Pediatric Beta Blocker/Calcium Channel Blocker OD

Question 1

Pediatric BB/CCB OD - Initial actions

Answer 1

Obtain vitals including BGL

Question 2

Pediatric BB/CCB OD - Symptomatic bradycardia?

Answer 2

Follow pediatric bradycardia algorhythm - Atropine can be given concurrently with fluid boluses

Question 3

Pediatric BB/CCB OD - BP less that 70+(2x age) and symptomatic?

Answer 3

Initial transport
NS 20 ml/kg to total of 40 ml/kg
Then consider:
Glucagon 0.1 mg/kg IV/IO/IM single max of 1 mg q 5 min total max of 4 mg

Question 4

Pediatric BB/CCB OD - Glucagon induced N/V treatment?

Answer 4

Zofran 0.1 mg/kg IV single max of 4 mg

Question 5

Pediatric BB/CCB OD - Hypotension refractory to glucagon?

Answer 5

Calcium chloride 20 mg/kg, single max q 10, total max 60 mg/kg

Question 6

Pediatric BB/CCB OD - QRS greater than 0.12 seconds?

Answer 6

Sodium Bicarbonate 1 mEq/kg SIVP/IO

Question 7

Pediatric BB/CCB OD - Hypotension refractory to glucagon, calcium chloride?

Answer 7

OLMC to discuss vasopressors

Question 8

Pediatric BB/CCB OD - Examples of Beta Blockers?

Answer 8

acebutolol (Sectral) 
atenolol (Tenormin) 
bisoPROLol (Zebeta)
metoPROLOL (Lopressor)
propranolol (Inderal)

Question 9

Pediatric BB/CCB OD - Examples of Calcium Channel Blockers?

Answer 9

amLODIPine (Norvasc)
diltiazem (Cardizem)
niFEDipine (Adalat)
verapamil (Isoptin).

Question 10

Pediatric BB/CCB OD - Glucagon indications

Answer 10

Hypotensive BB/CCB OD refractory to fluid boluses

Question 11

Pediatric BB/CCB OD - Glucagon dose

Answer 11

0.1 mg/kg SIVP/IO/IM, single max 1 mg

q 5 min total max 4 mg

Question 12

Pediatric BB/CCB OD - Glucagon EMS contraindications

Answer 12

Hypersensitivity to glucagon, beef or pork proteins

Question 13

Pediatric BB/CCB OD - Glucagon precautions

Answer 13

Use with caution if cardiovascular or renal disease

Glucagon may cause nausea and vomiting. Treatment is ondansetron

Question 14

Pediatric BB/CCB OD - Calcium Chloride indication

Answer 14

Hypotensive BB/CCB OD refractory to fluid boluses and glucagon

Question 15

Pediatric BB/CCB OD - Calcium Chloride dose

Answer 15

20 mg/kg SIVP/IO single max 1 g

q 10 min total max 60 mg/kg

Question 16

Pediatric BB/CCB OD - Calcium Chloride EMS contraindications

Answer 16

Hypersensitivity
Hypercalcemia
Patients with digitalis toxicity

Question 17

Pediatric BB/CCB OD - Calcium Chloride precautions

Answer 17

Avoid extravasation due to the risk of tissue irritation / necrosis - administer in a large vein

Question 18

Pediatric BB/CCB OD - Sodium Bicarbonate indication

Answer 18

QRS width>0.12 sec in BB/CCB OD

Question 19

Pediatric BB/CCB OD - Sodium Bicarbonate dose

Answer 19

1 mEq/kg SIVP/IO

Question 20

Pediatric BB/CCB OD - Sodium Bicarbonate EMS contraindications

Answer 20

None when used in emergency situations
Excessive chloride loss
Metabolic or respiratory alkalosis
Patients with hypocalcemia in whom alkalosis may induce tetany

Question 21

Pediatric BB/CCB OD - Sodium Bicarbonate precautions

Answer 21

Use with caution in CHF, severe renal impairment, concurrent corticosteroid treatment
Avoid extravasation due to the risk of tissue irritation / necrosis

Question 22

Pediatric BB/CCB OD - Zofran indication

Answer 22

N/V due to glucagon administration

Question 23

Pediatric BB/CCB OD - Zofran dose

Answer 23

0.1 mg/kg SIVP/IO single max 4 mg

Question 24

Pediatric BB/CCB OD - Zofran EMS contraindications

Answer 24

Hypersensitivity