Cardiovascular Emergencies

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Cardiovascular Emergencies
2014-05-27 11:00:13
Cardiovascular Emergencies

MEDIC 2013
Show Answers:

  1. Risk factors for Heart disease
    • Hypertension
    • Elevated cholesterol
    • Smoking 
    • Poor diet
    • Obesity
    • High Stress
    • Sedentary lifestyle (no physical activity)
    • Use of oral contraceptives (birth control)
    • Hormone replacement therapy
  2. The heart is strong enough to circulate how much blood around the body daily
    7000 L - 9000 L
  3. The wall of the heart consist of what three layers
    • Epicardium (Outmost)
    • Myocardium (Middle)
    • Endocardium (Inside)
  4. The term used to describe the period of time when the atria or ventricles are resting
  5. The term used to describe the period of time when the atria or ventricles are contracting
  6. Deoxygenated blood enters the _________ from the__________and proceeds to the________, and travels to the lungs via the ________
    • Right atrium
    • Venae cavae
    • right ventricle 
    • Pulmonary arteries
  7. Oxygenated blood enters the ________ from the ________, proceeds to the __________, and is pumped to the body via the _________
    • Left atrium
    • Pulmonary vein
    • Left ventricle
    • Aorta
  8. The amount of blood that is pumped out either ventricle
    Normal range of an adult
    • Cardiac output (CO)
    • 5 to 6 L/min
  9. The amount of blood pumped out by either ventricle in a single contraction (heartbeat)
    Normal range
    • Stroke volume (SV)
    • 60 to 100mL
  10. The number of cardiac contractions (heartbeats) per minutes
    & Normal range for Adults
    • Heart rate (HR)
    • 60 to 100 beats/min
  11. The percentage of blood that leaves the heart each time it contracts (usually taken from only the left ventricle;its the primary pump for the heart)

    Normal range
    • Ejection fraction (EF)
    • 55% to 70%
  12. The smallest veins are called _______ that empty in to the largest veins of the body are called_________ & ___________
    • Venules
    • Inferior & Superior venae cavae
  13. If a patient is found unresponsive and is suspected of being in cardiac arrest the primary assessment order is
    • CAB
    • Circulation
    • Airway 
    • Breathing
  14. In the context of Acute Coronary Syndromes (ACS), dyspnea may be the first clue to:
    Failure of the left side of the heart
  15. What can happen when CO suddenly declines, leading to reduction in cerebral perfusion
    Syncope (fainting)
  16. An excellent indicator of the adequacy of cerebral perfusion
  17. External jugular veins reflect the
    Pressure within the patient's systemic circulation

    (blood has back up in systemic veins)
  18. Refers to an ECG tracing that is the result of interference, such as patient movement, rather than the heart's electrical activity
  19. Every patient taking antihypertensive drugs should have their blood pressure checked in what positions:
    To detect:
    • Recumbent (lying down)
    • Sitting

    Orthostactic hypotension
  20. EPINEPHRINE HCL (1st drug)
    Pulseless Arrest: Adult Dosage
    IV/IO: 1 mg of 1:10,000 solution repeat every 3 - 5 minutes
    VF/Pulseless VT: Adult Dosage
    IV: 300 mg over 30 – 60 seconds, may repeat in 3-5 minutes with 150 mg IV push
    Conversion of supra ventricular tachycardias 
    Adult Dosage:
    • Initial: 6 mg rapid IV bolus over 1-3 seconds
    • Special administration procedure: Follow immediately with 20 ml normal saline flush 

    Repeat: If no response in 1-2 minutes may repeat 12 mg twice
  23. Restriction of cardiac contraction, failing cardiac output, and shock, caused by the accumulation of fluid or blood in the pericardium
    Cardiac tamponade
  24. What valves lies between right atrium and right ventricle
    Tricuspid valve
  25. What valve has only two cusps – Lies between left atrium and left ventricle
    Mitral (bicuspid) valve
  26. Cardiac output (CO) equals
    • Stroke volume (SV) multiplied by heart rate
    • CO = SV × HR
  27. Up to a limit, the more a myocardial muscle is stretched, the greater the force of contraction (and stroke volume)
    Frank-Starling Law
  28. Records electrical voltages (potentials) generated by depolarization of heart muscle
  29. ECG strip: Width of each small box =
    0.04 second
  30. ECG strip: Width of each large box (5 small boxes) =
    0.20 second
  31. ECG Strip: 
    •  5 large boxes (consisting of 5 small boxes) =
    •  15 large boxes = 
    •  30 large boxes =
    • 1 second
    • 3 seconds 
    • 6 seconds
  32. Represents atrial depolarization and is characterized by a smooth round, upright shape.
    P wave
  33. The process by which muscle fibers are stimulated to contract
  34. Represents the amount of time it takes for the atria to depolarize and for the impulse to travel through the AV node. It is measured from the start of the P wave to the point at which the QRS complex begins.
    • PR Interval
  35. Normal duration of the PR Interval
    • 0.12 to 0.20s, or 120 to 200ms
    • (3 to 5 small boxes on the ECG strip)
  36. Consists of three waveforms that represents depolarization of 2 simultaneously contracting ventricles
    • QRS Complex
  37. The point in the ECG where the QRS complex ends and the ST segment begins; representing the end of depolarization and the apparent beginning of reploarization
    • J Point
  38. The ST segment represents
    Early ventricular reploarization
  39. The QT interval represents:
    All the electrical activity of one complete ventricular cycle
  40. Five step method of interpreting an ECG strip
    • I.d. the waves (P-QRS-T)
    • Measure the PRI
    • Measure the QRS duration
    • Determine rhythm regularity
    • Measure the heart rate
  41. Three major classes of drugs used to relieve the pain of angina:
    • Nitrates
    • Beta blockers
    • Calcium channel blockers

    *all diminish myocardial O2 demand
  42. Delivering a current to the heart that is powerful enough to depolarize all of its component muscles cells; leading to a cardiac contraction
  43. Indicated for rapid ventricular and superventricular rhythms that are associated with severely compromised CO
    Emergency cardioversion
  44. Medications commonly used to sedate when cardioversion is to be performed on a conscious patient would include
    • Benzodiazepines
    • Diazepam (valium)
    • IV: 2mg increments slow push. 

    • Midazolam (versed)
    • Patients 14 to 60 years of age:
    • IM: 2 to 5 mg IM
    • IV/IO: 1 to 10 mg IV/IO, titrate to effect, administer slowly in small increments of no
    • more than 2.5 mg over at least 2 minutes.

    • Patients over 60 years of age:
    • IM: 1 to 5 mg 
    • IV/IO: 1 to 3.5 mg IV/IO, titrate to effect, administer slowly in small increments of no
    • more than 1.5 mg over at least 2 minutes.
  45. A small electrical charge that is passed through the patients skin across the heart between one externally placed pacing pad and another
    TCP- Transcutaneous Cardiac Pacing
  46. A term associated with deplolarization of the ventricles, which appears as a wide QRS complex on the ECG and results in a corresponding pulse
  47. TCP is the first line treatment if the patient is in what type of condition
    Second degree type II or Third-degree heart block
  48. If atropine and TCP are unsuccessful in a patient with symptomatic bradycardia you should consider administering:
    • Dopamine (intropin) or
    • Epinephrine as a drip
  49. To stimulate a patients vagus nerve who is in SVT; the most common technique is to have the patient:
    • Vagal down
    • (bearing down on the closed glottis)
  50. Stimulating the vagal nerve does what
    Stimulates the parasympathetic nervous system to slow the heart rate
  51. Four important properties that help the heart to function as an efficient machine:
    • Excitability
    • Conductivity
    • Automaticity
    • Contractility
  52. The property that allows cells to respond to an electrical impulse
  53. The electrical conduction system of the heart:
    Impulses that originate in the____spread through the ____and along the internodal pathways to the____. From the _____, they travel down the ________ and right and left _______ and into the ______________
    • SA node
    • Atria
    • AV node
    • AV node
    • Bundle of his
    • Bundle branches
    • Purkinje network
  54. A common drug used to block the actions of the parasympathetic nervous system; to block the vagus nerve and thereby causes an increase in the heart rate
  55. Increase heart rate, strengthens the force of cardiac muscle contractions, and provides other adaptive responses to ensure that the tissues increased oxygen demands are satisfied with increased CO
    The sympathetic nervous system
  56. Sympathetic agent (primarily alpha), causing vasoconstriction. It is used to increase the bloop pressure when the  hypotension is caused by vasodilation (as in neurogenic shock)
    Norepinephrine (levophed)
  57. Sympathetic agent, used to increase renal perfusion, increase rate and force of myocardial contraction, and constrict peripheral blood vessels
    Dopamine (intropin)
  58. In patients with ACS the most common chief complaints are:
    • Chest pains
    • Dyspnea
    • Fainting
    • Palpitations
    • Fatigue
  59. Palpitations are often caused by:
    Cardiac dysrhythmia
  60. Anticoagulant drugs are? Usage?
    • Blood thinners
    • Used: to diminish the ability of the blood to clot
    • (Coumadin, Panwarfin)
  61. How do calcium channel blockers relieve angina
    • Prevents spasms of the coronary arteries
    • Weakens cardiac contractions (decreases myocardial O2 demand)
  62. Drugs that are Calcium Channel Blockers
    • Diltiazem (Cardizem)
    • Verapamil (Isoptin)
  63. What are the two main groups of leads
    • Limb leads
    • Precordial leads
  64. If the distance is exactly the same between R waves, the rhythm is:
  65. In no two R waves are equidistant, the rhythm is:
    Irregularly irregular
  66. If the R waves are irregular, but appear to follow a pattern the rhythm is:
    Regularly irregular
  67. The most common methods of determining the rate of a cardiac rhythm strip:
    • 6-second method
    • Sequence method
    • 1500 method
  68. Defibrillation needs to be carried out as sson as possible in what two rhythms:
    • Ventricle fibrillation
    • Pulseless ventricular tachycardia
  69. The use of a synchronized direct current (DC) electric shock to convert tachydysrhythmias (such as atrial fibrillation) to normal sinus rhythm
    Synchronized cardioversion
  70. A mode available on automated external defibrillators, allowing the paramedic to interpret the cardiac rhythm and determine if defibrillation is needed
    Manual defibrillation

    *Method of choice for paramedics
  71. Algorithm for bradycardia
    Persistent bradyarrhythmia
    Does the patient have any of the following:
    • Acute altered mental status
    • Acute heart failure
    • Ischemic chest discomfort
    • Hypotension
    • Signs of shock
  72. Drug administration for Symptomatic braycardia
    Atropine: IV - 0.5mg 3 to 5 min; max 3mg

    TCP or,

    Dopamine: IV - 2 to 10 mcg/kg/min or, 

    Epinephrine: IV - 2 to 10 mcg/min
  73. Algorithm for Tachycardia
    Persistent tachyarrhythmia
    Does the patient have any of the following:
    • Acute altered mental status
    • Acute heart failure
    • Ischemic chest discomfort
    • Hypotension
    • Signs of shock
  74. Precordial leads should be placed in what manner
    • V1: R. sternum, 4th intercostal space
    • V2: L. of sternum, 4 ICS
    • V4: Midclavicular, 5th ICS
    • V3: Between V2 & V4
    • V6: Midaxillary, 5th ICS
    • V5: Between V4 & V6
  75. The time frame that starts at the first moment of patient contact by EMS providers, and ends when definitive therapy occurrs
    EMS-to-balloon time
  76. Which electrolyte flows into the cell to initiate depolarization?
    NA+ (sodium)
  77. Which electrolyte flows out of the cells to initiate repolarization?
    K+ (potassium)
  78. When a impulse reaching the AV node is delayed and results in a PR interval longer than 0.20 seconds
    • First - degree heart block
  79. A specialized structure located in the lower portion of the right atrium; 
    Allows atria to contract & complete filling of ventricles before next ventricle contraction;
    Slows conduction through the AV junction
    • Atrioventricular (AV) node 
  80. The intrinsic firing rate for the AV node:
    40 to 60 bpm.
  81. The SA node has an intrinsic rate of:
    60 to 100 beats per minute
  82. The intrinsic rate for the purkinje system is:
    20 to 40 bpm.
  83. The bundle of his connects what structures
    • AV node with the bundle branches
    • Discharge rate of 40-60 bpm
  84. May assume responsibility for pacing the heart if:
    –  The SA node fails to discharge
    –  An impulse from the SA node is generated     but blocked as it exits the SA node
    –  The rate of discharge of the SA node is         slower than that of the AV junction
    –  An impulse from the SA node is generated
        and is conducted through the atria but is       not conducted to the ventricles
    AV Junction
  85. A term used to describe the AV node and the bundle of his structures
    AV Junction
  86. The electrical impulse travels backward (retrograde) to activate the atria when this structure is pacing the heart
    AV junction
  87. Ectopic (irregular) complexes that occur out of normal location
    Usually earlier than expected
    R-R interval will be closer
    P-wave may or may not be present; inverted, upside down, before or after QRS
    Pre-mature junctional complex (PJC)
  88. Narrow with inverted "P" wave or without "P" wave
    PR interval: 120ms>
    QRS complex: 40 to 120 ms

    * May be a predictor of future cardiac dysrhythmias
    Premature Junctional Complex (PJC)
  89. Causes of PJC's
    • • Congestive heart failure
    • • Acute coronary syndromes
    • • Mental and physical fatigue
    • • Valvular heart disease
    • • Digitalis toxicity
    • • Electrolyte imbalance
    • • Rheumatic heart disease
    • • Stimulants: caffeine, tobacco
  90. Signs and symptoms of Pre mature junctional Complex (PJC)
    • Mostly asymptomatic 
    • Palpitations (skipped beats)
  91. Originates in the AV junction
    Occurs when the SA node ceases functioning; 
    after a conduction delay from the atria 
    AV node takes over as pacemaker
    Prevents cardiac stand still
    Rhythm rate 40 - 60 bpm
    Junctional escape beat
  92. Junctional escape beat
  93. How do you recognize a Junctional escape beat:
    • Rate: 40-60 bpm
    • Rhythm: regular
    • P-wave: inverted or upside down;
    • before, during, or after QRS
    • PR interval: .12> (if p-wave)
    • QRS: .10>
  94. Junctional escape beats/rhythms causes:
    • Increased parasympathetic tone
    • Immediately after surgery
    • Hypoxia
    • Medications
    • AMI
    • Rheumatic heart disease
    • Valvular disease
    • Disease of SA node
  95. Digoxin/Digitalis are:
    • Medications used to treat heart rhythm problems (A-fib), or
    • Heart failure
    • Used with water pills (diuretic)
  96. Junctional rhythms signs & symptoms:
    • Pt. maybe asymptomatic; or
    • may experience signs & symptoms of slow HR, or decreased CO
  97. Signs & symptoms of slow Heart rate, or Decreased Cardiac output
    • Weakness
    • Chest pain or pressure
    • Syncope
    • ALOC
    • Hypotension
  98. An etopic rhythm caused by enhanced automaticity of the bundle of his
    Rate: 60-100 bpm
    Rhythm: regular
    QRS: .10>
    Accelerated Junctional Rhythm
  99. Treatment for Accelerated junctional rhythm:
    • Monitor;
    • Consider withholding medications (diuretics)
  100. Accelerated junctional rhythm Causes:
    • Rheumatic fever
    • COPD
    • Hypokalemia
    • Digitalis toxicity
    • AMI
    • Cardiac surgery
  101. An inflammatory disease that may develop after an infection with group A Streptococcus bacteria (such as strep throat or scarlet fever). The disease can affect the heart, joints, skin, and brain
    Rheumatic fever
  102. A rhythm of slow onset with a heart rate that increases to more than 100 beats per minute; due to enhanced automaticity of the atrioventricular junctional tissue, often secondary to disease or trauma.
    Nonjunctional junctional tachycardia
  103. A rhythm with a rapid heart action that starts and stops abruptly
    Rate: more than 140 bpm
    Paroxysmal junctional rhythm
  104. Causes of junctional tachycardia:
    • Enhanced automaticity
    • Acute coronary syndromes
    • – Congestive heart failure
    • – Theophylline administration
    • – Digitalis toxicity
  105. Used to prevent and treat wheezing, shortness of breath, and chest tightness caused by asthma, chronic bronchitis, emphysema, and other lung diseases
  106. Junctional tachycardia associated with acute coronary syndrome may have what symptons:
    • – Increase myocardial ischemia
    • – Increase the frequency and severity of chest pain
    • – Extend the size of a myocardial infarction
    • – Cause congestive heart failure, hypotension,
    • or cardiogenic shock
    • – Predispose the patient to ventricular
    • dysrhythmias
  107. Junctional tachycardia if symptomatic treatment:
    – Oxygen therapy, IV access

    – Vagal maneuvers, adenosine

    • – Possible beta-blocker, calcium channel blocker,
    • if no contraindications exist
  108. • Originate in the AV junction
    • Occur when the SA node is suppressed
       or conduction is blocked
    • Impulses cause retrograde depolarization    and inverted P waves in leads II, III, and aVF
    Junctional arrhythmias
  109. A beat that occurs before a normal beat and causes an irregular rhythm

    A ectopic beat that occurs when an irritable location within the AV junction acts as a pacemaker and fires either prematurely or out of sequence 

    The atria are depolarized in retrograde fashion, causing an in-
    verted P wave.
    Premature junctional contraction (PJC)
  110. Premature junctional contraction (PJC)
  111. The normal slowing of impulses as they pass through the AV node allows the atria to:
    Pump the maximum amount of blood possible into the ventricles
  112. Define a junction rhythm:
    Occurs when the SA node ceases functioning and the AV node takes over as the pacemaker of the heart
  113. If the ventricles are depolarized first in a junctional rhythm, the P wave will appear:
    After the QRS complex
  114. Ventricles assume responsibility for pacing the heart if:
    • SA node fails to discharge
    • Impulse is blocked 
    • Rate from SA node is slower than ventricles
  115. The ventricles are the heart’s least
    efficient pacemaker with a intrinsic rate of
    20–40 bpm
  116. Ventricular beats & rhythms originate from any part of the ventricles QRS complex's; and are typically characterized by QRS complexes that are:
    • Abnormally shaped and prolonged
    • (greater than 0.12 sec)
  117. This type of beat occurs earlier than the next expected sinus beat

    – QRS is typically 0.12 sec or greater

    – T wave is usually in the opposite direction of
    the QRS complex
    • Premature ventricular Complex (PVC)
  118. PVC patterns:
    • Pairs: 2 sequential pvc's
    • Runs or bursts: 3 or more
    • Bigeminal: every other beat
    • Trigeminal: every 3rd beat
    • Quadrigeminal: every 4th beat
  119. PVCs that look alike and may originate from the same ectopic focus are called
  120. PVC: Couplets and Three-beat run / Burst
  121. Ventricular Tachycardia
  122. Atrial flutter
  123. Atrial Fibrillation
  124. Ventricular escape beats are also known as:
    Idioventricular rhythms (IVR)
  125. Acts as safety mechanisms to prevent ventricular standstill when no impulses are conducted
    The His-Purkinje system take over and act as the heart’s pacemaker
    Idioventricular rhythms / (Ventricular escape beat)
  126. Idioventricular rhythm / Ventricular escape beat
  127. Three or more ventricular escape
    beats occurring in a row at a rate of 20–40
    Idioventricular rhythm
  128. Accelerated idioventricular rhythm
  129. Idioventricular rhythm should never be treated with:
    • Lidocaine or other antiarrhythmics
    • that would suppress that safety mechanism
  130. Provides electrical links between the atrium and ventricles
    AV Junction
  131. If a delay or interruption in impulse conduction occurs within the AV node, Bundle of his, or His-purkinje system, the resulting dyrhythmia is called:
    Atrio ventricular (AV) block
  132. AV blocks are classified according to the:
    • Degree of the block
    • Site of the block
  133. The key to differentiating the type of AV block is:
    (First-degree AV block)
    (Second-degree AV block type I)
    (Second-degree AV block type II)
    The PR interval
  134. The width of the QRS complex is the key in differentiating what about a block
    The location
  135. The only heart block that is complete:
    3rd degree AV block
  136. How do you recognize a 1st degree AV block
    PR interval: Prolonged (greater than 0.20 sec) but constant
  137. Treatment of 1st degree heart block:
    • Nothing; monitor for bradycardia
    • or
    • Signs of shock
  138. When some, but not all, atrial impulses are
    blocked from reaching the ventricles 

    SA node generates impulses in a normal manner 

    Not every P wave will be followed by a QRS
    Second degree AV block
  139. Second degree AV block Type I (the block) is located where:
    Above bundle of his
  140. Second degree AV block Type II (the block) is located where:
    At or below Bundle of his
  141. Impulses generated by the SA node take longer and longer to conduct through the AV node until a sinus impulse id blocked
    2nd degree AV block type I
  142. How do you recognize a 2nd degree AV block type II
    P waves occur at regular intervals 

    • Appears on ECG as a P wave with no QRS
    • after it
  143. Prinzmetal's angina is; and treatment
    • Intense spasm of coronary artery
    • segment 
  144. Nitro completely relieves the chest pain
  145. Drug indicated for suppression of ventricular arrhythmias (ventricular tachycardia, ventricular fibrillation, PVC's); and
    • Pulseless VF/VT: 1.0-1.5 mg/kg IV every 3-5 min to a total of 3 mg/kg.  

    • Antidysrhythmic or rhythms with a pulse:
    • 1.0-1.5 mg/kg IV; additional boluses 0.5-0.75 mg/kg every 5-10 min to a total dose of 3 mg/kg.
    Dosage: Pulseless Arrest
    IV/IO: 1 mg of 1:10,000 solution repeat every 3 - 5 minutes
    Dosage: Continuous Infusion for Hypotension or Symptomatic Bradycardia:
    • 1 mg to 500 mL of NS at 1 mcg/min titrated to desired hemodynamic response
    • (range 2-10 mcg/min)
  148. Contraindications to NITROGLYCERIN
    • Hypovolemia
    • Increased Intra cranial pressure
  149. An abnormal buildup of fluid in the air sacs of the lungs, which leads to shortness of breath.
    Pulmonary edema
  150. NITROGLYCERIN Adult Dosage:
    SL for Chest pain: 
    SL for Pulmonary edema:
    SL for Chest pain: 1 (0.4 mg) tablet or one full spray, may repeat x 3

    SL for Pulmonary edema: 1-2 (0.4 mg) tablets SL every 5-10 minutes as long as the systolic BP is greater 90-100 systolic
  151. ATROPINE SULFATE Adult dosage
    Symptomatic Bradycardia:
    • IV – 0.5 mg every 5 minutes.
    • Do NOT exceed a total dose of 3 mg  
  152. An abnormal widening or ballooning of a portion of an artery due to weakness in the wall of the blood vessel.
    Aneurysm (worst condition)
  153. a blood clot, a fat globule or a gas bubble in the bloodstream, which can cause a blockage.
  154. Cincinnati Prehospital Stroke Scale
    • Facial Droop
    • Arm Drift
    • Abnormal Speech
    • Time 

    (3 hour window)
    • A — Alcohol/Acidosis
    • E — Epilepsy
    • I — Infection
    • O — Opiates, Overdose
    • U — Uremia (renal failure)
    • T — Trauma
    • I — Insulin
    • P — Poisoning/Psychosis
    • S —Stroke
  156. Seizures indicate:
    Electrical malfunction of the brain
  157. When blood flow to a part of the brain stops for a brief period of time. A person will have stroke-like symptoms for up to 24 hours, but in most cases for 1 - 2 hours.
    Transient ischemic attack (TIA)
  158. A condition when the heart has been damaged so much that it is unable to supply enough blood to the organs of the body
    Cardiogenic shock
  159. Blood backs up behind ventricle
    •  Blood builds up in lungs
    •  Left atrium swells with blood
    •  Atrial muscle fibers stretch
    •  Pulmonary veins cannot empty into left atrium
    •  Pressure within pulmonary muscles increases
    •  Forces fluid from pulmonary capillaries across alveolar walls into lung alveoli
    Left ventricle failure
  160. A failure of the right side of the heart brought on by long-term high blood pressure in the pulmonary arteries and right ventricle of the heart
    Cor pulmonale
  161. • High-concentration O2 by mask
    • Reduce preload
    • Reduce afterload
    • Improve myocardial contractility
    • Position of comfort
    • Sitting position with feet dangling 
    Treatment for:
    Heart failure
  162. Heart failure medications that reduces preload:
    • Diuretics (Lasix)
    • Vasodilators (Nitro)
  163. Heart failure medications that reduce afterload
  164. Hypertension damages the:
    • Heart
    • Brain
    • Eyes
    • Blood vessels
    • Kidneys
  165. Uncontrolled hypertension increases risk of:
    • Stroke
    • Heart attack
    • Heart failure
    • Kidney failure
  166. Treatment of seizure (drug):
    • Versed
    • IM: 0.2 mg/kg
    • IN: 0.3mg/kg for status seizures if no IV/IO access