Questions and Answers
What is the characteristic sputum production in Heart Failure?
Which of the following is a risk factor for both Heart Failure and Acute Myocardial Infarction?
What is the typical chest pain duration in Acute Myocardial Infarction?
What is the characteristic air entry pattern in Pneumonia?
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What is the characteristic temperature pattern in Pneumonia?
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What is the characteristic crackle pattern in Heart Failure?
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What is the typical blood pressure pattern in severe shortness of breath?
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What is the characteristic wheezing pattern in COPD?
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Which of the following is NOT a primary function of non-invasive positive pressure ventilation (NIPPV) / CPAP?
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Which of the following clinical findings suggests the potential need for NIPPV/CPAP in a patient with respiratory distress?
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How does NIPPV/CPAP help improve alveolar aeration?
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Which of the following is NOT a potential benefit of NIPPV/CPAP in patients with respiratory distress?
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How does NIPPV/CPAP affect afterload?
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Which of the following describes the mechanism by which NIPPV/CPAP improves pulmonary compliance?
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Which of the following is a key characteristic of NIPPV/CPAP that distinguishes it from other forms of ventilation?
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Which of the following would be a contraindication to the use of NIPPV/CPAP?
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What is the significance of a concordant ST elevation ≥ 1 mm in terms of scoring?
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According to the updated Smith criteria, what happens if the ST-QRS ratio is greater than 0.25?
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What does excessive discordant ST elevation ≥ 5 mm suggest in the context of the QRS complex?
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How does the Smith criteria differ from the Sgarbossa’s criteria regarding point allocation?
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Which of the following is an indicator of Left Main Disease?
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In the context of diagnosing myocardial infarction in patients with known LBBB, what is the sensitivity and specificity of having any single criterion present?
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Which dosage of Acetaminophen IV should be administered for a child weighing 15.4 lbs (7 kg)?
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What is the maximum total dose of Acetaminophen IV that can be given in a single day?
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For a child weighing 22 lbs (10 kg), how much Epinephrine IV should be administered?
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What defines a posterior STEMI based on the content provided?
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What is the dose of Midazolam to be given to a child weighing 30 lbs (14 kg)?
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How should Fentanyl be administered for a child weighing 9 kg?
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What is the minimum dose of Diphenhydramine that can be administered to a child?
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In the context of cardiac conditions, which ST elevation criteria applies to women?
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What is the maximum single dose of Midazolam that can be given?
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How much Naloxone should be administered for a child with a weight of 40 lbs (18 kg)?
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A patient has a fractured proximal humerus. Which route of medication administration is contraindicated?
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Which of the following is NOT a contraindication for IO access?
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When administering a medication intranasally, what should be done if the total volume exceeds 0.4 mL?
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Which of the following is a critical step to take before administering a medication intravenously?
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In which situation would an intramuscular (IM) injection be preferred over an intranasal (IN) injection?
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What is the purpose of the Medication Administration Cross-Check Procedure (MACC)?
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What is the recommended site for an intramuscular injection in adults?
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Which of the following routes of medication administration is most likely to be associated with rapid onset of action?
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Study Notes
Drug Routes
- IN route is generally preferred over IM unless contraindicated
- IN or NAS routes: use nostrils for secretions/obstructions, suction, and remove NPA; max 1 mL/nostril
- IM preferred site: Vastus Lateralus muscle in mid-anterolateral thigh
- IO approved sites: Proximal humerus, proximal tibia, distal tibia, and distal femur (depending on age)
- IV selection: based on vein condition, purpose (fluid/drugs to be infused), patient age/size, clinical status, and presence of special vein & skin problems
7 RIGHTS of Medication Administration
- RIGHT Patient: Confirm absence of allergy
- RIGHT Drug: Check package/drug container for name, concentration, integrity/sterility of parenteral medication, and expiration date
- RIGHT Dose: Prepare dose in compliance with SOP/OLMC, with consideration for controlled substances, IV inopressors, and high-risk meds
- RIGHT Route: Verify correct route of administration
- RIGHT Time: Verify correct time of administration
- RIGHT Response: Monitor for desired response and side effects
- RIGHT Documentation: Accurately document medication administration
Medication Doses for Pediatrics
- Acetaminophen IV: 15 mg/kg, max dose 750 mg, max daily dose 3750 mg
- Adenosine: 0.1 mg/kg, max 6 mg
- Amiodarone: 5 mg/kg
- Atropine: 0.02 mg/kg
- Diphhenhydramine: 1 mg/kg, max 50 mg
- Epinephrine: 0.01 mg/kg IM/IN, max 0.3 mg
ECG Interpretation
- STEMI:
- Men < 40: 2.5 mm STE in V2 or V3, 1 mm in any other lead
- Men ≥ 40: 2 mm STE in V2 or V3, 1 mm in any other lead
- Women: ≥ 1.5 mm STE in V2 or V3, 1 mm in any other lead
- Posterior STEMI:
- ST depression in leads V1, V2, V3 (V4?)
- Tall, broad R waves (dominant in V2)
- Upright T waves
- LBBB:
- Smith criteria:
- Concordance: ST segment is in the same direction as the QRS
- Discordance: ST segment is in the opposite direction to the QRS
- Appropriate discordance: ST segments in all leads should be discordant to the majority direction of the QRS
- Smith criteria:
Differential Diagnosis for SOB
- HF/PE:
- S&S: SOB, cough, sputum, fever, sweats, chest pain
- Sputum: Frothy (pink)
- Chest pain duration: Variable
- Hypertension: + Risk
- AMI:
- S&S: SOB, cough, sputum, fever, sweats, chest pain
- Chest pain duration: Usually > 20 min
- Hypertension: + Risk
- COPD:
- S&S: SOB, cough, sputum, wheezing, cyanosis
- Sputum: Clear
- Chest pain: -
- Hypertension: -
- Pneumonia:
- S&S: SOB, cough, sputum, fever, sweats, chest pain
- Sputum: Yellow/green
- Chest pain duration: Gradually worsening
- Hypertension: -
Non-Invasive Positive-Pressure Ventilation (NIPPV) / CPAP
- Primary functions:
- Provides high flow O2 and constant positive airway pressures throughout inspiration and expiration
- Improves pulmonary compliance and keeps distal airways open longer
- Recruits and stabilizes collapsed alveoli
- Reduces inspiratory work and relieves respiratory muscle fatigue
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Description
This quiz covers the different routes of medication administration, including intranasal, intramuscular, and intravenous routes, highlighting important considerations and contraindications.