Protocol Test Prep Flashcards by Steve Teigers

adrenal insufficiency txment

125mg solumedrol

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with Hx of adrenal insufficiency, stress doses can be administered in what symptoms

shock, fever over 100.4, multi-system trauma, multiple long bone Fx’s, vomiting/diarrhea and dehydration

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ETOH withdrawals

500 NS, 2.5 iv versed (or 5mg im versed) all are q5 for iv and q10 for im

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anaphylaxis txment

0.3mg im epi q5 until symptoms resolve (max 4 doses), consider up to 4 albuterol tx’s, 25-50 iv benadryl for hives

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if im epi doesn’t resolve anaphylaxis use…

2-10mcg/min iv epi

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pediatric epi/benadryl dosing for anaphylaxis

0.3mg im over 25kg, 0.15mg im under 25kg, q5 max 3 doses, then 0.1mcg/kg/min epi (titrate to effect);

1mg/kg IV/IM benadryl or 1.25mg/kg po benadryl

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symptoms indicating a brief resolved unexplained event

child under 2 involving apnea, color change, cyanosis, limpness, choking; assume caregiver’s Hx is accurate

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asthma, copd, rad in an adult

assist Pt w/ MDI (4-6 puffs), consider duoneb (max 3 doses), consider 125mg solumedrol or 10mg dexamethasone or 1.25mg levalbuterol, consider mag and epi

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asthma in kids

assist MDI 4-6 puffs q5, move to duoneb 3 tx’s max, then cpap; standing orders for dexamethasone 0.6mg/kg po preferred or solumedrol

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bronchiolitis in kids

low grade fever, runny nose, wheezing under 2 y/o, use racemic epi if doesn’t respond to suctioning or for impending failure

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croup in kids

0.6 mg/kg PO dexamethasone

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croup with stridor at rest

consider racemic epi after dexamethasone

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epiglotitis in kids

transport in upright position, usually 2-6 m/o infants

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pediatric fever (>3 mo)

passive cooling, for fever over 101.5, if no tylenol in last 4 hours, consider 15 mg/kg PO tylenol or a catch up dose

Don’t treat fevers under 3 m/o

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adult hyperglycemia

500ml saline bolus then 250ml/hr, get 12 lead, consider potential for sepsis

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pediatric hyperglycemia

10ml/kg saline bolus, repeat to 3 total boluses, not to exceed 500ml

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dka

uncontrolled bgl over 250 with weakness, ams, abd pain, n/v, polyuria/polydipsia, tachypnea,

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hyperglycemia hyperosmolar nonketotic syndrome

bgl over 600, dehydration, neuro deficits including coma or ams

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hyperkalemia causes

renal failure/injury, crush injury, rhabdomyolysis

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hyperkalemia signs

wide qrs (>250ms), loss of p waves, peaked t waves

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hyperkalemia txment

1gm CaCl2 over 5 min, may repeat either x1 q5, nebulized albuterol up to 20mg

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levofed indications

sepsis, ROSC

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levofed dose

1-30mcg/min titrated to effect

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reglan dose for nausea/vomiting

5-10mg iv/im may repeat once q10

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reglan dose for migraine

10mg iv over 15 min or 10mg im

reglan other name

metoclopramide

toradol other name

ketoralac

toradol contraindications

pregnancy, renal insufficiency, likely to need surgery, undifferentiated abd pain, suspected fx's, over 55 y/o

toradol dose

15 mg iv/im

toradol precautions

don't combine with other nsaids

ketamine restraint dose

4mg/kg im (round to nearest 50mg) max single dose of 500mg, may administer additional 100mg im q5-10min, 1mg/kg IV

ketamine pain dose

0.3mg/kg iv/im max 30mg, no repeat dose

ketamine post intubation dose for sedation

1-2mg/kg

fentanyl post intubation analgesia dose

1-2 mcg/kg max 200

versed restraint dose

5mg im or 2.5mg iv, repeat at 5 min

with benzos for restraint consider

10mg haldol im

pediatric ketamine restraint dose

same as adult

Ketamine adverse Rx's

Tachycardia/hypertension, emergence Rx's, vomitting, respiratory depression lasting a few minutes, laryngospasm

Ketamine side effects

Nystagmus, facial flushing, bronchospasm

Ketamine contraindications

Head injury, stroke, schizophrenia, heart failure Pt's

Burn victim less than 1hr txport time

Saline at 500ml/hr

Burn victim saline dosing

4ml × tbsa% × kg, 50% in first 8hrs, 50% in next 16hrs

CHF meds

0.4-0.8mg SL nitro at while symptoms persist, no max If ineffective consider Nitro 1-2" (if IV nitro unavailable)

Ketamine for pain in the elderly

0.15mg/kg

For suspected dehydration but no shock

250ml saline bolus

Ventilatory rate for bls airway

Adult 12-20 Child 12-20 Infant 20-30

Ventilatory rate for advanced airway

Adult 8-10 Child 8-10 Infant 18-20

Respiratory rates indicating failure in peds

Under 6 y/o - less than 20 Less than 16 y/o -less than 12 For any kid more than 60

Racemic epi dose

0.5ml of 2.25% with 3ml saline

Glucagon adult

1mg, recheck BGL at 15min, repeat dose if BGL still under 70 and AMS at 15min

Hypoglycemia and insulin pump

If BLS or ALS care is given then don't touch the pump, if interventions aren't able to be given, stop or remove the pump

Danger meds in hypoglycemia pt's

Sulfonylureas (glyburide, glipizide)

Pediatric glucagon dose

0.5mg if under 20kg

Pediatric nausea vomitting

10-20ml/kg saline bolus 0.15mg/kg zofran iv max 4 If over 5 y/o 4mg PO zofran

Pediatric atropine for OP poisoning

0.05mg-0.1mg/kg atropine repeat at as needed

Pediatric fentanyl dose

1mcg/kg initial, repeat a half dose at 5min to max 3 doses

Pediatric ibuprofen

10mg/kg max 400

FLACC scores

Under 3 y/o

Wong baker

3-8 y/o

Sodium channel blocker overdose ekg changes

Wide complex tachycardia

Sepsis txment

Two large bore IV's, 500ml saline boluses q20 to maintain bp>90 After 2L consider pressers Bolus saline up to 4L

Pediatric sepsis

20ml/kg NS boluses up to 3 boluses (60ml)

Pediatric atropine dose

0.02mg/kg iv may repeat just once

Pediatric verses dose for pacing or cardioversion

0.05mg/kg iv

CA lidocaine dose

1.5mg/kg iv, repeat 0.75mg/at 5-10min if unsuccessful cardioversion, can repeat once more If ROSC achieved, infuse at 1-4mg/min

Pediatric defib dose

2J/kg then 4J/kg

Per amiodarone dose

5mg/kg max 300

Ped lido dose

1mg/kg max 100

Ped mag dose for torsades in CA

25-50 mg/mg over 1-2min

Parkland formula

4ml × kg × BSA % Half is given in first 8hrs, half in the next 16hrs Only if more than 20% TBSA

HFl burns

Apply gauze soaked in 2.5% calcium gluconate gel, change gauze q2min

Ped arms BSA

Each arm is 9%

Ped legs bsa

Each leg is 13.5%

Submersion drowning

Dies of hypoxia then cools down

Immersion CA

Cools down in water then dies, better prognosis

Needle decompression

2nd intercostal midclavicular

Pediatric shock

20ml/kg max 3 boluses

SMR kids under 6

Just use the ped restraint device

Ventilatory rate for TBI

``` Only if signs of cerebral herniation present Adult 20 Child 25 Infant 30 aim for end tidal between 30-35 ```

Signs of cerebral herniation

Posturing, lack of motor response to noxious stimuli, asymmetric or non reactive pupils, decrease in gcs >2 if initial score <9

Tidal volume for ventilators

6-8ml/kg

Indications for posterior stemi

Depression in v1 - v3

Weight guideline for versed in seizure

5mg versed<39kg, 10mg versed >39kg (85lbs)

Weight guideline for epi in anaphylaxis

15kg

Weight guideline for glucagon

20kg

Symptomatic beta blocker or ca channel blocker overdose

5mg glucagon over 3-5min

amiodarone infusion dose

1mg/min post conversion

lidocaine infusion dose

1-4mg/min post conversion

narrow and regular tachycardia electricity

100J synchronize

narrow and irregular tachycardia electricity

200J synchronized

wide and regular tachycardia dose

100J synchronized

wide and irregular tachycardia dose

200J UNSYNCHRONIZED

heat stroke, AMS cooling

above 104 degrees initiate cooling, DC at 101.5 or if excessive shivering, DO NOT TRANSPORT IF ABLE TO COOL ON SCENE, cool for minimum 20 min or until clinical improvement

pediatric fever tylenol dose

15mg/kg if no tylenol in last 4 hours, if there was then catch up dose

pediatric definition

under 79lbs or 4'9"

morphine dose for acs

.1mg/kg max 5mg q5, total of 15 max

severe preeclampsia symptoms requiring txment

sbp>160 or dbp>110, new onset cerebral or visual disturbances, RUQ pain, pulmonary edema, seizures; usually last 10 weeks of gestation or up to 48hrs post partum

preterm labor txment

20ml/kg iv nacl, may repeat x1

preeclampsia txment

4grams in 100ml saline bolus over 10min, 1gram/hr infusion