Medical(30-40) Flashcards
Allergic Reaction… go
Hive/Rash: 25-50 Diphenhydramine, Methylprednisolone 125mg
Shock:
Epi 0.3-0.5
500 mL
Albuterol 90-180 or 2.5-5mg NEB
Diphenhydramine 25-50
Methylprednisolone
If still bad then
5-15/min of epi
Child Allergic Reaction… go
Hive/Rash: 1-2 mg/kg Diphenhydramine(50), Methylprednisolone: 2mg/kg
Shock:
Epi 0.01mg/kg(0.3)
20 ml/kg IVF
Albuterol 4-8 inhalations q20, <20kg 2.5 NEB, >20kg 5 mg NEB
Diphenhydramine 25-50
Methylprednisolone 2 mg/kg(120)
Patient is swinging wat do?
Ketamine 4-5 or 1-2 q10
Lorazepam 2-4
Midazolam 2.5-5 q 15-30
Hyperglycemia
> 250
1L IVF(10-20 mL/kg)
Sugar check q30
0.1 U/kg/hr insulin
Hypoglycemia
<70
W/AMS
10-25 g of dextrose
or
1 mg Glucagon IM
w/o AMS
Oral Glucose
Wheezes
- 100% NRB
- 90-180 Albuterol or 5 mg NEB
- Consider epi 0.3-0.5
- Methylprednisolone 125 mg
- Consider Mag 2 g/ 20min in 50-100 of NS or D5W
- Last resort 1 mg/kg Ketamine
Wheezes Ped
- 100% NRB
- 90 Albuterol or 5 mg NEB(max 12 doses per 24 hrs)
- Consider epi 0.3 for > 30kg or .15 for 15-30 kg, or 0.01 mg/kg
- Methylprednisolone 1-2 mg/kg
- Mag 25-50 mg/kg SLOW in 50-100 of NS or D5W
- Last resort 0.5 mg/kg Ketamine
Rales/CHF
- PPV
- Nitro 400 mcg q5 SBP>90
- Consider furosemide 60-80 mg if not improving
Rales/CHF Ped
- PPV or 100% NRB if PPV not tolerated
- Furosemide 1mg/kg if not improving
Upper respiratory distress
- 100% NRB
- 90-180 Albuteral or 2.5-5mg Neb
- Consider Epi 0.3
- Methylprednisolone 125 mg
Upper Resp Distress Ped
-100% NRB
- Racemic Epi (0.5 mL/kg) MAX 5mL
- Consider Epi(0.15, 0.30 or 0.01 mg/kg)
- Administer methylprednisolone 1-2 mg/kg
Active Seizure
- Midazolam 5 IV/IO/IN or 10IM
- Lorazepam 4 or Diazepam 4
- Keppra 1500 mg / 15 followed by 1000 mg q12
Active Seizure Pregnancy
Administer 4 G Mag over 15 min
Active Seizure Child
- Lorazepam 0.05-1 mg/kg or Midazolam 0.2 mg/kg
- Keppra 60 mg/kg once
- If sugar < 40 give thiamine 25 mg or D25 2ml/kg or glucagon 0.05mg/kg
What is status epilepticus?
- Seizure >15min or two or more continuous seizures without a period of
consciousness / recovery
Sepsis?
<96.8 or < 100.4
HR> 90
SBP <90
RR>20
Sepsis Tx
- > 93% SPO2
- 2 IV/IO sire
- 1L Bolus or 30mL/kg to target SBP>100 and MAP >65
- UOP 0.3-0.5
- For temp consider 1 g Tylenol
- For refractory hypotension: Norepi: 2-12/min, Vasopressin: 0.03 u/min, Epi 2-20/min
- Consider Ceftriaxone 2g or Cefepime 2g in 100 cc NS
When to stack Vasopressin?
When going above 8-10 of norepi
What is considered over resuscitation?
> 0.5 ml/kg/hr UOP
wet lungs
Increasing work of breathing
Toxic Ingestion Low/high Blood Sugar
- <60, 50 mL D50 in 500 NS or Glucagon 1 mg
- Charcoal 1 g/kg(if alert and <1hr from ingestion)
BB OD
Glucagon 3-10 IV/IM followed by 3-5 mg/hr
Opiates OD
0.4-2mg
TCA OD
12 lead, if QRS > 100 or hypotension then Bicard 1 mEq/kg and 100-150 mEq in 1L D5/NS @ 100-200
Organophosphate OD
-Atropine 2 mg q 45 + 2 PAM 600mg IV/IM
- If seizure 2.5 versed
