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ADVANCE EMT CARDIAC > MED QUIZ 4 > Flashcards

MED QUIZ 4 Flashcards

Diltiazem, Midazolam, Diazepam, Calcium Gluconate, Sodium Bicarbonate

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1
Q

DILTIAZEM - AKA

A

CARDIZEM

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2
Q

DILTIAZEM - CLASS

A

CALCIUM CHANNEL BLOCKER

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3
Q

DILTIAZEM - MOA

A

blocks calcium influx in cardiac cells, decreasing myocardial contractility

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3
Q

DILTIAZEM - INDICATIONS

A

RAPID ATRIAL FIBRILLATION/FLUTTER

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4
Q

DILTIAZEM - CONTRAINDICATIONS

A
  1. hypotension
  2. sick sinus syndrome
    sinus bradycardia (heart rate < 40 bpm)
    sinus pauses (sudden pauses of the sinus node shorter than 2–3 seconds)
    sinus arrest (sudden pauses of the sinus node longer than 2–3 seconds)
  3. second- or third-degree AV block
  4. Cardiogenic shock
  5. Wide-complex tachycardia (eg. VTach)
  6. poison or drug induced tachycardia
  7. Wolff-Parkinson-White (WPW)
    syndrome, Lown-Ganong-Levine (LGL) or other pre-excitation syndromes (group of conditions that cause the heart’s ventricles to activate faster than normal due to atrial impulses.)
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5
Q

DILTIAZEM - ADVERSE REACTIONS/SE

A
  1. CNS: dizziness, weakness, headache
  2. RESPIRATORY: dyspnea
  3. CV: hypotension, bradycardia, arrhythmias, CHF, peripheral edema, AV blocks, syncope, VFIB, VTACH, cardiac arrest, chest pain
  4. GI/GU: N/V, dry mouth
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6
Q

DILTIAZEM - DRUG INTERACTIONS

A

none in emergency setting

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7
Q

DILTIAZEM - DOSAGE ADMINISTRATION ADULT NAT

A

INITIAL DOSE: 0.25 mg/kg IV/IO over 2 min (max dose: 25mg)
… no response in 15 min….
SECOND DOSE: 0.35 mg/kg IV/IO over 2 min (max dose: 25mg)

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8
Q

DILTIAZEM -DOSAGE ADMINISTRATION PEDI NAT

A

NOT RECOMMENDED

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9
Q

DILTIAZEM - DOSAGE ADMINISTRATION ADULT RI

A

NARROW COMPLEX TACHYCARDIA
initial dose: 0.25 mg/kg IV (max dose: 20 mg)
…. if SBP >/= 100 repeat x1….
second dose: 0.35 mg/kg IV (max dose 25 mg)

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10
Q

DILTIAZEM - DOSAGE ADMINISTRATION PEDI RI

A

NOT RECOMMENDED

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11
Q

DILTIAZEM - DURATION OF ACTION

A

onset: 2-5 min
peak: variable
duration: 1-3 hrs

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12
Q

DILTIAZEM - SPECIAL CONSIDERATIONS

A
  1. Diltiazem vials expire in 30 days if not kept refrigerated
  2. rapid push of diltiazem can cause severe hypotension/bradycardia
  3. Consider a fluid bolus (NORMAL SALINE 500-1000 ml IV/IO) in patients with a history
    suggestive of dehydration and no evidence of overt heart failure/pulmonary edema.
  4. Consider CALCIUM CHLORIDE 1 gm SLOW IV/IO prior to administering DILTIAZEM if the BP
    is tenuous BP (SBP ~100)
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13
Q

MIDAZOLAM HYDROCHLORIDE - AKA

A

VERSED

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14
Q

MIDAZOLAM HYDROCHLORIDE - CLASS

A

BENZODIAZEPINE
[depressants that produce sedation and hypnosis, relieve anxiety and muscle spasms, and reduce seizures - ALSO Valium®, Xanax®, Halcion®, Ativan®, and Klonopin®-]

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15
Q

MIDAZOLAM HYDROCHLORIDE - INDICATIONS

A
  1. SEIZURES
  2. SEDATION FOR ELECTRICAL THERAPY
  3. CHEMICAL RESTRAINT IN BEHAVIORAL EMERGENCIES
  4. STIMULANT TOXICITY
  5. ANXIETY DUE TO CPAP MASK
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16
Q

MIDAZOLAM HYDROCHLORIDE - CONTRAINDICATIONS

A
  1. SHOCK
  2. COMA
  3. ALCOHOL INTOXICATION
  4. OPIOID/BENZODIAZEPINE
  5. DEPRESSED VITAL SIGNS
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17
Q

MIDAZOLAM HYDROCHLORIDE - DOSAGE ADMINISTRATION ADULT NAT

A

ANXIETY DUE TO CPAP MASK:
1-2mg IV/IO slow push

SEIZURES:
2.5 mg. repeat every 3-5 min (x4) to MAX of 10 mg. IV/IO/IM/IN

SUSPECTED STIMULANT TOXICITY:
2.5 mg IV/IO slow push, may repeat in 5 min

SEDATION FOR ELECTRICAL THERAPY:
2.5-5mg IV/IO/IM/IN slow push

CHEMICAL RESTRAINT BEHAVIORAL EMERGENCY (>/= 16 Y/O):
2.5-5 mg IV/IO or 5 mg IM/IN may repeat PRN to MAX total dose 10 mg (5 mg if age >65y/o)

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17
Q

MIDAZOLAM HYDROCHLORIDE -ADVERSE REACTIONS/SE

A

CNS: headache, somnolence (sleepy or ready to fall asleep), anterograde amnesia (memory loss that occurs when you can’t form new memories)
RESPIRATORY: respiratory depression, respiratory arrest, apnea
CV: hypotension

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18
Q

MIDAZOLAM HYDROCHLORIDE -DRUG INTERACTIONS

A

NONE IN EMERGENCY SETTING

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19
Q

MIDAZOLAM HYDROCHLORIDE - DOSAGE ADMINISTRATION PEDI NAT

A

SEIZURES:
0.1 mg/kg IV/IO or 0.2mg/kg IM/IN (MAX single dose: 4mg) may repeat every 5 min to MAX of 1mg/kg

SEDATION FOR ELECTRICAL THERAPY:
0.1 mg/kg (MAX 2.5mg) IV/IO/IM/IN slow push

SUSPECTED STIMULANT TOXICITY:
0.05 mg/kg IV/IO/IN slow push, may repeat in 10 min (do not administer if <5kg)

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20
Q

MIDAZOLAM HYDROCHLORIDE -DOSAGE ADMINISTRATION ADULT RI

A

NARROW COMPLEX TACHYCARDIA:
2.5-5 mg IV [5 mg IM/IN] …..or DIAZEPAM

WIDE COMPLEX TACHYCARDIA:
2.5-5 mg IV [5 mg IM/IN] …..or DIAZEPAM

PATIENT COMFORT FOR ELECTRICAL THERAPY:
2.5-5 mg IV/IM/IN ……or DIAZEPAM

RESPIRATORY DISTRESS (ASTHMA/COPD/RAD) or ACUTE DECOMPENSATED HEART FAILURE:
CPAP mask compliance, contact MEDICAL CONTROL for authorization to administer MIDAZOLAM 1-2 mg IV

BEHAVIORAL EMERGENCIES -CHEMICAL RESTRAINT >/= 16Y/O aggressive or agitated behavior, without suspected acute substance abuse (alcohol):
2.5-5 mg IV or 5 mg IM/IN, may repeat PRN if the SBP >100 to a cumulative dose of 10 mg (5 mg if age ≥65).

EXCITED DELIRIUM SYNDROME (ExDS):
2.5-5 mg IV [5 mg IM/IN] (repeat as needed if the SBP >100 to a max
of 10 mg)…. MONITOR ETCO2, SPO2, ECG

SEIZURES:
active generalized or focal seizures in the patient without IV access: 10 mg IM or 2 mg IN active generalized or focal seizures in the patient with IV access or pt refractory to prior Midazolam (no IV):
2.5 mg IV [5 mg IM or 2 mg IN] (repeat 2 mg every 3-5 minutes to a max of 20 mg) OR LORAZEPAM OR DIAZEPAM

TOXICOLOGICAL EMERGENCIES:
2.5 mg IV/IN [5 mg IM] (may
repeat in 5 minutes, IM dose in 20 min) …..or LORAZEPAM

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21
Q

MIDAZOLAM HYDROCHLORIDE -DOSAGE ADMINISTRATION PEDI RI

A

PRE SHOCK SEDATION (NARROW/WIDE COMPLEX TACHY:
0.1 mg/kg [2.5 mg max] IV/IM/IN (may repeat x1) [do not administer if <5kg
….OR FENTANYL

PATIENT COMFORT FOR ELECTRICAL THERAPY:
0.1 mg/kg [2.5 mg max] IV/IM/IN
….. OR FENTANYL

SEIZURES:
`active generalized or focal seizures:
0.2 mg/kg IM/IN OR 0.1 mg/kg IV [4 mg max single dose via any route)] (may repeat every 5 minutes to a max of 1 mg/kg) OR LORASEPAM OR DIAZEPAM

TOXICOLOGICAL EMERGENCIES:
0.05 mg/kg IV/IN (may repeat x1 in 10 minutes) [do not administer if < 5 kg].

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22
Q

MIDAZOLAM HYDROCHLORIDE - DURATION OF ACTION

A

onset: immediate
peak effect: variable
duration: 26-31 hours

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23
Q

MIDAZOLAM HYDROCHLORIDE - SPECIAL CONSIDERATION

A
  1. dilution in 250 mL NS required to prevent vasotoxicity
  2. in cardiac arrest, hydroxocobalamin can be given as a rapid infusion
  3. mandatory continuous monitoring of waveform EtCO2, SpO2, ECG for any sedation drug
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24
Q

DIAZEPAM - AKA

A

Valium

25
Q

DIAZEPAM - CLASS

A

benzodiazepine

26
Q

DIAZEPAM -MOA

A

Increases effects of GABA (primary inhibitory neurotransmitter) causing sedation and increased seizure threshold

27
Q

DIAZEPAM - INDICATIONS

A
  1. Seizure
  2. Sedation before electrical therapy
28
Q

DIAZEPAM - CONTRAINDICATIONS

A
  1. hypersensitivity
  2. Narrow angle Glaucoma
  3. Myasthenia Gravis (chronic autoimmune disorder- breakdown in communication between nerves and muscles)
  4. Respiratory insufficiency
  5. Coma
  6. Head Injury
29
Q

DIAZEPAM - ADVERSE REACTIONS/SE

A
  1. CNS: dizziness, drowsiness, confusion, headache
  2. RESPIRATORY: respiratory depression
  3. CV: hypotension, reflex tachycardia
  4. GI/GU: N/V
  5. MUSCULOSKELETAL: muscle weakness
  6. OTHER: tissue necrosis, ataxia (no coordination), thrombosis (blood clots block your blood vessels), phlebitis (inflammation of a vein near the surface of the skin)
30
Q

DIAZEPAM - DRUG INTERACTIONS

A

potentiate effects of alcohol and opiates

31
Q

DIAZEPAM - DOSAGE ADMINISTRATION ADULT NAT

A

SEIZURE:
5 mg IV/IO/IM/PR (repeat every 3-5 min to MAX of 20 mg)

PREMEDICATION FOR CARDIOVERSION:
2.5-5 mg IV/IO/IM

32
Q

DIAZEPAM - DOSAGE ADMINISTRATION PEDI NAT

A

SEIZURE:
0.1 mg/kg IV/IO (5mg MAX single dose)
….OR
0.5 mg/kg PR (20 mg MAX single dose). May repeat every 3-5 min to a max of 1 mg/kg.

33
Q

DIAZEPAM - DOSAGE ADMINISTRATION ADULT RI

A

PATIENT COMFORT-CARDIOVERSION/PACING (narrow/wide complex tachy rate >150):
2.5-5 mg IV/IM (if the SBP ≥100.)…..OR MIDAZOLAM

SEIZURE (active generalized or focal seizures in the patient with IV access):
5 mg IV (repeat every 3-5 min to a max of 20 mg)

34
Q

DIAZEPAM - DOSAGE ADMINISTRATION PEDI RI

A

SEIZURE (active generalized or focal seizures):
0.1 mg/kg IV [5 mg max single dose] or 0.5 mg/kg PR [20 mg max single dose] (may repeat every five minutes to a max of 1 mg/kg).

35
Q

DIAZEPAM - DURATION OF ACTION

A

onset: 1-5 min
peak: 15 min
duration: 20-50 min

36
Q

DIAZEPAM - SPECIAL CONSIDERATION

A
  1. must have continuous quantitative waveform capnography in place
  2. LONGEST HALF-LIFE AND LEAST DESIRABLE CHOICE WHEN OTHER BENZODIAZEPINES ARE AVALIABLE
  3. only benzo EMS can administer rectally (patient may be prescribed DIAZEPAM rectal gel)
37
Q

CALCIUM GLUCONATE - CLASS

A

ELECTROLYTE

38
Q

CALCIUM GLUCONATE - MOA

A
  1. Increases cardiac contractility
  2. Counteracts effects of hyperkalemia by stabilizing the heart
39
Q

CALCIUM GLUCONATE - INDICATIONS

A
  1. Beta blocker or calcium channel blocker overdose
  2. hyperkalemia
40
Q

CALCIUM GLUCONATE - CONTRAINDICATIONS

A
  1. Hypercalcemia
  2. Ventricular fibrillation
  3. Digitalis toxicity (Antiarrhythmic and Blood pressure support)
41
Q

CALCIUM GLUCONATE - ADVERSE REACTIONS/SE

A

CNS: syncope
CV: cardiac arrest, arrhythmia, bradycardia, hypotension, asystole, peripheral vasodilation
GI/GU: N/V, metallic taste
OTHER: tissue necrosis at injection site

42
Q

CALCIUM GLUCONATE - DRUG INTERACTIONS

A
  1. May antagonize effects of calcium channel blockers
  2. DO NOT MIX OR INFUSE IMMEDIATLY BEFORE/AFTER SODIUM BICARBONATE WITHOUT INTERVENING FLUSH (forms salt crystals)
43
Q

CALCIUM GLUCONATE - HOW SUPPLIED

A

100 mg/mL of 10% solution

44
Q

CALCIUM GLUCONATE - DOSAGE ADMINISTRATION ADULT NAT

A

3 gm IV/IO (may repeat x1)

45
Q

CALCIUM GLUCONATE - DOSAGE ADMINISTRATION PEDI NAT

A

60 mg/kg IV/IO (may repeat x1)

46
Q

CALCIUM GLUCONATE - DOSAGE ADMINISTRATION ADULT RI

A

DIALYSIS EMERGENCY (cardiac arrest or with suspected hyperkalemia)
Cardiac Arrest Protocol - contact MEDICAL CONTROL for authorization to administer CALCIUM GLUCONATE 3 gm IV OR CALCIUM CHLORIDE (and SODIUM BICARBONATE)

CHEMICAL AND ELECTRICAL BURN INJURY (hydrofluoric acid HF):
2.5 topical gel to all contact points. If the hands or digits are involved, the gel
should be placed in an exam glove and the glove worn on the affected hand. If
there is ocular exposure, irrigate the affected eye with (if available) CALCIUM
GLUCONATE 1% solution.

CRUSH INJURY:
CALCIUM GLUCONATE 3 gm IV OR administer CALCIUM CHLORIDE (and SODIUM BICARBONATE)

TOXICOLOGICAL EMERGENCIES (beta blocker/calcium channel blocker CCB toxicity):
MED CONTROL to give 3 gm IV (may repeat x1) OR CALCIUM CHLORIDE AND GLUCAGON

47
Q

CALCIUM GLUCONATE - DOSAGE ADMINISTRATION PEDI RI

A

TOXICOLOGICAL EMERGENCIES(CCB toxicity):
MED CONTROL 60 mg/kg IV (may repeat x1) OR CALCIUM CHLORIDE AND GLUCAGON

48
Q

CALCIUM GLUCONATE - DURATION OF ACTION

A

onset: immediate
peak: immediate
duration: 30 min - 2hrs

49
Q

CALCIUM GLUCONATE - SPECIAL CONSIDERATIONS

A
  1. Common situations to suspect hyperkalemia: crush injuries, dialysis emergencies
  2. do not administer by IM or SQ - causes significant tissue necrosis
50
Q

SODIUM BICARBONATE - CLASS

A

Alkalizing (buffering) agent

51
Q

SODIUM BICARBONATE - MOA

A

Buffers build up acids that cause metabolic acidosis in the body. Reverses sodium channel blocker effects.

52
Q

SODIUM BICARBONATE - INDICATIONS

A
  1. Hyperkalemia
  2. Suspected metabolic acidosis in cardiac arrest
  3. sodium channel blocker overdose (tricyclic overdose)
53
Q

SODIUM BICARBONATE - CONTRAINDICATIONS

A
  1. Metabolic and respiratory alkalosis
  2. Hypokalemia
  3. Electrolyte imbalance due to severe vomiting and GI loss
54
Q

SODIUM BICARBONATE - REACTIONS/SE

A
  1. CNS: seizures
  2. CV: fluid retention
  3. OTHER: Hypernatremia, metabolic alkalosis, tissue sloughing, cellulitis, or necrosis at injection site, hypokalemia, electrolyte imbalance, tetany (low calcium involuntary muscle contraction), sodium retention, peripheral edema
55
Q

SODIUM BICARBONATE - DRUG INTERACTIONS

A

NONE

56
Q

SODIUM BICARBONATE - DOSAGE ADMINISTRATION ADULT NAT

A

HYPERKALEMIA OR CARDIAC ARREST WITH METABOLIC ACIDOSIS:
50 mEq IV/IO once

SODIUM CHANNEL BLOCKER OVERDOSE:
50 mEq slow IV/IO (repeat every 5 min as needed)

57
Q

SODIUM BICARBONATE - DOSAGE ADMINISTRATION PEDI NAT

A

SODIUM CHANNEL BLOCKER OVERDOSE:
1mEq/kg slow IV/IO push (repeat every 5 min as needed)

58
Q

SODIUM BICARBONATE - DOSAGE ADMINISTRATION ADULT RI

A

DIALYSIS EMERGENCIES AND RENAL FAILURE /CRUSH INJURY w/ cardiac arrest/suspected hyperkalemia:
MED CONTROL authorization to administer SODIUM BICARBONATE 50 mEq IV (and CALCIUM CHLORIDE or CALCIUM GLUCONATE.)

EXCITED DELIRIUM SYNDROME(ExDS) (CARDIAC ARREST):
SODIUM BICARBONATE 50 mEq IV (and cardiac arrest protocol.

CRUSH INJURY:
NORMAL SALINE 1000 ml with 150
mEq of SODIUM BICARBONATE added at 1.5 L/hr (reduce to 500 ml/hr once crush resolved ….OR D5W (preferred)
w/ suspected hyperkalemia/CA same as above

TOXICOLOGICAL EMERGENCIES:
1. suspected tricyclic antidepressant or other sodium channel blocking agent
toxicity (if seizures are present or the QRS is >0.12 sec):
contact MEDICAL CONTROL authorization to administer SODIUM BICARBONATE 50 mEq IV (repeat every 5 minutes as indicated)

59
Q

SODIUM BICARBONATE - DOSAGE ADMINISTRATION PEDI RI

A

CRUSH INJURY (>30min):
NORMAL SALINE 1000 ml with 150
mEq of SODIUM BICARBONATE added at 20 ml/kg x3. once crush injury resolved reduce infusion rate to age appropriate maintenance rate….OR D5W (preffered)

TOXICOLOGICAL EMERGENCIES:
1. suspected tricyclic antidepressant or other sodium channel blocking agent
toxicity (if seizures are present or the QRS is >0.09 sec):
MEDICAL CONTROL authorization to administer SODIUM BICARBONATE 1 mEq/kg IV (repeat every five minutes as indicated)

60
Q

SODIUM BICARBONATE - DURATION OF ACTION

A

Onset: Seconds
Peak: 1-2 minutes
Duration: 10 minutes

61
Q

SODIUM BICARBONATE - SPECIAL CONSIDERATIONS

A
  1. Sodium bicarbonate and calcium preparations are not compatible and should be given through separate IV lines if possible. If they must be administered via the same IV line, the line should be flushed in between the administration of each. (WILL CRYSTALIZE WHEN MIXED)
  2. Sodium bicarbonate is preferentially mixed in D5W (150 mEq/1000ml), utilization of 0.9% saline for this purpose is less desirable.
  3. SODIUM BIC. USED ONLY WHEN METABOLIC ACIDOSIS IS SUSPECTED IN CARDIAC ARREST-(used to be common but not used infrequently).

ADVANCE EMT CARDIAC (5 decks)

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