PALS - Resp. EM

Question 1

Croup Tx

Answer 1

Nebulized epinephrine, Corticosteroids

Question 2

Croup Tx: Nebulized Epinephrine

Answer 2

0.25-0.5 mg racemic soln. (2.25%) in 3 mL NS; 3 mL 1:1000 EPI in 3 mL NS yields 0.25 mg solution

Question 3

Croup Tx: Corticosteroid

Answer 3

Dexamethasone:

0.6 mg/kg PO/IM/IV (max 16 mg)

Question 4

Anaphylaxis Tx

Answer 4

IM Epinephrine, Albuterol, Antihistamines, Corticosteroids

Question 5

Anaphylaxis Tx: IM Epinephrine

Answer 5

Autoinjector: 0.3 mg (m > 30 kg); 0.15 mg (10 kg < m < 30 kg)
1:1000 (High): 0.01 mg/kg IM q 15 min (max single dose 0.3 mg)
1:10,000 (Reg): 0.1 mg/kg IV/IO q 3-5 min (max single dose 1 mg) if hypotensive
Infusion: 0.1-1.0 mcg/kg/min IV/IO infusion if persistent hypotension after fluids & IM EPI

Question 6

Anaphylaxis Tx: Albuterol

Answer 6

MDI: 4-8 puffs q 20 min PRN w/spacer (or ET tube)
Nebulizer: 2.5 mg (m < 20 kg); 5 mg (m > 20 kg) q 20 min
Continuous: 0.5 mg/kg/h (max 20 mg/h)

Question 7

Anaphylaxis Tx: Antihistamine

Answer 7

Diphenhydramine:
1-2 mg/kg IV/IO/IM q 4-6 h (max single dose 50 mg)

H2 Blocker (Ranitidine)

Question 8

Anaphylaxis Tx: Corticosteroid

Answer 8

Methylprednisolone:
Load: 2 mg/kg IV/IO/IM (max 60 mg); only use acetate salt IM
Maintenance: 0.5 mg/kg IV/IO/IM q 6 h (max 120 mg/d)

Question 9

Bronchiolitis Tx

Answer 9

Nasal suctioning, bronchodilator trial

Question 10

Bronchiolitis Tx: Bronchodilator Trial

Answer 10

Nebulized epinephrine or albuterol

Question 11

Asthma Tx

Answer 11

Albuterol w/Ipratropium, corticosteroids, SQ epinephrine, MgSO4, Terbutaline

Question 12

Asthma Tx: Albuterol

Answer 12

MDI: 4-8 puffs q 20 min PRN w/spacer (or ET tube)
Nebulizer: 2.25 mg (m < 20 kg); 5 mg (m > 20 kg) q 20 min PRN
Continuous: 0.5 mg/kg/h (max 20 mg/h)

Question 13

Asthma Tx: Ipratropium

Answer 13

250-500 mcg q 20 min PRN x 3 doses

Question 14

Asthma Tx: Status Asthmaticus

Answer 14

Methylprednisolone (corticosteroid) & terbutaline

Question 15

Status Asthmaticus Tx: Corticosteroid

Answer 15

Methylprednisolone:
Load: 2 mg/kg IV/IO/IM (max 60 mg); only use acetate salt IM
Maintenance: 0.5 mg/kg IV/IO/IM q 6 h (max 120 mg/d)

Question 16

Status Asthmaticus Tx: Terbutaline

Answer 16

0.1-10 mcg/kg/min IV/IO infusion; consider 10 mcg/kg IV/IO load over 5 min (max single 0.4 mg)

Question 17

Refractory Status Asthmaticus Tx

Answer 17

MgSO4:

25-50 mg/kg IV slow infusion over 15-30 min

Question 18

Bronchiolitis Tx: Bronchodilator Trial

Answer 18

Nebulized epinephrine or albuterol

Question 19

Asthma Tx

Answer 19

Albuterol w/Ipratropium, corticosteroids, SQ epinephrine, MgSO4, Terbutaline

Question 20

Asthma Tx: Albuterol

Answer 20

MDI: 4-8 puffs q 20 min PRN w/spacer (or ET tube)
Nebulizer: 2.25 mg (m < 20 kg); 5 mg (m > 20 kg) q 20 min PRN
Continuous: 0.5 mg/kg/h (max 20 mg/h)

Question 21

Asthma Tx: Ipratropium

Answer 21

250-500 mcg q 20 min PRN x 3 doses

Question 22

Asthma Tx: Status Asthmaticus

Answer 22

Methylprednisolone (corticosteroid) & terbutaline

Question 23

Status Asthmaticus Tx: Corticosteroid

Answer 23

Methylprednisolone:
Load: 2 mg/kg IV/IO/IM (max 60 mg); only use acetate salt IM
Maintenance: 0.5 mg/kg IV/IO/IM q 6 h (max 120 mg/d)

Question 24

Status Asthmaticus Tx: Terbutaline

Answer 24

0.1-10 mcg/kg/min IV/IO infusion; consider 10 mcg/kg IV/IO load over 5 min (max single 0.4 mg)

Question 25

Refractory Status Asthmaticus Tx

Answer 25

MgSO4:

25-50 mg/kg IV slow infusion over 15-30 min