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1. Laryngoscopy - ANSWER Step1-Appropriate Sniffing Position: head back,
neck flexed (ear hole/external auditory eatus is at same plane as sternal
notch. Need to elevate head 5-7inches up (once elevated, tilt head all the
way back).
Step2-translate mandibular process by opening mouth, two finger technique
Step3-Insert scope, inch down tongue until you see epiglottis
Step4-Make Vallecula actual space with ELM, and with no force yet, put blade
under vallecula
Step5-Lift until see posterior notch, or until head moves up
2. CVA HTN Tx if over Sys: 210 or Dia: 120 - ANSWER Start with
Nicardipine, 5mg/hr and titrate up with adding 2.5mg/hr every 5
minsnprior to dropping back down, up to 15mg
3. Bougie Cricothyrotomy - ANSWER Step1-Equipment (6cuffed,
syringe,scalpel, bvm w/Etco2, dressing, bougie)
Step2-Landmarks (between cricoid ring and thyroid cartilage)-can't find, then
vertical incision
,Step3-1.5-2cm incision into cricothyroid membrane, immediately placing finger
into incision to augment/keep location.
Step4-insert bougie, feel for tracheal clicks
Step5-insert 6 ETT, make have to put pressure/back&forth, and once balloon in,
your good to blow up cuff
4. Hypotension with ACS - ANSWER Consider 1-2L NS, and then inotropes:
dopamine/dobutamine
5. For AMS and hx Alcoholism/Malnutrition - ANSWER Give Thiamine IV
100mg
6. Options for Combative Patient - ANSWER 1)Versed 2-5mg IV
2)Ativan 1-2mg IV, q/3mins can repeat
3)Valium 5-10mg can repeat 15min
4)Haldol same as Valium but IM also
5)Ketamine .2mg/kg
6. For adult anaphylaxis don't forget - ANSWER corticosteroid:
Solumedrol, helps with late phase
200mg Anaphylaxis, 125mg Hace and Resp. Distress
7. History of WPW, treat like - ANSWER V-Tach Protocol, not Afib-RVR
so Ami 150mg in ten mins, may repeat
, 8. Afib RVR Stable vs. Unstable - ANSWER Dilt IV 5-10 mins =Stable (can
repeat in 5-10) .25mg/kg (repeat at .35)
Cardiovert 100J=Unstable
don't forget 12 leads
9. Positioning for CVA pts - ANSWER 20-30 degree head elevation
10.Cincinnati Stroke Scale - ANSWER Droop, Drift, Speech
11. On CVAs don't forget? - ANSWER 12-lead, over 185/110 & candidate,
over 185 2x give 10mg labetalol, titrate to effect but don't drop more than
15%
12. Blood Glucose should not be dropped? - ANSWER 50-100 mg/dl per
hour
13. In DKA patients, avoid? - ANSWER intubation, if you have to, set RR
@30, help breath off acid
14. Sepsis Patient Induction - ANSWER Use Ketamine over Etomidate due
to adrenal suppression,
15.Fun Facts of Sepsis - ANSWER 1-raise HOB 30-45 degrees
, 2-CVPs goal=8-12mmHg
3-MAP goal= greater than 65
4-fluid challenges, 3l crystalloid over 45 mins
16.Levels of hyperkalemia - ANSWER 1-Tall peaked T waves (6mEq/l)
2-Prolonged PR interval (6.5mEq/l)
3-Loss of p-wave (6.5-7)
4-Widening of qrs (7-7.5)
5-Sine wave, v-fib/tach (8-10)
17. Hyperkalemia Treatment - ANSWER 1-CaCl 500mg IV over 3 mins (EKG
changes or K+ greater than 6.2),
2-NaHCO3 50meq/or 1meEq/kg over 5 mins (especially if acidotic)
3-Albuterol 5-20mg over 15 mins
4-Glucose/Insulin: 10 units reg. insulin IV push, and 25 grams D50W IV push (just
give the 10U of insulin is BS more than 200)
18. Significant Sepsis Prognostic - ANSWER Lactate greater than 4, ticking
time bombs
19. GI Hemorrhage - ANSWER -NG/OG
-Octreotide: decreases GI Motility/Acid Prod., decreases hepatic portal pressures,
relieves venous congestion, 25-50mcg IV Push, and then 25-50 mcg/hr IV