Cardiac
What is Nitroglycerin dose, indications, and contraindications
Nitroglycerin is a vasodilator
0.4 mg SL every 5 min (Max of 3 dose)
Can not be given if ED meds have been taken
Angina pectoris/MI or relief of pulmonary edema caused by left side heart failure.
What non-narcotic pain management do we have and what is the dose?
Ketorolac (toradol) 15mg IV 30mg IM single dose only
NSAID
contraindications active bleed or incomplete bleeding control such as trauma.
What is the adult Anaphylaxis Epi dose?
Epi 1:1,000 (1mg/1ml)
IM 0.5mg/.5ml May repeat dose every 5 min as needed.
Pediatric dose for anaphylaxis
Epi 1:1,000
IM 0.01mg/kg Max dose of 0.3mg
If >25kg then give 0.3mg IM
May repeat every 5 min as needed
What is the dose and unique contraindications to Ipratropium?
Ipratropium (Atrovent)
Adult/Peds 0.5mg added to nebulized albuterol. may repeat x1.
Contraindication Hypersensitivity to soy lecithin or related food products soybeans and peanuts
What cardiac drugs do we use in cardiac arrest
Cardiac Epi 1:10,000
Amiodarone 300mg second dose 150mg
Lidocaine 1mg/kg repeat every 3-5min max 3mg/kg
What is your dose for fentanyl and routes?
Fentanyl 25-100mcg q5 min IV/IO/IM/IN (Max 200)
Contraindication for known fentanyl allergy
Adverse effects decreased level of consciousness respiratory depression/arrest, bradycardia, nausea and/or vomiting
What is the adult dose and volume of Dextrose 10%
Dextrose 10% 25g/250ml
IV/IO infuse 125ml (12.5g) then recheck blood sugar. If below <70 may repeat 125ml dose
What is your IV fentanyl dose/volume for a 66lbs patient?
Fentanyl 50mcg/ml The patient weights 30kg
IV/IO/IM 1mcg/kg (Max 50 per dose)
IN 2mcg/kg (Max 100 per dose)
Answer 30mcg/.6ml
What medication do we care that has the ability to potentiate the effects of narcotics?
Promethazine
What drug besides Push dose Epi can be used in Bradycardia. (Dose)
Atropine 1mg IV/IO (Max dose of 3mg)
Not indicated for high degree blocks
What is your dose for morphine adult and pediatric?
Morphine (10mg/1mg)
Adult 2-10mg q5 min IV/IO/IM titrated to effect (max 15mg)
Pedi 0.1mg/kg (max of 4mg per dose) IV/IO/IM titrated to effect (max 15mg)
What two medications do we have for nausea and vomiting? What are the doses?
Ondansetron (Zofran) 4-8mg IV/IM/PO/ODT
Promethazine (Phenergan) 12.5-25mg IV
Promethazine considerations Dilute in 5-10ml - Avoid in elderly Pt's due for sedation - give through AC
What is your pediatric dose for Midazolam for a 33lbs patient actively seizing? (Dose and volume)
Midazolam (5mg/ml) answer IV/IO 1.5mg/.3ml IN/IM 3mg/.6ml
IV/IO 0.1mg/kg (Max 5mg) repeat once in 5min if needed (total 10mg max)
IN/IM 0.2mg/kg (Max 5mg) repeat once in 5min if needed (total 10mg max)
What medication do we have to treat Organophosphate poisoning and dose?
Atropine sulfate
2mg Rapid IV preferred or IM repeated every 10 min until control of symptoms
What drug can be given for SVT to chemicaly restart the heart. (Dose)
Adenosine 6mg first 12 mg second rapid bolus
Acts on the AV node to slow conduction and inhibit reentry pathways half life is <5 seconds
What is the IV/IO ketamine dose for pain?
Ketamine (50mg/ml)
Dose IV/IO 10-20mg every 5 min to the desired effect or max dose of 40mg
pulse oximetry is mandatory for ketamine use.
What is your dose for haloperidol (haldol)?
Haloperidol antipsychotic (10mg/1ml)
IM 5-10mg once
IV/IO 2-5mg once
Exercise caution in Pt's with hx of alcohol abuse
Onset 15-20 min
What is your Epi treatment for croup and how do you prepare it?
"Racemic Epi" Dose/perpetration
Epi 1-2-3 we use Epi 1:1,000 2mg mixed with 3ml of NS nebulized
A Pt experiencing a Heat emergencies has been given cold fluids 500-1000cc of NS Bolus. The patient started to experience shivers what medication can be administered? (Med and Dose)
Midazolam 10mg/2ml
IN/IM/IV/IO - 5mg, may repeat once in 5 min if needed (total max dose 10mg)
When do we do synchronized cardioversion and whats the Joules?
Unstable Tachycardia
Unstable Wide Complex (QRS >120 msec) Tachycardia
(100J Repeat doses 200J)
What is your ketamine dose for a combative/excited delirium patient?
Ketamine (50mg/ml)
IM 4mg/kg once (Max 300mg/6ml)
IV/IO 1mg/kg every 10min for desired results (200mg/4ml)
What drug and dose would you give a 100kg adult Pt actively seizing.
Midazolam 10mg/2ml
IN/IV/IO 5mg, may repeat once in 5 min, if needed. Total max dose:10mg
IM 10mg, May repeat once after 5 min if unable to establish IV/IO
You have a 44lbs patient that is in cardiac arrest and requires their first round of Epi. What is your dose and volume?
Epi 1:10,000 1mg/10ml The patient is 20kg
IV/IO 0.01mg/kg max dose of 1mg
answer IV/IO 0.2mg/2ml
answer IV/IO 0.2mg/2ml
What is the online medical control treatment for cough variant asthma with severe coughing inhibits respiratory function (with or without audible wheezes)
Respiratory distress COG
Lidocaine 2% 40-60mg (2-3ml) added to albuterol for adult patients with cough variant asthma
How do you make Push dose Epi?
What is the Dose of Push dose Epi
10mcg as needed to maintain a SBP>100mmHg
What is the IN dose for ketamine?
Ketamine intranasal 50mg x 1 dose
See pain management COG
What are 2 of the uses of sodium bicarbonate and doses?
Sodium Bicarbonate (50mEq/50ml)
Indication: Metabolic acidosis caused by circulatory insufficiency, cardiac arrest w/prolonged CPR, tricyclic overdoses, and hyperkalemia.
Cardiac arrest IV/IO 1mEk/ml may repeat every 5min x2
Tricyclic overdose with sustained HR>120 bpm, QRS>0.10, Hypotension unresponsive to fluids, or ventricular dysrhythmias IV/IO 1mEk/mg slow push
You have a 44 lbs patient that is in cardiac arrest you have given your first round of Epi your patient is in V-Fib and you are on your second line medication what is it? what is your dose and volume?
The medication is Amiodarone the ped dose is 5mg/kg. The patient weighs 20kg
5x20=100mg of amiodarone carried in a concentration of 50mg/ml therefore we have 2ml of medication to administer.
Set up a Epi drip for a 180lbs patient with a dose of 0.2mcg/kg/min with a 15 drip set and 4mg of Epi 1:1,000 in a 1,000cc bag of NS. What is my drip rate per minute?
The concentration in the bag of NS is 4mcg per ml. Our Pt is 81kg. (0.2mcg x 81kg = 16mcg/min)
16mcg/1min x 1ml/4mcg = 4ml/min
4ml/min x drip factor of 15gtts = 60 gtts/min