Premedications

Question 1

Fentanyl Classification

Answer 1

Narcotic analgesic

Question 2

Fentanyl action

Answer 2

Potent Analgesic, sedative, euphoric

Question 3

Fentanyl 1. Onset 2.Duration

Answer 3

1. 1 min IV, 7-8 min IM

2. 30-60 min IV, 1-2 hrs IM

Question 4

Fentanyl indication

Answer 4

1. severe pain
2. back pain with muscles spasm
3. premedication for RSI?

Question 5

Fentanyl contraindication

Answer 5

1. Head trauma with ICP
2. ALOC
3. severe liver or renal insufficiency

Question 6

Fentanyl use with caution

Answer 6

1. bradycardia

2. respiratory depression

Question 7

Fentanyl dosage and administration

Answer 7

Adults:
Traumatic emergencies - 50mcg IV/IO or 50-100mcg IN, every 5-10 min to max dose 200mcg if SBP>100
Cardiac emergencies - 25mcg IV/IO or 50mcg IN every 2-3 min up to 100mcg if SBP>100
Pediatric: 1-2mcg/kg IV/IO/IN/IM

Question 8

Fentanyl adverse reaction

Answer 8

1. hypotension
2. bradycardia
3. CNS depression
4. nausea and vomiting
5. respiratory depression
6. chest wall rigidity

Question 9

Fentanyl References

Answer 9

Traumatic (musculoskeletal trauma, amputated parts, Burns, crush injury)
Cardiac (chest discomfort and ACS)

Question 10

Lidocane classification

Answer 10

Antiarrhythmic

Question 11

Lidocane action

Answer 11

1. suppresses ventricular arrhythmias

2. local aesthetic

Question 12

Lidocane 1. Onset 2. Duration

Answer 12

1. Immediate

2. 10-20 min

Question 13

Lidocane indication

Answer 13

1. cardiac arrest from VF/VT

2. Stable VT, wide complex tachycardia of uncertain type, wide complex PSVT

Question 14

Lidocane contraindication

Answer 14

Heart blocks

Question 15

Lidocane use with caution

Answer 15

1. liver disease
2. CHF
3. respiratory depression
4. hypovolemia
5. shock
6. heartblock

Question 16

Lidocane Dosage and Administration

Answer 16

Cardiac arrest from VF/ VT:
a. 1-1.5mg/kg IV/IO bolus
b. for refractory VF, additional .5-.75 mg/kg IV/IO, repeat in 5-10 min; max dose 3mg/kg
c. ET dose: 2-3mg/kg in 10 ml NS
2. Perfusing arrhythmia stable VT
a. .5-.75mg/kg up to 1.5mg/kg IV/IO
b. Repeat every 5-10 min to total of 3mg/kg
3. Maintenance Infusion mix 1g/250ml NS 2-4mg/min
4. RSI for ICP 1.5mg/kg I/V
5. IO anesthesia adult only: 20-50mg prior to infusion
Pediatric: 1mg/kg IV/IO or 2-3mg/kg IN in 5ml NS

Question 17

Lidocane adverse reaction

Answer 17

1. CNS: dizzy, somnolence, confusion, Paresthesias, muscle twitching, seizure, slurred speech
2. CV: hypotension, bradycardia
3. EENT: tinnitus, blurred vision

Question 18

Lidocane reference

Answer 18

1. cardiac
2. RSI
3. pediatric arrest

Question 19

Atropine Classification

Answer 19

Parasympathetic blocker, anticholinergic

Question 20

Atropine Action

Answer 20

Cardiac:
1. Chronotropic effect of Increase SA node rate by blocking vagus nerve
2. Positive dromotropic effect in AV Node
Non-Cardiac:
1. decrease body secretions
2. dilate pupils and eye paralysis
3. Decrease bladder tone and increase urinary retention
4. CNS Stimulant

Question 21

Atropine 1.Onset 2.Duration

Answer 21

1. Immediate IV

2. 4 Hrs

Question 22

Atropine Indication

Answer 22

1. Bradycardia with HYPOTN, AMS, PVC, Cpx,
2. 2nd, 3rd heart block, asystole but not very effective
3. Organophosphate, Nerve agent poisoning
4. Pre-medication for pediatric intubation

Question 23

Atropine Contraindication

Answer 23

1. Afib/flutter
2. HR>60
3. Bradycardia due to ICP (stroke/trauma)

Question 24

Atropine Use with Caution

Answer 24

1. Do not mix with sodium bicarb

2. Be certain bradycardia not due to hypoxia or ICP

Question 25

Atropine Dosage and Administration

Answer 25

1. Bradycardia
   Adult: .5mg IV every 3-5 min as needed, not to exceed .04mg/kg, ET 1mg diluted in 10ml NS
   Ped: .02mg/kg, min = 0.1mg, max single dose = 0.5mg, max total dose = 1mg
   Adolescent single dose = 1mg, max total = 2mg
   ET = .05mg/kg in 5ml NS
2. Poisoning
   Adult: 1mg every 1 min until Sy clear, up to 10mg, If using MARK1 kit give up to 3 sets of meds
   Ped: <12yo .5mg IV/IO every 1 min. until Sy clear, max total 10mg.
   RSI = .02mg/kg, min dose = .1mg, max dose = .5mg

Question 26

Atropine Adverse Reaction

Answer 26

Cardiac: tachy, palpitations, V-Fib

Non Cardiac: Dry mouth, diplopia, restless, irritability, AMS, injection site px

Question 27

Atropine Reference

Answer 27

Cardiac
Environmental
RSI
Pediatric Cardiac Arrest Guide