Questions and Answers
What is the maximum single dose of Racemic Epinephrine that can be administered for bronchospasm?
Which medication is administered for excited delirium with a potential repeat dose?
What is the recommended dosage of Morphine for IV administration?
Which of the following medications requires Narcan to be on hand during administration?
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What is the maximum dose of Midazolam that can be administered for a conscious patient?
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For hypertensive emergencies related to cocaine or methamphetamine use, which medication should be used?
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When preparing for rapid sequence intubation (RSI), which medication is used as a paralytic?
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What is the appropriate repeat dose interval for Lorazepam during sedation for a conscious patient?
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What is the maximum dose of Esmolol that can be administered for hypertension in aortic aneurysm or dissection?
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Which medication should be used for anaphylaxis if symptoms persist after the first dose?
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What is the infusion rate of Sodium Bicarb for crush injury maintenance?
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For patients experiencing hyperthermia or heatstroke, how often can Normal Saline 9% be repeated?
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What is the maximum amount of Regular Insulin that can be given immediately after 25g of D10W?
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What is the appropriate dosage of Mannitol for traumatic brain injury, based on patient weight?
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Which medication is given for burn trauma and how should it be administered?
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What is the initial bolus amount of Heparin for pulmonary embolism treatment based on patient weight?
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What is the maximum infusion rate for Nicardipine in the management of hypertensive emergencies?
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In the treatment protocol for unstable bradycardia, what is the maximum total dose of Atropine that can be administered?
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What dose of Thiamine is recommended for patients with a history of alcohol abuse in case of altered mental status?
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What is the maximum dose of Nitroglycerin for a patient with chest pain and SBP > 90mmHg?
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In case of hypoglycemia, what should be administered if blood sugar remains below 60 but symptoms persist after one dose of D10W?
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What is the initiation dose of Esmolol for a patient requiring rate control in narrow complex tachycardia?
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What is the maximum dose of Lidocaine that can be administered per kg in the case of an overdose?
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What is the appropriate dose of Ranitidine for GI bleeding management?
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During an ischemic stroke protocol, what is the maximum dose of Alteplase that can be administered?
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In managing a patient with anaphylaxis, what is the first-line medication?
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In a case of SBP > 180 or DBP > 110 during or after Alteplase administration, what is the appropriate medication to manage hypertensive episodes?
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What is the appropriate dosage for Magnesium Sulfate in the case of suspected Torsades de Pointes?
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What is the initial bolus dose for fluid resuscitation in septic shock?
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Which medication has been shown to be contraindicated in cases of digoxin toxicity?
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Study Notes
Pain Control
- Morphine: 2-5mg IVP every 5 min (administered over 2 min) or 2-5mg IM every 15 min.
- Fentanyl: Administer 50-100mcg IVP (over 2 min), repeat in 5 min (maximum total of 100mcg). For IM, 50mcg can be repeated once in 15 min (maximum total 100mcg).
- Hydromorphone: 0.5-1mg IVP, with one allowed repeat.
- Ketamine: 30mg IVP post-opioid, may repeat in 15 min.
- Zofran: 4mg IVP/IM (over 2 min), can repeat in 15 min for a total of 8mg.
- Narcan should be available during pain medication administration.
Sedation
-
Conscious patients:
- Midazolam: 2.5-5mg IVP/IN/IM every 5 min.
- Lorazepam: 1-4mg IVP every 15 min.
- Diazepam: 2-10mg IVP/IM every 10 min.
-
Intubated patients:
- Propofol: Continue current rate; increase by 5-10mcg every 5-10 min (range: 5-55mcg/kg/min).
- Midazolam: 2.5-5mg IVP/IN/IM, repeat in 5 min.
- Rocuronium: 0.6-1.2mg/kg every 30 min if paralytics are indicated.
-
Excited Delirium:
- Ketamine: 1mg/kg IVP or 2mg/kg IM, may repeat once only.
Blood Reaction
-
Allergic reaction:
- Diphenhydramine: 25-50mg IVP/IM.
-
Signs of CHF:
- Furosemide: 20mg IVP/IO every unit.
Bronchospasm
- Albuterol: 2.5mg/3ml nebulized, repeat PRN.
- Ipratropium: 0.5mg/2.5ml nebulized (or as DuoNeb), repeat up to 4 times.
- Prednisone: 60mg PO; Methylprednisolone: 125mg IVP; Dexamethasone: 10mg IVP.
- Racemic Epi: Max single dose of 0.5ml, may repeat every 20 min.
- Magnesium Sulfate: 2g IVP over 20 min for severe asthma exacerbation.
- Epi 1:1,000: 0.3mg IM; Terbutaline: 0.25mg SQ/IM.
Hypertensive Emergencies
-
HTN due to cocaine/meth use:
- Midazolam, Lorazepam, and Diazepam for management with varied dosing intervals.
- HTN with tachycardia, headache, and confusion: Use Labetalol, Hydralazine, Nicardipine, Esmolol, or Nitroglycerin with specific dosing parameters.
- For non-response, Nitroprusside can be employed with incremental increases.
Pulmonary Edema/CHF
- Use Nitroglycerin and Furosemide for symptom relief; Enalapril for specific conditions, Milrinone for cardiogenic shock.
ACS/STEMI Management
- Aspirin, Heparin, and Nitroglycerin are key agents for management; protocols establish dosing limits.
Seizures
- Lorazepam, Midazolam, and Diazepam are primary medications for acute seizure management.
- In refractory cases, consider Fosphenytoin or Phenobarbital.
Stroke Management
- Ischemic Stroke: Administer Alteplase with strict guidelines on dosing and monitoring.
- Hypertensive management during Alteplase uses Labetalol or Nicardipine.
- Hemorrhagic Stroke: Same medications apply, with possible use of Mannitol for intracranial pressure management.
Toxin Exposure Management
- Beta Blockers: Normal saline and Calcium agents for overdoses.
- CO Poisoning: Use Cyanokit if initiated.
- Narcotic OD: Narcan administration is critical.
Hypoglycemia & Hyperglycemia/DKA
- Hypoglycemia: Utilize Thiamine, D10W, and Glucagon for quick correction.
- Hyperglycemia/DKA: Manage with NS and Insulin Infusion protocols.
Special Cases
- Anaphylaxis: Immediate treatment includes fluids, bronchodilators, and Epinephrine.
- Sepsis management: Balance fluids and vasopressors as needed to maintain hemodynamics.
Miscellaneous
- Protocols for managing altered mental status, potassium imbalances, heat-related illnesses, traumatic injuries, and crush injuries have specific medication outlines.
- Transcutaneous pacing and ventilation strategies involve adjusting rates based on real-time metrics of CO2.
General Guidelines
- All medications have specified dosing intervals, maximum allowable doses, and considerations for clinical conditions.
- Protocols emphasize monitoring responses and adjusting therapies to ensure patient safety and efficacy.
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Description
This quiz covers essential medications used in critical care settings for pain control, including dosages and administration routes. Learn about the specific medications such as Morphine, Fentanyl, and others, and their administration protocols. Understanding these medications is crucial for effective patient care in emergency situations.
