ED CEP

Question 1

Peds Brady (hr less than 60)

Answer 1

-start cpr
-epi 0.01mg/kg(0.1ml/kg) 1:10k ivp
-atropine 0.02mg/kg (min 0.1mg…max 0.5mg); can repeat x 1
-transvenous or transcutaneous pacing
-H’s t’s

Question 2

Svt - peds

Answer 2

-vagal maneuvers (ice to face/blow on syringe/straw)
-adenosine (0.1 mg/kg can repeat to 0.2mg/kg - max for both doses is adult dose)
-synch cardio version (0.5-1j/kg then 2j/kg)

Question 3

VT c a pulse - peds

Answer 3

-consider adenosine if regular and monomorphic;expert consultant advised
-amio 5mg/kg over 20-60 mins
OR
-procainamide 15mg/kg give over 30-60mins
-synch cardioversion 0.5-1j/kg and then 2j/kg

Question 4

Peds pea

Answer 4

-cpr
-epi 0.1mg/kg q 3-5mins
-cpr(15:2 or resp. 2-3 seconds if advanced airway)
-consider advanced airway and treat h and t

Question 5

V fib/pulselsss VT - peds

Answer 5

-cpr
-defib 2j/kg
-cpr
-defib 4j/kg
-cpr
-epi 0.01mg/kg every 3-5 mins
-defib up to 10j/kg
-amiodarone 5mg/kg up to 300mg may repeat up to 3 doses for refractory
-consider lidocaine 1mg/kg; initial loading dose

Question 6

H

Answer 6

Hypoxia
Hypothermia
Hyper/hypokalemia
Hypoglycemia
Hydrogen ion(acidosis)
Hypovolemia

Question 7

Fluids for peds

Answer 7

Na 20ml/if heart wnl
5-10ml/kg if not wnl heart
Prbcs 10ml/kg
D25 2-4ml/kg

Question 8

Adult bradycardia

Answer 8

Atropine 1mg q 3-5 mins; max 3 doses
If ineffective
Tcp
Or
Dopamine gtt 5-20mcg/kg/min
Or epi gtt 2-10mcg/min
Or tcp/tvp

Question 9

Adult asystole

Answer 9

Cpr
1mg epi q 3-5mins
Treat h and t

Question 10

Adult vf/pulselsss VT

Answer 10

Shock
Cpr
Epi 1mg q 3-5 mins
Shock
Amio 300mg OR lidocaine 1-1.5mg/kg….
Second dose amio 150mg
Second dose lido 0.5-0.75mg/kg

Question 11

T’s

Answer 11

Toxins
Thrombus (coronary/pulmonary)
Tamponade
Tension ptx

Question 12

Initial stabilization phase after cpr

Answer 12

Make sure et tube
Start rr at 10/min
Goal sp02 92-98%
Paco2 35-40
Maintain sbp 90 or map 65
Ttm if not causing

Question 13

Adult svt

Answer 13

Vagal
Adenosine 6mg
Second dose 12mg
Can consider expert consultant or b blocker or ca channel blocker
Infusions for wide complex stable…..
Procainamide 20-50mg/min
Or amio 150mg over ten mins followed by maintenance 1mg/min
Sotalol 100mg (1.5mg/kg) over 5 mins…avoid with prolonged qt

Question 14

Art line supplies

Answer 14

500ml NS bag
500ml pressure bag
Transducer c pump
Red pressure cable
Transducer holder
Bubbler leveler

Question 15

Chest tube supplies

Answer 15

Chest tube insertion tray
Atrium
Sx tubing
Foam tape
Sterile gloves
Petroleum/gasoline gauze
4x4 fenestrated gauze

Question 16

Life sharing triggers

Answer 16

Gcs if less than 4
Rosc
Any ttm
Neurological injury or anoxic brain injury
Discussions of withdrawal of life support

Question 17

LAST s/s

Answer 17

Early signs: paresthesia of face, mouth, tongue, anxiety, disroientation, tachycardia
Late signs: aloc, sz, cardiac arrhythmias/hypotension

Question 18

What to avoid in LAST

Answer 18

Avoid propofol, avoid b blockers/ca channel blockers

Question 19

Med for LAST

Answer 19

Obtain 20% infusion order and have anesthesia to push bolus and start infusion

Question 20

Htn in pregnancy

Answer 20

If bp 140/90 send to A station, notify md, and recheck bp in 15mins
If bp 160/110 get consult from ob gym, stay in Ed

Question 21

First line anti htn meds for preeclampsia/eclampsia

Answer 21

Lavetelol IV
Hydralazine IV
Nifidepine PO

Question 22

Mag dosing for eclampsia/pre-eclampsia

Answer 22

10g
4-6g loading over 20-60m
Maintanence dose 1-2g/hr

If on mg gtt already give 2g over 5 mins; if continuous sz then 2mg Ativan or Versed.

Question 23

OB HTN 160/110 w IV

Answer 23

Hydralazine or labetelol

Question 24

Eclamptic sz no IV

Answer 24

10mg IM; split in two syringes 10ml into each buttock

If continuous sz; give versed 10mg IM

Question 25

OB HTN BP 160/110 no IV

Answer 25

nifedipine IR or labetelol PO