)
CroFab 4-6 vials till initial control envenomation syndrome
– in 250ml NS over 60 min
Glaucoma Meds
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
Toxic ASA level
30 mg/dL
- Dialysis:
- acute > 100 mg/dL
- chronic > 60 mg/dL
ASA overdose Mngmnt
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)
Lithium Overdose Mngmnt
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
Iron Overdose Mngmnt
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
Anion Gap
Na - (Cl + HCO3)
Normal - 8-12 mEq/L
Causes high anion gap acidosis
ACAT MUDPILE Alcoholic ketoacidosis Cyanide, CO Aspirin Toluene Methanol, Metformin Uremia Dka Paraldehyde Iron, Isoniazid Lactic acidosis Ethylene Glycol
Serum Osmolarity
2 (Na) + BUN + Glu + EtOH
2.8 18 4.6
Normal < 10
Sodium Bicarb Drip
3 amps of 50 mEq NaHCO3 into 1 L D5W, run at 2 ml/kg/h + 40 mEq KCl rider
Methanol Antidote
Fomepizole
Ethylene Glycol Antidote
Fomepizole
Carbon Monoxide Antidote
Oxygen / HBO
Anticholinergic Antidote
Physostigmine
Organophosphate Antidote
1) Atropine
- 0.5mg up to 100mg
- repeat freq titrate to secretions/bronchospasm/bronchorrhea)
2) Pralidoxime
- 2g bolus followed by 250 mg/hr infusion
Cyanide Antidote
1) Sodium Nitrite
2) Sodium Thiosulfate
3) Vitamin B12
Methemoglobinema Antidote
Methylene Blue 1mg/kg IV
Symptoms with level >15%
Arsenic / Lead Antidote
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)
Acetaminophen Tox Mngmt
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
Digoxin Tox Mngmt
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
Ped tube size
[16 + age] / 4
RSI Litany
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.
Intubation Premedication meds
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)
Peds Sedation meds
1) Etomidate 0.3 mg/kg
2) Ketamine 1mg/kg
3) Midazolam 0.2 mg/kg
Peds Paralytic
1) Succinylcholine 2 mg/kg
2) Rocuronium 1 mg/kg
Peds Epi Dose
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
Pulseless VF/VT Peds
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
Peds Septic Arthritis Abx
0-2 months
- Nafcillin and
- Gentamicin
> 2 months
- Nafcillin
- Ceftriaxone
- +/- Vancomycin
