Final Mix

Front 1

FACILITIES AND EQUIPMENT:

1) Newly installed facilities must be checked for what 2 things?
2) N2O has to be capable of ___% O2 and never less than ___% O2, or else you need?
3) Positive pressure O2 (>____% concentration at ___ L/min flow, or ___ L/min with anesthesia bag) for minimum of ___ hr. (____L, "__" cylinder)
4) Functional ___ (with backup)
5) Appropriate ___ and _____ should accommodate children of all ages and sizes
6) __ and __ should be available to resuscitate non-breathing patient

Back 1

1) Proper gas delivery, fail-safe function
2) 100%, 25%, in-line O2 analyzer
3) 90%, 10 L/min, 15 L/min, 1 hr. 650 L, E cylinder
4) Suction
5) Monitors, equipment
6) Emergency kit, drugs

Front 2

3 requirements of pediatric sedation facility procedure room and recovery area?

Back 2

1) Be adequately sized to permit emergency management
2) Have a chair/board suitable for CPR
3) Be equipped with suction and positive pressure oxygen and back-up units

Front 3

All the required equipment required for sedation?

Back 3

PABST’S Delicious SIPS
- Positive pressure oxygen system + backup + full face mask for pedo
- Airways of appropriate size for pedo patient
- BP cuff and stethoscope
- Suction + backup + tonsil suction tip
- Thermometer
- Scale
- Defibrillator
- Sphygmomanometer
- IV set-up/fluids/16 specific drugs
- Pulse ox AND pre-tracheal or -cordial steth, OR capnograph continuously used

Front 4

If there is an emergency happening, what are the "7" steps of "CPR" or management?

Back 4

1) Circulation
2) Positioning
3) Airway
4) Breathing
5) Dx, drugs, defib
6) Education (protocols, action plans)
7) Fictional practice - scenarios

Front 5

1) How do you determine if there's circulation?
2) Child 1-8 years old has an inadequate pulse, what do you do?
3) What is proper positioning?
4) 9 pieces of airway equipment?
5) 3 steps for ensuring airway patency?
6) 3 way suction units are powered?
7) 2 things the Yankauer tonsillar suction tip can attach to?

Back 5

1) Palpate carotid artery for sign of >60 BPM or 1 beat/sec
2) One-handed chest compression to 1/3 chest depth (2 inches). Open airway (head tilt/chin lift), 2 slow (1 sec) breaths via BVM. 15:2 compression:ventilation. 20 cycles, then 911 and AED
3) Head tilt-chin lift/jaw thrust (clear airway obstruction by tongue)
4) My Suction Can Open Some Little Kids' Endotracheas. Really! - Mouth prop (Molt), Suction unit + Yankauer with bulb tip, Curved hemostat or Magill forceps, Oral/nasal airways, Stethoscope and/or capnograph, Laryngeal mask airway, King supraglottic airway, Endotracheal intubation, Rusch Quicktrach
5) Position tongue forward, clear airway of any obstruction (no blind finger sweeps!) Secure airway
6) Battery operated, hand powered, foot powered
7) Regular for attachment to saliva ejector, high speed suction adapter

Front 6

1) What are the oral airway sizes available?
2) What is the proper airway size for an infant?
3) Child?
4) Adult?
5) What are the nasal airway sizes?
6) What do you always need to have in stock with nasopharyngeal tubes?

Back 6

1) 50, 70, 80, 90, 110
2) 50
3) 70
4) 90
5) Size 20-30 in 2 increments
6) Lubrication!

Front 7

ORAL AIRWAY:

1) What are the sizes available, and how do you select it?
2) When do you choose to use one?
3) How do you insert it (what do you use to insert it, and in what direction)
4) 2 types?
5) Should you use the oropharyngeal mask if you're going to transport a patient?

Back 7

1) #0-5, select based on external length of mandible (corner of mouth to tip of ear)
2) Patient falls unconscious and the chin lift/jaw thrust fails
3) Use tongue blade or rotate sideways
4) Hollow (Guerdel) or solid/lateral groove (Berman)
5) No, not stable. Use nasopharyngeal

Front 8

1) How do you select the right size nasal airway? What are the 2 options and sizes?
2) How should you insert it (directionwise?) What should you use in conjunction with it?
3) Which nares should you put it in and why?

Back 8

1) Measure from edge of nose to back of the ear. Latex (blue, 8 sizes, 20-36 mm), and non-latex (green).
2) Straight on - don't insert from below because it'll bump top. Use lubricant.
3) Right - it'll be in the midline. If you put it through the left, it'll run up against posterior pharynx

Front 9

Laryngeal Mask Airway (LMA)

1) What are its advantages and disadv. of insertion?
2) What does it block and what does this prevent?
3) How do you select the size? Sizes?
4) How do you insert?
5) What are the components of a LMA?
6) How does the King LT-D disposable supraglottic airway work? How does it come packaged? Minimal weight? What are the colors and sizes? How expensive is it?
7) Is the Igel supraglottic airway device inflatable? What is it, and what are the sizes? What is the downside?

Back 9

1) Flexible + easy to insert, but easier to dislodge
2) Esophagus, prevents regurgitation
3) Based on weight of patient. 2.0 (10-20 kg), 2.5 (20-30 kg), 3.0 (30-50 kg)
4) Push down and up against the palate with your fingers, slide it down. Once it feels secure, attach syringe to it, pump some air, blow up the cuff to block esophagus and have a direct portal to trachea. You don't need to put the tube in the trachea. (Blindly introduced into the pharynx until it meets resistance - cuff is then inflated and ventilation assessed)
5) Tube with cuffed mask at the distal end
6) Seals in esophagus and and orophayrnx to provide positive pressure ventilation. Single inflation part, sterile lube included, latex free, color coded. Minimal weight = 26 lbs. Green = size 2, Orange = 2.5 size. $47 each (cheap)
7) Non-inflatable. Bite block. Sizes 3-5. Soft, may not provide as tight of a seal

Front 10

ENDOTRACHEAL INTUBATION:

1) What is the #1 complication with intubation?
2) Miller is (straight/curved)
3) MacIntosh is (straight/curved)
4) In children, which is preferred to pick up the epiglottis - Miller or Macintosh?
5) How is the tube placed in kids?
6) Do we used noncuffed or cuffed tubes in kids, and why? What is the downside to using what we use?

Back 10

1) Avulsion or displacement of teeth
2) Straight
3) Curved
4) Miller
5) Small, uncuffed ET tube is place dw/ a slight leak @ 15-20 cm H2O
6) Noncuffed, because their airways are so narrow. If we used cuffed, it'd traumatize airway, cause edema, cause it to narrow more postoperatively. Downside: fluid can go down into lungs (throat pack prevents this), you'll get gas that you'll be breathing in

Front 11

Field trach intubation vs. Bag-Mask ventilation:

1) How do they compare in training requirements, and which is more effective?
2) Is there an overall difference in survival rate?
3) Is there an overall difference in survival from respiratory arrest?

Back 11

1) Tracheal intubation requires advanced training, and BMV may be as effective as intubation if transport time is short
2) NO (~28%)
3) BVM has greater survival rates (85%) vs. intubation (61%)

Front 12

According to Gausche: COMPLICATIONS OF FIELD ENDOTRACHEAL INTUBATION

1) Successful tracheal intubation rate: __%
2) Intubation attempts increased time at scene by ____ minutes
3) Unrecognized tube displacement or misplacement: ___%. Esophageal intubation __%, unrecognized extubation ___%
4) Why are these unrecognized esophageal intubations or unrecognized extubations bad?
5) What is the new AHA acceptable alternatives to endotracheal intubation?

Back 12

1) 57%
2) 2-3 minutes
3) 8%. 2%, 6%
4) FATAL !
5) Supplemental oxygen with BMV and LMAs

Front 13

1) If everything fails and you can't intubate, or it a foreign object gets stuck subglottally, what is your last choice?
2) 4 indications?
3) How do you do it?
4) What is the equipment for this, how does it come packaged? Sizes?

Back 13

1) Surgical cricothyrotomy
2) Failure to ventilate with BMV, relieve airway obstruction, intubation attempts, and suspected foreign body inhibits intubation
3) Incise crico-thyroid membrane, insert large IV catheter connect to ambu with 3 mm ET tube connector
4) Rusch Quicktrach - pre-assembled, Needle, 2 MM FOR PEDO, 4 mm for adults, plastic cannula. 10 mL syringe, padded neck strap, connecting tube.

Front 14

1) 4 types of breathing equipment?
2) 3 steps of checking breathing?
3) What is the FIRST and MOST important drug given in EVERY pediatric emergency?
4) 3 components of an oxygen delivery system?
5) 6) Oxygen cylinder is __ size, ___ PSI at full = ___ L. You have ___ hours @ a flowrate of 5 L/min

Back 14

1) POMP up the oxygen - Paper bags (for hyperventilation), Oxygen cylinder/regulator, Manual resuscitators (ambubags), Pulse ox monitor
2) Look, Listen, Feel
3) Oxygen
4) Oxygen cylinder, regulator with pressure valve, flowmeter
5) E. 2000 psi = 600 L.2 hours

Front 15

Oxygen flowmeter settings:

1) What is the total capacity?
2) What is the flowrate for nasal cannula, and what % O2 does it deliver and for how long
3) Non-rebreathing mask?
4) BVM?

Back 15

1) 0-15 L/min
2) Nasal cannula (sponatenous breathing): 4-6 L/min, 30-40% O2 for 120 minutes
3) Non-rebreathing mask: 6-10 L/min, 50-70% O2 for 60 minutes
4) BVM (resuscitate): 10-15 L/min, 80-90% O2 for 40 minutes

Front 16

1) If you use the quick connect outlet available on most nitrous oxide units, what mL flowmeter is usually on there, and how much flow will it provide?
2) What size non-breathing masks do they have for supplemental oxygen for spontaneous ventilation? Why are they clear?
3) What size nasal cannulas do they have?

Back 16

1) 8 mL flowmeter, will provide 15 mL flow necessary for resuscitation
2) Infant, child, adult. Clear so you can see vomit
3) Child, adult

Front 17

Non-rebreathing mask - Hudson type:

1) How big is the reservoir bag, and when do you fill it?
2) What is the flow rate? What do you adjust based on?
3) What does the one-way value in mask allow for?
4) What does the open valve permit?

Back 17

1) 1 L, filled prior to placement on placement
2) 6-10 lpm, adjust based on inflation/deflation ratio of reservoir bag
3) Expiration of CO2, prevents non-rebreathing of exhaled breath
4) Mixture with room air

Front 18

Supplemental O2 Full Face Mask - Venturi Type

1) What does the one-way valve in mask allow for? Prevents?
2) Open valve permits?
3) What is the O2 concentration delivered?
4) When it is selected for use?

Back 18

1) Expiration of CO2, prevents non-rebreathing of exhaled breath
2) Mixture with room air
3) 30-40%
4) When CO2 retention is a concern

Front 19

BVM:

1) What is it called?
2) How is it packaged?
3) Sizes of masks?

Back 19

1) Ambubag (self-inflating)
2) Reservoir bag/hose
3) Infant/child/adult

Front 20

What % oxygen do you get when you use:

1) Exhaled breath (mouth to mask)
2) Ambient air (self-inflating "Ambu-bag")
3) Supplemental oxygen (bag-mask-valve resuscitator)
4) What are the 3 requirements for face masks?

Back 20

1) 16%
2) 21%
3) 100%
4) Appropriate size, clear, inflatable cushion

Front 21

MOUTH TO MASK VENTILATION:

Advantages? (5)

Back 21

1) No direct contact
2) Positive pressure ventilation
3) Oxygenates well if O2 is attached
4) Easier to perform than BVM
5) Best for small-handed rescuers

Front 22

PUSH-VALVE RESUSCITATOR:

1) How is it activated?
2) As a resuscitator, what can it deliver through a manual button?
3) What can the operator control?
4) Should you use this in kids? Why?
5) Why are ambubags better?

Back 22

1) Patient can activate valve on demand by breathing
2) Fixed flow rate of oxygen
3) Duration of positive pressure flow
4) No - you have no control or feeling with button, can overinflate lungs => gas goes into stomach => causes vomiting
5) You can feel the compliance of the chest wall

Front 23

AMBUBAG:

1) What are the two big components of a manual resuscitator? Smaller components?
2) What are the sizes and ages at which you use them?
3) When do you lock the valve?

Back 23

1) Self-inflating (recoiling) bag (Ambu), reservoir bag with supplemental oxygen. Valves (one way, non-rebreathing). Face mask (clear, silicone). Pop-off valve - pressure release.
2) Adult (>8 y/o), child (1-8), infant (<1 year)
3) Only when you're trying to break a laryngospasm

Front 24

Resuscitators - Spur II by Ambu:

1) When do you use an adult size? Bag reservoir volume?
2) Child? Bag reservoir volume?
3) Infant? Bag reservoir volume?

Back 24

1) 66 lbs +, 10 y/o. 800 mL
2) 22-66 lbs, 1-10 y/o. 450 mL.
3) Below 22 lbs, 1 y/o. 150 mL

Front 25

1) What is proper ventilation technique with an Ambubag?
2) Pressures >30 cm H2O does what?
3) What is the child respiration rate? __/min, or once every ___ seconds
4) Adult is __/min. Once every __ seconds.
5) 2 ventilation techniques?

Back 25

1) Finger placement on bone, not soft tissue. C clasp with thumb and forefinger, slow, gentle compressions at a pressure of 20 mmHg.
2) Lifts epiglottis, forces air itno esophagus and stomach
3) 20. 3
4) 5 seconds
5) Assisted or forced

Front 26

1) 5 advantages of Bag-Mask ventilation?
2) 2 potential complications?
3) To avoid gastric insufflation and subsequent risk of regurgitation, pulmonary aspiration and/or gastric rupture, maximum inspiratory pressure must be less than __ cm H2O
4) What is the key to ventilation volume, aka how do you know when you're administering enough?
5) Proper 2-rescuer-bag-mask ventilation?
6) You should excessive ___ and ___ when ventilating
7) What two things can reduce gastric inflation?
8) Cricoid pressure aka ___ ? Where do you press?
9) How does the maneuver work?
10) is it recommended?

Back 26

1) AEIOH - Assists spontaneous respirations, Excellent short-term support of ventilation, Immediate ventilation/oxygenation, Operator gets sense of compliance/airway resistance, High oxygen concentrations are possible
2) Hypoventilation, gastric inflation
3) 15 cm H2O
4) Enough to produce chest rise
5) 1 rescuer uses both hands to open airway and maintain a tight mask-to-face seal, other compresses manual resuscitator bag and may apply cricoid pressure. Both verify adequate chest expansion
6) Volume, pressure
7) Increased inspiratory time, cricoid pressure
8) Sellick Maneuver. Press down on cricoid ring, below larynx, toward the cervical spine
9) Occludes esophagus, prevents gastric distension w/ resultant vomiting
10) NO

Front 27

LOOK AT CHART ON PAGE 20 OF LECTURE 7

Back 27

OK

Front 28

5 tools/methods to ensure circulation?

Back 28

1) Stethoscope
2) BP cuff (adult, child)
3) Pulse ox
4) AED
5) Chest compressions

Front 29

1) If carotid pulse is present, SBP is at least?
2) Brachial?
3) Radial?
4) Pulse ox is inaccurate when SBP goes below ___ if using toe probe, or below __ with finger probe
5) What is the best position to get the heart pumping enough blood again? Why?

Back 29

1) 60
2) 70
3) 80
4) 70, 80
5) Legs up - preloads the heart and cardiac rate and stroke volume improves systolic BP

Front 30

BLS for an unconscious infant (inadequate pulse, 2 rescuers)

Back 30

CIRCULATION:

1) palpate BRACHIAL artery for sign of >60 BPM. If less or pulseless, chest compression to 1/3 chest depth (1.5 inches) using "thumb encircling hands" technique @ rate of 100/min
2) Breathing (pulseless = not breathing), open airway, head tilt/chin lift, 2 slow 1 sec breaths via BMV and see if chest rises

Compression:ventilation = 15:2. Complete 20 cycles, THEN call 911 and AED

Front 31

BLS for unconscious infant, adequate pulse, 1 rescuer

Back 31

Circulation - palpate brachial artery, if >60 BPM then no chest compression

Breathing if apneic or weak: open airway (head tilt/chin lift or jaw thrust only if neck injury is present or suspected), give slow breaths until chest raises via mouth to nose (NOT BMV) at 1 breath every 3-5 seconds, then call 911

Front 32

BLS for unconscious child (1-8 y/o), inadequate pulse, 2 rescuers

Back 32

1) Palpate CAROTID pulse for sign of >60 BPM. If pulseless, chest comp. 1/3 chest depth (1.5-2 inches), one handed technique, 100/min

2) Open airway (head tilt/chin lift), 2 slow 1 sec breaths via BMV (better than intubation) q 3-5 secs. Compression to ventilation 15:2

3) Complete 20 cycles, THEN call 911 and AED

4) IO access, if IV cannot be established within 90 seconds

Front 33

BLS Changes:

1) What's changed with ABC's? Head tilt chin lift jaw thrust?
2) Pulse check?
3) Rescue breathing rate for adults? Infant/child?
4) What is the rate of compression? What is O2 delivery dependent upon?
5) Depth?
6) If an advanced airway (examples?) is in place, how often do you breathe?
7) If no advanced airway, what is the compression:breath ratio?
8) What route do you use for medications? Should you interrupt CPR?
9) What will excessive ventilation cause?
10) SaO2 saturation should be maintained at ___% or greater
11) What is now recommended to monitor ventilation?
12) How do you evaluate ET Tube or LMA to ensure correct placement?
13) What is no longer used to greet all chest pain patients?

Back 33

1) Now CAB's, but still do head tilt chin lift and jaw thrust
2) Don't do it unless you notice after 1 full cycle of CPR, then recheck every 2 minutes (5 cycles)
3) Adults: 1 breath every 5-6 seconds, infant/child are 1 breath every 3-5 seconds
4) 100/minute (O2 delivery dependent upon rate of compression, not blood O2 saturation)
5) Allow complete recoil, adults 2 inches, kids 1/3 AP diameter of chest (1.5 for infant, 2 inches for child)
6) LMA or ET Tube. Breathe is 1 every 6-8 seconds
7) 30:2
8) IV/IO, should not interrupt CPR
9) Compromised venous return & cardiac output due to interrupted CPR and increased intrathoracic pressure
10) 94%
11) Capnography
12) Evaluate clinically and with monitors
13) MONA

Front 34

What should you do if your pt has V-Fib and pulseless V_TACH?

Back 34

SCREAM:

1) Shock
2) CPR for 2 minutes
3) Rule out cuases
4) E: vasopressor of either 40 units of vasopressin or 1 mg of epi (1 minute delay in action)
5) A: Antiarrhythmic of 300 mg of Amiodarone or 1 mg/kg of Lido (refractory VF/VT not controlled by CPR, shock, and vasopressor)
6) M: Magnesium sulfate for torsade de pointes associated with prolonged QT interval

Front 35

1) When is a child determined to have symptomatic bradycardia?
2) Most common cause of symptomatic bradycardia?
3) 5 other causes of symptomatic bradycardia?

Back 35

1) When HR <60 BPM for kids,
2) Hypoxia
3) Altered mental status, poor capillary refill, difficulty breathing, loss of consciousness, chest pain

Front 36

1) 4 universal control steps of AED?
2) T or F: with every analysis and shock, no one touches the patient
3) What kind of warnings do you need before you shock
4) AED use isn't prohibited, but there is insufficient evidence to recommend use in children under ___
5) When should you consider smaller pads?
6) Where do you place them on kids?

Back 36

1) Turn it on, attach pads, analyze rhythm, shock if indicated
2) T
3) VERBAL: I'm clear, you're clear, we're all clear, VISUAL check. PHYSICAL add hands gestures)
4) 8
5) When kids are <55 lbs/25 kg
6) One on chest, one on back

Front 37

PEDIATRIC CARDIAC ARRESTS:

1) T or F: Most cardiac arrests are sudden, and most are cardiac in origin
2) Pediatric cardiac arrest is a secondary event to _____________ problems
3) Hypoxia => what cardiac problems?
4) Shocking the hypoxic heart gets you?
5) Studies of cardiac arrest in children demonstrated that ___% had shockable rhythms, __% survival rate

Back 37

1) F
2) Respiratory problems (hypoxia)
3) Hypoxia => bradycardia => asystole
4) Grilled beef
5) 7%, 10%

Front 38

CIRCULATION:

1) What is the preferred route for admin of medication and fluid bolus
2) What are the 3 main routes for vascular access?
3) During CPR, if you can't get a reliable IV line in 90 seconds, then place what?
4) Where does IO cannulation go?
5) EZ-IO - where do you use it? What are the needle set sizes based on? Needle set into the medullary space using what instrument?
6) What drugs can be given IO?
7) What doses do you give IO?
8) Are submucosal route plasma levels achieved comparable to IM/IV routes (IM - midazolam, IV - flumazenil)

Back 38

1) Vascular
2) IV route (peripheral veins of hands, antecuboidal fossa, saphenous vein (foot)), interosseous route, submucosal route
3) Interosseous line
4) Tibia depression
5) Proximal tibia, 2 weight based needle set sizes, set into medullary space by orthopedic drill
6) Anyting that can be safely injected into a central venous catheter can also be safely injected IO
7) Same as IV
8) Yes, after 5-10 minutes

Front 39

1) What is an AAPD additional drug to the arsenal?
2) FL BOD additionals?

Back 39

1) Ammonia inhalant
2) PLAN MV - Promethazine, Labetalol, Amiodarone, Nitroglycerin, Midazolam, Vasopressin

Front 40

DRUG DOSAGES "As a rule"

1) If they're based on weight, what is an adult dose, pediatric dose, infant dose?
2) If it's based on volume administered, what is the adult, pediatric, and infant dose?

Back 40

1) Adult: >30 kg, Pediatric: 15-30 kg, Infant <15 kg
2) Adult: 1 mL, pediatric: 0.5 mL, infant: 0.25 mL

Front 41

Emergency drug requirements:

EPINEPHRINE:

1) What 5 things do you use it for?
2) Epi is the PRIMARY DOC of choice as a?
3) How many mL and mg does an epi pen contain?
4) mL or mg in an epi pen jr?
5) T or F: with the epi auto-injector, the second dose is a manual injection
6) Preferred site for epi-pen injection?
7) Epi ampules: What are the 2 dosages, and what do you use them for?
8) What is the dosage for epi ampules, IM/SM?
9) Proper dosage for a 15 kg child?

Back 41

1) Helps ASAP - Hypotension (severe), Anaphylaxis, Symptomatic bradycardia that is unresponsive to O2, Asthma (severe) and bronchospasm, Pulseless v-tach and v-fib
2) Bronchodilator, vasopressor
3) 0.3 mL of 1:1,000 = 0.3 mg
4) 0.3 mL of 1:2,000 = 0.15 mg
5) T
6) Vastus lateralus
7) 1:1,000 (1 mg/mL) IM/SM, anaphylaxis or asthma/bronchospasm
1:10,000 (0.1 mg/mL) IV, symptomatic bradycardia or cardiac arrest
8) 0.01 mg/kg, repeat q3-5 min PRN
9) 0.15 mL in a 1 mL syringe

Front 42

1) What epi ampule do you use if you're having anaphylaxis or asthma/bronchospasm?
2) What epi ampule do you use if you're having symptomatic bradycardia or cardiac arrest?

Back 42

1) 1:1000 epi (1 mg/mL) IM/SM
2) 1:10,000 epi (0.1 mg/mL, IV)

Front 43

Emergency drug requirements: ATROPINE

1) What conditions do you use it for?
2) How it is packaged?
3) Dosage?
4) This is the 2nd choice after epi for what 2 conditions?

Back 43

1) Vagal or succinylcholine induced bradycardia
2) 0.4 mg/mL in a 20 mL vial
3) 0.02 mg/kg, repeat q 5 min x 4
4) Symptomatic bradycardia associated with poor perfusion or hypotension

Front 44

Emergency drug requirements: BRONCHODILATOR (Albuterol)

1) What condition is it used to tx?
2) Dosage?
3) How does it come packaged?
4) Albuterol Solution and Nebulizer is used for what emergencies? What does it deliver?

Back 44

1) Mild asthmatic attack and bronchospasm
2) 3 puffs q 5-10 minutes
3) 17 gm sprayer
4) Severe asthma attack and bronchospasm, concurrent delivery of aerosolized albuterol and high concentrations of oxygen

Front 45

Emergency Drugs: ANTIHISTAMINE

1) What condition is it used to tx?
2) What are the 2 types and dosages?
3) Injectible diphenhydramine is a primary drug for what condition, and a secondary drug for what condition? Dosage? How does it work, and what is it packaged at?

Back 45

1) Delayed allergic reactions (no bronchospasm or respiratory compromise)
2) Oral Diphenhydramine (Benadryl), 25 mg PO qid for 2 days. Dosage = 1 mg/kg

Oral Loratadine (Claritin), give 10 mg PO, qid for 2 days. Reditabs can dissolve under tongue

3) Primary drug for immediate allergic reaction and secondary drug for anaphylaxis. 25 mg IM STAT, SM dose can be irritating. Histamine blocker, 50 mg/mL in 10 ml vial

Front 46

Emergency drug requirements: Corticosteroid

1) What conditions is it used for? Is this a second or first
2) Dexamethasone - what do you use this for? What does it inhibit? Is this a primary or secondary DOC? How is it packaged? Route of dosage? Dose?
3) How many mg of prednisone or hydrocortisone are equivalent to dexamethasone?

Back 46

1) Angioneurotic edema, croup, allergic reactions
2) Laryngeal edema (croup) and anaphylactic shock. Inhibits edema and capillary dilation. Secondary DOC after epi. 4 mg/mL injectable in 10 mL vial. 2-4 IV or IM, 4 mg or 0.6 mg/kg
3) 20 mg Prednisone, 100 mg hydrocortisone

Front 47

Emergency drug requirements: Antihypoglycemic (Glucose/Dextrose):

1) What is this used for?
2) Available options?

Back 47

1) Insulin shock (PO)
2) Instra-glucose gel (1g/kg PO), GlucoBurst, OJ, dextrose 50% unit dose syringe (0.5 g/ML) or 50 mL IV bag (05. g/kg IV), Glucagon

Front 48

Emergency drug requirements: Narcotic Antagonist

1) Name?
2) How is it packaged?
3) Dosage?
4) Proper dose in a 15 kg child?

Back 48

1) Naloxone (Narcan)
2) 0.4 mg/mL in a 10 mL vial
3) 0.1 mg/kg q 2-3 minutes up to 2 mg (5 mL) total
4) 4 mL SM in 10 mL syringe

Front 49

Emergency drug requirements: Benzodiazepene Antagonist

1) Name?
2) How is it packaged?
3) Initial dosage?
4) Max cumulative dose?
5) How do you dose a 15 kg child?
6) IV admin: incidence of injection pain is ___%. Onset of action? Duration of action? Plasma half-life?
7) SM admin: Where do you administer? Onset of action?
8) T or F: blood level achieved with Flumazenil is similar between IV, SM, and IL routes routes
9) T or F: SM injection site tissue biopsy is normal
10) How do you dose a 20 kg child?

Back 49

1) Flumazenil
2) 0.1 mg/mL in a 5 mL vial
3) 0.01 mg/kg up SM/SL q 3-5 min PRN up to max dose of 0.2 mg (2 mL)
4) 0.05 mg/kg or 1 mg (10 mL)
5) 1.5 mL (mg) dose SM in 3 mL syringe
6) 6%, 1-2 minutes, 20-30 minutes, 1-1.5 hours
7) Max tuberosity site away from LA site, 5 minutes.
8) T
9) T
10) Initially: 0.2 mg -> 2 mL in 3 mL syringe given SM/SL. Wait 3-5 minutes for desired effect, follow up dose of 0.1 mg -> 1 mL SM/sL. Have reached max dose at this weight

Front 50

Flumazenil: IN route:

1) Max dose?
2) Peak plasma concentration?
3) Plasma half-life? Elimination?
4) Absorption is better with a (smaller/larger) volume. Why?
5) Max dosage per naris?
6) What barrier does this go through and why is it so effective?

Back 50

1) 0.004 mg/kg
2) 2 minutes
3) Metabolic = 30 mins, elimination (2 hours)
4) Smaller, excess volume is wasted in the pharynx
5) 1 mL per naris
6) Cribriform plate is the only barrier between the nasal mucosa and brain

Front 51

Flumazenil: Recovery

1) What do you have to support and supplement?
2) Half-life? How does it compare to midazolam's?
3) How long do you have to observe the patient? What should you use to monitor and what should you observe for?
4) T or F: a single intraoral injection of flumazenil can immediately reverse oversedation created by incremental SL dosing with triazolam.
5) T or F: Reversal for the purpose of discharging the patient early is appropriate and safe

Back 51

1) Support airway, supplement O2
2) 20-30 minutes (1/4 that of midazolam)
3) 2 hours, pulse ox - resedation, hypoventilation, anxiety
4) F
5) F

Front 52

Emergency Drug Requirements: NITROGLYCERIN

1) For tx of?
2) How does it come packaged?
3) Dosage?
4) 3 actions?

Back 52

1) Angina
2) Nitrostat (0.4 mg tablets) or nitrolingual spray
3) 0.4 mg sublingual, repeat up to 3 doses at 5 minute intervals
4) Dilates coronary arteries, reverses vasospasm, increases coronary collateral blood flow

Front 53

Emergency drug requirements: ASPIRIN

1) For tx of?
2) How does it come?
3) How does it work?

Back 53

1) Suspected MI
2) 325 mg chewable, non-enteric tablets or powder
3) Blocks synthesis of thromboxane from platelets, prevents vasoconstriction of coronary arteries

Front 54

Emergency Drug Requirements: DIAZEPAM (valium) or MIDAZOLAM:

1) Used to tx?
2) Dosages?
3) What should you prepare for?

Back 54

1) Status epilecticus (seizure for 5 minutes or more)
2) IN Midazolam (0.2-0.3 mg/kg)**, IM midazolam (5 mg), IV diazepam (2-20 mg) (0.1-0.3 mg/kg IV), titrate 5 mg/min or midazolam (1 mg/min titration)
3) Prolonged postictal phase

Front 55

Emergency Drug Requirements: ANTIEMETIC/ANTICHOLINERGIC:

1) For treatment of?
2) Choices?

Back 55

1) Nausea/vomiting
2) Promethazine (25 mg/mL) or Zofran aka Ondansetron (2 mg/mL)

Front 56

Emergency Drug Requirements: VASOPRESSOR

1) For treatment of?
2) What is the drug, how is it packaged, and how does it work? (There is one main drug and two additional options)
3) Dose?
4) If patient is hypotensive, what is the DOC?

Back 56

1) Hypotension
2) Vasopressin (20 units/mL). Anti-diuretic hormone, raises BP by constricting blood vessels. Other options: ephedrine, phenylephrine
3) Give 0.25 mL (5 units) IM, SM, or IN
4) Epinephrine

Front 57

Emergency drug requirements: ANTIHYPERTENSIVE

1) For tx of?
2) Drug? Dosage?
3) What do you have to apply to monitor

Back 57

1) Hypertension
2) Labetalol, 5 mg/mL in 20 mL multiple dose vial, give 10-20 mg (2-4 mL IV or IM q 15 minutes)
3) ECG

Front 58

Emergency drug requirements: LIDOCAINE

1) For tx of?
2) How does it work?
3) How is it packaged? Dose?

Back 58

1) Ventricular dysrhythmias/tachyarrhythmias
2) Increases threshold of the action potential of the heart, decrease irritability of heart
3) 20 mg/mL vial in 5 mL syringe. 1 mg/kg IV/IO q 3-5 minutes

Front 59

Emergency Drug Requirements: Amiodarone
1) What is it used for?
2) How is it packaged?
3) Recommended dose for children and adults, and what is the issue?

Back 59

1) REFRACTORY ventricular fibrillation (initially resuscitated but relapsed)
2) 150 mg ampule, 50 mg/ml vial
3) Adult 300 mg IV push, Child 5 mg/kg bolus (BUT NOT recommended for kids by manufacturer!)

Front 60

Emergency Drug Requirements:

1) 3 additional things required by Florida BOD for deep sedation?

Back 60

1) PSVT - Adenosine, 3 mg/mL
2) Muscle relaxant for Laryngospasm, succinylcholine 100 mg/mL
3) Antidysrhythmic, Verapamil 2.5 mg/mL in 2 and 4 mL ampules

Front 61

Emergency Drug Requirements Recommended by AAPD: Ammonia Inhalants

1) To tx what?
2) Do healthy children faint?
3) Proper positioning?

Back 61

1) Vasovagal syncope and prolonged recovery
2) No
3) Supine position with feet elevated

Front 62

4 ways you can organize your emergency drugs?

Back 62

1) Tackle box
2) Individual zip-lock plastic bags with vial, syringe, and dose sheet
3) Broslow Tape and Bag system (7 specific child-length based modules), tape indicates choice of module (color) and provides doses
4) Cart drawer with labeled dividers

Front 63

8 things that you should do while communicating with an EMS operator

Back 63

1) State that you have a medical emergency
2) Tell them if the patient's conscious
3) Tell them what happened to cause the emergency
4) What you're doing to fix it
5) Who's doing it
6) Location/address
7) Ask how long before an ambulance will arrive
8) Don't hang up until the operator tells you to

Front 64

How does the attending faculty start the ball rolling on the note card system of duties?

Back 64

1) Assess nature of emergency
2) Determines level of assistance required (level 1 = urgent, level 2 = emergent, level 3 = cardiac arrest), gives duty cards to emergency response team, communicates level to assistant #2, who delivers card to receptionist.

Front 65

What's on the attending faculty's note card for an emergency?

Back 65

1) Distribute equipment from emergency cart
2) Directs initiation of therapy
3) Determines drugs/dosages
4) Draws and administers drugs (IM) or hands to resident for SM route

Front 66

What is the duty of the resident on the emergency card?

Back 66

1) Follows directive of attending faculty
2) Performs BLS (CAB)
3) Administers bag-mask ventilation

Front 67

What are the duties of the assistant #1?

Back 67

1) Suctions airway
2) Attaches vital signs monitor (pulse ox probe on great toe, BP cuff on calf of opposite leg)
3) Records vitals and drugs given
4) Assists in BLS (does the chest compressions)

Front 68

What is the role of the recorder - what 4 things do they need to document?

Back 68

1) Any meds delivered, including O2
2) Time and amount of drugs delivered
3) Condition of the patient as emergency treatment progresses
4) Time EMS called and arrived

Front 69

What are the duties of assistant #2 during an emergency?

Back 69

1) Brings emergency cart with vital signs monitor to attending faculty
2) Distributes duty cards to emergency response team
3) Communicates level of emergency to receptionist
4) Returns to site to assist management and communication
5) Communicates with parent (family liaison)

Front 70

What are the duties of the receptionist during an emergency?

Back 70

1) Response to level communicated by assistant #2 (urgent or emergent)
2) Go out to hallway to direct personnel