Pharmacology
What is an analgesic we heavenly worry about respiratory depression and we used to use in the past a lot as medica? Give me the dose, route, and time for present time....
Morphine • Indications: Severe Pain • 5mg IV/ IO q 10 min as needed • Onset: 5 min, peak at 10 min, duration 2-4 hours • Repeat Dose: q10 min prn to control pain (MONITOR Respiratory Depression)
What are 3 different benzodiazepines we use for TBI injuries? Dosages as well?
Lorazapam (Ativan) 1-2 mg for seizures (medium on/long off) DOC for seizure • Midazolam (Versed) 5-10 mg for seizures (quick on/ quick off) • Diazepam (Valium) 5-10 mg for seizures
If burns are greater than ____% of TBSA, fluid resuscitation should be initiated as soon as IV/IO access is established. Resuscitation should be initiated with Lactated Ringer’s, normal saline, or Hextend. If Hextend is used, no more than 1000 ml should be given, followed by Lactated Ringer’s or normal saline as needed.
20%>
What are the two valves in the heart?
Tricuspid and mitral valve
Between what months can an infants start to stand and walk?
6-12months
What's the indicaters to correct hypocalcemia, citrate toxicity, or cardiac function in massive hemorrhage or Blood Transfusion patients? Give me the medication, dosage, and route
How it's used
Administer 30 mL of 10% calcium gluconate immediately after the first unit of blood is transfused
Repeat the dose after every four units of blood
Monitor serum calcium levels during resuscitation
Administer additional calcium gluconate if ionized calcium levels are less than 1.2mmol/L
Why it's used
Calcium gluconate replaces calcium lost during hemorrhage and blood transfusions
Calcium helps prevent cardiac dysfunction and hypotension
Calcium plays a key role in the coagulation cascade, which helps convert factor X to factor Xa and prothrombin to thrombin
After a patient has a severe Traumatic brain injury are they give a prophylaxis antieliptic for 5 , 7, 10, days?
The greater the amount of cerebral injury/inflammation, the more likely it is the patient will begin to seize. Because of this, TBI patients are given antiepileptic medications prophylactically for seven days following their injury. Current literature demonstrates that the seven-day seizure prophylaxis is effective in reducing the risk in mild and moderate TBI patients. Patients with severe TBIs may require longer term anti-seizure medication regimens.
To give AEDs or not to give AEDs in prehospital TBI patients? As with all things in medicine, this answer is not black and white. Although there is a lack of research on the prehospital management of TBI, seizure prophylaxis is initiated in most inpatient TBI patients for at least seven days.
If you have a burn patient, do you skip pre hospital antibiotics? Which one would you give?
g.Prehospital antibiotic therapy is not indicated solely for burns, but antibiotics should be given per the TCCC guidelines in Section (11) if indicated to prevent infection in penetrating wounds
What vitamin does our skin make?
Vitamin D
How much blood volume in millimeters is in their in a 1 yr infant?
75-80ml/kg, 330ml
What's the dose for Levetiracetam in the emergency trauma setting?
levetiracetam (500 mg every 12 hours) to prevent early seizures after traumatic brain injury (TBI).
Also known as keppra
What do you use paralytics and antieliptics for? Give me 3 examples
Intubation, Suicidal Intentions, and severe TBI
If patient develops invasive burn wound infection (signs: sepsis/septic shock, changes in color of wound, possible foul smell of wound), treat with broad-spectrum antibiotics to include gram-positive and gramnegative coverage that ideally includes coverage for both, what combination of meds would work?
ertapenem + ciprofloxacin
A preventer and a killer
what regin of the brain controls our emotional response
Amygdola and hypothalamus
In infants this lower airway disease presents with grunting, crackles or wheezing when auscultating and anorexia in later signs, what is it....
Pneumonia
How many dosages of ertapenam 1g can you give a patient that needs antibiotics for a chronic infection over several days? Give an example
Acute Pelvic Infections
1 g/day IV/IM for 3-10 days
Complicated Intra-abdominal Infections
1 g/day IV/IM for 5-14 days
Complicated Skin/Skin Structure Infections
1 g/day IV/IM for 7-14 days; may be continued up to 4 weeks for diabetic foot infections, depending on severity of infection and response to therapy (treatment excludes diabetic foot infections with osteomyelitis)
Give me an example of when it's appropriate and not appropriate to give benzodiazepines?
Trauma patients and BZD use
Paramedics use it for seizure patients, anxiety agitatation, or procedure sedation.
BzDs are the standard of care for AWS, but phenobarbital (PHB) may be a safer alternative.
BZDs are not recommended for PTSD because they may worsen symptoms and reduce the benefits of therapy.
What is your minimum, better, and best treatment plan in your PACE plane for your severe burn patient?
Best: Rapid-sequence intubation by skilled provider, followed by continuous sedation and airway maintenance, supplemental oxygen, portable ventilator.
Better: Cricothyroidotomy followed by continuous sedation and airway maintenance, supplemental oxygen via an oxygen concentrator, portable ventilator.
Minimum: Cricothyroidotomy, ketamine, ambu bag with positive end-expiratory pressure (PEEP) valve.
What's the strongest ligament in the body?
iliofemoral ligament is the strongest ligament in the human body
Infants and children can be what age for an IO...
Any age even newborns....
Ketamine 0.5 mg/kg IM/IN 0.1-0.2 mg/kg IV/IO TCCC recommended dose: 50-100mg IM/IN q 20-30min prn 20-30mg slow IV/IO push q 20min
Scenario 2: A 175lb (80kg) soldier suffered a traumatic amputation after stepping on a landmine. Pt presents with bleeding controlled with a TQ, but is showing signs of compensated shock. Pt is in 10/10 pain.
– A starting dose of 100 mcg slow push may be appropriate, or you can give 50 mcg slow push and titrate 25 mcg “bumps” to effect if you’re concerned about side effects.
Scenario 1: A 220lb (100kg) soldier breaks his leg during a parachute landing. His vitals are stable and he hasn’t lost any blood, but he is in 10/10 pain.
– A starting dose of 100 mcg slow push may be appropriate, or you can give 50 mcg slow push and titrate 25 mcg “bumps” to effect if you’re concerned about side effects.
You are a alerted to a explosion at the FOB dinning facility, which you see black smoke. When you get their you see a 70 kg soldier sustained a 25% TBSA burn blast injury to his torso and both legs. You do not have air superiority, and the bird is delayed 24hrs. What is the total amount of fluids you use in 24hrs?
Parkland Formula: 4 mL/kg * 70 kg * 25% = 7000 mL total fluid requirement over 24 hours.
Administration: 3500 mL in the first 8 hours and 3500 mL in the next 16 hours.
USAISR Rule of Ten: 25% * 10 mL/hour = 250 mL/hour initial fluid rate.
The occipital lobe of the mid brain is part of the limbic system which _____.
Processing vision information from the environment
PEDIATRIC NORMAL HR, RR & SYSTOLIC BP....
AGE HR RR
NB - 1 yr 140 bpm 40/min
1 yr - 4 yr 120 bpm 30/min
4 yr - 12 yr 100 bpm 20/min
> 12 yrs 80 bpm 15/min
AGE SYSTOLIC BP
NB - 1 mos 60 mmHg
1 mos - 1 yr 70 mmHg
1 yr - 10 yrs Lower limit of normal: 70 mmHg + (2x yrs of age)
Median normal: 80 mmHg + (2x yrs of age)
Upper limit of normal: 90 mmHg + (2x yrs of age)
> 10 yrs 90 mmHg