ICEMA CERTIFICATION STUDY GUIDE 2026
COMPLETE QUESTIONS AND SOLUTIONS
VERIFIED A+
● Pain management #14100. Answer: Patients with a GCS of 15 or at
baseline mentation and have a pain score of 5 or higher and have: acute
traumatic injuries, acute abdominal/ flank pain, burn injuries, cancer
pain, or sickle cell crisis
• What drugs/dosages are used?
- Must always monitor and assess vital signs prior to administration of
any analgesic. After administration must continually monitor EKG and
place on capno. Reassess vital signs, capno, and pain scores every 5
minutes.
- Once a pain medication has been administered via route of choice,
changing route (i.e. IM to IV) requires BHO.
- Shifting from one analgesic while treating a patient requires BHO
- For pain and a SBP below 100, administer 0.3mg/kg Ketamine IVPB to
a max single dose of 30 mg. May repeat once in 15 minutes.
- For pain and an SBP above 100, administer 50 mcq Fetanyl slow IV/IO
push over 1 minute. May repeat every 5 minutes titrated to pain but not
to exceed 200 mcq OR 100 mcq IM/IN. May repeat 50 mcq every 10
minutes titrated to pain, not to exceed 200 mcq. Peds dose is 0.5mcq/kg
slow IV/IO over 1 minute. May repeat in 5 min titrated to pain, not to
exceed 100 mcq OR 1 mcq/kg IM/IN, may repeat every 10 minutes
titrated to pain but not to exceed 200 mcq. Can also use 0.3mg/kg of
Ketamine IVPB to a max of 30mg as a single dose in 50-100mL of NS
,over 5 minutes. May repeat one time in 15 minutes, if pain is still a 5 or
higher. DO not administer IVP, IO, IM, IN
● Respiratory emergencies-Peds #14120. Answer: - Maintain airway
with appropriate adjuncts, obtain O2 sat room air if possible.
- Administer 2.5mg Albuterol with 0.5mg of Atrovent nebulized as
indicated. May repeat Albuterol 2 times and Atrovent 1x.
- If no response to Albuterol or Atrovent, consider 0.01mg/kg Epi 1:1000
via IM no to exceed adult dosage of 0.3mg. Obtain vascular access at
TKO rate
- If allergic reaction suspected, administer 1mg/kg diphenhydramine
IV/IO, not to exceed adult dose of 25mg IV or 2mg/kg IM not to exceed
adult dose of 50mg IM. Need orders for patients 2 years of age or older
- If apneic and unable to ventilate, consider oral tracheal intubation for
patients who are taller than the maximum length of a pediatric
emergency measuring tape or equivalent measuring from the top of the
head to the heel of the foot. BHO may order additional medications or
interventions
- Base hospital: for severe asthma / respiratory distress that has failed to
the other previous treatments, administer 50 mg/kg of Magnesium
Sulfate slow IV drip over 20 minutes. DO not exceed adult dosage of
2gm total. Do not repeat.
● Allergic reactions-Peds #14140. Answer: - Maintain airway with
appropriate adjuncts, obtain room air saturation if possible. Administer
2.5mg Albuterol nebulized, may repeat 2x. Combine with 0.5mg of
Atrovent. Only give 1x.
, - If no response to Albuterol, consider 0.01mg/kg of Epi 1:1000 IM, not
to exceed adult dose of 0.3mg IM
- Administer 1mg/kg Benadryl IV/IO not to exceed 25mg IV or 2mg/kg
IM, not to exceed 50mg IM
- For symptomatic hypotension with poor perfusion, consider fluid bolus
of 20ml/kg of NS, not to exceed 300 mL NS and repeat as indicated.
- Est IV/IO access if indicated
- For anaphylactic shock (no palpable radial pulse and a depressed LOC)
administer 0.01mg/kg of Epi 1:10000 IV/IO, no more than 0.1mg per
dose. May repeat to maximum of 0.5mg.
- If apneic and unable to ventilate, consider oral tracheal intubation for
patients who are taller than the maximum length of a pediatric
measuring tape or equivalent measuring from the top of the head to the
heel of the foot.
● Cardiac arrest-Peds #14150. Answer: - High quality CPR ventilate 12-
20 per minute. Ventilation rate decreases as patient age increases. Obtain
IV/IO access (IO preferred if under 9)
- For continued signs of inadequate tissue perfusion, administer fluid
bolus of NS. Reassess after each bolus. May repeat 2x for continued
signs of inadequate tissue perfusion. 1-8 years: 20mL/kg NS and 9-14
years: 300mL NS
- Determine cardiac rhythm and defibrillate at 2J/kg (or manufacturer
recommended equivalent) if indicated. After defibrillation, immediately
resume CPR, beginning a 2-minute cycle.
COMPLETE QUESTIONS AND SOLUTIONS
VERIFIED A+
● Pain management #14100. Answer: Patients with a GCS of 15 or at
baseline mentation and have a pain score of 5 or higher and have: acute
traumatic injuries, acute abdominal/ flank pain, burn injuries, cancer
pain, or sickle cell crisis
• What drugs/dosages are used?
- Must always monitor and assess vital signs prior to administration of
any analgesic. After administration must continually monitor EKG and
place on capno. Reassess vital signs, capno, and pain scores every 5
minutes.
- Once a pain medication has been administered via route of choice,
changing route (i.e. IM to IV) requires BHO.
- Shifting from one analgesic while treating a patient requires BHO
- For pain and a SBP below 100, administer 0.3mg/kg Ketamine IVPB to
a max single dose of 30 mg. May repeat once in 15 minutes.
- For pain and an SBP above 100, administer 50 mcq Fetanyl slow IV/IO
push over 1 minute. May repeat every 5 minutes titrated to pain but not
to exceed 200 mcq OR 100 mcq IM/IN. May repeat 50 mcq every 10
minutes titrated to pain, not to exceed 200 mcq. Peds dose is 0.5mcq/kg
slow IV/IO over 1 minute. May repeat in 5 min titrated to pain, not to
exceed 100 mcq OR 1 mcq/kg IM/IN, may repeat every 10 minutes
titrated to pain but not to exceed 200 mcq. Can also use 0.3mg/kg of
Ketamine IVPB to a max of 30mg as a single dose in 50-100mL of NS
,over 5 minutes. May repeat one time in 15 minutes, if pain is still a 5 or
higher. DO not administer IVP, IO, IM, IN
● Respiratory emergencies-Peds #14120. Answer: - Maintain airway
with appropriate adjuncts, obtain O2 sat room air if possible.
- Administer 2.5mg Albuterol with 0.5mg of Atrovent nebulized as
indicated. May repeat Albuterol 2 times and Atrovent 1x.
- If no response to Albuterol or Atrovent, consider 0.01mg/kg Epi 1:1000
via IM no to exceed adult dosage of 0.3mg. Obtain vascular access at
TKO rate
- If allergic reaction suspected, administer 1mg/kg diphenhydramine
IV/IO, not to exceed adult dose of 25mg IV or 2mg/kg IM not to exceed
adult dose of 50mg IM. Need orders for patients 2 years of age or older
- If apneic and unable to ventilate, consider oral tracheal intubation for
patients who are taller than the maximum length of a pediatric
emergency measuring tape or equivalent measuring from the top of the
head to the heel of the foot. BHO may order additional medications or
interventions
- Base hospital: for severe asthma / respiratory distress that has failed to
the other previous treatments, administer 50 mg/kg of Magnesium
Sulfate slow IV drip over 20 minutes. DO not exceed adult dosage of
2gm total. Do not repeat.
● Allergic reactions-Peds #14140. Answer: - Maintain airway with
appropriate adjuncts, obtain room air saturation if possible. Administer
2.5mg Albuterol nebulized, may repeat 2x. Combine with 0.5mg of
Atrovent. Only give 1x.
, - If no response to Albuterol, consider 0.01mg/kg of Epi 1:1000 IM, not
to exceed adult dose of 0.3mg IM
- Administer 1mg/kg Benadryl IV/IO not to exceed 25mg IV or 2mg/kg
IM, not to exceed 50mg IM
- For symptomatic hypotension with poor perfusion, consider fluid bolus
of 20ml/kg of NS, not to exceed 300 mL NS and repeat as indicated.
- Est IV/IO access if indicated
- For anaphylactic shock (no palpable radial pulse and a depressed LOC)
administer 0.01mg/kg of Epi 1:10000 IV/IO, no more than 0.1mg per
dose. May repeat to maximum of 0.5mg.
- If apneic and unable to ventilate, consider oral tracheal intubation for
patients who are taller than the maximum length of a pediatric
measuring tape or equivalent measuring from the top of the head to the
heel of the foot.
● Cardiac arrest-Peds #14150. Answer: - High quality CPR ventilate 12-
20 per minute. Ventilation rate decreases as patient age increases. Obtain
IV/IO access (IO preferred if under 9)
- For continued signs of inadequate tissue perfusion, administer fluid
bolus of NS. Reassess after each bolus. May repeat 2x for continued
signs of inadequate tissue perfusion. 1-8 years: 20mL/kg NS and 9-14
years: 300mL NS
- Determine cardiac rhythm and defibrillate at 2J/kg (or manufacturer
recommended equivalent) if indicated. After defibrillation, immediately
resume CPR, beginning a 2-minute cycle.
