Upload
rockhyrax
View
1.033
Download
1
Embed Size (px)
Citation preview
DateSingleJeopardy
FinalJeopardy
PRIZE !!
100
200
300
400
500
100
200
300
400
200
300
400
500
100
200
300
400
500
100
200
300
400
localanesthetics analgesics sedation more
sedation fun facts
SINGLE JEOPARDY
Appropriate alternative locale anesthetic for patient with
reported allergy to procaine?
Topic I 100 Question
What is any Amide local anesthetic?
Amides Esters
• Lidocaine• Mepivacaine• Bupivacaine• Prilocaine
• Procaine• Benzocaine• Tetracaine
Topic I 100 AnswerGo To Single
Jeopardy
DOUBLE JEOPARDY
2 local anesthetics which can cause methemoglobinemia
Topic I 200 Question
What are:
Topic I 200 AnswerGo To Single
Jeopardy
Benzocaine and Prilocaine
A one year old boy, 10 kg, has just been bitten by a cockapoo...
Topic I 300 Question
No, of course not, it was a pit bull...
He will require extensive laceration repair. Calculate the
maximum doses of lidocaine 1 % with and without epinephrine?
PRIZE !!
What are:
4.5 cc plain, 7 cc with epi?
% solution = gram/dl ; 0.5% = 5 mg/ml, 1.0 % = 10 mg/ml
• Lidocaine 1%: Max dose 4.5 mg/kg plain, 7 mg/kg with epinephrine
• Mepivacaine 1 %: Max dose 5 mg/kg plain, 7 mg/kg with epinephrine
Topic I 300 AnswerGo To Single
Jeopardy
Topic I 400 Question
While injecting lidocaine to anesthetize a laceration, your
patient complains of her tongue feeling numb. Instead of thinking “crazy patient”, you should prepare for the
following 2 problems:
What are:
CNS Toxicity (seizures, coma)
and
Cardiovascular Toxicity (dysrhythmias, myocardial depression)
Toxicity of local anesthetics• All with dose-dependent CV toxicity via
sodium channel blockade (myocardial depression and dysrhythmias)
• Bupivacaine highest CV toxicity• CNS toxicity • Early sx: lightheadedness, peri-oral
paresthesias, tongue numbness, twitching• Seizures-->anticipate VT
Topic I 400 AnswerGo To Single
Jeopardy
5 ways to decrease the pain of infiltration of local
anesthetics?
Topic I 500 Question
What are:1. Inject slowly2. Buffer with sodium bicarbonate3. Inject through open margins of wound4. Use warm anesthetic5. Use small needle6. Reassure patient/distraction
Topic I 500 AnswerGo To Single
Jeopardy
Safe and appropriate oral analgesic choice for patient
reporting an allergic reaction of vomiting to codeine
Topic II 100 Question
What is:
Anything except codeine
Analgesic Classes• Phenanthrenes: Morphine, Hydromorphone,
Codeine, Hydrocodone, Oxycodone, mixed agonists/antagonists
• Phenylpiperidines: Fentanyl, Meperidine
• Diphenylheptanes: Methadone
Topic II 100 AnswerGo To Single
Jeopardy
Analgesic just removed from US market on 11/19/2010
Topic II 200 Question
PRIZE !!
What is propoxyphene?
Topic II 200 AnswerGo To Single
Jeopardy
(darvon, darvocet)
The correct increasing order of potency for the following ORAL
analgesics
• oxycodone• hydromorphone• codeine• morphine• hydrocodone
Topic II 300 Question
What are:
• codeine 200 mg• hydrocodone 30 mg• morphine 30 mg• oxycodone 20 mg• hydromorphone 7.5 mg
Topic II 300 AnswerGo To Single
Jeopardy
This relative of clonidine has sedative and analgesic properties
and reportedly very little respiratory depression
Topic II 400 Question
PRIZE !!
What is dexmedetomidine?
Topic II 400 AnswerGo To Single
Jeopardy
Leave blank
Topic III 100 Question
Leave blank
Topic III 100 AnswerGo To Single
Jeopardy
ASA physical status classification for patient with
well controlled asthma requiring procedural sedation
Topic III 200 Question
What is II?
Topic III 200 AnswerGo To Single
Jeopardy
Amount of time recommended by ASA to wait before sedation after
patient has drank clear liquids
Topic III 300 Question
What is 2 hours?
ASA guidelines
• 2 hrs for clear liquids• 4 hrs for breast milk• 6 hrs for other milk or a light meal
Topic III 300 AnswerGo To Single
Jeopardy
Medication used for procedural sedation which is associated with
adrenal insufficiency and myoclonus
Topic III 400 Question
What is Etomidate?
Buzz words for:PROPOFOL• No analgesia• Decrease ICP• Hypotension• Anti-emetic• Anti-epileptic• Infection• “propofol syndrome”• ?more resp. depression
ETOMIDATE• No analgesia• Decrease ICP• Hemodynamic
stability• Vomiting• Adrenal insufficiency• Myoclonus
Topic III 400 AnswerGo To Single
Jeopardy
An increasingly popular mixture of two procedural medications has this name and contains this
common ratio of the medications
Topic III 500 Question
What is Ketofol?
• Single-syringe 1:1 mixture of 10 mg/mL ketamine and 10 mg/mL propofol
• Usually requires approximately 1 mg/kg (0.5 mg/kg of each)
• Academic Emergency Medicine 2010; 17:194–201
Topic III 500 AnswerGo To Single
Jeopardy
The reason not to use Ketamine in small children with active
URIs
Topic IV 100 Question
PRIZE !!
What is Laryngospasm?
Topic IV 100 AnswerGo To Single
Jeopardy
The most appropriate induction agent for an 18 yo male brought to ED after a single GSW to the
abdomen with a BP of 70/40 who is not protecting his airway
Topic IV 200 Question
What is Ketamine?(would also accept Midazolam)
Topic IV 200 AnswerGo To Single
Jeopardy
Contraindication to use of Nitrous Oxide
Topic IV 300 Question
PRIZE !!
Topic IV 300 AnswerGo To Single
Jeopardy
What is/are: pneumothorax, SBO, middle ear effusion, balloon tip catheter use? Also
head injuries, psych, intoxication
Patient responding to verbal/light touch with adequate spontaneous ventilation
after etomidate sedation is at this sedation level
Topic IV 400 Question
What is Moderate Sedation?
1. Anxiolysis/Minimal Sedation2. Moderate Sedation3. Deep Sedation4. General Anesthesia
Topic IV 400 AnswerGo To Single
Jeopardy
Three requirements prior to the safe discharge of a patient from the ED after procedural sedation
Topic IV 500 Question
What are:
1. Stable Vital Signs2. No respiratory distress3. Has ride home with responsible adult4. No significant N/V, able to take po5. Awake, at neuro baseline, ambulatory,
following instructions
Topic IV 500 AnswerGo To Single
Jeopardy
Alternative method of delivery for Fentanyl besides IV and Transdermal
and Intranasal
Topic V 100 Question
What is Inhaled?
• In Australian study of children with long bone fractures, 1 mic/kg inhaled Fentanyl similar analgesia to 0.2 mg/kg IM morphine
Topic V 100 AnswerGo To Single
Jeopardy
These two drugs are used in the treatment of Complex Regional Pain
Type I (reflex sympathetic dystrophy)
Topic V 200 Question
What are corticosteroids and calcitonin?
Complex Regional Pain I/II
• Type I (RSD), is due to prolonged immobilization or disuse
• Type II (causalgia) from peripheral nerve injury
• Both types with same presentation early: burning pain, edema, warmth, local sweating
• Tx both with steroids, Type I also with calcitonin
Topic V 200 AnswerGo To Single
Jeopardy
What the abbreviation EMLA stands for
Topic V 300 Question
PRIZE !!
What is: What is: Eutectic Mixture of Eutectic Mixture of Local AnestheticsLocal Anesthetics
(prilocaine and lidocaine)
• TAC (tetracaine, adrenaline, cocaine 11.8%)• LET (Lidocaine, Epi 1:1000, Tetracaine)• EMLA (Lidocaine + Prilocaine), occlusion• ELA-Max/LMX (Liposomal Lidocaine), no
occlusion
Topic V 300 AnswerGo To Single
Jeopardy
This high potency ultra-short acting opioid is on the horizon as
a sedative/analgesic
Topic V 400 Question
Topic V 400 AnswerGo To Single
Jeopardy
What is remifentanil?
FINAL JEOPARDY
Analgesia
Ketamine can be used in this dosing regimen as a sub-dissociative drip for
pain control (recently discussed on EM-RAP for trauma patients).
FINAL JEOPARDY
What is 0.3 mg/kg IV bolus then drip of 0.3 mg/kg/hour
IV?
Credits
Software Template Design by David L. Shenson
Use of this software is free. Please maintain the credits so creditCan be given where it is due.
Comments and suggestions can be made by e-mail to [email protected]