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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 postintubation 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: 2040
 Breath type: Pressure
 PC or Volume: not able to do volume, use PC = 15
 PS: 10
 FIO2: anything
 ITime: 0.4
 PEEP: 35
 Goal for VTE: 2128 ml (68 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
Versed
Epinephrine
 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: 7090+age * 2: 80100 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 minimed 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 minimed. 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
1.0 mg/kg

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 Adults
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

Etomidate Doses
 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)

Nitroglycerin Doses
 SL NTG  0.4 mg SL q 5min
 Infusion  initiate at 10 mcg/min, titrate 510 mcg (maintain MAP >60)
 IV Bolus  100 mcg slow push q 3 min

Calcium Chloride
 20 mg/kg (max 500mg) IVP
 repeat based on clinical response

Terbutaline Dose
 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

Amiodarone,
monomorphic vtach WITH A PULSE
Administer 150 mg bolus mixed in 100 ml NS over 10 minutes, may repeat q 10 minutes as needed

Sodium Nitroprusside
Doses
 Initiate 0.2 mcg/kg/min
 titrate increments of 0.1 mcg/kg/min q 5 mins
 Max dose 10 mcg/kg/min

