Medicine (Medical Emergencies)

Question 1

What is the rate of rescue breathing?

Answer 1

-One breath every 6-8 secconds

Question 2

What is the ideal compression technique and rate?

Answer 2

-100-120/min
-Depth of 2 inches (1/3 depth of chest for children)
-30 compressions per 2 rescue breath (15:2 in 2 person children)

Question 3

What dysrhythmias can be treated with an AED?

Answer 3

-V-Fib
-Pulseless V-Tach

Question 4

What is esmolol and dosage?

Answer 4

-Short acting selective beta-1 blocker (onset in 1 min, duration 10-20)
-5-10 mg over 1 minute q3 min

Question 5

What is labetalol and dosage?

Answer 5

-Non-selective beta blocker and alpha-1 blocker (onset 5 minutes, duration 3-6 hours)
-5-10 mg q10 min

Question 6

What is hydralazine and dosage?

Answer 6

-Direct arterial vasodilator (onset 5 minutes, duration 2 hours)
-2.5-5 mg IV q10 minutes (max 25 mg)
-Good for HTN with bradycardia. Avoid if myocardial ischemia

Question 7

What is nitroglycerin and dose?

Answer 7

-Venodilator (arterial dilator at high doses)
-5-10 mcg/min q5 min IV (onset 2-5 minutes, duration 10-20 minutes)
-0.4 mg sublingual q5 minutes (max 3 doses)
-Can’t use if on phosphodiesterase inhibitor (cause hypotension)
-Can’t use if pt is hypotensive

Question 8

What is your differential in a patient with hypotension?

Answer 8

-Allergic reaction
-Hypovolemia
-Anesthetic depth
-PE
-PTX

Question 9

What is atropine and dosage?

Answer 9

-Cholinergic antagonist
-Useful in hypotension with bradycardia
-0.5 mg q2-3 minutes. Max 3 mg

Question 10

What is ephedrine and dosage?

Answer 10

-Alpha and beta agonist
-Useful in hypotension with normal heart rate
-2.5-5 mg q5-10 minutes

Question 11

What is phenylephrine and dosage?

Answer 11

-Selective alpha agonist
-Useful in hypotension with tachycardia
-100 mcg q5 minutes (Need to double dilute)
-Onset 2-3 minutes

Question 12

What are the H’s and T’s?

Answer 12

-Hypovolemia, hypoxia, hydrogen ion acidosis, hypo/hyperkalemia, hypothermia
-Tension PTX, Tamponade, Toxins, Thrombosis (coronary/pulmonary)

Question 13

Describe the cardiac arrest algorithm.

Answer 13

-Shockable rhythm (V-fib, pulseless V-Tach)
-CPR 2 min
-Shock 2 min (Biphasic 120-200J)
-Epi q3-5 min (1 mg q3-5 min)
-Amiodarone (300 mg bolus first dose, 150 mg second dose), Lidocaine (1 mg/kg first dose, 0.5 mg/kg second dose)

-If not shockable, CPR and epi 1 mg q3-5 min

Question 14

Describe the Adult Bradycardia Algorithm.

Answer 14

-Identify and treat causes. If symptomatic (hypotensive, AMS, signs of shock)…

-Atropine 1 mg bolus (q3-5 minutes, max dose 3 mg)
-Transcutaneous pacing
-Dopamine 5-20 mcg/kg/min
-Epinephrine 2-10 mcg/min

Question 15

Describe the adult tachycardia algorithm.

Answer 15

-Identify and treat underlying causes. If symptomatic (hypotensive, AMS, shock)…

-Synchronized cardioversion

-If stable and regular narrow complex consider adenosine (6 mg IV push first dose, 12 mg IV push second dose)
-If stable and wide QRS treat with antiarrhythmic infusion (Procainamide, amiodarone 150 mg over 10 minutes, sotalol)

Question 16

What is your post-cardiac arrest care?

Answer 16

-Manage airway
-Respiratory parameters (10 breaths/min, SPO2 >92%, PaC02 35-45)
-Hemodynamic parameters (Systolic >90, MAP >65)
-Targeted temp management (32-36 x 24h)

Question 17

What is the pediatric bradycardia algorithm?

Answer 17

-Start CPR if HR <60/min
-Epinephrine 0.01 mg/kg
-Atropine 0.02 mg/kg (max dose 0.5 mg)
-Check pulse q2 min

Question 18

What is the pediatric tachycardia algorithm?

Answer 18

-Eval rhythm on 12 lead

-If stable: Eval QRS
-Narrow <0.09: Likely SVT, consider vagal manuevers. Adenosine 0.1 mg/kg rapid dose, 0.2 mg/kg second dose
-Wide: Possible V-tach. If regular and monomorphic, adenosine 0.1 mg/kg, 0.2 mg/kg second dose

If unstable:
-Narrow: SVT, Adenosine 0.1 mg/kg, 0.2 mg/kg second dose. Synchronized cardioversion. 0.5-1 J/kg
-Wide: Possible V-tach, synchronized cardioversion 0.5-1 J/kg

Question 19

What is the pediatric cardiac arrest algorithm?

Answer 19

-Shockable: V fib/pulseless V-tach
-CPR q2 min
-Epinephrine 0.01 mg/kg q3-5 min
-Amiodarone 5 mg/kg bolus (3 total doses)
-Lidocaine 1 mg/kg loading dose

-Non-shockable: Asystole/PEA
-Epi 0.01 mg/kg q 3-5 min
-CPR
-Treat reversible causes

Question 20

How is angina managed?

Answer 20

-Get monitors: Pulse ox, EKG, BP
-Oxygen 4 L/min NC
-Look at EKG for changes
-Ensure diastolic BP >90 mmHg and no PDE inhibitors (Viagra), give 0.5 mg SL nitroglycerine q 5 minutes
-Call EMS
-ASA 325 mg (crushed or chewed)

Question 21

What are cardiac enzymes used for MI?

Answer 21

-Troponins (trend), rise over 3 hours and remain elevated
-Creatine kinase myocardial band (best marker for early test)

Question 22

What is a PVC and how is it treated?

Answer 22

-QRS widened without a P wave
-Must treat if 6 or more PVCs/min

-Ensure defibrillator available
-Treat with beta-blocker (esmolol 500 mcg/kg IV or metoprolol 5-10 mg)

Question 23

How is torsades de pointes treated?

Answer 23

-Magnesium sulfate 1-2 g in D5W/NS

Question 24

How is an allergic reaction treated?

Answer 24

Mild:
-Diphenhydramine 50 mg IV (or 100 mg IM)

Severe:
-1 L bolus
-Epi 1:1000 0.15 mg if 10-25 kg or 0.3 mg IM
-Epi 10 mcg to 1 mg bolus (1-10 mcg/kg bolus in kids) IV
-B2 agonist (albuterol)
-Antihistamines: Diphenhydramine 0.5 mg/kg for children 50 mg for adult
-Steroids: Hydrocortisone 1-2.5 mg/kg IV or 100 mg IV

Question 25

What is malignant hyperthermia?

Answer 25

-A hypermetabolic state that occurs on exposure of volatile anesthetic agents and succinycholine
-Genetic mutation in ryanodine receptor
-Sinus tachycardia, hypercarbia, rigidity

Question 26

What is the treatment for hyperthermia?

Answer 26

-Stop procedure, discontinue volatile agents, call 911 and malignant hyperthermia hotline
-Hyperventilate with 100% oxygen
-Dantrolene 2.5 mg/kg IV bolus q4-10 minutes up to 10 mg/kg (20 mg dantrolene with 60 mL sterile water)
-IV fluids
-Ice packs

Question 27

How is a laryngospasm managed?

Answer 27

-Stop surgery, suction airway, pack off surgical site
-100% oxygen with positive pressure ventilation
-Deepen level of sedation
-Succinylcholine 10-20 mg IV (sub paralyzing) or rocuronium 1 mg/kg

Question 28

How is a bronchospasm treated?

Answer 28

-Stop surgery, suction airway, pack off surgical site
-Administer 100% oxygen via positive pressure ventilation
-6-10 puffs of b-2 agonist (albuterol)
-Epinephrine: 10 mcg to 1 mg bolus q 2 minutes (1-10 mcg/kg in children)
-Diphenhydramine 225-50 mg IV
-1-2 mg/kg succinylcholine (intubating dose), place ETT

Question 29

How is emesis treated?

Answer 29

-Turn patient to right side in trendelenburg
-Suction
-100% oxygen
-Auscultate lungs
-Transfer to ER with CXR

Question 30

How is an intra-arterial injection treated?

Answer 30

-Leave catheter in place
-Administer 10 cc of 1% lidocaine as vasodilation
-Consider transfer to hospital for vascular surgery consult

Question 31

How is hypoglycemia treated?

Answer 31

-Measure glucose
-IV access
-Supplemental oxygen, EKG/BP monitoring
-If conscious 15 g of carb to swallow
-If unable to swallow: D50 (increase 40-350 mg/dL), Children D25 2-4 mL/kg
-IM glucagon if no IV access (1 mg for adults, 0.5 mg for kids)

Question 32

In a stroke patient what is the goal and limit for fibrinolytic therapy?

Answer 32

-Goal: 1 hour from hospital arrival
-Needs to be within 3 hours of onset of symptoms

Question 33

What is a stroke assessment?

Answer 33

-Facial droop
-Arm drift
-Abnormal speech