Life Support + Procedures

Question 1

When intubating using succ in children under X, premedicate with Y at what dose to prevent Z (or use roc)

Answer 1

Children <2, premedicate with atropine 0.01 mg/kg to prevent bradycardia

Question 2

Transtracheal jet ventilation (as opposed to just using BVM) contraindicated age

Answer 2

5

Question 3

Elevated ICP, premedicate with (2 meds + dose) before intubation to blunt rise in ICP

Answer 3

lidocaine 1.5 mg/kg, fentanyl 1 ug/kg

Question 4

Septic shock + chronic steroids or non-responsive to pressors –> give

Answer 4

hydrocortisone 100 mg

Question 5

Adult levophed dosing (not weight based)

Answer 5

1-30 ug/min

Question 6

2nd pressor after levophed for septic shock and dose

Answer 6

0.04 U/min

Question 7

Goal directed therapy in sepsis. What objective measures?

Answer 7

SBP >90, MAP > 65, UOP 0.5 cc/kg/hr, CVP 8-12, ScvO2 > 70

Question 8

Septic pt. What procedures?

Answer 8

CVC, aline, foley, low threshold to intubate

Question 9

Pulse present but insufficient respirations. What do you do?

Answer 9

Bag q5-6 sec + q2 min pulse check

Question 10

Pt codes in front of you. First 2 things to verbalize.

Answer 10

Begin compressions. Activate code blue.

Question 11

Hs and Ts

Answer 11

Hypothermia, hypovolemia, hypoxia, H+, hyper/hypokalemia, hypoglycemia, toxins, tension PTX, thrombus (PE/MI), tamponade

Question 12

Hyperkalemia treatment (ACLS)

Answer 12

Calcium, insulin 10U + d50 1 amp, nebulized albuterol. Dialysis if needed.

Question 13

ACLS acidosis - consider (med + dose)

Answer 13

bicarb 1 mEq/kg

Question 14

PE circling drain –> TPA dosing

Answer 14

50 mg immediately, can give 50 more at 15 min

Question 15

Bradycardia escalating steps

Answer 15

atropine 0.5 mg (up to 3). Epinephrine 2-10 ug/min. Transcutaneous –> transvenous pacing

Question 16

Tachycardias more likely to respond to lower dose cardioversion vs likely require higher

Answer 16

Lower (100 J): aflutter, SVT

Higher (200 J): afib, vtach

Question 17

Stepwise escalation of cardioversion energy e.g. unstable afib

Answer 17

200 - 300 - 360 J

Question 18

Stable tachycardia stepwise approach: narrow complex, regular

Answer 18

Vagal maneuvers/treat underlying issue e.g. fluids. Adenosine 6 -12 -12. CCB (dilt 0.25/kg -> 0.35/kg) or BB. Digoxin if EF <40

Question 19

WPW EKG

Answer 19

PR <120 (orthodromic), slurred QRS upstroke, widened QRS, ST/T wave changes

Question 20

Antidromic WPW treatment options.

Answer 20

Procainamide, amiodarone, or cardiovert. Otherwise treat like VT. AVOID AV nodal blockers including adenosine, BB, CCB, digoxin.

Question 21

Orthodromic WPW

Answer 21

Can treat same as SVT; vagal, adenosine, CCB

Question 22

Tachycardia. Narrow, irregular. Ddx and tx options. Tx if EF <40%

Answer 22

Afib, aflutter. Dilt 0.25 mg/kg -> 0.35 mg/kg. Cardioversion if <48 hrs and properly anticoagulated. OR metop. EF < 40% = digoxin.

Question 23

Wide, regular tachycardia. Ddx and stepwise mgmt.

Answer 23

Monomorphic VT vs SVT with aberrancy. Cardiovert if unstable/consider for stable right away as well. Otherwise amiodarone 150 mg over 10 min. OR procainamide 10 mg/kg (give 100 mg q5 min til reaching full dose)

Question 24

Wide, irregular tachycardia. Ddx and stepwise mgmt.

Answer 24

Polymorphic VT, afib with aberrancy. Synchronized cardioversion if unstable. Correct underlying abnl - electrolytes, magnesium, MI. Torsades: magnesium. Amiodarone vs BB. Consider overdrive pacing.

Question 25

Wide, irregular tachycardia >200 bpm. What is it (most likely) and how to treat?

Answer 25

WPW + afib. Use ONLY cardioversion and/or procainamide. No adenosine, BB, CCB, or digoxin.

Question 26

Versed status epilepticus dose

Answer 26

0.2 mg/kg

Question 27

Consider ketamine for induction for RSI with which specific condistions

Answer 27

hypotension/sepsis, asthma, bronchospasm

Question 28

Pediatric fluid resuscitation dose. When to start pressors (how much given in fluids)

Answer 28

20 cc/kg boluses then reassess. Add pressors if 60 cc/kg given w/o adequate response.

Question 29

Cardioversion, defibrillation, defibrillation subsequent dose energy settings for PEDS

Answer 29

Cardiovert 1J/kg. Defib 2J/kg -> 4 J/kg

Question 30

Cardioversion/defibrillation paddle sizes for peds

Answer 30

Infant: 4.5 cm paddles. Older child: 8 cm paddles. can use AP OR right ant + left lateral placement.

Question 31

Meds that can be given through ETT

Answer 31

LEAN: lidocaine, epi, atropine, narcan

Question 32

Peds Dosing: adenosine

Answer 32

0.1 mg/kg -> 0.2 on subsequent

Question 33

Peds Dosing: amiodarone (pulseless VT/VF). Maximum?

Answer 33

5 mg/kg bolus. Max 15 mg/kg/d. (Give 5 mg /kg over 20 min if perfusing rhythm)

Question 34

Peds Dosing: atropine

Answer 34

0.02 mg/kg IV (same or double ETT). Min: 0.1 mg. Max: 1 mg.

Question 35

Peds Dosing: epi for cardiac arrest bolus dosing

Answer 35

0.01 mg/kg (=1 mL for every 10 kg 1:10,000). Dose x10 if using via ETT (no access, use 1:1000 epi)

Question 36

Peds Dosing: epi infusion

Answer 36

0.1-0.2 ug/kg/min

Question 37

Peds Dosing: magnesium (polymorphic VT)

Answer 37

25-50 mg/kg over 10-20 min

Question 38

Pediatric bradycardia drug of choice

Answer 38

epinephrine (can consider atropine, but epi first unlike adults)

Question 39

Procedure on a pt: steps to verbalize

Answer 39

Consent, time out, antiseptic prep

Question 40

Critical action: joint injury

Answer 40

evaluate joint above and below. evaluated CMS.

Question 41

When to reduce a dislocated joint prior to imaging (2)

Answer 41

neurovascular compromise, skin tenting

Question 42

Posterior shoulder dislocation critical action

Answer 42

pinprick sensory discrimination over axillary nerve territory

Question 43

Posterior shoulder dislocation reduction technique +1 thing to avoid

Answer 43

Supine, in line traction. Avoid forced external rotation.

Question 44

Distal radius fx: do not reduce in ED if ______

Answer 44

intraarticular extension

Question 45

Distal radius fx critical actions

Answer 45

Test median, ulnar, and radial nerve. Check for snuffbox tenderness.

Question 46

Hip reduction textbook approach

Answer 46

Anterior traction and slight external rotation

Question 47

Knee dislocation critical actions

Answer 47

Neurovascular check before and after reduction. Reduce asap (no imaging prior). CTA afterward. Orthopedics consult.

Question 48

Ankle dislocation stepwise mgmt

Answer 48

Neurovasc assmt. Reduce before imaging if clear. Posterior slab. Ortho consult.

Question 49

LP reasons to delay

Answer 49

Anticoagulated (consider), elevated ICP, thrombocytopenia

Question 50

LP procedural specifics to verbalize

Answer 50

Mark L4-L5 space. Decubitus. Cleanse, drape. Bevel up.

Question 51

Pericardial effusion predisposing conditions

Answer 51

Lupus, cancer, TB

Question 52

Pericardial effusion with tamponade beck's triad

Answer 52

muffled heart sounds, JVD, hypotension. Likely has narrow pulse pressure.

Question 53

Perimortem c-section indicated at how many weeks if known? Decide to initiate w/in how long?

Answer 53

23 weeks. 3-4 min (could consider up to 20 but that'd be weird)