Just-Doses-Cross-Referenced Flashcards

Question

Norepinephrine Bolus: Drip:

Answer 1

Bolus: 5-10mcg drip: 0.02-0.3 mcg/kg/min (same as epi) can go as high as 2mcg/kg/min but probably need an additional pressor before then.

Answer 2

0.2- 0.3 mg/kg

Answer 3

Bolus: 1-3mcg/kg but most do 25- 100mcg Infusion: 25-200mcg/hr or 1-3mcg/kg/hr for easy memory (use with caution, long- context sensitive half life). off: 45- 60 min before end of procedure

Answer 4

Bolus 10 units Start IV insulin drip @ Initial Rate: 0.1 units/kg/hr (6.8 units/hr for 68 kg). keep running IV until anion gap closed < 12 if BS < 200 and anion gap is still above 12 then start D5w & 1/2 NS and keep the insulin infusion running. Switch to subq insulin when anion gap has closed. Make sure patient is not borderline hypokalemic before starting insulin (rare but important). If so , replace K+ first. regonition: Kussmal's Breathing, acidotic, BS > 400

Answer 5

1. Recognition: o Monitor ECG for signs of myocardial ischemia:  ST depression and/or T-wave inversion  Hypotension and tachycardia (or inappropriate bradycardia in some cases). GET A 12 LEAD!!! 2. Management: o Restore Coronary Perfusion Pressure (CPP):  Begin with Phenylephrine drip:  Start at 10 mcg/min and titrate up to 200 mcg/min to increase BP and improve coronary perfusion. o Control Heart Rate:  Administer Esmolol for HR control:  Give a 10 mg IV bolus.  Start Esmolol drip at 50 mcg/kg/min, titrate to a maximum of 250 mcg/kg/min as needed to achieve optimal HR (typically < 80 bpm). o Improve Coronary Flow:  Initiate Nitroglycerin drip to dilate coronary arteries:  Start at 0.2 mcg/kg/min and titrate every 3 minutes by increments of 0.1.. so rang is 0.2-1.5 mcg/kg/min, or 10-200mcg/min can give a bolus of 10-50 mcg while starting drip. (note nitroprusside is the same dosing but has slightly longer effect). 3. Additional Supportive Measures: o Increase FiO₂ to 100% and increase flows to 10L to optimize oxygen delivery. o Ensure adequate volume status:  Administer balanced salt solution or colloids as needed for preload optimization. o Consider reducing volatile anesthetic depth if hypotension persists. 4. Monitor: o Continuously monitor ECG for resolution of ischemic changes. o Assess BP, HR, and rhythm frequently after adjustments to therapy.

Answer 6

most common: Neruo where lesion is above heart. 3. Venous Air Embolism (VAE): o Signs: Sudden hypotension, decreased EtCO₂, or mill-wheel murmur on precordial Doppler . o Management:  Notify surgeon to flood the surgical field.  Place patient in left lateral decubitus and Trendelenburg position.  Aspirate air through central venous catheter if in place.  100% O2  Start Inotrope support and fluid bolus. (patient may have distended jugular veins, sign of Right heart not pumping).  Administer epinephrine (100- 300 mcg IV) for cardiovascular collapse. or Epi drip @ 0.02-0.3mcg/kg/min or Use Dobutamine 2-20 mcg/kg/min as it has less decrease on SVR than Milrinone).

Answer 7

Recognition: Hemodynamic Indicators: Increased Pulmonary Artery Pressure (PAP): Elevated readings from a pulmonary artery catheter. (normal is 25/10) Systemic Hypotension: Due to RV failure reducing cardiac output. Increased Central Venous Pressure (CVP - 2-6): Reflecting RV overload. Decreased Cardiac Output (CO- 4-8L/min norm) or Index (CI- 2.5-4L norm): Measured via PAC or other hemodynamic monitors. Right Ventricular Dysfunction: Tachycardia: Attempt to compensate for decreased cardiac output. Jugular Venous Distension (JVD): From RV overload. RV strain on ECG: Right axis deviation, peaked P waves, or RBBB. Respiratory Changes: Hypoxemia: Worsening oxygen saturation despite adequate ventilation. Increased Peak Airway Pressures: Secondary to pulmonary vasoconstriction (HPV) and reduced lung compliance. Clinical Signs: Cyanosis, cool extremities, and signs of poor perfusion. Sudden onset of dyspnea or desaturation. TX: Immediate Interventions Oxygenation: Administer 100% FiO₂ to optimize oxygen delivery and reduce hypoxic vasoconstriction. Optimize Ventilation: Maintain normocapnia or mild hypocapnia (PaCO₂: 35-40 mmHg) to avoid acidosis-induced vasoconstriction. Avoid high PEEP as it can impair venous return to the RV. Pulmonary Vasodilators Inhaled Nitric Oxide (iNO): Dose: Start at 20 ppm (10-40 ppm), titrate based on PAP and systemic BP response. Rationale: Selective pulmonary vasodilation reduces RV afterload without systemic hypotension. Intravenous Prostacyclin (Epoprostenol): Dose: Start at 2-4 ng/kg/min, titrate up to 20-40 ng/kg/min based on response. Rationale: Reduces PVR and has anti-platelet effects to reduce microvascular thrombosis. Sildenafil or Tadalafil: Consider oral or IV formulations if available for chronic PH management, though less effective in acute crises. Inotropic Support: Dobutamine: Start at 2-5 mcg/kg/min (infusion range is 0.5- 20 mcg/kg), titrate for improved RV contractility and cardiac output. Milrinone: Loading dose of 25-50 mcg/kg over 10 minutes, then infusion at 0.125–0.75 mcg/kg/min. Avoid in severe hypotension due to vasodilatory effects (greater SVR & PVR reduction than dobutamine). Epi is also an option. Vasopressors: Norepinephrine: Start at 0.02 mcg/kg/min, titrate to maintain systemic perfusion and RV coronary perfusion. Avoid RV Afterload Increases: Treat systemic hypotension carefully to maintain RV perfusion pressure while avoiding excessive increases in PVR. Address Precipitating Factors Hypoxia: Increase oxygenation. Hypercapnia or Acidosis: Optimize ventilation and administer sodium bicarbonate (50mEq) if severe acidosis (pH <7.2). Pain or Agitation: Administer analgesia (e.g., fentanyl) or anxiolytics to blunt sympathetic stimulation. Bolus fluid cautiously, if CVP is low < 8mmHg then probably ok.. do slowly (10 min), if worsens situation then stop immediately

Answer 8

SPECIAL EQUIPMENT / INVASIVE LINES * Arterial Line (Radial or Femoral): Continuous blood pressure monitoring and frequent arterial blood gas analysis. REASONING: Critical for managing hemodynamic instability and guiding resuscitation. * Large Bore Peripheral IVs (14-16G x 2): For rapid administration of fluids and blood products. REASONING: Ensures adequate access for massive transfusion. * Rapid Infuser (e.g., Level 1 or Belmont): For rapid administration of warmed blood products and fluids. REASONING: Critical for managing massive hemorrhage and maintaining normothermia. * TEG- monitor ACTs Activate Massive Transfusion Protocol - Call for HELP Fluids Administered: Start with 1-2 L crystalloid; transition rapidly to blood products. Massive Transfusion Protocol (MTP): Ratio-based resuscitation (1:1:1 or 2:1:1 RBC:FFP). * Blood Products: Begin with 2 units of O-negative blood, then switch to type-specific once available. Continue with a 1:1:1 ratio of PRBCs:FFP:platelets COMPONENTS The three components of MTP are: 1. Packed Red Blood Cells (PRBCs): Replaces lost red blood cells to restore oxygen-carrying capacity. 2. Fresh Frozen Plasma (FFP): Provides clotting factors to help correct coagulopathy. 3. Platelets: Replenishes platelet count to aid in clot formation. * 1:1:1 Ratio (PRBCs:FFP): This means for every unit of PRBCs given, one unit of FFP and one dose of platelets are also administered. This approach aims to provide a balanced replenishment of red cells, plasma, and platelets. * 2:1:1 Ratio (PRBCs:FFP): This means for every two units of PRBCs given, one unit of FFP and one dose of platelets are administered. This approach might be used initially to rapidly restore oxygen-carrying capacity while still addressing coagulopathy. * First Cooler: o 2 Units of O-Negative PRBCs o 4 Units PRBCs o 4 Units FFP o 1 Six-Pack Platelets o Cryoprecipitate: As indicated by laboratory results and clinical assessment. o Use the Belmont rapid transfuser/warmer or pressure bag. Set blood transfusion tubing up with a fluid warmer(s). o 100% O2 & increase flows lower volatile concentration. o Actively warm the patient. Bair Hugger where you can Calcium Gluconate: 1-2 g IV after every 4-6 units of PRBCs. Calcium Chloride: 1 g IV (preferred for acute hypocalcemia or cardiac instability). * Laboratory Monitoring: After the first cooler, draw blood for TEG, CBC, ABG, and CMP. Repeat as necessary to guide further blood product administration. Active Coagulation Monitoring with TEG/ROTEM: Incorporate thromboelastography (TEG) or ROTEM to guide targeted blood product administration: FFP: For prolonged clotting time. ACT > 140 Platelets: For low MA (maximum amplitude) < 50 . Cryoprecipitate: For low fibrinogen levels (<1.5 g/L). FIBTEM MCF low (ROTEM) or K time > 3 min (TEG) or @ angle < 53 (TEG) Laboratory monitoring should include TEG, CBC, fibrinogen, ABG, ionized calcium, and lactate. Cryoprecipitate and Fibrinogen Replacement: Indication: Use cryoprecipitate if fibrinogen is <1.5-2 g/L. Dose: Cryoprecipitate: 1 bag per 10 kg body weight (usually 10-15 bags). Fibrinogen Concentrate: 3-4 g IV for rapid correction. If Coagulopathy is suspected give 1g TXA over 10 min Vasopressor support

Answer 9

1. Thyroid Storm: Signs: Fever, tachycardia, hypertension, arrhythmias. Management:  Esmolol drip for HR and BP control. 50-300mcg/kg/min or 10-40mg boluses (drip better)  Propylthiouracil (PTU) 200-400 mg NG to inhibit thyroid hormone release.  Hydrocortisone 100 mg IV to block peripheral conversion of T4 to T3. 2. Hemodynamic Instability: o Treat hypotension with Phenylephrine boluses (50-100 mcg IV- rare). o Avoid ephedrine or other agents that can exacerbate tachycardia.

Answer 10

1. 100% fiO2 & increase flows 2. Balanced salt solution or colloid - often rapid infusion of 1 - 4 lL !!! required. 3. Epinephrine (initial dose 10 - 100 mcg IV): reassess and redose if needed q3 min o Beta adrenergic effect inhibits degranulation of mast cells and causes bronchodilation. o Alpha effect causes vasoconstriction. 4. Diphenhydramine (initial dose 50 - 100 mg IV): Blunts histamine effects. 5. Albuterol Inhaler (initial dose 10 puffs per ETT): For bronchospasm. 6. Phenylephrine (initial dose 25-100 mcg IV): Raises BP through alpha-adrenergic effect. 7. Corticosteroids - Methylprednisolone (40-60mg): 4x more potent than hydrocortisone. o Enhances beta effects of Epinephrine. o Inhibits production of leukotrienes. o Reduces complement system activation. Methylene Blue for refractory hypotension: 10-50mg IV

Answer 11

Maintain Preload, Afterload, and Sinus Rhythm: Preload: Ensure adequate volume to maintain ventricular filling. Afterload: Avoid hypotension as the heart relies on systemic vascular resistance (SVR) for forward flow. Sinus Rhythm: Preserving atrial contraction is critical for diastolic filling in a non-compliant left ventricle. (Have pads on, quickly cardiovert any A-fib!!!) Induction Plan Medications to Administer: Etomidate 0.2-0.3 mg/kg IV: Preserves SVR with minimal myocardial depression. Fentanyl 2-5 mcg/kg IV: Blunts sympathetic response to intubation. Rocuronium 0.6-1.2 mg/kg IV: For muscle relaxation. Rapid Response to Hypotension: Administer Phenylephrine 100 mcg IV bolus to quickly restore afterload if hypotension occurs. Maintaneance Phase: (keep MAP > 70) Anesthetic Agents: Sevoflurane 0.5-0.7 MAC: Maintain lower MAC to reduce myocardial depression and maintain SVR. Supplement with Remifentanil infusion (0.05-0.2 mcg/kg/min) to achieve adequate analgesia and further reduce MAC requirements. Avoid Nitrous Oxide: Prevents hemodynamic compromise. Ventilation Settings: Avoid hyperventilation; maintain normocapnia (EtCO₂ 35-40 mmHg) to avoid decreasing preload. Fluid Management: Use crystalloids judiciously to maintain preload without causing volume overload. Avoid rapid boluses; use a controlled infusion if needed, guided by CVP or PAC monitoring. Vasopressor Support: Start a Phenylephrine infusion (0.05-0.1 mcg/kg/min) 40-80mcg/min is most common dose and titrate to maintain MAP > 70 mmHg. Emergence Phase Extubation Criteria: Ensure hemodynamic stability (MAP > 70 mmHg). Confirm adequate spontaneous ventilation and airway reflexes. Neuromuscular Reversal: Use Sugammadex to avoid bradycardia associated with neostigmine. Postoperative PONV Prophylaxis: Ondansetron 4 mg IV at the end of surgery Special Considerations for Aortic Stenosis Hypotension Management: Use Phenylephrine (50-100 mcg IV) or titrate infusion to maintain afterload. Avoid ephedrine, as tachycardia worsens diastolic filling. Tachycardia Management: Esmolol 0.5 mg/kg (10-40mg) IV bolus or infusion for HR > 90 bpm. Avoid Fluid Overload: Monitor urine output and CVP to guide fluid resuscitation. Intraoperative Dysrhythmias: ****Treat atrial fibrillation aggressively with cardioversion (100 -200 joules) and amiodarone 150mg.

Answer 12

Vortex Principle: Get Help First, try adjuncts w/ the 3 techniques Three Airway Techniques: Face mask ventilation. Supraglottic airway (e.g., LMA). Endotracheal intubation. no more than 3 attempts per technique - Oxygenation is key, if you cannot oxygenate at the end of the vortex and are unable to reverse the patient to wake up THEN...make sure you have an extra set of hands, place a foam roll under the shoulders to expose the neck, adjust lighting and start an emergency cricothyrotomy. Airway Optimization Strategies - FOR EVERY PHASE CONSIDER OXYGENATION, ADJUNCTS, SWITCHING PROVIDERS, AND MUSLCE RELAXANTS for optimal position. 1. Face Mask Ventilation Seal: Ensure a tight seal by adjusting head position, mask grip, or using a two-person technique (two handed). (JAW THRUST).. Try a new mask size. Airway Adjuncts: Insert an oropharyngeal (OPA) or nasopharyngeal (NPA) airway to reduce obstruction. Pressure: Increase positive pressure ventilation (PPV) cautiously, using PEEP or CPAP if needed. 2. Supraglottic Airway (SGA) Placement: Ensure correct placement of the SGA. Size: Switch to a larger size if ventilation is inadequate. if 3 go 4. Also you can switch to a different type of LMA. Position: Adjust head/neck alignment or reposition the device. 3. Endotracheal Intubation- more Paralysis ?? Positioning: Optimize the sniffing position for better glottic visualization. (Try different blade, different size). Video Laryngoscopy: Use if direct laryngoscopy fails or is predicted to fail. (Fiberoptic if available as well) Bougie: Insert to facilitate tube passage. External Manipulation: Apply BURP (Backward, Upward, Rightward Pressure) on the larynx. REVERSE PARALYTICS w/ SUGGAMADEX 16mg/kg - WAKE THE PATIENT UP DON'T KEEP DOING THE SAME SHIT, GET HELP AS SOON AS YOU RECOGNIZE YOU CANNOT OXYGENATE PATIENT ACCORDING TO ORIGINAL PLAN.

Answer 13

Past History: Look for conditions like OSA, prior difficult intubation, or airway surgery. Facial Features (Predictors of Difficult Mask Ventilation): Beard: Often requires RSI; difficult to achieve a seal. Edentulous (No teeth): Increases difficulty in mask ventilation. Jaw protrusion limitation: Predicts difficulty with both bag-mask ventilation and intubation. Airway Exam (Predictors of Difficult Intubation): Mallampati Score: Class 3-4 predicts difficulty. Neck Extension: Limited extension (<35°) is predictive of difficulty. Thyromental Distance (TMD): Normal: >6.5 cm (~3 fingerbreadths). Difficulty: <6 cm. Inter-incisor Distance (Mouth Opening): Normal: >4 cm (~3 fingerbreadths). Difficulty: <3 cm. Neck Circumference: Normal: <40 cm. Predicts difficult intubation if >43 cm (especially in obese patients).

Answer 14

10-50mg IV Mechanism of Action Inhibits Nitric Oxide (NO)-Mediated Vasodilation: Anaphylaxis triggers the release of mediators like histamine and nitric oxide, which lead to profound vasodilation and decreased systemic vascular resistance (SVR). Methylene blue inhibits guanylate cyclase, reducing cyclic GMP (cGMP) production and counteracting nitric oxide's vasodilatory effects. This restores vascular tone and improves blood pressure. Acts as a Vasopressor Adjunct: It directly promotes vasoconstriction and enhances the effectiveness of other vasopressors like norepinephrine and phenylephrine. When to Use Methylene Blue Consider methylene blue in patients with: Refractory hypotension that does not respond to epinephrine, fluids, and standard vasopressors. Evidence of severe distributive shock due to anaphylaxis.

Answer 15

Dose: The entire vial 5mL of 0.8% (40mg) IV push half life: 4-5 min excreted via kidneys may cause transient HTN. Urological Procedures: Indigo carmine is commonly used during surgeries involving the urinary system to visualize the ureters and confirm their patency or to detect injury. It is filtered by the kidneys and excreted in the urine, producing a blue-colored output that helps surgeons identify ureteral function and integrity. Gynecological Procedures: Used to ensure ureteral patency after pelvic surgeries like hysterectomy or to evaluate possible urinary tract injury. Other Uses: Can aid in identifying fistulas or leaks in the urinary tract. Occasionally used for dye-based localization during other procedures.

Answer 16

adults: 0.2mg per mg of Neostigmine peds: 15mcg/kg IV or 4mcg/kg IM

Answer 17

dose: 5-10mg peds: 0.1-0.2mg/kg q4 onset: 10-20 min duration: 3-6 hours

Answer 18

adults: 20-40mg PO Peds: 0.2mg/kg PO

Answer 19

Adult: 100mg IV, then 25-100mg IV every 6-8 hours. (depending on stress of surgery). Peds: 0.1-0.2mg/kg q4 hr Indications for Stress-Dose Hydrocortisone Known Adrenal Insufficiency: Primary adrenal insufficiency (e.g., Addison's disease). Secondary adrenal insufficiency (e.g., pituitary dysfunction). Chronic Steroid Use: Patients on long-term steroids (prednisone ≥5 mg/day for >3 weeks) may have suppressed adrenal glands and cannot produce sufficient cortisol in response to stress. Acute Adrenal Crisis: Hypotension unresponsive to fluids and vasopressors. Features of adrenal crisis, such as weakness, confusion, or hypoglycemia. Major Surgical Procedures or Trauma: Especially in patients with known or suspected adrenal insufficiency undergoing: Major surgeries (e.g., open abdominal, thoracic, or vascular surgery). Significant trauma or sepsis.

Answer 20

Adults: 0.5-2mg IV Peds: 5-10 mcg/kg IV prn infusion: 0.5-4mg/hr onset: 5-15 min duration: 2-4 hrs

Answer 21

Adult & Peds: LAST: 1.5 mL/kg followed by infusion 0.25 mL/kg/min up to 0.5 mL/kg/min (IDBW) start CPR, bolus 20% intralipid @ 1.5mL/kg. Repeat bolus q3-5 min and double infusion if still unresponsive. Continue infusion until hemodynamically stable. Max total dose 8mL/kg

Answer 22

Induction: 0.5-2mg/kg give w/ Midazolam Maintenance and sub anesthetic dose (analgesia): 0.2-0.5 mg/kg IV or 0.1-0.5mg/kg/hr Post op sedation and analgesia: 1-2 mg/kg/hr (also used for ped heart case) Neuraxial analgesia: Epidural: 30 mg intrathecal/spinal/ subarachnoid: 0.1-0.3mg/kg Duration: 10-20 min

Answer 23

dose: 15-30mg Q6hrs neck: NO, use ofirmev, as NSAIDs are prone to cause bleeding and hematoma.. no good in neck cases. Avoid in renal failure or CR > 1, avoid w/ Ashtma patients and Cox allergies. You know you're not allergic to the COX ; -) This is not Tramadol, which is an opioid!

Answer 24

induction & arrest: 1-1.5mg/kg (Max 100mg) infusion: 0.5-3 mg/kg/hr IV - usually 1mg/kg/hr for MAGA plain: 5mg/kg w/ epi: 7mg/kg duration: 60-120 min Don't go over 300mg total without epi or 500mg total w/ epi

Answer 25

Adult: 1-4mg IV Peds: 0.1mg/kg IV

Answer 26

Adult: Asthma & pain: 2 gm IV over 20 min; Eclampsia/preeclampsia: Load 4-6 gm IV, infusion 1-2 gm/hr IV; TdP: 1-2 gm IV, infusion 0.5-1 gm/hr IV Peds: Asthma: 25-75 mg/kg (max 2 gm) IV over 20min; TdP: 25-50 mg/kg/dose (max 2 gm) IV TdP = Torsades de Pointes

Answer 27

Recognition: Upper airway obstruction; inspiratory stridor, Typically on emergence), O2 sats drop TX: Turn APL valve to 40-70, (positive pressure). increase flows, Tight mask seal with jaw thrust and Larson's maneuver (two handed). If doesn't work then Succinylcholine 10-20 mg IV or 3-4mg/kg IM in kids without IV access.

Answer 28

12.5mg for post op shivering Mechanism: Meperidine has a unique anti-shivering property mediated by its action on kappa-opioid receptors and potential inhibition of the shivering reflex in the hypothalamus. Dexmedetomidine works as well to widen shiver threshold

Answer 29

Adult: 0.2 mg IM; repeat q 5-10min max 2 doses for PPH

Answer 30

Adult: Asthma: 40-80mg IV; Anaphylaxis: 125mg IV Peds: Asthma: 1mg/kg IV; Anaphylaxis: 1-2mg/kg IV

Answer 31

Adult: 10-20 mg IV/PO, repeat 5-10 mg q6hr prn Peds: 0.1-0.15 mg/kg IV/PO q6hr prn

Answer 32

Adult: 0.5-4 mg IV Peds: 0.1-0.2 mg/kg IV, 0.5 mg/kg PO/PR

Answer 33

Adult: 1mg PR used for inducing and PPH

Answer 34

Adult: 1 - 10 mg IV/IM Peds: 0.05-0.1 mg/kg IV/IM onset: 10-20 min duration: 4-5 hrs

Answer 35

dose: 40-80 mcg (less than the 2mg giving to people who OD.. we don't want to reverse all analgesia).. reassess and redose if needed onset: 1-5 min duration: 30 min !!! (shorter than opioids)

Answer 36

Adult & Peds: 0.04-0.07 mg/kg IV (max 5 mg) Add atropine IV 0.5-1 mg (adults), 20 mcg/kg (peds) w/ edrophonium

Answer 37

Bolus: 10-50mcg Adult: Infusion: 10-200 mcg/min IV or 0.1-1.5mcg/kg/min (Note these doses are the same for nitroprusside) Peds: 0.5-20 mcg/kg/min IV Infusion duration: 3-5 min

Answer 38

Bolus: 10-50mcg Adult: Infusion: 10-200 mcg/min IV or 0.1-1mcg/kg/min (Note these doses are the same for nitroglycerin) Peds: 0.5-20 mcg/kg/min IV Infusion duration: 1-10 min (longer duration than nitro)

Answer 39

Adult: 4-8 mg IV, repeat q4-8hr prn Peds: 0.15 mg/kg IV; repeat q6-8hr prn

Answer 40

Adult: 5-15 mg (or higher depending on opioid tolerance), repeat q3-4hr prn Peds: 0.1 mg/kg PO; repeat q3-4hr prn

Answer 41

Adult: standard 20 units (2 vials ) in a L.. sec, consider repeat dosing and infusion Should be in a Liter, just roll it open in the event of PPH

Answer 42

Adult: 500-1000 mg IV/PO, repeat q4-6 prn (max 3-4 gm/day) Peds: PO/IV: 10-15 mg/kg, repeat q6h prn, PR: 40 mg/kg x 1, Max: 75 mg/kg/24 hour

Answer 43

Adult & Peds: Status epilepticus: 15-20 mg/kg IV, may repeat 5-10 mg/kg in 10min prn x 1 Make sure you dilute, this shit is a vesicant!!

Answer 44

Adult: 40-100 mcg IV q1-2min prn; Infusion 10-200 mcg/min

Answer 45

Adult: 5-10 mg IV/IM/PO q3-6 hrs prn (max 40 mg/day) Peds: 0.1-0.15 mg/kg PO/IM/IV q6-8h prn (max 10 mg/dose

Answer 46

Adult: 6.25-25 mg PO/PR q4-6hr prn Peds: 0.2-0.5 mg/kg PO/PR q6-8h Max 25 mg/dose (do not give if < 2 yo) vesicant; good rescue drug (if puking)

Answer 47

Induction: 1.5-2.5mg/kg MAC: 25-100mcg/kg/MIN TIVA: 100-300mcg/kg/MIN

Answer 48

Adult: 50 mg IV; 150-300 mg PO Peds: 1 mg/kg IV; 2.5 mg/kg PO Antihistamine and Antacid It can treat and prevent heartburn. it can also treat stomach ulcers, gastroesophageal reflux disease (GERD), and conditions that cause too much stomach acid.

Answer 49

Adult & Peds: Bolus: 0.5-1 mcg/kg IV; 50mcg bolus common Infusion (adjunct w/ prop or volatile): 0.05 - 2 mcg/kg/min IV MAC/Fiber: 0.025-0.1 mcg/kg/min .. Keep resp > 10 (Titrate by 0.01, do not even bolus 1cc of propofol w/ this setup bc of apnea) prop running at 50mcg/kg/min for MAC. duration: 5-10 min

Answer 50

Adult: 0.6-1.2 mg/kg IV (t1⁄2 = ~60 min) Peds: 0.9-1.2 mg/kg IV duration: 35-75 min

Answer 51

Adult & Adolescents: 1 patch q72hr Peds: 6 mcg/kg IV (max 0.3 mg)

Answer 52

Adult: 15-30mL PO q6h prn Peds ≥ 2 yo: 1-1.5 mL/kg q6-8h prn (max 30 mL/dose)

Answer 53

Adult: 50-100 mEq IV prn (1"Amp" of 50 mL 8.4% = 50 mEq) Peds: 1-2 mEq/kg IV

Answer 54

IV: 1-1.5mg/kg IM: 3-4mg/kg

Answer 55

Adult: Analgesia: 5-10mcg bolus Infusion: 0.2-0.5mcg/kg/hr common is 0.3mcg/kg/hr -> 0.2 -> 0.1 as the case progresses. Turn off 15-30 min before the end of case duration: 1-1.5 hrs

Answer 56

Adult: 2 TOF Twitches: 2 mg/kg; 0 TOF, 1-2 PTC (post tetanic): 4 mg/kg; Immediate emergent reversal : 16 mg/kg

Answer 57

5-10mcg/kg IV Bronchospasm: IV Dose: 5-10 mcg/kg IV every 15-30 minutes, titrated based on response. Maximum single dose: 250 mcg. Tocolysis: IV Dose: 5-10 mcg/kg IV every 15-30 minutes, titrated for uterine relaxation. Alternatively, a continuous infusion can be initiated at 2.5-10 mcg/min, titrated as needed. Maximum infusion rate: 80 mcg/min. Tocolysis is a medical procedure that uses medications to delay preterm birth by relaxing uterine muscles and suppressing contractions

Answer 58

IV: 4 mg/kg (technically 3-6) ***re-dose after 30 min d/t rapid redistribution

Answer 59

Adult: 25-100 mg PO q4-6h prn Peds: not recommended in children < 12 yo

Answer 60

Adult: 1 g IV (over 10 min!!!!!), repeat x 1 after 30 min prn If someone tells you to just push it, hand the stick to them and say be my guest.. You don't want to be the one to blame for a PE.. (just because they haven't had one yet doesn't mean it's safe).

Answer 61

Adults: (shock) 0.03 - 0.04 units/minute drip Bolus: Can bolus 0.5- 1 units, (might need bolus in acute setting if patient is hypocalemic, as this will hinder other vasoactive medications from working). Peds: (shock) Infusion: 0.002 units/kg/min IV

Answer 62

Adult & Peds: (induction) 0.1 mg/kg IV (t1⁄2 = ~ 65 min) 0.8-1.7 mcg/kg/min drip onset: 2-3 min duration: 45-90 min

Answer 63

drip: 1-20mcg/min when: Third degree heart block to keep CO up (which will maintain BP). This is a temporary fix while you pace the heart or whatever else is needed.

Answer 64

Loading dose of 25-50 mcg/kg over 10 minutes, then infusion at 0.125–0.75 mcg/kg/min. Avoid in severe hypotension due to vasodilatory effects increase cAMP and HR, contractility

Answer 65

Intravenous (IV) Dose: Initial Dose: 1-5 mg IV bolus, administered slowly Titration: Repeat every 5 minutes as needed, up to a maximum of 15 mg in most settings. Onset: 1-2 minutes after IV administration. Duration: duration: 5-8 hours for IV doses (depending on patient metabolism and other factors).

Answer 66

CCB Bolus: 50-100mcg Onset: 1 min Duration: 5- 15 min drip: 1-16mg/hr ultra short acting

Answer 67

Use: HTN and angina drip: 1-15mg/hr Titration: Increase by 2.5 mg/hour every 5-15 minutes to achieve the desired blood pressure. Duration: The effects last 15-30 minutes after discontinuation, depending on the duration of infusion. Use Cases in the OR Setting Intraoperative Hypertension: Effective for rapid control of elevated blood pressure during surgery, especially in neurosurgical, vascular, or cardiac cases. Preferred when precise and titratable blood pressure management is needed. Postoperative Hypertension: Used to stabilize blood pressure in the immediate postoperative period, particularly in high-risk patients. Hypertensive Emergencies: Nicardipine is a go-to agent for controlling hypertensive crises due to its rapid action and titratability. Neurosurgery: Useful in managing blood pressure to prevent secondary brain injury (e.g., during aneurysm clipping or craniotomies). Cardiac Surgery: Helps reduce afterload without significant myocardial depression, which is ideal for patients with impaired cardiac function.

Answer 68

drip: 5-15 mg/hr; titrate by 5mg/hr indications: Control rapid ventricular response from Afib/flutter, PSVT, HTN, Harvesting radial grafts (CABAG- stops arterial spasm), Angina (PO) ONLY USE IF VENTRICULAR RATE > 100

Answer 69

dose: 0.2-0.3mg/kg duration: 1-2 days, NMDA effects

Answer 70

dose: 4-8mg Peds: 0.2-0.5mg/kg (max 20mg) onset: 10-30 min duration: 2-10 hrs antiemetic steroidal, anti-inflammatory.

Answer 71

dose: 1-5mg use: antiemetic anti-DA, QT prolongation

Answer 72

dose: 2.5-10mg PO anti-DA

Answer 73

NK1 Neurokinin Receptor Antagonist dose: 40mg more for chemo like 100mg onset: give 3 hours before induction constraceptives will not work as well for 28 days

Answer 74

T10: 10-15mg @ 0.75% solution would be 1.3-2cc T4: 12- 20mg @ 0.75% solution would be 1.6- 2.6 cc onset: 4-8 min duration: 130-220 min + 20-50% w/ epi

Answer 75

T10: 12-18 mg @ 0.5% solution would be 2.4-3.6cc T4: 18-25mg @ 0.5% solution would be 3.6-5cc onset: 3-8 min duration 80- 210 min ( less than bupivacaine (slightly less lipophilic)

Answer 76

Common Adjuncts for Spinal Anesthesia Epinephrine: 0.1-0.2mg Morphine : 50-300mcg (Max 300) Fentanyl: 10-25mcg Peak 2hr & 6-12hr: only for postop pain. Must monitor 24 hrs due to risk of delayed respiratory depression Clonidine: 30- 60 mcg (caution black box warning for maternal hypoTN and bradycardia) Common mix: 2.5-15 mg 0.5-0.75% hyperbaric bupiv +/- 10-15 mcg fentanyl +/- 100-150 mcg morphine +/- 50-100 mcg epinephrine

Answer 77

T4-T7: PCEA (bolus/lockout/rate/hr limit) 0.1% bupiv 5 mL/10 min/8 mL/32 mL T7-T12: PCEA (bolus/lockout/rate/hr limit) 0.1% bupiv 5 mL/10 min/8 mL/32 mL L1-L5: PIB 0.0625-0.1% bupiv + fentanyl 5-10 mL/30 min PCEA 5-10 mL/10-15 min

Answer 78

Dose: 0.03–0.06 mg/kg IV (ideal body weight). For an average 70 kg patient, this equates to 2-4 mg IV. This is the way to go over awake fiber-optics in penetrating eye injury according to studies apparently.