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BCEHS Guidelines 2024 > Medications > Flashcards

Medications Flashcards

BCEHS Guidelines 2024 ACP/PCP/EMR

1
Q

What are your 6 R’s?

A

Right Pt.
RIght Medication
Right Dose
Right Time
Right Route
Right Documentation

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2
Q

What is the dose for acetaminophen in adults?

A

500mg to 1,000mg PO

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3
Q

What are the contraindications for acetaminophen?

A

Allergy
Severe alcoholic hepatitis or liver dysfunction with active alcohol consumption
Acute liver injury
Acetaminophen-induced liver disease

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4
Q

What is the weight based dosing for acetaminophen for pediatrics?

A

<30 kg: 15 mg/kg PO (use liquid preparation)
30-50 kg: 500 mg PO (may use liquid preparation or tablets, depending on patient ability)
> 50 kg: 500-1,000 mg PO

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5
Q

What is the mechanism of action of acetaminophen?

A

Inhibits prostaglandin synthetase in the CNS, reducing pain and pyrexia

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6
Q

What is the toxic dose of acetaminophen?

A

7.5g in adults
150mg/kg in pediatrics

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7
Q

What is the dose of ASA for adults?

A

162mg PO (chewed and then swallowed)

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8
Q

What are the indications for ASA?

A

Chest pain or signs and symptoms consistent with cardiac ischemia

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9
Q

What are the contraindications of ASA?

A

Allergy
Pt. who experienced bronchospasm with ASA admin, or other NSAID
Active or recent bleeding of any kind, especially GI/Head
Pediatric pt. with signs and symptoms of a viral infection

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10
Q

What is the mechanism of action of ASA?

A

Inhibits the formation of Thromboxane A2, through the COX 1 pathway

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11
Q

What is the toxic dose of ASA?

A

150mg/kg

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12
Q

What is the dose of adenosine for adults?

A

Adults:
6mg for first dose
If that does not convert SVT
12mg for second dose

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13
Q

What is the dose of adenosine for pediatrics?

A

Pediatrics:
.1mg to a max of 6mg
.2mg to a max of 12mg

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14
Q

What are the indications for adenosine?

A

Conversion and termination of SVT

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15
Q

What are the contraindications for adenosine?

A

Allergy
2nd or 3rd degree AV node block
Sick sinus syndrome in pt. without an artificial pacemaker

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16
Q

What is the mechanism of action for adenosine?

A

slows the conduction through the AV node by hyperpolarizing the cells in the AV node.

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17
Q

What is the dosing of amiodarone for adults?

A

Cardiac arrest:
300mg first dose refractory to two shocks and after one epi
150mg second dose after 10mins of the initial dose

Unstable VTach following cardioversion:
150mg infusion over 10mins

Stable monomorphic VTach:Clinicall required prior to admin
150mg infusion over 10mins

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18
Q

What is the dosing of amiodarone for pediatrics?

A

clinicall is required, safety and efficacy hasnt been proven in the pediatric realm

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19
Q

What are the indications for amiodarone?

A

VFib
Pulseless Vtach
Unstable Vtach
Recurrent Vtach following cardioversionWha

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20
Q

What are the contraindications of amiodarone?

A

Allergy
Cardiogenic shock
Marked symptomatic sinus bradycardia
2nd or 3rd degree AV block

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21
Q

What is the mechanism of action of amiodarone?

A

Class III antiarrhythmic (Potassium channel blockade) with effects on all classes of antiarrhythmics.

Class IA: Mild sodium Channel blocker
Class IB: Weak sodium channel blocker
ClassIC: Strong sodium channel blocker
Class II: Beta blocker
Class III: Potassium channel blocker
Class IV: Calcium channel blocker
Class V: Other

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22
Q

What is the adult dosing for atropine?

A

Bradycardia:
.6mg IV to a max of 3.0mg (0.04mg/kg)

Organophosphate Poisoning: Clinicall required
1-2mg IV/IM every 5-60mins repeat until symptoms resolve

Secretions in palliative:
.6mg IM

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23
Q

What is the pediatric dosing for atropine?

A

Bradycardia:
0.02mg/kg IV min 0.1mg to a max of 0.4mg

Organophosphate Poisoning: Clinicall Required
0.02mg-0.05mg/kg IV every 10-20 mins until symptoms resolve

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24
Q

What are the indications for atropine?

A

Restoration of heart rate in bradydysrhythmias
Sinus bradycardia (<50BPM) with hemodynamic compromise
Bradycardia secondary to AV node blocks
Treatment of organophosphate poisoning
Control of secretions in palliative care

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25
Q

What are the contraindications of atropine?

A

Allergy
Tachycardia
Narrow angle glaucoma
Thyrotoxicosis
Prostatic hypertrophy
Myasthenia gravis

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26
Q

What is the mechanism of action for atropine?

A

It is a anticholinergic and an antimuscarinic that competitively antagonizes those receptors causing a parasympatholytic and vagolytic effects. Blocks the parasympathetic tone in the body

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27
Q

What is the dosing for calcium chloride in adults?

A

Cardiac arrest/ Suspected HyperK+/ Ca++ Channel Blocker Toxic
1-2g IV over 10 mins, may repeat once

Clinicall is REQUIRED for hyperk+ and Calcium channel blocker pt. with a perfusing rhythm.

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28
Q

What is the dosing for calcium chloride in pediatrics?

A

Cardiac arrest:
20mg/kg (max 1g) IV over 3 mins, may repeat once after 10mins

All other indications (Hyperk+ and Calcium channel blocker)
10mg/kg (max 1g) pver 15mins, may repeat once in 10 mins

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29
Q

What is the indications for calcium chloride?

A

Suspected hyperK+ - Clinicall REQUIRED
Suspected Calcium channel blocker toxicity - Clinicall REQUIRED

Cardiac arrest due to suspected hyperkalemia, must find clinical or historical findings to support your treatment

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30
Q

What is the contraindications for calcium chloride?

A

Allergy
Primary or secondary hypercalcemia

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31
Q

What is the mechanism of action of calcium chloride?

A

Essential electrolyte in the human body

Increase nerve conduction, muscle contraction, renal function and coagulation, as well as increasing myocardium contractility and ventricular automaticity

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32
Q

What is the dose for dextrose in adults?

A

10 to 25g (equivalent to 100-250mls of D10W)

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33
Q

What is the dose for dextrose in pediatrics?

A

5ml/kg D10W

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34
Q

What is the indications for dextrose?

A

suspected or known hypoglycemia

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35
Q

What are the contraindications for dextrose?

A

none

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36
Q

What is the mechanism of action of dextrose?

A

Provides immediate source of glucose and water to cells

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37
Q

What is the dose for dimenhyDRINATE for adults?

A

25-50mg IV/IM
12.5mg should be given to elderly or frail pt.
Be cautious giving this medication to dementia pt. as it can cause and exacerbation of it.

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38
Q

What is the dose for dimenhyDRINATE for pediatrics?

A

1.25mg/kg to max of 25mg IV/IM

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39
Q

What are the indications for dimenhyDRINATE?

A

Prevention or control of nausea caused by motion sickness
Vomiting or nausea
Prevention of nausea caused my a narcotic (do not use it for fentanyl)

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40
Q

What are the contraindication for dimenhyDRINATE?

A

Allergy

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41
Q

What is the mechanism of action of dimenhyDRINATE?

A

inhibits cholinergic vestibular and reticular stimulation from motion

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42
Q

What is the dose for diphenhydrAMINE for adults?

A

1mg/kg to a max of 50mg IV/IM

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43
Q

What is the dose for diphenhydrAMINE for pediatrics?

A

1mg/kg to max of 50mg IV/IM

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44
Q

What are the indications for diphenhydrAMINE?

A

Treating hypersensitivity reaction
Allergic reaction, used as an adjunct to epi

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45
Q

What are the contraindications for diphenhydrAMINE?

A

Allergy
Neonates
Premature infants

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46
Q

What is the mechanism of action for diphenhydrAMINE?

A

Antihistamine with anticholinergic with sedating side effects.

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47
Q

What is the dose of EPINEPHrine for adults in anaphylaxis?

A

.5mg IM every 5mins repeat up to 3 times
50-100mcg IV pre-arrest anaphylaxis

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48
Q

What is the dose of EPINEPHrine for pediatrics in anaphylaxis?

A

0.01mg/kg IM to max single dose of 0.5mg, repeat up to 3 times
5mcg/kg IV

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49
Q

What is the dose of EPINEPHrine for adults in severe bronchospasm?

A

0.5mg IM every 5-20mins until symptoms resolve
50-100mcg IV, may repeat as necessary

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50
Q

What is the dose of EPINEPHrine for pediatrics in severe bronchospasm?

A

0.01mg/kg IM to a max single dose of 0.5mg, do not repeat

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51
Q

What is the dose of EPINEPHrine for adults in cardiac arrest?

A

1mg IV/IO every 3-5 mins (suggested max dose removed from handbook in December 2023)

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52
Q

What is the dose of EPINEPHrine for pediatrics in cardiac arrest?

A

0.01mg/kg to a max of 1mg IV/IO

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53
Q

What is the dose of EPINEPHrine for NEONATAL’s in cardiac arrest?

A

0.02mg/kg for initial to 0.03mg/kg for subsequent dosing is needed

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54
Q

What is the dose of EPINEPHrine for adults in peri-arrest hypotension?

A

10mcg IV/IO slow push every 2-3 mins

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55
Q

What is the dose of EPINEPHrine for adults in bradycardia?

A

2-10mcg/min IV/IO infusion

56
Q

What is the dose of EPINEPHrine for pediatrics with stridor secondary to croup?

A

5mg by nebulizer mask

57
Q

What is the dose of EPINEPHrine for pediatrics in peri-intubation resuscitation?

A

1mcg/kg slow push IV/IO every 2-3 mins

58
Q

What is the indications for EPINEPHrine?

A

Anaphylaxis
Severe bronchospasm
Stridor secondary to croup
Cardiac arrest
Peri-arrest hypotension
Significant bradycardia
Peri-intubation

59
Q

What are the contraindications of EPINEPHrine?

A

There are NO absolute contraindications for epi.

60
Q

What is the mechanism of action of EPINEPHrine?

A

effects teh A1, B1 and B2 adrenergic receptors

61
Q

What is the dose of fentaNYL for an adult?

A

-0.5mcg-1.0mcg/kg IM/IV/IO to a maximum single dose of 100mcg, may repeat every 5mins to a total dose of 300mcg
-1.5 - 2.0mcg/kg IN to a maximum single dose of 100mcg, may repeat every 5 mins to a total dose of 300mcg
Clinicall is required if higher doses are warranted

62
Q

What is the dose of fentaNYL for an pediatric?

A

1.5-2.0mcg/kg IN to maximum single dose of 100mcg
1-2mcg/kg IV/IO to a maximum single dose of 100mcg

63
Q

What are the indications for fentaNYL?

A

moderate to severe pain
Adjunct for awake intubation

64
Q

What are the contraindications for fentaNYL?

A

Allergy
Myasthenia gravis
pre-existing respiratory depression
acute asthma
upper airway obstruction

65
Q

What is the mechanism of action for fentaNYL?

A

Agonist of the U or K receptors on the CNS inhibiting the pain response through the CNS to the brain

66
Q

What is the dose of ibuprofen for adults?

A

300-400mg PO for pain and pyrexia

67
Q

What is the dose of ibuprofen for pediatrics?

A

For pain:
10mg/kg to a max daily dose of 40mg/kg

For pyrexia:
<39c 5mg/kg
>= 39c 10mg/kg

68
Q

What are the indications for ibuprofen?

A

Mild to moderate pain
Pyrexia

69
Q

What are the contraindications of ibuprofen?

A

Allergy
Active GI bleed or ulcer
Pregnancy

70
Q

What is the mechanism of action for ibuprofen?

A

inhibits prostaglandin synthesis through the COX 2 pathway

71
Q

What is the dose of Ipratropium for adults?

A

160mcg MDI
500mcg via nebulizer (can be combined with salbutamol in the same nebulizer for co-adminsteration)

72
Q

What is the dose of ipratropium for pediatrics?

A

<30 days not indicated
>= 30 days to 12 years:
-250mcg via nebulizer
-80mcg via MDI

73
Q

What are the indications for ipratropium?

A

bronchospasm in asthma or COPD

74
Q

What are the contraindications for ipratropium?

A

allergy

75
Q

What is the mechanism of action for ipratropium?

A

anticholinergic localized to the bronchial smooth muscle

76
Q

What is the dose for ketamine in adults for analgesia?

A

0.3mg/kg IV/IO repeat after 5mins half the loading dose
0.5mg/kg IM repeat after 5mins 0.3mg

77
Q

What is the dose for ketamine in adults for procedural sedation?

A

0.5mg/kg IV/IO for loading dose, repeat with 0.25mg/kg to titrate to effect

78
Q

What is the dose for ketamine in adults for anesthesia induction?

A

Shock index <1: 2mg/kg IV/IO
Shock index >1: 1mg/kg IV/IO

79
Q

What is the dose for ketamine in adults to maintain anesthesia?

A

Half of the required induction dose every 10-15mins

80
Q

What is the dose for ketamine in adults for excited delirium?

A

4-5mg/kg IM bolus

81
Q

What is the dose for ketamine in pediatrics for analgesia?

A

<6months not indicated

> 6months:
0.3mg/kg IV/IO to a max single dose of 20mg repeat once if necessary

0.5mg/kg IM, repeat at 45mins at 0.3mg/kg

1.5mg/kg IN, repeat at 20mins at 1mg/kg, max single dose of 100mg

82
Q

What is the dose for ketamine in pediatrics for procedural sedation?

A

Follow weight base dosing

0.3mg/kg IV/IO to a max single dose of 20mg repeat once if necessary

0.5mg/kg IM, repeat at 45mins at 0.3mg/kg

1.5mg/kg IN, repeat at 20mins at 1mg/kg, max single dose of 100mg

83
Q

What is the dose for ketamine in pediatrics for excited delerium?

A

CLINICALL required for any patient under the age of 12 to discuss treatment plans.

May have to use adult dosing

84
Q

What are the indications for ketamine?

A

analgesia
Induction of sedation prior to intubation
Procedural sedation
Severe agitation or excited delirium

85
Q

What are the contraindications for ketamine?

A

allergy
unable to manage side effects of ketamine
where hypertension may be harmful
<6 months

86
Q

What is the mechanism of action for ketamine?

A

NMDA antagonist that blocks glutamate from entering the neuron cells. NMDA is primarily the excitatory receptor.

87
Q

What is the dose for lidocaine for adults in cardiac arrest?

A

1.0 - 1.5mg/kg IV bolus, repeat dose is 0.5mg - 1.0mg/kg after 10 mins

88
Q

What is the dose for lidocaine for adults during local anesthesia in IO cannulation?

A

40mg SLOW push over 120 seconds

89
Q

What is the dose for lidocaine for adults during local anesthesia in awake intubation?

A

spray as you go procedures, do not exceed 5mg/kg (one pre load is 100mg)

90
Q

What is the dose for lidocaine for pediatrics in cardiac arrest?

A

1.0 - 1.5mg/kg IV bolus, repeat dose is 0.5mg - 1.0mg/kg after 10 mins

91
Q

What is the dose for lidocaine for pediatrics during local anesthesia in IO cannulation?

A

40mg SLOW push over 120 seconds

92
Q

What is the dose for lidocaine for pediatrics during local anesthesia in awake intubation?

A

spray as you go procedures, do not exceed 5mg/kg (one pre load is 100mg)

93
Q

What are are indications for lidocaine?

A

control of ventricular arrhythmias
local anesthesia during IO cannulation
Local anesthesia during awake intubation

94
Q

What are the contraindications for lidocaine?

A

Allergy
3rd heart block
ventricular escape rhythm
WPW

95
Q

What is the mechanism of action of lidocaine?

A

Class Ib antiarrhythmic

96
Q

What is the dose of magnesium sulfate in adults for ventricular arrhythmias?

A

Perfusing rhythms: 2g IV over 15mins
Cardiac arrest: 4g IV push

97
Q

What is the dose of magnesium sulfate in adults for bronchospasm?

A

2g IV over 20 mins

98
Q

What is the dose of magnesium sulfate in adults for managing seizure in pregnancy?

A

4g IV over 20mins
5g IM

99
Q

What is the dose of magnesium sulfate in pediatrics for cardiac arrest?

A

50mg/kg to a max dose of 2g IV/IO push

100
Q

What is the dose of magnesium sulfate in pediatrics for all other indications?

A

50mg/kg IV/IO infused over 15 mins

101
Q

What are the indications for magnesium sulfate?

A

-Treatment of V-fib and v-tach which are refractory to first line antiarrhythmics
-Recurrent and intermittent episodes of wide complex tach
-Treatment for torsades de pointes
-Bronchospasm refractory to bronchodilation in acute asthma
-Management of seizures in pregnancy associated with hypertension

102
Q

What are the contraindications for magnesium sulfate?

A

allergy
2nd or 3rd degree heart block

103
Q

What is the mechanism of action of magnesium sulfate?

A

poorly understood, the best answer we have is that it a some sort of calcium channel blocker which can slow conduction and relax muscles.

104
Q

What is the dose for MIDAZOLam in adults for all indications?

A

2-5mg IV/IO increments to effect
5-10mg IM
Max dose is 30mg
CLINICALL is required if more midaz is needed

105
Q

What is the dose for MIDAZOLam in pediatrics for all indications?

A

0.2mg/kg IN to a max dose of 10mg

0.1mg/kg IV/IO to max of 5mg

106
Q

What is the indications for MIDAZOLam?

A

-Sedation of agitated patients
-Control of seizures
-Maintenance of anaesthesia in intubated patients

107
Q

What are the contraindications for MIDAZOLam?

A

-Allergy
-Acute narrow-angle glaucoma
-Shock
-Decreased LOC
-Hypotension

108
Q

What is the mechanism of action for MIDAZOLam?

A

Increases the frequency of the opening of GABA receptors on the CNS causing hyperpolarization of the cells, thus subsequently the threshold to depolarize is much higher.

109
Q

What is the dose for MORPHine in adults?

A

0.1mg/kg SC to max of 2.5mg-5mg

110
Q

What are the indications for MORPHine?

A

For palliative care pt.

111
Q

What are the contraindications for MORPHine?

A

allergy

112
Q

What is the mechanism of action of MORPHine?

A

works on the u and k receptors on the CNS which decrease pain.

113
Q

What is the dose of nitroglycerin for adults?

A

0.4mg SL every 3-5mins

114
Q

What is the indication for nitroglycerin?

A

-Relief of chest pain that is suggestive of ACS
- Reduction of preload in acute cardiogenic pulmonary edema

115
Q

What are the contraindications for nitroglycerin?

A

-Allergy
-Viagra or levitra in last 24hrs
-Cialis in last 48hrs
-Severe anemia
-Restrictive pericarditis or pericardial tamponde
-Documented right sided acute MI
-hypotension or uncorrected hypovolemia

116
Q

What is the mechanism of action for nitroglycerin?

A

Relaxes smooth muscle vasculature

117
Q

What is the dose of PhenyLEPHRine in adults?

A

100mcg IV slow push every 2-5mins to a max of 500mcg

118
Q

What is the indications for PhenyLEPHRine?

A

maintenance of BP in acute hypotensive states or shock following adequate fluid replacement in airway management.

119
Q

What are the contraindications of PhenyLEPHRine?

A

allergy
pediatrics
allergy to sulfites
severe hypertension or VTACH
Pheochromocytoma

120
Q

What is the mechanism of action of PhenyLEPHRine?

A

agonizes a1 receptors causing vasoconstriction

121
Q

What is the indications for salbutamol?

A

Bronchospasm from asthma or COPD
Adjunct for hyperkalemia

122
Q

What is the dose for salbutamol in adults for bronchospasm?

A

5mg nebulized, repeat as needed
4x100mcg MDI repeat as necessary

123
Q

What is the dose for salbutamol in adults for hyperkalemia?

A

10-20mg via nebulizer with back to back doses

124
Q

What is the dose for salbutamol in pediatrics for bronchospasm?

A

<1 year: 2.5mg nebulizer
>= 1 year: 5mg nebulizer

125
Q

What is the contraindications for salbutamol?

A

allergy

126
Q

What is the mechanism of action for salbutamol?

A

beta2 agonist producing bronchodialation and at higher does a beta1 effect forcing k+ into the cells.

127
Q

What are the indications for sodium bicarbonate?

A

-Known or suspected hyperkalemia
-TCA overdose
-Suspected or confirmed metabolic acidosis
-Pretreatment prior to weight release in crush injury

128
Q

What is the dose of sodium bicarbonate in adults?

A

For all indications:
1mEq/kg IV/IO slow push - repeat every 10-15 mins at 0.5mEq/kg

129
Q

What is the dose of sodium bicarbonate in pediatrics?

A

For all indications:
1-2mEq/kg slow IV/IO push - repeat 10-15mins at 0.5mEq/kg

130
Q

What is the contraindications for sodium bicarbonate?

A

suspected alkalosis
history of excessive vomiting

131
Q

What is the mechanism of action of sodium bicarbonate?

A

It is a base and neutralizes acid, overcomes sodium channel blockades

132
Q

What are the indications for TXA?

A

-Signs of shock or hypoperfusion with an injury suggestive of occult or ongoing bleeding
-Signs of shock in maternal vaginal bleeding >20 weeks or postpartum hemorrhage

133
Q

What is the dose of TXA for an adult?

A

2g IV push over 1 min

134
Q

What is the dose of TXA for a pediatric?

A

15mg/kg IV over 1min

135
Q

What are the contraindications for TXA?

A

allergy
GI bleeding
>3 hours from injury
<1 year ACP

136
Q

What is the mechanism of action for TXA?

A

Prevents clot degradation by competing for TPA receptors.

137
Q
A

BCEHS Guidelines 2024 (13 decks)

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