Er Memorization

Front 1

Status Epilepticus

Back 1

Lorazepam 2mg IV (to .1mg/kg)
+
Phenytoin 20-30mg/kg

Front 2

Adult:
Bradycardia (symptomatic)

Back 2

-Transcutaneous pacing (without delay for 2nd degree type II or 3rd degree block)
-Atropine 0.5mg IV repeatable to total dose of 3mg
-consider Epi (2-10ug/min) or dopamine (2-10ug/kg/min) infusion while awaiting pacer or if pacing ineffective

Front 3

Adult:
Pulseless Arrest
VF/VT

Back 3

-1 shock
-5 cycles
-1 shock
-Epi 1mg q3-5mins
-5 cycles
-1 shock
-Amiodarone 300mg IV once, then consider 150mg once
or
-Lidocaine 1-1.5mg/kg first then 0.5-0.75mg/kg max 3mg/kg
-Consider Mg 1-2g IV for torsades

Front 4

Adult:
Pulseless Arrest
Asystole/PEA
Causes?

Back 4

-Epi 1mg q3-5mins
6 Hs and 5 Ts of PEA:
Hypovolemia, Hypoxia, Hydrogen ion, Hypo/hyperkalemia, Hypothermia
Toxins, Tamponade, Tension pneumo, Thrombosis (coronary or pulmonary), Trauma

Front 5

Adult:
Tachycardia with pulses
Unstable

Back 5

Immediate synchronized cardioversion

Front 6

Adult:
Tachycardia with pulses
Regular Narrow QRS

Back 6

-Vagal maneuvers
-Adenosine 6mg, then 12mg, then 12mg
-If ineffective or recurs, control rate with diltiazem 15-20mg (then 5mg/hr) or B-blockers

Front 7

Adult:
Tachycardia with pulses
Regular Wide QRS

Back 7

-Amiodarone 150mg IV over 10 minutes repeatable to max 2.2g/24 hours
-Elective synchronized cardioversion

Note: could be SVT with aberrancy, in which case give Adenosine (see Regular Narrow QRS card)

Front 8

Adult:
Tachycardia with pulses
Irregular Wide QRS

Back 8

AF + WPW? Avoid AV nodal blocking agents (adenosine, digoxin, diltiazem, verapamil). Consider Amiodarone 150mg IV. Expert consult.
Torades? Mg 1-2g over 5-60 minutes.
AF with aberrancy? Rate control with diltiazem 15-20mg (then 5mg/hr) or B-blockers.

Front 9

Adult:
Tachycardia with pulses
Irregular Narrow QRS

Back 9

(AF or flutter or MAT)
-Rate control with diltiazem 15-20mg (then 5mg/hr) or B-blockers

Front 10

RSI

Back 10

-Induce (Etomidate 0.3mg/kg)
-Paralyze (Succinylcholine 1.5mg/kg)
-Check position
-Don't forget analgesia and sedation post-intubation

Front 11

Initial ED vent settings and goals

Back 11

Settings: A/C, 100% FiO2, 10mL/kg Tidal volume, RR 12/min, Inspiratory flow rate 60L/min, I:E ratio 1:2, PEEP 5.
Goals: PaO2 60-90, PaCO2 40, pH 7.35-7.45, FIO2 40-60%, Inspiratory peak pressure <35mmHg.

Front 12

Malignant hyperthermia

Back 12

Dantrolene sodium 2.5mg/kg repeat up to total 10mg/kg

Front 13

Neuroleptic malignant syndrome

Back 13

Primarily supportive. Withdraw antipsychotics, consider intubation and paralysis (preferably with nondepolarizing agent). Consider dantrolene sodium 2.5mg/kg followed by 1mg/kg q6h for severe cases (off label).

Front 14

CHF and acute pulmonary edema

Back 14

O2 (mild) -> CPAP (mod) -> intubation (sev)
Nitro 0.4mg sublingual q1-5mins then 0.2-0.4ug/kg/min IV (avoid in hypotension, hypertrophic cardiomyopathy, or aortic stenosis).
Then furosemide 40mg IV (or usual po dose IV).
(All other heart failure drugs not needed in acute setting but, for example, ACE-I should be started prior to discharge).

Front 15

Aspirin overdose

Back 15

Activated charcoal 1-2gm/kg single dose (+/- gastric lavage or whole bowel irrigation).
NS fluid resuscitation with potassium supplementation (fluid resus and probable hypokalemia).
Na bicarb 1-2mEq/kg bolus followed by continuous infusion (to alkalinize urine).
Include 5% dextrose in fluids (hypoglycemia implicated in neuro damage).
Recheck serum salicylate and electrolytes q1-2 hours initially.
Dialysis for severe.