Practical exam prep questions Flashcards
1
Q
Describe non-electrolyte pharmacology (including doses) used in pediatric cardiac arrest
A
- Epinephrine: 0.01mg/kg IV/IO q.3-5 minutes
- Given at 1:10,000 concentration, 1mL=100mcg (i.e. 0.1mL/kg)
- Amiodarone: safety/efficacy not established. Consult clinicall
- Lidocaine: 1.0-1.5mg/kg IV/IO
- Repeat PRN @ 0.5-1.0mg/kg
2
Q
How does pediatric cardiac arrest management differ from adult CAM? (not including drug dosages)
A
- C:V ratio = 15:2
- ETI currently contraindicated in pts. <12YO
- Early conveyance is considered appropriate in pediatric patients (following 10 minutes of on-scene resuscitation)
- The underlying cause is most commonly hypoventilation
- The role of amiodarone is uncertain, and lidocaine may be preferred
- Electrical therapy is weight-based
- 2J/kg for first defibrillation, 4J/KG for subsequent
3
Q
Briefly Summarize pediatric dosing for analgesia
A
- “rule of 15s”
- 15mg/kg acetaminophen (MAX 500mg) PO
- 1.5mcg/kg Fentanyl (any route, IN preferred over IM)
- MAX 50mcg IV or 100mcg IN
- 1.5mg/kg Ketamine IN (MAX 50mg)
- OR 0.5mg/kg IM
- OR 0.3mg/kg IV/IO
4
Q
Briefly summarize pediatric dosing for sedation or seizure termination
A
- Midazolam
- 0.2mg/kg IM/IN (IN recommended over IM)
- MAX 10mg
- 0.1mg/kg IV/IO
- MAX 5mg
- 0.2mg/kg IM/IN (IN recommended over IM)
- Ketamine
- Follow adult guidelines
- 0.1-0.5mg/kg (any route)
- titrate to effect, repeat doses at 60s intervals
5
Q
Describe induction dosing for pediatric intubation
A
Trick Question!
- not currently supported, SGA or bust
- IFF in a CVCO situation, follow adult dosing
- 1-2mg/kg IV/IO ketamine, titrated to shock index
6
Q
Summarize the procedure for awake intraosseous cannulation
A
- Select and clean site
- Proximal tibia is preferred for most awake patients
- 3cm inferior and 2cm medial to lower margin of patella
- Proximal humerus available for adult patients
- internally rotate arm, mid-line between AAL and MAL, rotate 45 degrees medial and inferior
- Proximal tibia is preferred for most awake patients
- Insert the needle (without activating the drill) until feeling contact with bone
- at least one black line must be visible
- Activate the driver until give/pop is felt. Withdraw/secure the needle and aspirate for marrow
- Prime the extension set with lidocaine solution and gently instill 40mg lidocaine over 120s. Gently flush the set with 10mL N/S and allow a further 60s dwell time
- Vigorously flush the line with 20mL N/S
7
Q
Describe electrolyte dosing in pediatric cardiac arrest
A
- Calcium Chloride: 20mg/kg SLOW push (MAX 3g)
- Repeat x1 after 10 minutes
- Sodium Bicarbonate: 1.0-3.0mEq/Kg SLOW push
- REpeat 0.5mEq/kg q.10-15 minutes
- Magnesium Sulfate: 50mg/kg push to MAX of 2g
8
Q
what is the minimum allowable weight for the T-POD pelvic immobilizer?
A
40lbs.
9
Q
Compare pdiatric fluid management in the following shock states:
- Sepsis
- DKA
- CHD
- Hypovolemic/hemmorhagic
A
- Sepsis
- Agressive! Up to 30cc/kg rapid infusion in 10cc/kg aliquots
- DKA
- Conservative! 10cc/kg aliquots tolerating relative hypotension
- CHD
- Extremely Conservative! 5cc/kg aliquots
- Hypovolemic/hemmorhagic
- Do not wait for hypotension, look for PAT signs of decompensation
- 10cc/kg aliquots targeting SBP > 70 + 2*age
10
Q
Compare and contract use of pressors in adult and pediatric patients
A
- Adults
- Push-dose epinephrine or epinephrine infusion preferred for most cases
- 10mcg push-dose aliquots
- 50-100mcg push-dose aliquots for pre-arrest anaphylaxis/asthma
- 2-10mcg/min infusion (unit rate = 4mcg/min with 250mL bag, 1mg epinpehrine, 60gtt/s set)
- Phenylephrine for peri-intubation hypotension following adequate fluid resuscitation
- 100mcg slow pushes q.2-3minutes to a MAX of 500mcg
- Push-dose epinephrine or epinephrine infusion preferred for most cases
- Pediatrics
- Push-dose epinephrine is the only supported method
- 1mcg/kg for most indications, 5mcg/kg for peri-arrest anaphylaxis
- CPGs currently only support use in CAM, ETI, and anaphylaxis
11
Q
Describe ECG features suggestive of RV infarct
A
- Inferior infarct pattern with:
- STE in V1 and/or ST depression in V2 (presence of both is highly specific for RV infarct)
- STE in III > II
- STE in V4R > 0.5mm
12
Q
Describe pre-hospital management of pathologies primarily affecting the right ventricle (RV infarct, PE, pulmonary hypertension)
A
- RV is preload-dependent and afterload-sensitive. Fluid overload may lead to bowing of the IVS into the LV leading to cardiopulmonary collapse
- Avoid preload reduction!
- No NTG
- Do not stand/exert the patient
- Conservative fluid administration to target end-organ perfusion
- Pressors should be avoided where possible, with epinephrine strongly preferred over phenylephrine
13
Q
How may CCB and beta-blocker toxicity be differentiated in cases of mixed or unknown ingestion?
A
- Both typically present with hypotension/bradycardia with similar ECG features
- Findings suggesting BBlocker toxidrome
- agitation/delirium/seizures
- bronchospasm
- hypoglycemia
- Findings suggesting CCB toxidrome
- Signs of acute heart failure
- hyperglycemia
14
Q
Compare and contrast pre-hospital management of Beta-Blocker and CCB overdose
A
- Both
- Treat the underlying bradycardia and hemodynamic instability FIRST
- Atropine is considered first-line treatment
- Both may respond to 5mg IV glucagon following other treatments
- Beta-blocker
- Initial management is atropine and/or TC pacing (followed by transport)
- High-dose epinephrine infusion is second-line
- Glucagon, CaCl2, NaHCO3, and MgSO4 are tertiary
- CCB
- Atropine and rapid transport are preferred treatments
- Early CaCl2 (1-3g over 10 minutes) should be given with consultation
- epinephrine or TC pacing are tertiary and may not be successful
15
Q
Describe findings suggestive of aortic dissection and pre-hospital management
A
- Suggestive findings:
- thoraco-abdominal pain
- SBP differntial >20mmHg or pulse differential (unilateral hypoperfusion)
- New aortic regurgitation murmur
- Hx of HTN, AAA, or connective tissue disorders
- Management:
- Minimize strain on pt.
- Cautious fluid resuscitation targeting MAP >65mmHg
- Avoid pressors
- Analgesia
