Bored of Veins and Bones – Review

 

In the spirit of paralyzing terror that makes you seep through all holes like some cholinergic toxidrome, lets talk some ACLS medications in meds. Sitting comfortably in your last set of bodega-bought undergarments, oblivious of the contact dermatitis that is soon to ensue, you receive a notification:

 

3 year old patient in cardiac arrest, ETA 2 minutes.

 

On arrival, there is no venous access and the IO has been stolen by a hipster patient, now using it as a sarcastic makeshift pepper grinder.

 

What meds can you administer via the endotrachial tube in the pediatric patient (what about the adult)?

Pediatric:

L – lidocaine

E – epinephrine

A – atropine

N – naloxone

Adult:

N – naloxone

A – atropine

V – vasopressin

E – epinephrine

L – lidocaine

 

Think you're smart? What is the dose of epi and how do you prepare these medications for peds and adults?

General rules Peds:

  • Dilute in 5cc of NS, administer rapidly.
  • Know your Epi, look up the rest: Epi is 10X the IV/IO dose (1:1000 instead of 1:10,000). At 0.1mg/kg (the trick is that regardless of concentration, its 0.1 ml/kg).

General rules in adults:

  • Dilute in 10cc NS.
  • Use 2X the IV/IO dose of LEAN (except vasopressin).

 

+++ Answer this correctly first in the comments to be featured in next weeks BR Photoshop masterpiece (e.g Fish Poisoning and Blunt Abd Injuries):

Q: What are all treatment options for Tet spells (exacerbations of Tetralogy of Fallot).

 

References

Tintinalli, Judith E., Gabor D. Kelen, and J. Stephan. Stapczynski.Emergency Medicine: A Comprehensive Study Guide. New York: McGraw-Hill, Medical Pub. Division, 2004. Print.

Uptodate.com

 

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Itamar

Resident in the combined Emergency and Internal Medicine program at Kings County Hospital and SUNY Downstate Medical Centers.

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1 comment for “Bored of Veins and Bones – Review

  1. edenkim
    February 3, 2016 at 12:05 pm

    Tet spell treatments
    1. knee to chest position
    2. 100% O2 via nrb
    3. calm the kid by putting him in the parent’s arms
    4. morphine 0.1mg/kg
    5. NS 20cc/kg bolus
    6. sodium bicarb 2 mEq/kg bolus
    7. propranolol 0.2mg/kg
    8. phenylephrine 2-10mcg/kg/min
    9. intranasal fentanyl 2mcg/kg
    10. refractory = RSI and neuromuscular blockade

    PHOTOSHOP MEEEE

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