Eso Flashcards
ET tube meds
Lidocaine, atropine, narcan, and epinephrine at 2-2.5x dose diluted in 10ml NS.
Asystole
Cpr x 2 mins
O2 15l nrbm.
1mg epi ivp q 3-5 mins.
Repeat cpr cycle q2 mins
Consider other causes.
PEA
Cpr x 2 mins (consider other causes h’s and t’s).
02 15l nrbm
Epi 1mg ivp q 3-5 mins
If hypovolemia: 250ml NS or LR; if no improvement repeat in 5 mins.
Stat cxr
Bradycardia - HR less than 50 and symptomatic.
02 10l nrbm
Transvenous or epicardial pacing if wires present
Atropine 1mg q3-5 mins; repeat for total of 3x
Transcutaneous pacing as soon as possible
If above ineffective;
Start dopamine 400,mg/250ml start at 2mcg a min; up to 20mcg/min
Epi gtt 1mcg/min-10mcg/min
H’s
Hypovolemia
Hypoxia
Hyper/hyperkalemia
Hypoglycemia
Hydrogen ion(acidosis)
Hypothermia
T’s
Thrombus (pulmonary/stroke)
Tamponade
Toxins
Tension ptx
Trauma
stable VT
Call MD
02 4lnc
12 lead EKG
Order k and mg
Unstable VT
O2 10l nrbm
If rate greater than 150; biphasic cardiovert at 200j (can repeat q 1 min max three times)
If time permits versed 0.5mg to sedate; can repeat x 1.
Obtain 12 lead
Draw k and mg
Pulseless vfib and VT
Provide cpr
If witnessed, shock
15l O2 ambu bag
Epinephrine 1mg q3-5 mins
Amiodarone 300mg; can try amio 150mg 3-5 mins after first dose.
If amio ineffective, can try lidocaine 1mg/kg
Chest pain
O2 4l nc
Ntg 0.4sl can repeat x 2 q 3-5 mins.
MS 2mg q 5mins up to 10mg.
Asa 325mg chewed or crushed.
If hypotension: 259ml NS bolus; can repeat in 5 mins.
12 lead EKG
CBC, bmp, ptt, pt/inr, troponin if none within 6 hours.
Hypotension
O2 10l nrbm
If hypovolemia suspected: 250ml NS bolus repeat x 5. Can use LR.
Can start norepi 4mg/250ml at 2mcg-32mcg
If blood loss sus: type n cross 2 units; stat h/h.
For pacu pts: ephedrine 5mg ivp; can repeat in 3mins.
ICP
Increase HOB at least 30 degrees
Hyperventilate with 100% fi02 for oc02 26-30
Draw serum osmolality, bmp, and abg.
Respiratory depression
O2 10l nrbm; if apnea ambu bag 15l - call code
Etco2 monitoring
Give narcan; 0.4mg ivp for apnea can repeat q2 mins up to 2mg; 0.1mg Ivp for depression q2 mins may repeat x 4.
Give romazicon for benzo: 0.2mg Ivp over 15 seconds May repeat in 45 seconds for max of 0.6mg.
Respiratory distress
02 10l nrbm
Stat cxr
For bronchospasm Albuterol 0.5mg in 3ml NS
Consider sx if secretions issue suspect
Abg
Bipap
Prolonged seizures
Lateral decubitus position
10l nrbm
2mg Ativan Ivp over 1 min; repeat x1 in 3-5mins
Draw bmp and anticonvulsants level
Anaphylaxis
02 10l nrbm
Epi 0.3mg IM; repeat in 5mins if no improvement
Place supine; elevate lower extremities
250ml me or LR; repeat in 5 mins for hypotension
If bronchospasm 0.5ml in 3ml Albuterol
Hydrocortisone 100mg Ivp
Benadryl 25mg Ivp
Pepcid 20mg Ivp
If no response to above epi gtt 2mg/250ml at 1mcg/min-10mcg/min
Suspected sepsis
If prompted by emr: order lactate c repeat
If hypotension: 250ml NS or LR - repeat in 5 mins.
Evuate for sirs - order lactate if needed.
Blood cultures x 2
Use nicom
If bp still low: norepi gtt 2mcg/min to 32 mcg/min - can do 30ml/kg at 126ml/hr.
