PGFD Medic Prep

Question 1

Name the
Comprehensive STROKE (3)
and
Primary STROKE Centers (6)
in the area

Answer 1

Comprehensive STROKE:
Hopkins - Baltimore
Bayview - Baltimore
UM - Baltimore

Primary STROKE:
Anne Arundel Medical
Cap Regional
Doctors
Holy Cross
Howard General
Southern Maryland

TIA/Mild - Primary
FULL Deficit/Severe - Comprehensive

Question 2

Name the (3) TRAUMA Centers in the area

Level 1

Level 2

And what is the difference?

Answer 2

Level 1 - Hopkins - Baltimore

Level 2 - Cap Region - Largo
** Suburban - Bethesda

Level 1 - more comprehensive, 24/7 surgeons, neurosurgeons, orthopedic

Level 2 - may not have same

Question 3

When do you hyperventilate HEAD injury?
What is the target capno?

Answer 3

When there is signs of HERNIATION:
Posturing,
dilation of pupils,
vomiting,
hypertension,
bradycardia,
irreg respiration

ETCO2 Target: **35-40 mmHg

20 bpm for adults
30 bpm for peds
35 bpm for infant**

Question 4

Treatment for Asthma / COPD -

Severe treatment -

And signs -

Answer 4

Albuterol 2.5mg Neb (can repeat once)
Atrovent 500 mcg

SEVERE - EPI 0.5mg IM (may repeat 3)
Dex 10mg IV
Terbutaline 0.25 mg IM (repeat once)

Consider CPAP 5cm or BVM

SIGNS - Hx, **SHARKFIN **Capno, and Wheezing

Contra - JVD, peripheral edema, rales (crackles)

Question 5

What is the age MINIMUM for Lucas Machine

Answer 5

13 years old

Question 6

What is the age of peds for TRAUMA and MEDICAL

What weight do you give adult dose?

Answer 6

TRAUMA is 15 years old

MEDICAL is 18 years old

Over 50kg (110lbs)

Question 7

What HR is Brady?

When do you withhold Med?

Answer 7

Below 60 bpm - Brady

Withhold Atropine (1mg) with Complete Blocks (2nd Degree Type II, 3rd Degree)

Question 8

When do you start CPR for Ped

Answer 8

HR below 60 bpm

Question 9

What is the FORMULA for PED BP (lowest)

What is the minimum age for this formula

Answer 9

**70 + (2 x age) = **systolic BP

Greater than 1 year old

Question 10

What do you give for each

Afib/Aflutter -

Wide QRS (stable)-

Torsades -

Answer 10

Afib/Aflutter - Cardizem 0.25mg/kg, 0.35mg/kg

Wide QRS - AMIO 150mg over 10 mins

Tosades - Mags Sulfate - 2g IV

Question 11

When do you Sync Cardiovert
and how many Jules?

And how

Answer 11

when: Unstable SVT over 150bpm

Afib/Aflutter - 200j, 300, 360

SVT - - 100j, 200, 300, 360j

Use 12lead, and pads, push synch button

Question 12

What is the general idea of WPW and LGL

Answer 12

They are** ACCESSORY PATHWAYS** from SA node to AV node

WPW has Delta Waves

LGL has short P-R interval, and narrow QRS

Question 13

What is the Jules ( J ) for PED Tachy

What is the HR for PED Tachy

Answer 13

0.5j, 1j, 2j

HR -
**INFANT 220 BPM

PED 180 BPM**

Question 14

What is the PED dose of ADENOSINE

Answer 14

0.1 mg/kg - Adenosine,
2nd Dose/ 3rd Dose** 0.2mg/kg**

Question 15

What is the Ped Dose of Amio

Answer 15

Amiodarone -** 5 MG/KG**

Question 16

What do you give for NA channel blocker (TCA)

Name one Na Drug and a TCA

Answer 16

GIVE Sodium BiCARB -** 1mEq/kg**

VerapaMIL or AmlodiPINE - na channel blocker

Amitriptyline - TCA

Question 17

For a CODE, for refractory VF/VT after Amio, what do you give

Answer 17

Amio then…
Mag Sulfate 2g IV/IO

Question 18

In a working CODE what are (4) Roles (JOBS)

Answer 18

• Role 1 - Start COMPRESSIONS 100-120, BVM till pads are on
• Role 2 - Attach PADS and VENTILATION 2 Breathes

- (my role) ROLE 3 - Establish I/O, Admin MEDS, iGEL, MONITOR

• Role 4 (Officer) - Time Keeper, Talk to Family

(Every one else **put on the lucas **and gets swapped in every 2 mins)

Question 19

For PED CODE, what is the JULES

What is the EPI and AMIO DOSE

Answer 19

Defib 2, 4, 6, 8, 10 (code)

Epi 0.1mg

Amio 5mg/kg

Question 20

For ROSC what do you do next

Answer 20

Finish 2 mins of CPR

**Obtain a 12 Lead and check pulse
**
If VF/VT was present give Amio drip if now SVT

Question 21

What are the EXCEPTIONS for Termination

Answer 21

Hypothermia, submersion, Pregnant

Question 22

For TERMINATION, what is the CAPNO

Answer 22

Less than 15mmHg

Question 23

What are the parameters to give Nitro

Answer 23

Bp greater than 90 sys
HR 60-150bpm
IV established
12 Lead has been performed first (within 10 mins)
ED drugs and Meds for Pulmonary Artery Hypertension (Adcirca, Revatio) within 48hrs

Stop if BP drops more than 20 mmHg

Question 24

What are the parameters for STEMI

Answer 24

• St elevation of 1 mm (atleast) in two or more anatomically contiguous leads

Or

- St Depression (1mm) in V1-V3

Question 25

For STEMI before giving NITRO

Answer 25

Check for Inferior involvement ( II, III, and avF) Then to V4r if needed. If ST elevation then withhold Nitro.

Question 26

How do you Identify a LBBB on a 12 lead

Answer 26

QRS is wider than **120ms (more than 3 blocks) ** Broad, **Slurred R wave in Lead I, Val, V5 and V6** Deep S wave in v1, v2 Find direction in V1 (confirm with slurred S) negative in V1

Question 27

When do you get Posterior pic of Heart

Answer 27

**ST depression in V1-V3 posterior** May indicate anterior ischemia

Question 28

Signs to Confirm CHF Treatment Protocol for CHF

Answer 28

Rales, Wheezing, Hypoxia Peripheral Edema Hypertension -** SBP OVER 150** JVD Hx of CHF or MI Dyspnea O2 LESS THAN** 94% **on Oxygen Assess Capno and waveform **(no sharkfin) ** Treatment - 12lead, IV, capo, Oxygen, NITRO 0.4, (up to 1.2) CPAP, Nitro paste (1 inch)

Question 29

Define RVR

Answer 29

RVR happens to people with A-FIB When HR is greater than **100 BPM** its serious because it can cause BLOOD CLOTS

Question 30

What are the PED DOSES of (10 drugs) AMIO EPI CROUP ADENOSINE BENADRYL NEB - ALBUTEROL and ATROVENT DEXAMETHOSONE D10 MIDAZOLAM

Answer 30

**AMIO** - **5 MG/KG** (pulse over 20 mins in 100mL, pulseless - may repeat twice up to 15mg/kg) **EPI** ASTHMA/ALLEGIC - less than **5y/o **- **0.15 MG** IM Thigh **EPI **CROUP - **2.5 ML **via neb, can repeat once severe croup - **0.01 mg/kg** IM max 0.5mg IM **ADENOSINE** - **0.1 MG/KG** then **0.2 MG/KG** (2nd and 3rd dose) **BENADRYL** - over **6**mos - **1mg/kg SLOW** IV/IM NEB -** ALBUTEROL** less than **2y/o - 1.25MG** **ATROVENT** - 1-2y/o **250 mcg** (no atrovent less than 1) **DEXAMETHASONE** - **0.5 MG/KG by mouth** (preferred) max 10mg **D10 **- 28 days - bgl LESS THAN **40** - **2 ML/KG** 28 - 4 y/o - bgl less 70 - **4 ML/KG ** (or 0.5 MG of Glucagon) 5y/o - 18 y/o - less 70 -** 4 ML/KG ** **MIDAZOLAM** - **0.1 MG/kg **in 2mg inc SLOW or **1mL **IN per nare

Question 31

What are the doses of EPI for PED CARDIAC ARREST

Answer 31

28 days - **0.05mg ** 29 days - 11mos - **0.1mg ** 1 - 4 y/o -**0.15mg ** 5 -12 -** 0.3 mg ** 13 - 18 (under 50kg) - **0.5mg** 13 - 18 (over 50 kg) - 1.0mg (adult dose)

Question 32

What is the treatment for 7 y/o with Severe Croup (3 steps)

Answer 32

- 0.01 mg/kg of Epi IM (max 0.5 mg IM) - Dexamethasone IV 0.5 mg/kg IV (10) - 2.5 mL Epi NEB Nebulized

Question 33

Pediatric Doses apply to patients weighing less than

Answer 33

50kg

Question 34

Infant is how old Child is how old Adult/Adolescent is how old How old is a newborn

Answer 34

infant - less than 1 year child - less than 12 adult medical - 13 or greater newborn - less than 1 hour after birth

Question 35

What are unstable hr for sync cardiovert for adult child infant

Answer 35

adult - over 150 child - over 180 infant - over 220

Question 36

Wide QRS (aflutter/afib) what med do you give , alert and oriented with cp and sob bp within normal limits

Answer 36

give Cardizem but wide QRS not afib, give Amio 150mg

Question 37

What is the joules settings for defibrillator 5 y/o in v-fib weighing 55lbs

Answer 37

50, 100, 150, 200, 250

Question 38

EMS may terminate resuscitation for asystole if

Answer 38

if AED advised no shockable rhythm prior to ALS arrival

Question 39

For a 5 y/o weighing 50 lbs in vfib with CPR in progress what dosages of drugs and volume and syringe will you need and joules

Answer 39

epi - o.o1 mg/kg IV IO 3mL syringe q 3-5 mins Amio 5mg/kg IV/IO repeat up to 2 times max 300 mg LR 20mL/kg bolus Joules 2-4j/ kg

Question 40

What is the ALS algorithm for Pulseless VFIB (and VTACH)

Answer 40

SHOCK IMMEDIATELY Epi every 3-5 mins (1mg) CPR, Ventilate Shockable 200, 300, 360 Amio 1st dose 300 Amio 2nd dose 150 shock, cpr, shock, cpr/epi, shock, amio

Question 41

What is the treatment for PED Seizures

Answer 41

Seizure lasting more than 10 mins check BGL Assist patient with prescribed benzodiazepine Establish IV/IO or give IM (active) Midazolam IM 0.2mg/kg IM max 5mg IM prefered IV 0.1 mg/kg in 2mg increments slow IVP max 5mg use 3 way stop cock with 1mL syringe

Question 42

Patient is in the middle of being treated for MI and becomes a VFIB arrest how do you manage this patient?

Answer 42

Need to Shock IMMED Attach **PADS and DEFIB at 200 J then give roles - Role 1 - Start **COMPRESSIONS** 100-120, BVM - Role 2 - VENTILATION** 2 Breathes **- (my role) ROLE 3 - Establish I/O, Admin MEDS, iGEL with CAPNO, MONITOR** - Role 4 (Officer) - Time Keeper, Talk to Family (Every one else **put on the lucas **and gets swapped in every 2 mins) NOTE: don't forget to charge during CPR 1min 45 seconds charge every 1:45 secs pulse check every 2 mins epi or amino every 5 mins capno range 10-20 (low too fast, high too slow)

Question 42

What is the protocol for CP

Answer 42

do 12 lead EKG (looking for INF STEMI) v4r , ASAP and allergies and ASA establish IV access give Nitro 0.4mg SL may repeat 2 more times if sys is over 90 and hr 60-150bpm INF - II, III, avF - right ventricular involvement