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ADVANCE EMT CARDIAC > MED QUIZ 3 > Flashcards

MED QUIZ 3 Flashcards

Adenosine, Atropine, Epinephrine, Lidocaine, Amiodarone, Calcium Chloride

1
Q

ADENOSINE - AKA

A

ADENOCARD

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2
Q

ADENOSINE - CLASS

A

ANTIARRHYTHMIC

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3
Q

ADENOSINE - MOA

A

SLOWS SA AND AV NODE CONDUCTION, INTURRUPTING SUPREVENTRICULAR TACHYCARDIA

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4
Q

ADENOSINE - INDICATIONS

A
  1. SVT
  2. STABLE MONOMORPHIC WIDE-COMPLEX TACHYCARDIA SUSPECTED TO BE WIDE COMPLEX SVT
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5
Q

ADENOSINE - CONTRAINDICATIONS

A
  1. Drug-induced tachycardia
  2. Atrial fibrillation with wolf-Parkinson-white syndrome
  3. Suspected ventricular tachycardia
  4. Second or third degree atrioventricular block (if not pacemaker present)
  5. Sick sinus syndrome (if not pacemaker present)
  6. Bronchoconstrictive or bronchospastic lung disease (asthma, COPD)
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6
Q

ADENOSINE - ADVERSE REACTIONS/SE

A

GENERALLY VERY SHORT LIVED
CNS: headache, dizziness
RESPIRATORY: dyspnea, bronchospasm
CV: arrhythmias, sinus pause/asystole, palpations, hypotension, chest pain, cardiac arrest
GI/GU: Nausea, metallic taste
MUSCULOSKELETAL: pain in head or neck
OTHER: paresthesia, flushing, diaphoresis, “sense impending doom”

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7
Q

ADENOSINE - DOSE ADMINISTRATION ADULT NAT

A

INTIAL DOSE: 6mg rapid IV push
SECOND DOSE (no response): 12 mg rapid IV push

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8
Q

ADENOSINE - DOSE ADMINISTRATION PEDI NAT

A

INITIAL DOSE: 0.1 mg/kg rapid IV push (MAX first dose 6 mg)
SECOND DOSE (no response): 0.2 mg/kg rapid IV push (MAX second dose 12 mg)

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9
Q

ADENOSINE - DOSE ADMINISTRATION ADULT RI

A

NARROW COMPLEX TACHYCARDIA (regular rhythm):
12 mg rapid push IV (may repeat x1)

WIDE COMPLEX TACHYCARDIA (QRS (≥0.12sec) + (rhythm is regular with monomorphic complexes):
ADENOSINE 12 mg rapid IV push (may repeat x1)

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10
Q

ADENOSINE - DOSE ADMINISTRATION PEDI RI

A

NARROW COMPLEX TACHYCARDIA:
VAGALMANEUVER FIRST
MEDICAL CONTROL for authorization to administer ADENOSINE 0.2 mg/kg
rapid IV push [max 12 mg], may repeat x1.

~ administered via a proximal vein and should be followed by a rapid flush of 5 ml normal saline~

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11
Q

ADENOSINE - DURATION OF ACTION

A

onset: seconds
peak: seconds
duration: seconds

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12
Q

ADENOSINE - SPECIAL CONSIDERATIONS

A
  1. Adenosine administration should be followed by a 10 ml flush of NS FOR ADULTS. Adenosine should be administered via a proximal vein and should be followed by a rapid flush of 5 ml normal saline FOR PEDI.
  2. Adenosine is not indicated in patients with sinus tachycardia, atrial fibrillation or atrial flutter. NO EFFECT ON VENTRICULAR TACHYCARDIA.
    –> Adenosine is not the first line agent for the management of atrial fibrillation, but may considered if the patient has a history of conversion with adenosine or to aid rhythm identification.
    –> First line agents for rate control in irregular tachycardias (atrial fibrillation) are calcium channel blockers. As per protocol, Adenosine may be considered to assist with diagnosis or if patient has history of Adenosine conversion, but Adenosine is NOT mandated
  3. MAY CAUSE BRONCHOCONSTRICTION IN ASTHMA PT
  4. EVALUATE ELDERLY FOR DEHYDRATION REQUIRING FLUID REPLACEMENT PRIOR TO ADMINISTERING ADENOSINE.
  5. initial dose for adenosine should be reduced to 6 mg and the repeat dose should be reduced to 12 mg in patients taking dipyridamole and those that are status post cardiac transplant.
  6. Theophylline and caffeine (methylxanthines) competitively antagonize adenosine’s
    effects; an increased dose of adenosine may be required.
  7. First line agents for rate control in irregular tachycardias (atrial fibrillation) are calcium channel blockers. As per protocol, Adenosine may be considered to assist with diagnosis or if patient has history of Adenosine conversion, but Adenosine is NOT mandated
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13
Q

ATROPINE SULFATE- CLASS

A

ANTICHOLINERGIC AGENT

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14
Q

ATROPINE SULFATE - MOA

A

INHIBITS THE ACTION OF ACETYLCHOLINE RESULTING IN INCREASED HEART RATE

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15
Q

ATROPINE SULFATE- INDICATIONS

A

BRADYCARDIA

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16
Q

ATROPINE SULFATE - CONTRAINDICATIONS

A
  1. TACHYCARDIA
  2. HYPERSENSITIVITY
  3. BRADYCARDIA DUE TO ACUTE HEMORRHAGE
  4. NARROW-ANGLE GLAUCOMA
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17
Q

ATROPINE SULFATE - ADVERSE REACTIONS/SE

A
  1. CNS: drowsiness, confusion, headache
  2. CV: tachycardia, palpations, arrhythmias, paradoxical bradycardia (doses less than 0.1 mg)
  3. GI/GU: N/V
  4. OTHER: pupil dilation
  5. ANTICHOLINERGIC EFFECTS: dry mouth/nose/skin, blurred vision, urinary retention, constipation, flushed, hot, dry skin
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18
Q

ATROPINE SULFATE - DRUG INTERACTIONS

A

ENHANCED BY ANTIHISTAMINES, PROCAINAMIDE, QUINIDINE, ANTIPSYCHOTICS, BENZODIAZEPINES, & ANTIDEPRESSANTS

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19
Q

ATROPINE SULFATE - DOSAGE AND ADMINISTRATION ADULT NAT

A

0.5 mg IV/IO every 3-5 min as needed (MAX: 3 mg)

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20
Q

ATROPINE SULFATE - DOSAGE AND ADMINISTRATION PEDI NAT

A

0.02 mg/kg IV/IO (MIN dose: 0.1 mg; MAX single dose: 0.5 mg) may repeat x1 in 3-5 min if needed

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21
Q

ATROPINE SULFATE - DOSAGE AND ADMINISTRATION ADULT RI

A

BRADYCARDIA <60:
0.5-1.0 mg IV, repeat every 3-5 min to achieve HR >60 (MAX dose 3 mg)
… OR transcutaneous pacing AND consider NS 250-500 ml IV

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22
Q

ATROPINE SULFATE - DOSAGE AND ADMINISTRATION PEDI RI

A

BRADYCARDIA <60 ( believed to be related to increased vagal tone or primary AV conduction block):
0.02 mg/kg IV (MIN dose 0.1 mg; MAX dose 0.5 mg) (may repeat x1)
AND EPI AND (IF INEFFECTIVE) TCP

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23
Q

ATROPINE SULFATE - DURATION OF ACTION

A

onset: immediate
peak: rapid to 1-2 min
duration: 2-6 hrs

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24
Q

ATROPINE SULFATE - SPECIAL CONSIDERATIONS

A
  1. Atropine sulfate should be used cautiously in the setting of myocardial ischemia/infarction
    as increased heart rate may worsen ischemia or infarction size.
  2. Atropine sulfate may be ineffective for treating bradycardia related to atrioventricular
    block (AVB) occurring below the AV node (type II second-degree block or third-degree [complete] block with wide QRS complex). Immediate TCP may be warranted in these patients. Atropine sulfate is also ineffective in patients who are status post cardiac
    transplant.
  3. IN PARAMEDIC SCOPE ALSO USED TO REVERSE ORGANOPHOSPHATE/NERVE AGENT/BETA BLOCKER/CA CHANNEL BLOCKER OVERDOSE
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25
Q

EPINEPHRINE (CARDIAC)- AKA

A

ADRENELINE

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26
Q

EPINEPHRINE (CARDIAC)- CLASS

A

SYMPATHOMIMETIC

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27
Q

EPINEPHRINE (CARDIAC)- MOA

A
  1. bronchodilation
  2. VASOCONSTRICTION
  3. INCREASED HR AND CONTRACTILE STRENGTH
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28
Q

EPINEPHRINE (CARDIAC)- INDICATIONS

A
  1. CARDIAC ARREST
  2. severe asthma
  3. croup
  4. allergic reaction
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29
Q

EPINEPHRINE (CARDIAC)- CONTRAINDICATIONS

A
  1. HYPOTHERMIA
  2. HYPOVOLEMIC SHOCK
  3. MYOCARDIAL ISCHEMIA
  4. pulmonary edema
  5. hypertension
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30
Q

EPINEPHRINE (CARDIAC)- ADVERSE REACTIONS

A
  1. CNS: nervousness, restlessness, headache, tremor
  2. RESPIRATORY: pulmonary edema
  3. CV: ARRHYTHMIA, CHEST PAIN, HYPERTENSION, TACHYCARDIA
  4. GI/GU: N/V
31
Q

EPINEPHRINE (CARDIAC)- DRUG INTERACTIONS

A

POTENTIATES OTHER SYMPATHOMIMETICS

32
Q

EPINEPHRINE (CARDIAC)- DOSAGE ADMINISTRATION ADULT NAT

A

CARDIAC ARREST:
1 mg of 1:10,000 solution rapid IV/IO every 3-5 min

33
Q

EPINEPHRINE (CARDIAC)- DOSAGE ADMINISTRATION PEDI NAT

A

CARDIAC ARREST:
0.01 mg/kg of a 1:10,000 solution rapid IV/IO every 3-5 min

34
Q

EPINEPHRINE (CARDIAC)- DOSAGE ADMINISTRATION ADULT RI

A

NON-SHOCKABLE RHYTHMS:
(1 mg/10 ml EPI) 1 mg IV every 5 minutes.

SHOCKABLE RHYTHMS:
(1 mg/10 ml EPI) 1 mg IV every 5 minutes after three cycles of of CPR and electrical therapy and one dose of
AMIODARONE or LIDOCAINE.

35
Q

EPINEPHRINE (CARDIAC)- DOSAGE ADMINISTRATION PEDI RI

A

CARDIAC ARREST:
(1:10,000 EPI) 0.01 mg (10 mcg/0.1 ml)/kg IV every 3-5 minutes
…. (VF/PVT) AND AMI AND/OR LIDOCAINE
….(PEA) AND LACTATED RINGERS OR NORMAL SALINE 20ml/kg IV [10 ml/kg for patients ≤ 3 months]

BRADYCARDIA:
(1:10,000 EPI) 0.01 mg/kg [0.1 ml/kg] IV, repeat every 3-5 min
… AND ATROPINE SULFATE (vagal tone or primary AV
conduction block) … Transcutaneous Pacing (TCP).

36
Q

EPINEPHRINE (CARDIAC)- DURATION OF ACTION

A

onset: immediate
peak: minutes
duration: several minutes

37
Q

EPINEPHRINE (CARDIAC)- SPECIAL CONSIDERATIONS

A
  1. Epinephrine (1mg/10ml) IV/IO for cardiac arrest (non-shockable rhythms)
  2. Some evidence suggests that in non-shockable rhythms, epinephrine is most beneficial
    when administered very early in cardiac arrest.
  3. early IV placement (preferred) in a site above the diaphragm. If attempts at IV access are unsuccessful or not feasible, IO access (if available) may be attempted, preferably using a site above the diaphragm in age-appropriate patients (adolescents [age ≥ 12]).
  4. Epinephrine is a α and β agonist, so it has positive inotropic, chronotropic and vasopressor properties.
  5. Available for autoinjectors [ADULT EPIPEN: 0.3 mg of 1:2000 solution; EPIPEN JR. 0.15 mg of 1:2000 solution]
38
Q

LIDOCAINE HYDROCHLORIDE - AKA

39
Q

LIDOCAINE HYDROCHLORIDE - CLASS

A

ANTIARRHYTHMIC

40
Q

LIDOCAINE HYDROCHLORIDE - MOA

A
  1. DECREASED CARDIAC AUTOMATICITY BY SLOWING CARDIAC DEPOLARIZATION
  2. ANESTHETIC WHEN ADMINISTERED LOCALLY
41
Q

LIDOCAINE HYDROCHLORIDE - INDICATIONS

A
  1. CARDIAC ARREST (pulseless VTach, VFib ONLY)
  2. VENTRICULAR TACHYCARDIA W/ PULSES
  3. PAIN RELIEF DURING INTRAOSSEOUS ACCESS
42
Q

LIDOCAINE HYDROCHLORIDE - CONTRAINDICATIONS

A
  1. HYPERSENSITIVITY
  2. ASYSTOLE
  3. 2nd OR 3rd degree AV BLOCK (ABSENCE OF ARTIFICIAL PACEMAKER)
  4. PROPHYLACTIC USE IN AMI
  5. WIDE COMPLEX VENTRICULAR ESCAPE BEATS W/ BRADYCARDIA
43
Q

LIDOCAINE HYDROCHLORIDE - ADVERSE REACTIONS/SE

A
  1. CNS: anxiety, drowsiness, confusion, seizures, slurred speech
  2. RESPIRATORY: respiratory arrest
  3. CV: HYPOTENSION, BRADYCARDIA, ARRHYTHMIAS, CARDIAC ARREST, AV BLOCK
    4: GI/GU: N/V
44
Q

LIDOCAINE HYDROCHLORIDE - DRUG INTERACTIONS

45
Q

LIDOCAINE HYDROCHLORIDE - DOSAGE ADMINISTRAION ADULT NAT

A

CARDIAC ARREST:
Initial dose: 1-1.5 mg/kg rapid OV/IO
Second dose (5-10min): 0.5-0.75 mg/kg rapid IV/IO

VENTRICULAR TACHYCARDIA W/ PULSES:
1-1.5 mg/kg slow IV/IO (may repeat x1 in 10 min)

PAIN RELIEF W/ INTRAOSSEOUS ACCESS:
20-50 mg of 2% (cardiac) lidocaine slow IO

46
Q

LIDOCAINE HYDROCHLORIDE - DOSAGE ADMINISTRAION PEDI NAT

A

CARDIAC ARREST:
1 mg/kg rapid IV/IO (may repeat x1 in 10 min)

VENTRICULAR TACHYCARDIA W/ PULSES:
1 mg/kg rapid IV/IO (may repeat x1 in 10 min)

PAIN RELIEF W/ INTRAOSSEOUS ACCESS:
0.5 mg/kg of 2% (cardiac) lidocaine slow IO

47
Q

LIDOCAINE HYDROCHLORIDE - DOSAGE ADMINISTRAION ADULT RI

A

CARDIAC ARREST (shockable rhythm):
After 3 cycles CPR 1 dose LID ….OR AMIODARONE WITH ELECTRIAL THERAPY+EPI

VFIB/PUSLESS VT:
LIDOCAINE 100 mg IV, repeat every 10 minutes x2 (ALTERNATIVE TO/REFRACTORY TO)… AMIODARONE REPEAT TO AT LEAST 1 DEFIB ATTEMPT

WIDE COMPLEX TACHYCARDIA:
[unstable/pre-arrest— synchronized cardioversion 100-200J (biphasic) or unsynchronized if irregular/wide w/ pre-shock sedation MIDAZOLAM/DIAZEPAM]
[regular rhythm w/ monomorphic complexes-ADENOSINE]
MED CONTROL to administer 1-1.5 mg/kg IV (may repeat x1 in 5 minutes) OR AMIODARONE.

VASCULAR ACCESS:
patient is awake and alert W/ IO IN PLACE provide intramedullary anesthesia by slowly injecting 2% (cardiac) LIDOCAINE through the IO device DOSE 20-50 mg

48
Q

LIDOCAINE HYDROCHLORIDE - DOSAGE ADMINISTRAION PEDI RI

A

CARDIAC ARREST (VF/PVT) -unresponsive to initial electrical therapy and one dose EPI:
LIDOCAINE 1 mg/kg IV (may repeat x1 in 10 minutes) – as alternative to AMIODARONE/refractory to AMI

WIDE COMPLEX TACHYCARDIA:
[unstable/pre-arrest— synchronized cardioversion 1J/kg can up to 2 J/kg. pre-shock sedation MIDAZOLAM<5kg/FENTANYL]
MED CONTROL to administer LIDOCAINE E 1 mg/kg IV (may repeat every 10 minutes x2, max cumulative dose 3mg/kg).

VASCULAR ACCESS:
patient is awake and alert W/ IO IN PLACE provide intramedullary anesthesia by slowly injecting 2% (cardiac) LIDOCAINE through the IO device DOSE 0.5 mg/kg.

49
Q

LIDOCAINE HYDROCHLORIDE - DURATION OF ACTION

A

onset: 1-5 min
peak: 5-10 min
duration: variable (15 min - 2hrs)

50
Q

LIDOCAINE HYDROCHLORIDE - SPECIAL CONSIDERATIONS

A
  1. For patients with VF/PVT, antiarrhythmic agents (amiodarone, lidocaine) should be
  2. administered after at least one attempt at defibrillation
  3. EXCEEDINGLY HIGH DOSES OF LIDOCAINE CAN RESULT IN DEATH AND COMA
  4. LIDOCAINE IS AN ALTERNATIVE TO AMIODARONE IN VFIB & VTACH
51
Q

AMIODARONE - AKA

A
  1. CORADARONE
  2. PACERONE
52
Q

AMIODARONE - CLASS

A

ANTIARRHYTHMIC

53
Q

AMIODARONE - MOA

A

blocks SODIUM and POTASSIUM channels, delaying ventricular repolarization

54
Q

AMIODARONE - INDICATIONS

A
  1. VENTRICUAR FIB
  2. PULSELESS VENTRICULAR TACHYCARDIA
  3. STABLE VENTRICULAR TACHYCARDIA W/ PULSES
55
Q

AMIODARONE - CONTRAINDICATIONS

A
  1. KNOWN HYPERSENSITIVITY
  2. CARDIOGENIC SHOCK
  3. SINUS BRADYCARDIA
  4. SECOND/THIRD DEGREE AV BLOCK (NO PACEMAKER PRESENT)
  5. SEVERE SINUS NODE DYSFUNCTION
  6. USE W/ CAUTION IN PTS W/ HEPTAIC FAILTURE
56
Q

AMIODARONE - ADVERSE REACTIONS/SE

A
  1. CNS: dizziness, fatigue, malaise, tremor, ataxia (no coordination)
  2. RESPIRATORY: adult respiratory distress syndrome ARDS, PULMONARY EDEMA, cough, progressive dyspnea
  3. CV: BRADYCARDIA, HYPOTENSION, worsening of arrhythmias, PROLONGED QT INTERVAL
57
Q

AMIODARONE - DRUG INTERACTIONS

A
  1. BETA-BLOACKER/CCB may POTENTIATE BRADYCARDIA, SINUS ARREST, AV HEART BLOCK
  2. concurrent use with PROCAINAMIDE (sodium channel blocker for cardiac arrhythmias) NOT recommended w/out expert consultation
58
Q

AMIODARONE - DOSAGE ADMINISTRATION ADULT NAT

A

VFIB/PVT:
initial dose: 300 mg IV/IO rapid push
second dose (after 1 defib): 150 mg IV/IO rapid push

STABLE VTACH W/ PULSES:
150 mg IV/IO over 10MIN (may repeat x1 if not response in 10MIN)

59
Q

AMIODARONE - DOSAGE ADMINISTRATION PEDI NAT

A

VFIB/PVT:
5 mg/kg IV/IO rapid push (may repeat x2 bt subsequent defibrillations)

STABLE VTACH W/ PULSES:
5 mg/kg IV/IO over 20MIN (may repeat x1 if no responses in 10MIN)

60
Q

AMIODARONE - DOSAGE ADMINISTRATION ADULT RI

A

CARDIAC ARREST (shockable rhythm):
After 3 cycles CPR 1 dose AMIODARONE….OR LIDOCAINE WITH 3 CYCLES ELECTRIAL THERAPY+EPI (EVERY 5MIN)

VFIB/PUSLESS VT:
AMIODARONE 300 mg IV, repeat 150 mg refractory to at least one defibrillation attempt.
(AS ALTERNATIVE TO/REFRACTORY TO AMIODARONE USE LIDOCAINE)

WIDE COMPLEX TACHYCARDIA:
MED CONTROL to administer AMIODARONE 150 mg IV over 10 MIN (may repeat x1 in 10 MIN) …OR LIDOCAINE

61
Q

AMIODARONE - DOSAGE ADMINISTRATION PEDI RI

A

CARDIAC ARREST (unresponsive to initial electrical therapy + one dose epi):
AMI 5 mg/kg IV (may repeat x2).
ALTERNATIVE TO AMI OR FOR VF/PVT REFRACTORY TO AMI LIDOCAINE

WIDE COMPLEX TACHYCARDIA:
MED CONTROL to administer AMIODARONE 5 mg/kg IV (150 mg MAX) over 20 MIN (may repeat x1 in 10 MIN) …OR LIDOCAINE

62
Q

AMIODARONE - DURATION OF ACTION

A

Onset: immediate
Peak: 10-15 min
Duration: 30-45 min

63
Q

AMIODARONE - SPECIAL CONSIDERATIONS

A
  1. For patients with VF/PVT, antiarrhythmic agents (amiodarone, lidocaine) should be
    administered after at least one attempt at defibrillation
  2. Arrhythmias with suspicion of Wolff-Parkinson-White (WPW) syndrome should be treated
    with amiodarone following the dosing regimen in the wide complex tachycardia protocol.
  3. MONITOR PT FOR HYPOTENSION
  4. MAY WORSEN OR PRECIPITATE NEW ARRHYTHMIAS
64
Q

CALCIUM CHLORIDE - CLASS

A

ELECTROLYTE

65
Q

CALCIUM CHLORIDE - MOA

A
  1. INCREASE CARDIA CONTRACTILITY
  2. COUNTERACTS EFFECTS OF HYPERKALEMIA BY STABILIZING THE HEART
66
Q

CALCIUM CHLORIDE - INDICATIONS

A
  1. BETA-BLOCKER/CCB OVERDOSE
  2. HYPERKALEMIA
67
Q

CALCIUM CHLORIDE - CONTRAINDICATIONS

A
  1. HYPERCALCEMIA
  2. VENTRICULAR FIBRILLATION
  3. DIGITALIS TOXICITY (CHF/heart rhythm problems- increase intracellular calcium)
68
Q

CALCIUM CHLORIDE - ADVERSE REACTIONS/SE

A
  1. CNS: syncope
  2. CV: CARDIAC ARREST, BRADYCARDIA, HYPOTENSION, arrhythmia, asystole, peripheral vasodilation
  3. GI/GU: N/V, metallic taste
  4. OTHER: TISSUE NECROSIS AT INJECTION SITE
69
Q

CALCIUM CHLORIDE - DRUG INTERACTIONS

A
  1. MAY ANTAGONIZE EFFECTS OF CCB
  2. DO NOT MIX/INFUSE IMMEDIATLY BEFORE OR AFTER SODIUM BICARBONATE W/OUT INTERVENING FLUSH (forms salt crystals)
70
Q

CALCIUM CHLORIDE - DOSAGE ADMINISTRATION ADULT NAT

A

OVERDOSE BB/CCB & HYPERKALEMIA:
1 gm IV/IO

71
Q

CALCIUM CHLORIDE - DOSAGE ADMINISTRATION PEDI NAT

A

OVERDOSE BB/CCB & HYPERKALEMIA:
20 mg/kg IV/IO

72
Q

CALCIUM CHLORIDE - DOSAGE ADMINISTRATION ADULT RI

A

DIALYSIS EMERGENCIES AND RENAL FAILURE [volume overload (PE, JVD CRACKLES, DYSPNEA) or hyperkalemia (peaked T waves, wide QRS, muscle weakness):
MEDICAL CONTROL authorization to administer CALCIUM CHLORIDE 1 gm IV
….. OR CALCIUM GLUCONATE AND SODIUM BICARBONATE

CRUSH INJURY >30min; EDG suggest hyperkalemia:
MEDICAL CONTROL for authorization to administer CALCIUM CHLORIDE 1gm IV ….OR CALCIUM GLUCONATE AND SODIUM BICARBONATE ……Consider ALBUTEROL

TOXICOLOGICAL EMERGENCIES (suspected BB/CCB toxicity):
MEDICAL CONTROL authorization to administer GLUCAGON AND CALCIUM CHLORIDE 1 gm IV ….OR CALCIUM GLUCONATE

73
Q

CALCIUM CHLORIDE - DOSAGE ADMINISTRATION PEDI RI

A

TOXICOLOGICAL EMERGENCIES (suspected BB/CCB toxicity):
MEDICAL CONTROL authorization to administer GLUCAGON AND CALCIUM CHLORIDE 20 mg/kg IV ….OR CALCIUM GLUCONATE

ADVANCE EMT CARDIAC (5 decks)

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