Adult BB/CCB OD

Question 1

Adult BB/CCB OD - Symptomatic Bradycardia treatment?

Answer 1

Treat concurrently with symptomatic bradycardia protocol

Question 2

Adult BB/CCB OD - Systolic BP 90 or less and symptomatic?

Answer 2

20 ml/kg bolus x 2 prn - goal of MAP 65
Glucagon 2 mg IV/IO/IM q 10 total max of 6 mg
Zofran if nauseated

Question 3

Adult BB/CCB OD - Refractory to initial treatment of bolus and glucagon?

Answer 3

Calcium Chloride 1 g q 10 min total max of 3 g

Question 4

Adult BB/CCB OD - QRS width greater than 0.12

Answer 4

Sodium bicarbonate 1 mEq/kg q 5 total max of 2 mEq/kg

Question 5

Adult BB/CCB OD - Hypotension refractory to Fluid, Glucagon and Calcium treatment?

Answer 5

Mandatory OLMC

Norepinephrine 0.1 - 0.3 mcg/kg/min

Question 6

Adult BB/CCB OD - Hypoglycemia?

Answer 6

Treat as per hypoglycemia protocol

Question 7

Adult BB/CCB OD - What must be administered prior to medications in this toxidrome?

Answer 7

2x 20 ml/kg fluid boluses

Question 8

Adult BB/CCB OD - Which medication can be given at the same time as the fluid boluses?

Answer 8

Atropine, if required according to the Bradycardia protocol

Question 9

Adult BB/CCB OD - Glucagon indication?

Answer 9

Hypotensive beta blocker or calcium channel blocker overdose refractory to fluid boluses

Question 10

Adult BB/CCB OD - Glucagon dose?

Answer 10

2 mg SIVP/IO/IM q 10 min prn total max of 6 mg

Question 11

Adult BB/CCB OD - Glucagon contraindications?

Answer 11

Hypersensitivity to glucagon, beef or pork proteins

Question 12

Adult BB/CCB OD - Glucagon precautions?

Answer 12

Use with caution if cardiovascular or renal disease

Glucagon may cause nausea and vomiting

Question 13

Adult BB/CCB OD - Ondansetron indication?

Answer 13

Nausea and vomiting as a result of glucagon administration

Question 14

Adult BB/CCB OD - Ondansetron dose?

Answer 14

ondansetron 4 mg SIVP/IO

ondansetron 8 mg IM/PO

Question 15

Adult BB/CCB OD - Ondansetron contraindications?

Answer 15

Hypersensitivity

Question 16

Adult BB/CCB OD - calcium chloride indications?

Answer 16

Hypotensive beta blocker or calcium channel blocker overdose refractory to fluid boluses and glucagon

Question 17

Adult BB/CCB OD - calcium chloride dose?

Answer 17

1 g SIVP/IO q 10 min prn total max of 3 g

Question 18

Adult BB/CCB OD - calcium chloride contraindications?

Answer 18

Hypersensitivity
Hypercalcemia
Patients with digitalis toxicity

Question 19

Adult BB/CCB OD - calcium chloride precautions?

Answer 19

Avoid extravasation due to the risk of tissue irritation / necrosis

Question 20

Adult BB/CCB OD - sodium bicarbonate indications?

Answer 20

QRS width greater than 0.12 seconds

Question 21

Adult BB/CCB OD - sodium bicarbonate dose?

Answer 21

1 mEq/kg SIVP/IO q 5 min prn to a total max 2 mEq/kg

Question 22

Adult BB/CCB OD - sodium bicarbonate contraindications?

Answer 22

None when used in emergency situations
Excessive chloride loss (from vomiting, continuous GI suctioning)
Metabolic or respiratory alkalosis
Patients with hypocalcemia in whom alkalosis may induce tetany

Question 23

Adult BB/CCB OD - sodium bicarbonate precautions?

Answer 23

Use with caution in CHF, severe renal impairment, concurrent corticosteroid treatment
Avoid extravasation due to the risk of tissue irritation / necrosis

Question 24

Adult BB/CCB OD - norepinephrine indications?

Answer 24

Beta Blocker / Calcium Channel Blocker overdose with hypotension refractory to fluid resuscitation

Question 25

Adult BB/CCB OD - norepinephrine dose?

Answer 25

Mandatory OLMC

0.1 - 0.3 mcg/kg/min titrate to effect

Question 26

Adult BB/CCB OD - norepinephrine contraindications?

Answer 26

Mesenteric or peripheral vascular thrombosis
Pregnancy
Profound hypoxia
Hypovolemia

Question 27

Adult BB/CCB OD - norepinephrine precautions?

Answer 27

MAOIs or TCAs

Be mindful of extravasation