Emergency Medicine Quiz
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Emergency Medicine Quiz

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Questions and Answers

What is a common early symptom of acute adrenal insufficiency?

  • Diarrhea
  • Severe chest pain
  • Fever
  • Dizziness (correct)

    • What is the maximum dose of SOLU-MEDROL for pediatric patients?

  • 2 mg/kg
  • 125 mg (correct)
  • 10 mg/kg
  • 100 mg

    • Which of the following is a contraindication for administering push-dose pressor epinephrine?

  • Electrolyte imbalances
  • Hypotension secondary to blood loss (correct)
  • Severe allergic reactions
  • Moderate dehydration

    • What is the initial fluid resuscitation dose of normal saline for adult patients?

    <p>1 L</p> Signup and view all the answers

    What is the dilution ratio used to create push-dose pressor epinephrine?

    <p>1:100,000</p> Signup and view all the answers

    What is the maximum single dose of Dextrose 10% (D10) that can be administered to a patient?

    <p>200 mL</p> Signup and view all the answers

    Which symptom is most commonly associated with hyperkalemia?

    <p>Tall peaked T-waves</p> Signup and view all the answers

    In cases of diabetic emergencies, what is the contraindication for administering Oral Glucose?

    <p>Patients who are not conscious enough to swallow</p> Signup and view all the answers

    Which medication is recommended for dystonic reactions in adults?

    <p>Benadryl</p> Signup and view all the answers

    What is the initial adult dosage of Normal Saline for fluid resuscitation?

    <p>1 L IV/IO</p> Signup and view all the answers

    What is the maximum dosage for pediatric patients requiring Normal Saline for hypotension?

    <p>20 mL/kg IV/IO</p> Signup and view all the answers

    Which of the following is FALSE regarding the administration of Sodium Bicarbonate?

    <p>Can be given with Calcium Chloride without flushing</p> Signup and view all the answers

    When should normal saline be given to a pediatric patient with a history of dehydration?

    <p>For indications like dry mouth or fatigue</p> Signup and view all the answers

    What is a common presentation for a dystonic reaction?

    <p>Muscle spasms in various body parts</p> Signup and view all the answers

    What is the correct dosage of glucagon for a pediatric patient weighing less than 20 kg?

    <p>0.5 mg IM/IN</p> Signup and view all the answers

    What is the maximum dose of Zofran for adults when administered via IV/IO?

    <p>8 mg</p> Signup and view all the answers

    Under what condition should caution be used when administering Zofran?

    <p>If the QTc is greater than 460 ms</p> Signup and view all the answers

    What is the recommended dosage of Normal Saline for pediatric patients who are hypotensive?

    <p>20 mL/kg IV/IO</p> Signup and view all the answers

    In patients with COPD or asthma experiencing respiratory distress, what is a primary concern during assisted ventilations?

    <p>Avoiding increased Intrathoracic pressure</p> Signup and view all the answers

    When administering CPAP to patients with CHF, what pressure setting is recommended?

    <p>10 cm H2O</p> Signup and view all the answers

    What is the protocol for discontinuing positive pressure ventilations in adults during respiratory distress?

    <p>20-40 seconds</p> Signup and view all the answers

    What is the dosage of Epinephrine for severe asthma not responding to treatment?

    <p>0.3 mg IM</p> Signup and view all the answers

    Which of the following patients requires caution when receiving Normal Saline?

    <p>Patients with significant coronary heart disease</p> Signup and view all the answers

    For pediatric patients weighing 20 kg to 39 kg, what is the maximum dose of Zofran via Sublingual administration?

    <p>4 mg</p> Signup and view all the answers

    What is the primary risk associated with Auto PEEP in respiratory distress management?

    <p>Hypotension</p> Signup and view all the answers

    What is the maximum total dose for Push-Dose Pressor Epinephrine?

    <p>0.2 mg</p> Signup and view all the answers

    What is the correct rate of administration for Push-Dose Pressor Epinephrine?

    <p>1 mL/minute</p> Signup and view all the answers

    Which of the following is NOT a precaution for Push-Dose Pressor Epinephrine?

    <p>Repeat administration every 2 minutes</p> Signup and view all the answers

    For a pediatric patient experiencing mild allergic reactions, what is the recommended dose of Benadryl?

    <p>1 mg/kg IV/IO/IM, max 50 mg</p> Signup and view all the answers

    Which symptom is NOT typically associated with diabetic ketoacidosis (DKA)?

    <p>Generalized urticaria</p> Signup and view all the answers

    What is the first-line treatment for adults with a blood glucose level (BGL) less than 60 mg/dL who are conscious enough to swallow?

    <p>Oral glucose 15g</p> Signup and view all the answers

    What is the purpose of diluting Push-Dose Pressor Epi to 1:100,000?

    <p>To achieve a safe and effective dosing concentration</p> Signup and view all the answers

    In cases of moderate allergic reactions, which medication dose should NOT be repeated more than twice?

    <p>Epinephrine</p> Signup and view all the answers

    Which route of administration is NOT recommended for Benadryl in pediatric patients with a mild allergic reaction?

    <p>PO</p> Signup and view all the answers

    What is the recommended dilution for Benadryl when given IV/IO?

    <p>9 mL Normal Saline</p> Signup and view all the answers

    What is the maximum dose of Dextrose 10% (D10) for adults with blood glucose less than 60 mg/dL?

    <p>200 mL</p> Signup and view all the answers

    In which situation should Push-Dose Pressor Epinephrine be administered with caution?

    <p>Patients with significant renal failure</p> Signup and view all the answers

    For a pediatric patient with severe allergic reactions, what is the maximum single dose of Epinephrine?

    <p>0.3 mg</p> Signup and view all the answers

    What is the maximum single dose of epinephrine for severe asthma treatment in children?

    <p>0.3 mg</p> Signup and view all the answers

    When administering magnesium sulfate, what is the maximum total dose that can be given?

    <p>2g</p> Signup and view all the answers

    For patients with croup, what age is most commonly associated with the condition?

    <p>1-3 years old</p> Signup and view all the answers

    What assessment tool is used to evaluate possible large vessel occlusion during a stroke alert?

    <p>RACE assessment</p> Signup and view all the answers

    What is the appropriate administration method for albuterol in children over 1 year old with bronchospasm?

    <p>2.5 mg via nebulizer</p> Signup and view all the answers

    Which condition is a contraindication for administering magnesium sulfate?

    <p>2nd and 3rd Degree Heart Blocks</p> Signup and view all the answers

    What is the preferred method of oxygen administration for pediatric patients in respiratory distress with pulse oximetry under 94%?

    <p>2 LPM NC</p> Signup and view all the answers

    What is the recommended position for a patient assessed for a stroke?

    <p>Supine</p> Signup and view all the answers

    What should be avoided when treating epiglottitis in a pediatric patient?

    <p>Intubation</p> Signup and view all the answers

    What is the initial dose of SOLU-MEDROL for a pediatric patient experiencing severe asthma?

    <p>2 mg/kg</p> Signup and view all the answers

    What may occur with rapid infusion of magnesium sulfate?

    <p>Hypotension</p> Signup and view all the answers

    Which of the following is not a common condition associated with seizures?

    <p>Hypertension</p> Signup and view all the answers

    What is the primary action required for a pediatric patient with stridor and a barky cough?

    <p>Expedite transport to a Comprehensive Pediatric ED</p> Signup and view all the answers

    Study Notes

    Acute Adrenal Insufficiency

    • Adrenal insufficiency, also known as Addison's disease, is an endocrine disorder characterized by insufficient cortisol and glucocorticoid hormone production by the adrenal glands.
    • This deficiency hinders the body's response to stress and inflammatory reactions.
    • Early signs and symptoms include pallor, dizziness, headache, and weakness/lethargy.
    • In adult patients, abdominal pain, nausea/vomiting, and hypoglycemia are additional indicators.
    • Treatment for adults includes administration of 1L IV/IO normal saline (titrated to maintain SBP ≥ 90 mmHg), followed by a single dose of 125mg IV/IO/IM Solu-Medrol.
    • If hypotension persists, administer push-dose pressor epinephrine (1:100,000) diluted to 10mcg/mL, at a rate of 1mL/minute IV/IO.
    • The maximum total dose of push-dose pressor epinephrine is 0.2mg (20mL).
    • Pediatric treatment involves 20mL/kg IV/IO normal saline (titrated to maintain age-appropriate SBP), followed by 2mg/kg IV/IO/IM Solu-Medrol (maximum dose 125mg).
    • If hypotension persists, administer push-dose pressor epinephrine (1:100,000) diluted to 10mcg/mL, at a rate of 1mL/minute IV/IO.
    • The maximum total dose of push-dose pressor epinephrine is 0.2mg (20mL).

    Allergic Reaction

    • Allergic reactions can manifest as generalized urticaria, airway swelling, respiratory distress, bronchospasm, tongue and/or facial swelling, nausea, vomiting, diarrhea, loss of radial pulse, or SBP < 90 mmHg.
    • Mild allergic reactions presenting only as generalized urticaria should be treated with 50mg IV/IO/IM Benadryl (diluted in 9mL normal saline for IV/IO administration).
    • Moderate allergic reactions with airway swelling, respiratory distress/bronchospasm, and/or tongue and/or facial swelling require administration of 0.3mg IM epinephrine (1:1,000, 1mg/mL) with the possibility of repeating the dose twice at 5-minute intervals.
    • Additionally, administer 50mg IV/IO/IM Benadryl (diluted in 9mL normal saline for IV/IO administration), nebulized albuterol (2.5mg) and atrovent (0.5mg), and 125mg IV/IO/IM Solu-Medrol.
    • Severe allergic reactions characterized by loss of radial pulse or SBP < 90 mmHg should be treated with push-dose pressor epinephrine (1:100,000) diluted to 10 mcg/mL, administered at a rate of 1mL/min IV/IO.
    • Administer 1L IV/IO normal saline, titrated to the desired effect.
    • Continue to assess lung sounds and BP frequently.
    • Additionally, repeat the administration of Benadryl, albuterol+atrovent, and Solu-Medrol as previously outlined.
    • Pediatric treatment for mild allergic reactions involves 1mg/kg IV/IO/IM Benadryl (diluted in 9mL normal saline for IV/IO administration), with a maximum dose of 50mg.
    • Treatment for moderate allergic reactions includes 0.01mg/kg IM epinephrine (1:1,000, 1mg/mL) with a maximum single dose of 0.3mg.
    • Additionally, administer 1mg/kg IV/IO/IM Benadryl (diluted in 9mL normal saline for IV/IO administration) with a maximum dose of 50mg.
    • Nebulized albuterol (2.5mg) and atrovent (0.5mg) should be administered.
    • Solu-Medrol (2mg/kg IV/IO/IM) with a maximum dose of 125mg should also be administered.
    • Severe allergic reactions warrant the administration of push-dose pressor epinephrine (1:100,000) diluted to 10mcg/mL at 1mL/minute IV/IO.
    • Administer 20mL/kg IV/IO normal saline, assess lung sounds and BP frequently, and repeat administration as necessary.
    • Continue with Benadryl, albuterol+atrovent, and Solu-Medrol treatments as previously outlined.

    Diabetic Emergencies

    • Diabetic patients taking oral hypoglycemic medications (e.g., Glyburide, Glimepiride, and Glipizide) should be transported promptly.
    • Signs and symptoms of diabetic ketoacidosis (DKA) include nausea/vomiting, abdominal pain, general weakness, Kussmaul respirations (deep rapid respirations), altered mental status (AMS), hypotension, tachycardia, and an acetone smell on the patient's breath.
    • Adult patients with BGL < 60 mg/dL should receive 15g of oral glucose, which can be repeated once if necessary.
    • If the patient is unconscious and unable to swallow, administer 100mL IV/IO Dextrose 10%, which can be repeated once with a maximum dose of 200mL.
    • In the case of cardiac arrest with BGL < 60 mg/dL, administer 250mL IV/IO Dextrose 10% rapidly.
    • If unable to provide the above treatment, administer 1mg IN or IM glucagon if available.
    • For BGL > 300mg/dL, administer 1L IV/IO normal saline, titrated to the desired effect, frequently assessing lung sounds and BP.
    • Pediatric patients (neonates) with a BGL < 40 mg/dL or older children with a BGL < 60 mg/dL should receive 15g of oral glucose if they are at least 3 years old and able to swallow and follow commands.
    • If the patient is unable to swallow, administer 5mL/kg IV/IO Dextrose 10% using a 10 gtt/set, with a maximum single dose of 100mL.
    • For patients with BGL > 300 mg/dL, administer; 20mL/kg IV/IO normal saline, assessing lung sounds and BP frequently.
    • Repeat the administration of normal saline as needed for BGL > 300mg/dL.

    Dystonic Reaction

    • Dystonic reactions are characterized by spasmodic or sustained involuntary muscle contractions.
    • Dystonic reactions most commonly affect the face, neck, trunk, pelvis, extremities, and even the larynx.
    • The following classes of medications commonly cause dystonic reactions: antipsychotic (e.g., Haldol, Risperdal), antiemetic (e.g., Compazine, Reglan, Phenergan), and antidepressant (e.g., Prozac, Paxil).
    • Adult treatment for dystonic reactions involves administering 50mg IV/IO/IM Benadryl (diluted in 9mL normal saline for IV/IO administration).
    • Pediatric treatment for dystonic reactions entails administering 1mg/kg IV/IO/IM Benadryl (diluted in 9mL normal saline for IV/IO administration) with a maximum dose of 50mg.

    Fluid Resuscitation/Dehydration

    • Fluid resuscitation is indicated for hypotension, fatigue, dark color urine, dry mouth, headache, prolonged vomiting or diarrhea, non-traumatic bleeding (vaginal or GI), suspected rhabdomyolysis, and at the discretion of the paramedic.
    • For adults, administer 1L IV/IO normal saline, titrated to the desired effect. In trauma patients, use Lactated Ringers for the first liter.
    • Monitor lung sounds and BP frequently, and repeat the administration of normal saline if necessary.
    • For pediatric patients, administer 20mL/kg IV/IO normal saline, monitoring lung sounds and BP frequently. In neonates, administer 10mL/kg IV/IO normal saline.
    • Repeat the administration of normal saline as needed to address age-appropriate hypotension.

    Hyperkalemia

    • Hyperkalemia is often observed in patients with renal failure/dialysis who are pre-dialysis and present with general weakness, cardiac arrhythmias, and ECG abnormalities.
    • Classic ECG abnormalities that signal hyperkalemia include tall peaked T-waves (most prominent early sign), sine wave, wide complex QRS, regular really wide complex tachycardia (RRWCT), and severe bradycardia, as well as high-degree AV blocks.
    • In the event of cardiac arrhythmias and ECG abnormalities associated with hyperkalemia, administer 1g of calcium chloride diluted in a 100mL D5W bag using a 10gtt/set over 2 minutes IV/IO.
    • Additionally, deliver 2.5 mg of nebulized albuterol and 50 mEq IV/IO of sodium bicarbonate over 2 minutes.
    • If the patient presents with hypotension, administer 500mL IV/IO of normal saline, titrated to effect while frequently assessing lung sounds.
    • Pediatric patients with hyperkalemia should be referred to a physician for appropriate treatment.

    Nausea / Vomiting

    • Patients presenting with nausea and/or vomiting should be assessed for potential underlying causes.
    • These may include cardiac issues, stroke, diabetic complications, head injuries, or other medical conditions.
    • For adults, administer 1L IV/IO normal saline, titrated to the desired effect, while monitoring lung sounds and BP.
    • Additionally, administer 4mg IV/IO/IM/PO of Zofran over 2 minutes, with a maximum dose of 8mg.
    • For pediatric patients, administer 20mL/kg IV/IO normal saline, monitoring lung sounds and BP frequently. In neonates, administer 10mL/kg IV/IO normal saline.
    • For children weighing less than 40kg, administer 0.1mg/kg IV/IO/IM of Zofran over 2 minutes.
    • For children weighing 40kg or more, administer 4mg IV/IO/IM Zofran over 2 minutes, with the potential for administering a second dose 30 minutes later with a maximum dose of 8mg.
    • If the patient is 20kg or more, administer 4mg sublingual of Zofran ODT, with the potential for repeating the dose once in 10-15 minutes for a maximum dose of 8mg.

    Respiratory Distress

    • COPD and asthma patients have prolonged exhalation secondary to bronchospasm, leading to air trapping and hypercapnia (high levels of CO2).
    • EtCO2 guidelines should be disregarded for these patients, as maintaining SpO2 levels at 90% is more critical.
    • Trying to maintain normal EtCO2 levels in COPD and asthma patients puts them at risk for auto PEEP.
    • Auto PEEP occurs when air enters the lungs during assisted ventilations before the patient can fully exhale, causing the lungs to expand like a balloon, potentially leading to a pneumothorax or hypotension.
    • COPD or asthma patients experiencing poor bag compliance or hypotension during positive pressure ventilations should have positive pressure ventilation discontinued to allow complete exhalation before resuming ventilations.
    • If an advanced airway is in place, disconnect the BVM to permit the patient to exhale for 20-40 seconds in adults and 10-20 seconds in pediatric patients.
    • Treatment for bronchospasm secondary to COPD, asthma, and pneumonia involves nebulized albuterol (2.5mg) and atrovent (0.5mg) for adults and albuterol (2.5mg) and atrovent (0.5mg) for pediatric patients, with an option to repeat the administration twice.
    • For moderate or severe respiratory distress, administer CPAP at 10cm H2O for CHF and 2.5-5cm H2O for asthma, pneumonia, and COPD.
    • Contraindications for CPAP include SBP < 90mmHg, absence of spontaneous respirations, decreased LOC (lethargic), and patients weighing less than 30kg.
    • For severe asthma patients not responding to initial treatments, 0.3mg IM epinephrine (1:1,000, 1mg/mL) can be administered with the possibility of repeating the dose twice at 5-minute intervals for adults and 0.01mg/kg IM epinephrine (1:1,000, 1mg/mL) with a maximum single dose of 0.3mg for pediatric patients.
    • Magnesium sulfate (2g diluted in a 100mL D5W bag using a 10gtt/set for adults and 50mg/kg diluted in a 100mL D5W bag using a 10gtt/set for pediatric patients) can be infused over 10 minutes IV/IO with a maximum total dose of 2g.
    • For croup and epiglottitis, administer 3mg (3mL total) of nebulized epinephrine (1:1,000, 1mg/mL) and ventilate the patient via BVM as needed.
    • Croup typically affects children under 3 years old with a gradual onset, low-grade fever, and a “sick” presentation for several days.
    • Epiglottitis commonly affects children between 3-6 years old, with a sudden onset, high-grade fever, and stridor or a “barky” cough.

    Seizure

    • Potential causes of seizures include meningitis, fever, head trauma, hemorrhagic stroke, drugs, alcohol, diabetes, and poisoning.
    • Monitor EtCO2 to assess the patient’s respiratory status and obtain a blood glucose level.
    • If the pregnant patient is seizing, refer to the “Eclampsia” protocol.
    • When a patient is actively seizing, administer 5mg IV/IO of Versed, which can be repeated once at 5-minute intervals if the seizure recurs or does not subside, with a maximum total dose of 10mg.
    • Alternatively, administer 10mg IN/IM of Versed.
    • Contraindications for Versed administration include hypotension, blood pressure ≥ 180mmHg, altered LOC with a GCS < 10, or if the paramedic deems a neurologic etiology is present based on the patient’s history.
    • If the patient's RACE score is 0, the paramedic must carefully consider a neurologic etiology.

    Stroke

    • The RACE assessment is a valuable tool for distinguishing potential large vessel occlusion (LVO) when the score is 5 or greater and/or cortical signs are exhibited.
    • When “STROKE ALERT” is activated during hospital telemetry, the RACE score should be provided.
    • If a cortical sign is noted, provide the RACE score followed by a “plus” after the number. Agnosia or Aphasia assessment is included in the RACE score.
    • The on-scene time for a Stroke Alert should be minimized to no more than 10 minutes, if possible.
    • All Stroke Alerts should be transported EXCLUSIVELY to a COMPREHENSIVE STROKE CENTER (CSC). ### Agnosia
    • Difficulty identifying familiar objects.
    • Example: Patient may not identify a key, safety pin, or dog.

    Aphasia

    • Impairment of language affecting production or comprehension of speech.
    • Difficulty with reading or writing.
    • May use words in the wrong order or inappropriate words.

    Stroke - Adult

    • Positioning: Supine
    • Exceptions:
      • Head elevated 15 degrees for diagnosed intracerebral hemorrhage (interfacility transport)
      • Head elevated 15 degrees for patients short of breath
    • Oxygen:
      • 2 LPM NC if pulse oximetry less than 94%
      • For respiratory distress, manage airway as needed and consider advanced airway intervention
    • IV Access:
      • Establish an 18g catheter in the antecubital vein (preferred)
      • Two IVs if possible
    • Normal Saline:
      • 500mL IV/IO, regardless of blood pressure
    • Transport:
      • Transport to a comprehensive stroke center.

    Stroke – Pediatric

    • Positioning: Supine
    • Exceptions:
      • Head elevated 15 degrees for diagnosed intracerebral hemorrhage (interfacility transport).
      • Head elevated 15 degrees for patients short of breath
    • Oxygen:
      • 2 LPM NC if pulse oximetry less than 94%.
      • For respiratory distress, manage airway as needed and consider advanced airway intervention
    • IV Access:
      • Establish an appropriate sized catheter.
      • Antecubital vein preferred.
    • Normal Saline:
      • 20mL/kg IV/IO, regardless of blood pressure.
      • Newborn: 10 mL/kg IV/IO. 
 - Max dose 250mL.
    • Transport:
      • Transport to Joe DiMaggio (preferred) or Broward Health Medical Center.

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    Test your knowledge on acute adrenal insufficiency, pediatric dosing of SOLU-MEDROL, contraindications for epinephrine, and fluid resuscitation protocols. This quiz is designed for those studying emergency medicine or healthcare professionals looking to refresh their knowledge in critical care.

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