Resuscitation

Question 0

What agents can you use for induction?

Answer 0

Etomidate, propofol, ketamine.

Question 1

What can you use to pretreat for RSI?

Answer 1

Fentanyl 3mcg/kg for normotensive patients, even with increased icp, cardiac ischemia, or aortic dissection.

Lidocaine 1mg/kg IV. Can be used for patients with possible icp or asthma.

Question 2

What is the dose, induction time, duration, benefits, caveats of Etomidate?

Answer 2

Dose 0.3mg/kg IV
Induction <1 min
Duration 10-20 min
Benefits Decreases icp, iop, neutral bp
Caveats: myoclonus jerking or seizures and vomiting in awake pts, no analgesia, decreased cortisol

Question 3

What is the dose, induction time, duration, benefits, caveats of propofol?

Answer 3

Dose: 0.5-1.5mg/kg IV
Induction 20-40s
Duration: 8-15mins
Benefits: antiemetic, anticonvulsant, dec icp
Caveats: apnea, dec bp, no analgesia

Question 4

What is the dose, induction time, duration, benefits, caveats of ketamine?

Answer 4

Dose: 1-2mg/kg IV
Induction 1min
Duration 10-20min
Benefits: bronchodilator, dissociative amnesia, analgesia
Caveats: inc secretions, inc bp, emergence phenomenon

Question 5

What neuromuscular paralytic agents can you use for RSI?

Answer 5

Succinylcholine or rocuronium

Question 6

What are the dose, onset, duration, complications seen with succinylcholine as a neuromuscular paralytic agent?

Answer 6

Dose: 1 to 1.5 mg per kilogram
Onset: 45 to 60 seconds
Duration: 5 to 9 minutes
Possible complications: hyperkalemia (in burns greater than five days old, denervation injury Greater than five days old, significant crush injuries greater than five days old, severe infection greater than five days old, pre-existing myopathies), bradycardia, masseter spasm, increased intragastric, intraocular, and possibly intracranial pressure, malignant hyperthermia, prolonged apnea with pseudocholinesterase deficiency, fasciculations

Question 7

What are the doses, onset, duration, and complications of Rocuronium as a neuromuscular paralytic agent?

Answer 7

Dose: 0.6 mg per kilogram
Onset: 1 to 3 minutes
Duration: 30 to 45 minutes
Complications: tachycardia

Question 8

What ET tube size would you use?

Answer 8

Woman: 7.5 to 8.0 mm
Man: 8.0 to 8.5 mm

Question 9

What is the tube length to ensure placement of the ET tube?

Answer 9

Woman: 21 cm
Man: 23 cm

Question 10

When should you consider noninvasive positive pressure ventilation and in whom is it contraindicated in?

Answer 10

Patients need to be cooperative and without cardiac ischemia, hypotension, dysrhythmia.

Question 11

What settings would you use for CPAP?

Answer 11

Between 5 and 15 cm H2O

Question 12

What settings would you use for BiPAP?

Answer 12

Initial settings of 8 to 10 cm H2O during inspiration and 3 to 4 cm H2O during expiration are reasonable

Question 13

What ECG characteristics do PACs have?

Answer 13

1. Ectopic P waves appear sooner than the next expected sinus beat, 2. Ectopic P waves have a different shape and direction, 3. Ectopic P-wave may or may not be conducted through the AV node.

Question 14

What is the emergency department care and disposition for PACs?

Answer 14

Discontinue precipitating drugs or toxins, treat underlying disorders such as stress or fatigue, and PACs that produce significant symptoms or initiate sustained tachycardias can be suppressed with agents such as beta adrenergic antagonist (metoprolol 25 to 50 mg PO TID)

Question 15

What are the different causes of sinus bradycardia and the management in the ED setting?

Answer 15

Causes can include physiologic (vagal tone), pharmacologic (calcium channel blocker, beta blockers or dig) and pathologic (acute MI, increased intracranial pressure, hypothyroidism, etc)

It usually does not require a specific treatment unless the heart rate is lower than 50 bpm and there is evidence of hypoperfusion. For unstable patients use transcutaneous cardiac pacing. If needed administer a sedative such as lorazepam 1 to 2 mg IV or morphine 2 to 4 mg IV for pain control. Atropine can also be used for symptomatic bradycardia. Dose is 0.5 mg IV push repeated every 3 to 5 minutes as needed for total of 3 mg IV.

If external pacing is not available you can use epinephrine 2 to 10 µg per minute IV or dopamine 3 to 10 µg per kilogram per minute IV.