Resuscitation

Question 1

Initial fluid resuscitation in DKA

Answer 1

20ml/kg IV bolus over 20 mins if stable, over 5-10 mins if hypotensive

Question 2

Ongoing IV fluids in DKA

Answer 2

5-9kg - 6.5ml/kg/hr
10-20kg - 6ml/kh/hr
20-40kg - 5ml/kg/hr
>40kg - 4ml/kg/hr (max 500ml/hr)

Question 3

When is it ok to use NaHCO3 in DKA?

Answer 3

hyperkalemia with ECG changes

Question 4

Risk factors for cerebral injury in DKA

Answer 4

lower pH
hypocapnia (pCO2 <18)
longer duration of symptoms
more severe dehydration (high HCT, BUN)
younger age (>5y)
new-onset diabetes
sick appearance

Question 5

Frequency of initial bloodwork monitoring in DKA

Answer 5

glucose + fluid balance q1h

VBG, lytes, urea, creat q2h

Question 6

How do you adjust fluid administration if evidence of cerebral edema in DKA?

Answer 6

lower to 75% of recommended rate

Question 7

What are the 3 cardinal signs of neurogenic shock?

Answer 7

Hypotension
Bradycardia
Peripheral Vasodilation

*hypothermia

Question 8

Above what level of injury is neurogenic shock most likely to happen

Answer 8

above T6

Question 9

medications that can be given endotracheally

Answer 9

epinephrine
atropine
naloxone
lidocaine
diazepam

Question 10

Steps in resuscitation of acute adrenal insufficiency

Answer 10

Hydrocortisone 50-100mg/m2 IV (or 1-2mg/kg)
Volume expansion 20-60ml/kg
Maintenance fluids with 10% dextrose and WITHOUT K+ until K+ in normal range
Consider therapy to decrease K+ IF ECG changes present

Question 11

What is part of a critical sample?

Answer 11

glucose
insulin
ketones
free fatty acids
lactate
uric acid
ammonia
cortisol
growth hormone
TSH
IGF1

Question 12

What should labs show in critical sample for hyperinsulinism?

Answer 12

hyperinsulinemia
hypofatty acidemia
hypoketonemia
inappropriate glycemic response to glucagon

Question 13

Meds to treat Torsades de Pointe

Answer 13

sulfate de Mg 25-50mg/kg, max 2g IV
lidocaine 1mg/kg

Question 14

Target temp after ROSC

Answer 14

normothermia (36° to 37.5°C) for 5 days

or hypothermia (32° to 34°C) for 2 days followed by 3 days of normothermia

Question 15

Parkland Formula

Answer 15

4 mL/kg/% of BSA of crystalloid over the first 24 hours, half during the first 8 hours from the time of injury and half during the next 16 hours

Question 16

What receptor(s) does epinephrine act on and what is its effect?

Answer 16

a1, b1, b2 stimulation
inotrope, chronotrope, vasoconstriction (higher dose)

Question 17

What receptor(s) does norepinephrine act on and what is its effect?

Answer 17

a1, b1 stimulation
inotrope + vasopressor

Question 18

What receptor(s) does dobutamine act on and what is its effect?

Answer 18

b1 stimulation, mixed alpha agonist/antagoist
inotrope + chronotrope

Question 19

What receptor(s) does vasopressin act on and what is its effect?

Answer 19

vasoconstriction (independent of adrenergic receptors)

Question 20

What receptor(s) does dopamine act on and what is its effect?

Answer 20

a1, b1, b2, D1 stimulation
inotrope, chronotrope, vasoconstrictor (higher doses)

Question 21

Mechanism of epinephrine in treating anaphylaxis

Answer 21

α-adrenergic agonist - vasoconstriction, increased blood pressure, and decreased capillary leakage
β-adrenergic agonist - stimulates bronchial smooth muscle relaxation, increased cardiac output, and inhibits further mediator release

Question 22

Dose of epi for cardiac arrest

Answer 22

0.01mg/kg (0.1ml/kg of the 0.1mg/ml concentration)
max dose 1mg

Question 23

CPR ratio compression:breaths for 1 person rescue

Answer 23

30:2

Question 24

CPR ratio compression:breaths for 2 person rescue

Answer 24

15:2

Question 25

When to initiate CPR

Answer 25

no pulse
HR < 60 with poor perfusion

Question 26

Up to what age do you use child AED pads?

Answer 26

8yrs

Question 27

Endotracheal dose of epi for cardiac arrest

Answer 27

0.1mg/kg (0.1ml/kg of the 1mg/ml concentration)

Question 28

Amiodarone dose for cardiac arrest

Answer 28

5mg/kg - repeat up to 3 total doses

Question 29

Lidocaine dose for cardiac arrest

Answer 29

1mg/kg bolus loading dose

Question 30

Defibrillation doses for cardiac arrest

Answer 30

1. 2J/kg
2. 4J/kg
   max 10J/kg or adult dose

Question 31

When is atropine used in resuscitation

Answer 31

bradycardia caused by increased vagal tone or primary AV block

Question 32

Dose of atropine for bradycardia

Answer 32

0.02mg/kg
may repeat once
min dose 0.1mg - max dose 0.5mg

Question 33

Adenosine dose for SVT

Answer 33

0.1mg/kg (max 6mg)
2nd dose 0.2mg/kg (max 12mg)

Question 34

Synchronized cardioversion dose

Answer 34

0.5-1J/kg
increase to 2J/kg PRN

Question 35

Rate of rescue breaths (with pulse or intubated patient)

Answer 35

1 breath q 2-3 seconds (20-30 breaths/min)

Question 36

Pair the vasopressor with the type of shock:
epinephrine
norepinephrine
cold shock
warm shock

Answer 36

epinephrine - warm shock
norepinephrine - cold shock

Question 37

Treatment of V Tach with pulse and good perfusion

Answer 37

Amiodarone 5mg/kg over 20-60 mins
or
Procainamide 15mg/kg over 30-60 mins

Question 38

Dose of epinephrine for anaphylaxis

Answer 38

0.01mg/kg using 1mg/mL formulation