Term
| How do you calculate a minumum normal SBP on a child and at what age does it start? |
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Definition
1 year of age and older
70 + 2x age in years |
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Term
| Where is the best place to check cap refill on a pediatric patient? |
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Definition
| The heel or palm at heart level |
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Term
| What is the strongest sign of dehydration in pediatric patients? |
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Definition
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Term
| How do you calculate MIVF in a pediatric patient? |
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Definition
(4-2-1)
4xkg first 10kg + 2x kg next 20 kg + the remaining kg = total MIVF rate
i.e. 32kg = 72ml/hr MIVF |
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Term
| What is the correct Adenosine dose in a pediatric patient, and when do you give it? |
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Definition
Tachycardia with a pulse and poor perfusion:
first dose - 0.1mg/kg RIVP (max 6mg)
second dose - 0.2mg/kg RIVP (max 12mg) |
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Term
| What is the correct Atropine dose in a pediatric patient and when do you give it? |
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Definition
Bradycardia with a pulse with poor perfusion:
0.02mg/kg (min dose 0.1mg; max dose 0.5mg) may repeat once |
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Term
| What is the correct Epinephrine dose in a pediatric patient during PALS? |
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Definition
| 0.01mg/kg (0.1cc/kg of 1:10,000) with a max of 1mg every 3-5 minutes for pulseless arrest |
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Term
| What are the correct Magnesium Sulfate doses in pediatric patients? |
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Definition
VT with torsades with a pulse = 25-50mg/kg IVP
VT with torsades w/o a pulse = 25-50mg/kg slow IVP
Asthma = 25-50mg/kg slow IVP over 10-20 minutes
(MAX SINGLE DOSE 2gm) |
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Term
| What is the corret Procainamide dose in a pediatric patient and when is it given? |
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Definition
Tachycardia with a pulse and poor perfusion:
15mg/kg over 30-60 minutes then an infusion rate of 20-80mcg/kg/min |
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Term
| What is the correct Etomidate dose in a pediatric patient for RSI? |
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Definition
0.3mg/kg slow IVP over 30-60 sec
(0.15-0.2mg/kg for shock or hypovolemia) |
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Term
| What is the correct Lidocaine dose in a pediatric patient for RSI and when do you give it? |
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Definition
| tight head & chest: 1-1.5mg/kg IVP over 1 minute |
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Term
| What is the correct Rocuronium dose in a pediatric patient for RSI? |
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Definition
| 1mg/kg IVP (onset 1-2 minutes) |
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Term
| What is the correct dosing and considerations of Succinylcholine in a pediatric patient for RSI? |
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Definition
Infant: 2mg/kg over 10-30 sec
Child: 1-1.5mg/kg over 10-30 sec
consider Atropine for little child, sick kids, or anticipated difficult airway. Manditory for multiple attempts if not successful. |
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Term
| What is the protocol for caring for a pediatric in DKA? |
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Definition
NO INSULIN, ONLY BOLUS SMALL AMOUNTS IF HYOPTENSIVE
Start out with an infusion rate of 10ml/kg x1 hr
Then change rate to twice the maintenance rate |
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Term
| What fluids are used and when in the pediatric fluid replacement protocol? |
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Definition
Hypovolemia - D5 1/2NS
Boluses - NS
TBI/Trauma - NS |
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Term
| What is the hypoglycemia treatment protocol? |
|
Definition
Under 2 y/o - D10 2-5ml/kg
Over 2 y/o - D25 2-5ml/kg
Adult - D50 |
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Term
| What are the two markers for verifying true hyperkalemia? |
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Definition
1) EKG changes (widened QRS, peaked T waves, flattened P wave)
2) Elevated CO2 levels |
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Term
| When treating a pediatric patient with hypekalemia what is the first thing you do? |
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Definition
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Term
| How do you treat pediatric kyperkalemia? |
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Definition
- Calcium Gluconate 10% 1cc/kg over 3-5 minutes, may repeat q 10-15 min
- HCO3 1-3meq/kg over 5-10 min
- Insulin 0.1 unit/kg IV bolus w D25W over 20-30 min OR...
- Insulin 0.1 unit/kg/hr w D25W 1-2ml/kg/hr
- Albuterol Neb 5-10mg |
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Term
| What are s/sx of pediatric myocarditis? |
|
Definition
- SOB w respitory symptoms
- persistant tachycardia despite interventions
- fever |
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Term
| What do you want to avoid in treatment of myocarditis? |
|
Definition
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Term
| What is the ABX treatment for pneumonia? |
|
Definition
- IV Rocephin
- IV Zithromax |
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Term
| What is the protocol for Asystole? |
|
Definition
1. Initial medical care.
2. If the patient remains pulseless:
A. Continue CPR
B. Intubate at once
C. Obtain IV access
D. Confirm asystole in more than one lead
3. Consider possible causes and treatments.
ASYSTOLE
A. Hypovolemia (volume infusion)
B. Hypoxia (ventilation)
C. Hydrogen ion--acidosis (ventilation, consider sodium bicarbonate severe acidosis,prolonged downtime)
D. Hyper-/hypokalemia (consider Hyperkalemia protocol)
E. Hypothermia (see Hypothermia protocol)
F. Tablets--drug overdose (Consider Cyclic Antidepressant Overdose protocol)
G. Tamponade, cardiac (consider pericardiocentesis)
H. Tension pneumothorax (needle decompression)
I. Thrombosis--coronary, acute MI (consider Coronary Insufficiency/Acute MI protocol)
J. Thrombosis--pulmonary embolism
4. Administer epinephrine 1 mg of a 1:10,000 solution IV push or ETT. Repeat every 3-5 minutes.
5. Consider termination of efforts. Consider sonosite visualization of cardiac motion or lack thereof. |
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Term
| What is the Adenosine dose in adults? |
|
Definition
6mg IVP, then 12mg IVP, may repeat 12mg IVP once.
Pg.11 |
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Term
| What are the indications for Adenosine use in adults? |
|
Definition
Narrow complex paroxysmal supraventricular tachycardia.
Pg.11 |
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Term
| What is the adult dose for Albuterol? |
|
Definition
| Initial dose is 5 mg with an Albuterol mixed with one DuoNeb. Then continuous Albuterol nebulizer at 10-20 mg/hr. |
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Term
| What are the adult indications for Albuterol in adults? |
|
Definition
| Asthma, COPD, CHF, and Hyperkalemia. |
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Term
| What is the adult dose and indications for Amiodarone? |
|
Definition
VF/VT with no pulse 300mg IVP.
VT with pulse 150mg over 10 minutes.
Then infusion at 1mg/min over 6 hours (1 amp [150 mg] in 100 D5W for a concentration of 1.5 mg/ml).
Set pump at 40cc/hr for a rate of 1mg/min.
Use inline filter if given through a peripheral line or draw up through a filtered needle. |
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Term
| What is the adult dose and indications for Atropine? |
|
Definition
0.5-1mg in Bradycardia.
0.02mg/kg in RSI |
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Term
| What is the adult dose for Calcium Gluconate 10%? |
|
Definition
| 10ml over 10 minutes or 1ml/kg over 3-5 minutes. |
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Term
| What are the adult indications for Calcium Gluconate 10%? |
|
Definition
| Hyperkalemia and calcium channel blocker overdose |
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Term
| What is the adult dose and indications for D50? |
|
Definition
Hypoglycemia-25 gm may repeat if little change in mental status.
Hyperkalemia-25 gm of D50 mixed in 50 ml D5W or NS infused over 20- 30 minutes. |
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Term
| What is adult dose for Dexamethasone? |
|
Definition
|
|
Term
| What are the indications for Dexamethasone? |
|
Definition
| Asthma, COPD, and Anaphylaxis. |
|
|
Term
| What is the adult dose for Benadryl? |
|
Definition
|
|
Term
| What are the adult indications for Benadryl? |
|
Definition
| Allergic reaction/anaphylaxis. |
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|
Term
| What is the adult dose for Dopamine? |
|
Definition
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|
Term
| What is the adult indication for Dopamine? |
|
Definition
| Hypotension with bradycardia |
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Term
| How do you mix a Dopamine drip? |
|
Definition
2.4ml of 80mg/ml and mix in 60ml D5W.
Concentration will be twice the normal.
3200mcg/ml. |
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Term
| What are medical conditions that mimic a stroke? |
|
Definition
- hypoglycemia
- electrolyte imballance
- ischemic vs hemorrhagic
- tumor |
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Term
| What is mnemonic to work-through for possible causes of altered mental state (AMS)? |
|
Definition
A — Alcohol/Acidosis
E — Endocrine, Epilepsy, Electrolytes, Encephalopathy
I — Infection
O — Opiates, Overdose
U — Uremia
T — Trauma
I — Insulin
P — Poisoning/Psychosis
S —Stroke |
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Term
| What is the paramount treatment with a leaky aneurysm? |
|
Definition
| NO ANTIHYPERTENSIVE MEDICATIONS |
|
|
Term
| How is a non type "A" aortic dissection treated? |
|
Definition
| Monitor and treat medically (BP, HR) |
|
|
Term
| How is a type "A" aortic dissection treated? |
|
Definition
|
|
Term
| How are ventilation strategies for asthma? |
|
Definition
- no PEEP
- lung protective stratigies
- prolonged expiraton (I-Time 0.8, rate 12) |
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|
Term
|
Definition
- Fluids to keep BP up (careful to not overload)
- Pressors to elevate BP
- Thrombolytics if over 2 hours |
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Term
| When and how is hyponatremia treated? |
|
Definition
- lab level <115 (<110 = seizures)
- treat cause!!
- 100mL 3% NS over 10 min then 100mL over 50 min |
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|
Term
| What is the most important thing to know about hyper/hypokalemia? |
|
Definition
|
|
Term
| What is the treatment for hypercalcemia? |
|
Definition
| NS fluids and diarhetics (flush out) |
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|
Term
| What is the target MAP for a trauma patient with TBI? |
|
Definition
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|
Term
| Clinical presentation for an Anteroseptal MI |
|
Definition
| BBBs, Ventricular Aneurysm |
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|
Term
| Clinical presentation for an Inferior MI |
|
Definition
| N/V, Brady-arrhythmias, 1st degree block, Wenckebach |
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|
Term
| Clinical presentation for an Anterior Wall MI |
|
Definition
| LV failure, BBB, Type II Block, 3rd AV Block, LV aneurysm & Rupture, Ventricular Ectopy |
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|
Term
| Clinical presentation for a Lateral Wall MI |
|
Definition
| Ventricular Ectopy, Hypotension |
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|
Term
| Clinical presentation for a Posterior MI |
|
Definition
| Tall broad R waves, ST depression, Tall upright T waves |
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