Pt is 80 kg, severe head trauma, requires RSI, Map is 70, you do not suspect airway difficulties, no know allergies
Name the medications and doses and total dose to be given
- Medication - Lidocaine 1 mg/kg Dose 80 mg
- Medication - Etomidate 0.3 mg/kd Dose 24 mg (or standard dose of 20 mg)
- Medication - Rocuronium 1 mg/kg Dose 80mg
- Alt Medication - Ketamine 2 mg/kg Dose 160 mg
You have an intubated 80 kg patient, vitals are as follows: HR 130, BP 180/90, RR 16 (on vent) SpO2 99%, Temp 37.2. You have decided the patient needs post-intubation sedation. Based on REACH protocols, what could you give and at what dose?
- Medication - Fentanyl Dose 50 mcg (standard) or 80 mcg (1 mcg/kg)
- Medication - Versed Dose 2 mg (std) or 4 mg (0.05 mg/kg)
- Medication - Ativan Dose 0.5 mg
- Medication - Morphine Dose 4 mg (std) or 8 mg (0.1 mg/kg)
You have been requested to transporpt an intubated infant (6 weeks old, 39 week term baby) weighing 3.5 kg. Upon arrival, pt is veing ventilated with an anesthesia bag and manometer. You note adequate chest rise at occurs at 15/5, patient is intubated with a 3.5 cuffed ETT, you have completed your assessment and are placing your patient on the ventilator, please list your initial vent settings based on this information
- MODE: SIMV
- RATE: 20-40
- Breath type: Pressure
- PC or Volume: not able to do volume, use PC = 15
- PS: 10
- FIO2: anything
- I-Time: 0.4
- PEEP: 3-5
- Goal for VTE: 21-28 ml (6-8 ml/kg)
Calculate your maintenance fluid and bolus for a 3.5 kg patient, name the type of fluid for each
- Maintenance: D5NS - 14 ml/hr
- Bolus: NS 70 ml
Your patient weighs 18 kg
Please calculate the following for each of these medications:
Concentration, dose in mg, volume in ml to be delivered
- Fentanyl: 10 mcg/ml, 18 mcg, 1.8 ml
- Versed: 5mg/5ml, 0.9 mg, 0.9 ml
- Epinephrine for cardiac arrest: 1:10,000, 0.18 mg, 1.8 ml
Your pt is 22 kg, 5 yr old. Per REACH protocol, calculate the ETT size and depth.
Calculate the typical blood pressure range per REACH protocol
- ETT Size: 16+5/4 = 5.25 so use a 5.0 cuffed ETT
- Depth: 12+1/2 age in years = 14.5 at lipline
- BP range: 70-90+age * 2: 80-100 systolic
Your sepsis patient (weight 95 kg) has a sudden decrease in LOC and you note significant hypotension that correlates with your patients skin signs and LOC. In addition to giving fluids the TT decides to start dopamine per REACH protocol. What dose will you deliver? Show all math to end up with ml/hr for the starting dose.
- 400 mg/250 ml= 1600 mcg/ml
- REACH start dose is 5 mcg/kg/min
- 5 x 96 x 60= 28,800
- 28,800/ 1600= 18 ml/hr
You are requested to transport a 3100 gram neonate, the sending MD requests that you run D10 at 80 ml/kg/day. What rate will you set?
- 33 ml/hr Minimed will do 10.3,
- syringe pump will do 10.33
A patient having acute chest pain with ST elevation reports no use of ED medications and is markedly hypertensive at 219/122. The TT decides to start a NTG infusion. What rate will you start at in mcg/min and ml/hr per REACH protocols?
- Mix 50 mg/250 ml d5w
- REACH dose is 10 mcg/min
- 200 mcg/ml
- 10 mcg/min= 600 mcg/hr= 3 ml/hr
Please calculate the infusion starting rate for esmolol per REACH protocols. Your patient weight is 79 kg.
- Start at 50 mcg/kg/min
- 2.5 gm in 250 mlD5W= 10,000 mcg/ml
- 50x79x60= 237,000 mcg/hr divide by 10,000= 23.7 ml/hr
Your patient weight is 79 kg. and is unresponsive to the highest dose of esmolol allowed by REACH protocol, you and your partner decide to start nipride. Please calculate the starting infusion rate.
- 2 mcg/kg/min
- 50 mg/250 ml= 200 mcg/ml
- 0.2x 79x 60= 948 mcg/hr
- Divide by 200= 4.74 ml/hr
Your dopamine infusion is going at 20 mcg/kg/min for a 46 kg patient when your mini-med malfunctions. You and your partner decide to run the gtt on gravity with a 10 gtt set. What is the rate in ml/hr and gtt/minute?
- Dopamine is 400 mg/ 250 ml= 1600 mcg/ml
- 20x46x60= 55,200 mcg/hr divided by 1600= 34.5 ml hr
- 10gtt per ml= 345 gtt/hr divided by 60= 5.75 gtt/min
Please calculate the infusion rate in ml/hr for an epinephrine gtt per REACH protocol at 0.1 mcg/kg/min. Patient weight is 20 kg.
- Mix 5 mg in 50 ml D5W= conc of 100 mcg/mlb.
- 20x0.1x60= 120 mcg/hr divided by 100 mcg/ml= 1.2 ml/hr
Please calculate the maintenance fluid rate for a 34 kg pediatric patient, what fluid would you use?
- a. Use 4/2/1 rule
- b. First 10 kg= 4ml/kg (40)
- c. Second 10 kg= 2 ml/kg (20)
- d. Each additional kg= 1 ml/kg (14)
- e. Total= 74 ml/hr
You pick up a patient from an IFT who is receiving Levophed at 8 mcg/ min. The drug is mixed as 8mg in 250 ml D5W. You notice the drug is infusing at 15 ml/hr. Is this correct rate? If not please calculate the correct rate and state how you would address this situation.
- a. 8mg/250 ml= 32 mcg/ml
- b. 8 mcg/min= 240 mcg/hr
- c. Correct rate is 7.5 ml/hr
- d. Crew should be double checking rates and if a discrepancy is noted notify sending RN and adjust gtt according to patient condition. You would need to assess whether correcting the rate to the mcg/min the patient was actually receiving will be beneficial or detrimental- This is always a tough situation from both a clinical and a customer service standpoint!
Your patient is receiving LR at 75 ml/hr on your mini-med. The mini med suddenly fails and you switch to gravity tubing, a 10 gtt set. How many drops per minute equals 75 ml/hr?
10 gtt per ml x 75 ml/hr= 750 drops/ hr, 750/ 60 min= 12.5 (round to 13) gtt/ minute.
You arrive at a sending facility and your patient is on propofol at 20 mcg/kg/min. Your patient weighs 80 kg, how could you verify that the sending rate is correct?
- a. 20 x 80 x 60 = 96,000 mcg/hr
- b. Propofol has 10,000 mcg/ml so 96,000/10000= 9.6 ml/hr
Please explain standard dilution for fentanyl in pediatrics and show the math for a weight based dose to be given to a 10 kg pt.
- a. Diluted by mixing 2 ml (100 mcg) fentanyl with an additional 8 ml NS to have 10 mcg/ml
- b. 10 kg pt receives 10 mcg fentanyl, or 1 ml.
Lidocaine Dose for RSI
Lidocaine dose for VF/VT
- 1.0 mg/kg,
- recurrent doses 0.5 mg/kg q 10 min
Lidocaine dose for IO insertion
0.5 mg/kg, Max 40 mg
Lorazepam Dose Anxiety
0.5 mg (q10 min, max 2 mg)
Lorazepam dose Seizures
0.5 mg (q 3 min, max 4 mg)
Dextrose Dose Adult
D10W 125 ml (12.5 gms) IV/IO over 10 mins
Dextrose dose Pediatric
D10W, 5ml/kg slow IV/IO over 10 minutes, max single dose 125 ml
Zofran Pediatric doses
- Age 1 month to 12 yrs or <40kg - 0.1 mg/kg IV or IN, repeat x1 in 20 minutes
- Pediatrics >40kg 4 mg IV, IM or IN x1 in 20 minutes
- Not indicated for neonate
Fentanyl Pediatric dose
- Dilute to 10 mcg/ml
- Dose is 1 mcg/kg of diluted solution
Calcium Gluconate 10%
Dose & caution Peds
Dose & caution Neo
- Adult 1000 mg (slow IVP over 10 minutes) - max admin rate is 200 mg/min
- Pediatric considerations - REQUIRES MD Consult
- Ped Dose 100 mg/kg slow IV infusion, max 1000mg
- Neo Considerations - REQUIRES MD consult
- Neo absolute - DO NOT administer to neonates who received rocephin within preceding 48 hours
- Neo Dose 100 mg/kg slow infusion, central line
- Standard: 20 mg (avg adult)
- Weight based: 0.3 mg/kg IV/IO slow - Max dose 30 mg
- Reduce dose to 0.2 mg/kg in following
- ->70 yrs age
- ->history of liver disease
- ->SBP <90 mmHg
- ->Peds patient if SBP <70+(2xage)
- SL NTG - 0.4 mg SL q 5min
- Infusion - initiate at 10 mcg/min, titrate 5-10 mcg (maintain MAP >60)
- IV Bolus - 100 mcg slow push q 3 min
- 20 mg/kg (max 500mg) IVP
- repeat based on clinical response
- 0.25 mg SQ
- may repeat q 20 min x 2
- Do not exceed 3 doses in two hours
Morphine Dose in ACS/MI
1 mg q 3 min
monomorphic v-tach WITH A PULSE
Administer 150 mg bolus mixed in 100 ml NS over 10 minutes, may repeat q 10 minutes as needed
- Initiate 0.2 mcg/kg/min
- titrate increments of 0.1 mcg/kg/min q 5 mins
- Max dose 10 mcg/kg/min