Cardiac
Narcotic
Pediatric
Fluids
Misc
100
What is the maximum number of Epi 1:10 doses that a provider can administer during cardiac arrest?
100
What are the four medications in our narc boxes?
Ketamine, Fentanyl, Midazolam, Morphine
100
What is the Handtevy method for quickly estimating a child's ideal body weight in kilograms?
100
Which medications are packaged and ready for administration? (Hint: there are 6)
Normal Saline, Lactated Ringers, Hypertonic Saline 3%, Acetaminophen, D10, TXA.
100
Amanda is preforming patient care when suddenly the patient projectile vomits all over her. What medication's could Amanda have used to try and prevent this from happening?
Ondansetron: 4mg
Promethazine: 12.5-25mg
200
When a patient is experiencing acute coronary syndrome, what is the four letter acronym of medications that should be administered? What are the medications and doses?
M-O-N-A or F-O-N-A
Morphine: 2-10mg q10 minutes.
Fentanyl: 25-50mcg q10 minutes.
Oxygen: 2-15LPM
Nitroglycerin: 0.4mg (q5 minutes) Max: 3
Aspirin: 325mg PO
200
What are the side effects of morphine?
Respiratory depression, nausea, vomiting, bradycardia, decreased LOC.
200
There is a 5YOM that is in cardiac arrest. Parents stated that he is 45 pounds. What is the appropriate EPI 1:10 dose this patient should receive?
Epi 1:10 = 0.01mg/kg
45lbs = 20kg
0.2mg which is 2cc of Epi 1:10
200
Your patient is breathing and has a pulse, but is unresponsive. During your assessment, the patient's blood glucose comes back at 29. What do you do?
Dextrose 10%: Infuse 125ml (12.5g) then recheck sugar. If glucose is <70, repeat dose.
200
What is the indication and dose for oral glucose?
15g
300
When should an anti-arrhythmic medications be administered during cardiac arrest? What medication will you use and what is the dosage?
Anti-arrhythmic medications are indicated for shockable rhythms that are unresponsive to defibrillation.
Amiodarone: 300mg & 150mg
300
You approach the scene of a 35YOF in an active seizure that has lasted more than five minutes. What medication and dose would you give this patient?
Midazolam IM: 10mg, may repeat after five minutes if IV access is unavailable.
IN/IV/IO: 5mg, may repeat after five minutes with a total max dose of 10mg.
300
You are working a 3YOM that suffered sudden cardiac arrest for an unknown reason. The patient is in a shockable rhythm and continues to be throughout the arrest. What is the defibrillation and anti-arrhythmic dose for this patient?
Defibrillation: 2j/kg-10j/kg: Start at 30j and continue on.
Amiodarone: 5mg/kg (Max of 300mg per one dose, 450mg in total) May repeat dose twice for a total of three administrations. 75mg per dose.
300
What is the dose for acetaminophen and how do you administer it?
15mg/kg. Talk about set up.
300
What are the contraindications of Nitro?
Hypersensitivity
Systolic BP <100
Right ventricle infarction (STEMI)
Erectile dysfunction medication within the last 24 hours.
400
What specific medications/procedures are used in the tachycardic and bradycardic algorithms? Meds and doses.
Adenosine: 6mg fast push followed by 20cc fluid bolus. Second dose is 12mg followed by 20cc.
Synchronized cardioversion: 100J. Repeat doses 200J. (J is 50 bonus points).
Atropine: 1mg per dose q3 minutes. Max of 3 doses.
Pacing: Start at a rate of 80BPM and titrate milliamps until mechanical and electrical capture. (setting up procedure is 50 bonus points).
Push Dose/Epi drip
400
Fentanyl: Concentration, dose, routes, contraindications, side effects.
Concentration: 100mcg in 2ml.
Dose: 25-50mcg q10 minutes.
Routes: IV, IO, IM, IN
Contraindications: Known allergy, respiratory depression, uncorrected hypotension.
Side effects: Respiratory depression, nausea/vomitting, decreased LOC, chest wall rigidity.
400
A 11YO is in the middle of a panic attack and is inconsolable. It has gotten so bad that you need medication to help this kid chill out. What would your dose of Midazolam be for a 65lb crotch goblin? Include dose for every route.
IV/IO: 0.1mg/kg (max 5mg) 3mg
May repeat once in 10 minutes, total max dose is 10mg
IN: 0.2mg/kg (max 5mg) 5mg
May repeat once in 10 minutes, total max dose is 10MG
IM: 0.2mg/kg (max of 10mg) 6mg Only once.
400
What are the indications for TXA?
Blunt or penetrating trauma on a patient >13 years of age, at high risk of ongoing internal hemorrhage or significant external bleeding, as well as:
Injury sustained within 3 hours
Systolic BP <90mmhg with ongoing hemorrhage AND/OR: Tachycardia > 110bpm with signs of hypoperfusion (altered mental status, pallor, cool extremities) and signs of ongoing hemorrhage.
400
What are the nebulized medications that we use? Tell me the set up and what each medication is used for.
Albuterol: 2.5mg in 3cc's bullet w/6-8lpm
Epi: 2mg of epi 1:1 w/3cc's of NS.
500
H's and T's... Go!
H's: Hypoxia, hypovolemia, hydrogen ion (acidosis), hyper/hypokalemia, hypothermia, hypoglycemia.
T's: Toxins, tension pneumothorax, cardiac tamponade, trauma, thrombosis (coronary and pulmonary)
500
The crew has been called to a long fall on a construction site. As Ryan is providing patient care, a rock falls from above and hits him in the chrome dome. He has ordered the patient receive ketamine for pain, but cannot remember the dose. This sends Ryan into an uncontrollable, violent rage and needs to be put down. What is the IV pain dose for the patient and what is the IM dose for Ryan who is now violent and a liability?
Adult Pain or Procedural-related anxiety:
IV/IO: 0.1-0.3mg/kg (max of 30mg)
Violent Patient
IM: 4mg/kg once (max of 300mg)
IV/IO: 1mg/kg every 10 minutes to the desired effect (max dose of 200mg)
500
You have a 7YOF that is severely hypotensive due to an untreated infection. The patient's blood pressure is 67/42. What is the lowest acceptable systolic blood pressure for this patient? What is your treatment plan for this patient?
Lowest acceptable systolic: 70mmHg + (age x 2)
= 84mmHg
Non-traumatic shock: Fluid Bolus: 500cc at a time, reassess and repeat up to a max of 2 liters.
Push dose epi: 10mcg as needed to maintain a SBP > 100mmGh AFTER fluid bolus
Epi Drip: 0.1-0.5 mcg/kg/min
500
You are paged to a 35YOM (80kg) that was caught in a house fire. Varsity at Station 51 has already retrieved the patient and brought him to the front yard. You assess the patient and find 2nd/3rd degree burns on the anterior portion of his torso, both arms, and right leg.
What is the % burn area and how would you use the parkland burn formula to identify how much fluid you should give this patient?
36% of his body is affected by 2nd/3rd degree burns.
4ml x BSA% x pt weight = total ml over 24hrs
4ml x 36% x (80kg) = 11,520ml 24hr total
First 8 hours: 5760ml or 720ml in the first hour
500
What are the criteria for scene release (non-AMA disposition) of a hypoglycemic patient? (Hint: there are 8)
Patient is refusing transport
Return to apparent normal mental capacity following treatment
Repeat blood glucose after treatment >70
Known diagnosis of diabetes
The patient is not taking oral anti-hyperglycemic medications for diabetes. (e.g. Glyburide or Glipizide)
Not a suicide attempt by overdose
There is at least one responsible party that can assist them in their recovery and is comfortable in their care
Children should be considered for transport for evaluation regardless of improvement in the field due to other possible etiologies for the episode.