Cardiac Arrest Pharmacology
Adult dose of calcium chloride for suspected hyperkalemia with ECG changes during cardiac arrest.
What is Calcium Chloride 1 gram IV/IO slow push?
An adult patient is in polymorphic ventricular tachycardia (Torsades de Pointes) with a pulse. What medication should be administered, and what is the adult dose?
What is Magnesium Sulfate 2 grams IV/IO over 10–20 minutes?
A patient with a suspected beta-blocker overdose remains profoundly bradycardic and hypotensive despite standard therapy. Which medication from the NCOEMS formulary should be administered, and what is the adult dose?
What is Glucagon 1 mg IM?
I stabilize the myocardium but never lower potassium.
What is Calcium Chloride?
Your patient requires 1 mg of epinephrine during cardiac arrest. The concentration is 0.1 mg/mL. How many milliliters will you administer?
What is 10 mL?
Adult dose of sodium bicarbonate for suspected tricyclic antidepressant overdose or hyperkalemia.
What is 1 mEq/kg IV/IO?
An adult patient in cardiac arrest is suspected of having hyperkalemia after missing several dialysis treatments. What medication is used to stabilize the myocardium, and what is the adult dose?
What is Calcium Chloride 1 gram IV/IO slow push?
An adult patient overdoses on acetaminophen. Which medication reverses this overdose?
What is none? N-acetylcysteine (NAC) is the antidote, but it is not carried on the standard NCOEMS medication list, so supportive care and rapid transport are indicated.
I shift potassium into the cell but never remove it from the body.
What is Sodium Bicarbonate?
You are administering 25 grams of D50. How many milliliters is this?
What is 50 mL?
During an adult cardiac arrest, the patient remains in refractory VF after three shocks, one dose of epinephrine, and 300 mg of amiodarone. What medication should be administered next, including the dose?
What is Amiodarone 150 mg IV/IO?
A patient with a suspected tricyclic antidepressant overdose develops a wide QRS complex and ventricular dysrhythmias. What medication is indicated, and what is the adult dose?
What is Sodium Bicarbonate 1 mEq/kg IV/IO?
I am an antiemetic that can be given IV, IM, or ODT. I work by blocking serotonin (5-HT3) receptors. What drug am I, and what is my adult dose?
What is Ondansetron 4 mg IV, IM, or ODT?
I turn a patient red like a lobster after administration and can interfere with pulse oximetry readings for hours.
What is Hydroxocobalamin (Cyanokit)?
You have naloxone 2 mg in 2 mL. The physician orders 0.4 mg IV. How many milliliters will you administer?
What is 0.4 mL?
During an adult cardiac arrest, you have administered the initial dose of amiodarone. The vial contains 150 mg in 3 mL. How many milliliters must you draw up to administer the recommended 300 mg dose?
What is 6 mL?
Following ROSC, an adult patient has persistent hypotension despite a 1-liter crystalloid bolus. Which medication should be initiated before transport to maintain perfusion?
What is an epinephrine infusion?
I am administered orally after certain ingestions to reduce gastrointestinal absorption of toxins. I am contraindicated in patients with an unprotected airway or after ingestion of caustics or hydrocarbons. What drug am I, and what is my adult dose?
What is Activated Charcoal 25–50 grams PO?
I am a catecholamine that stimulates different receptors depending on the dose. At lower doses I primarily increase cardiac contractility, while at higher doses I produce more vasoconstriction. I am administered as a continuous infusion. What drug am I? Dose?
What is Dopamine?
Dose: 5–20 mcg/kg/min IV infusion, titrated to maintain adequate perfusion.
An epinephrine infusion contains 4 mg in 250 mL NS. The patient requires 8 mcg/min. What is the infusion rate in mL/hr?
4 mg = 4000 mcg
4000 mcg ÷ 250 mL = 16 mcg/mL
8 mcg/min ÷ 16 = 0.5 mL/min
0.5 × 60 = 30 mL/hr
An adult patient remains in ventricular fibrillation despite multiple defibrillations, two doses of amiodarone, and repeated doses of epinephrine. According to the NCOEMS adult cardiac arrest algorithm, what are your next medication priorities?
What is continuing epinephrine 1 mg IV/IO every 3–5 minutes while continuing high-quality CPR, rhythm checks, defibrillation as indicated, and searching for/treating reversible causes (the H's and T's)?
An adult patient in ventricular fibrillation remains refractory after defibrillation, epinephrine, and the maximum cumulative dose of amiodarone. According to the NCOEMS Adult Cardiac Arrest protocol, what additional antiarrhythmic medication should be administered?
No additional antiarrhythmic is recommended after 300 mg followed by 150 mg of amiodarone. Continue high-quality CPR, defibrillation as indicated, epinephrine every 3–5 minutes, and aggressively treat reversible causes (the H's and T's).
I am given to improve oxygen delivery in carbon monoxide poisoning, but I do not remove carbon monoxide from hemoglobin. What medication am I?
What is Oxygen, titrated to maintain adequate oxygenation (100% oxygen by NRB or BVM when indicated)?
I am the corticosteroid currently carried by NCOEMS. Unlike my predecessor, I have a longer duration of action, require no reconstitution, and can be administered orally or intravenously. What drug am I, and what is my adult dose?
What is Dexamethasone 10 mg IV or PO?
A norepinephrine infusion contains 8 mg in 250 mL NS. Your patient needs 12 mcg/min. What is the infusion rate in mL/hr?
8 mg = 8000 mcg
8000 ÷ 250 = 32 mcg/mL
12 ÷ 32 = 0.375 mL/min
×60 = 22.5 mL/hr