Medical emergencies (& Trauma)

Question 1

Activated charcoal

Answer 1

For: Adsorbing toxic substances from GI tract

Adult dose: 1-2g/kg PO or via NGT

Ped dose: same

Contraindications: After ingestion of corrosive or caustic substances or petroleum distillates. Cannot be administered with other oral medications. Comatose pt

Notes: Does not adsorb cyanide, lithium, iron, lead, or arsenic

Question 2

Dexamethasone (neurology)

Answer 2

For: Prevention and tx of elevated ICP, spinal cord injury, as an adjunct to tx for shock

Adult dose: 1 mg/kg slow IV bolus (considerable variance through Medical
Control).

Pediatric: 0.25-1.0 mg/kg/dose IV, IO, IM

Contraindications: Hypersensitivity

Question 3

Dextrose (D10, D25, D50)

Answer 3

For: AMS 2/2 hypoglycemia

Adult dose: 12.5-25g slow IV, repeated PRN

Ped dose: 0.5-1g/kg/dose slow IV, repeated PRN

Contraindications: Intracranial hemorrhage, delirium tremens

Question 4

Diphenhydramine

Answer 4

For: Allergic reactions, anaphylaxis, acute dystonic reactions

Adult dose: 25-50mg IV/IM/PO

Ped dose: 1-2mg/kg IM or slow IV/IO

Contraindications: Asthma, glaucoma, pregnancy, HTN, infant pts

Question 5

Glucagon

Answer 5

For: AMS 2/2 hypoglycemia or as an inotropic agent in beta-blocker overdose

Adult dose, hypoglycemia: 0.5-1mg IM/SQ or slow IV, repeated every 20min PRN

Ped dose: 0.1mg/kg/dose IM/SQ/IN or slow IV/IO to a max of 1mg, repeated every 20min PRN

For beta-blocker OD: 2-5mg titrated to effect

Contraindications: Hyperglycemia, hypersensitivity

Note: Ineffective if glycogen stores are depleted

Question 6

Hydroxocobalamine (Vit B12)

Answer 6

Indications: Cyanide poisoning

Adult dose: 5g IV infusion over 15min (approx. 15mL/min). May repeat once if indicated.

Ped dose: 70mg/kg IV infusion over 15min

Contraindications: None

Notes: Be familiar with Cyanokit administration

Question 7

Mannitol

Answer 7

For: Reducing ICP (cerebral edema, space occupying lesions), rhabdomyolysis, blood transfusion reactions

Adult dose: 0.50-2g/kg IV infusion over 15-30min, repeated 5min after completion if no effect

Ped dose: 0.5-1g/kg IV/IO infusion over 30-60min, repeated 30min after completion if no effect

Contraindications: Hypotension, dehydration, hypovolemia, electrolyte depletion and esp. hyponatremia. Renal failure. Intracranial bleeding. Severe CHF with pulmonary edema

Notes: An in-line filter should always be used. Solution may crystallize below 7.8*C.

Question 8

Nalaxone

Answer 8

For: Respiratory depression 2/2 narcotic overdose

Adult dose: 0.4-2.0mg IV/IM/SQ/IN repeated at 5 minute intervals to a max of 10mg

Ped dose: 0.1mg/kg/dose IV/IM/SQ or diluted ET to a max of 0.8mg, repeated after 10 minutes if no response

Contraindications: Use cautiously in the narcotic-dependent

Question 9

Ondansetron (Zofran)

Answer 9

For: Nausea / vomiting

Adult dose: 4-8mg IV or PO

Ped dose <30kg: 1mg IV
Ped dose >30kg: 2mg IV

Contraindications: Hypersensitivity

Question 10

Phenylephrine

Answer 10

For: Treatment of hypotension, vascular failure in shock (other than septic)

Adult dose: 0.5-2 mcg/kg/min, titrated to desired MAP (significant variance through Medical Control)

Ped dose: 0.1-0.5mcg/kg/min IV infusion, titrated to desired MAP (significant variance through Medical Control)

Contraindications: None

Note: Use with caution in patients with preexisting bradycardia, partial heart block, myocardial disease, or severe coronary artery disease. Avoid or use with extreme caution in patients with heart failure or cardiogenic shock

Question 11

Phenytoin (Dilantin)

Answer 11

For: Seizures

Loading dose for opiate naïve adult: 15-20mg/kg at a rate of 25-50mg/min

Loading dose for opiate naïve child: same

Notes: Due to risk of adverse CV effects and local tissue injury, the max rate of administration is 50mg/min for adults and 1mg/kg/min for children under continuous cardiac, blood pressure

Question 12

2-PAM

Answer 12

For: Organophosphate poisoning

Adult dose: 1-2g IV/IM/SQ infusion over 15-30min (typically in 100mL NS), repeated every hour for persistent muscle weakness

Ped dose: 20-40mg/kg IV/IM/SQ infusion over 15-30min (typically in 100mL NS), repeated every hour for persistent muscle weakness

Contraindications: Myasthenia gravis

Question 13

Promethazine (Phenergan)

Answer 13

For: Nausea, vomiting

Adult dose: 6.25-25mg diluted slow IV over 10-15min OR 12.5-25mg undiluted IM

Ped dose: 0.2-0.5mg/kg diluted slow IV over 10-15min OR 0.25-0.5mg/kg undiluted IM

Contraindications: CNS depression from alcohol, barbiturates, or narcotics. Coma. Hypersensitivity

Question 14

Thiamine (Vit B1)

Answer 14

For: Delirium tremens, Wernicke’s encephalopathy

Adult dose: 100mg IM or slow IV

Ped dose: 10-25mg IM or slow IV

Contraindications: None

Question 15

TXA

Answer 15

For: Hemodynamic compromise and hemorrhage from blunt or penetrating trauma

Adult dose: 1g in 100mL NS over 10min

Ped dose: Not recommended

Contraindications: Subarachnoid hemorrhage, history of thromboembolic event, injury over 3 hours ago

Question 16

Magnesium sulfate (OB/GYN)

Answer 16

For: Eclamptic seizures

Dose: 4 gm IV over 10 minutes, followed by an infusion of 1-3g/hour. (Max dose: 40g/day)

Contraindications: Heart blocks; Myocardial damage

Question 17

Dexamethasone (neuro)

Answer 17

For: Elevated ICP, spinal cord injury, adjunct treatment to shock

Adult dose: Considerable variability (medical control option) but often a 1mg/kg slow IV bolus

Ped dose: Considerable variability (medical control option) but often 0.25-1mg/kg/dose IV, IO, IM

Contraindications: Hypersensitivity

Question 18

Morphine (pulmonary)

Answer 18

For: Severe CHF, pulmonary edema

Adult dose: 0.1 mg/kg IV,IM,SQ to a max of 10mg

Ped dose: 0.1-0.2mg/kg/dose IV,IO,IM,SQ every 5min titrated to a max of 5mg

Contraindications: Head injury, respiratory depression, hypotension/hypovolemia, decreased LOC, undiagnosed abd pain