DateSingle
Jeopardy
Final
Jeopardy
PRIZE !!
100
200
300
400
500
100
200
300
400
200
300
400
500
100
200
300
400
500
100
200
300
400
local
anesthetics
analgesics sedat...
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 Answer...
DOUBLE JEOPARDY
2 local anesthetics which can
cause methemoglobinemia
Topic I 200 Question
What are:
Topic I 200 Answer
Go 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?
PR...
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...
Topic I 400 Question
While injecting lidocaine to
anesthetize a laceration, your
patient complains of her
tongue feeling n...
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...
5 ways to decrease the pain of
infiltration of local
anesthetics?
Topic I 500 Question
What are:
1. Inject slowly
2. Buffer with sodium bicarbonate
3. Inject through open margins of wound
4. Use warm anestheti...
Safe and appropriate oral
analgesic choice for patient
reporting an allergic reaction of
vomiting to codeine
Topic II 100 ...
What is:
Anything except
codeine
Analgesic Classes
• Phenanthrenes: Morphine, Hydromorphone,
Codeine, Hydrocodone, Oxycodone, mixed
agonists/antagonists
• ...
Analgesic just removed from US
market on 11/19/2010
Topic II 200 Question
PRIZE !!
What is propoxyphene?
Topic II 200 Answer
Go To Single
Jeopardy
(darvon, darvocet)
The correct increasing order of
potency for the following ORAL
analgesics
• oxycodone
• hydromorphone
• codeine
• morphine...
What are:
• codeine 200 mg
• hydrocodone 30 mg
• morphine 30 mg
• oxycodone 20 mg
• hydromorphone 7.5 mg
Topic II 300 Answ...
This relative of clonidine has
sedative and analgesic properties
and reportedly very little
respiratory depression
Topic I...
What is dexmedetomidine?
Topic II 400 Answer
Go To Single
Jeopardy
Leave blank
Topic III 100 Question
Leave blank
Topic III 100 Answer
Go To Single
Jeopardy
ASA physical status
classification for patient with
well controlled asthma requiring
procedural sedation
Topic III 200 Que...
What is II?
Topic III 200 Answer
Go 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 Answ...
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
• “propofo...
An increasingly popular mixture
of two procedural medications
has this name and contains this
common ratio of the medicati...
What is Ketofol?
• Single-syringe 1:1 mixture of 10 mg/mL
ketamine and 10 mg/mL propofol
• Usually requires approximately ...
The reason not to use Ketamine
in small children with active
URIs
Topic IV 100 Question
PRIZE !!
What is Laryngospasm?
Topic IV 100 Answer
Go 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 ...
What is Ketamine?
(would also accept Midazolam)
Topic IV 200 Answer
Go To Single
Jeopardy
Contraindication to use of Nitrous Oxide
Topic IV 300 Question
PRIZE !!
Topic IV 300 Answer
Go To Single
Jeopardy
What is/are: pneumothorax, SBO, middle
ear effusion, balloon tip catheter use? A...
Patient responding to verbal/light touch
with adequate spontaneous ventilation
after etomidate sedation is at this
sedatio...
What is Moderate Sedation?
1. Anxiolysis/Minimal Sedation
2. Moderate Sedation
3. Deep Sedation
4. General Anesthesia
Topic IV 400 Answer
Go To Singl...
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 Signs
2. No respiratory distress
3. Has ride home with responsible adult
4. No significant N/V, ...
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 t...
These two drugs are used in the
treatment of Complex Regional Pain
Type I (reflex sympathetic dystrophy)
Topic V 200 Quest...
What are corticosteroids and
calcitonin?
Complex Regional Pain I/II
• Type I (RSD), is due to prolonged
immobilization or disuse
• Type II (causalgia) from periphe...
Topic V 200 Answer
Go To Single
Jeopardy
What the abbreviation EMLA
stands for
Topic V 300 Question
PRIZE !!
What is:What is: Eutectic Mixture ofEutectic Mixture of
Local AnestheticsLocal Anesthetics
(prilocaine and lidocaine)
• TAC (tetracaine, adrenaline, cocaine 11.8%)
• LET (Lidocaine, Epi 1:1000, Tetracaine)
• EMLA (Lidocaine + Prilocaine), o...
This high potency ultra-short
acting opioid is on the horizon as
a sedative/analgesic
Topic V 400 Question
Topic V 400 Answer
Go 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...
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 credit
C...
 Jeopardy sedation sg 2010
 Jeopardy sedation sg 2010
 Jeopardy sedation sg 2010
 Jeopardy sedation sg 2010
 Jeopardy sedation sg 2010
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  • Also cardiac (IV) lidocaine to avoid PABA preservative in Esters. Also IV formulation of benadryl given SQ
  • Prilocaine in EMLA
  • Epinephrine more painful
  • propoxyphene diphenylheptane
  • Fentanyl high potency transdermal, 25/50/75 mic for 72 hours, need something for breakthrough for first 1-2 days, not for opioid naive
  • alpha 2 agonist, 1 mic/kg load then 0.5 mic/kg aliquots as needed. Can give intranasal, buccal. HTN/bradycardia possible. Lasts around an hour (not super short)
  • Also Dissociative (Ketamine), and Neurolepsis (antipsychotics). The term “Conscious” sedation no longer used.
  • No driving for 24 hours
  • Late-above alternates with cold, pale, cyanosis and atrophy
  • onset 1 minute, duration 5-10 minutes, both sedative and analgesic, can use intranasally. More potent than fentanyl.
  • Jeopardy sedation sg 2010

    1. 1. DateSingle Jeopardy Final Jeopardy PRIZE !!
    2. 2. 100 200 300 400 500 100 200 300 400 200 300 400 500 100 200 300 400 500 100 200 300 400 local anesthetics analgesics sedation more sedation fun facts SINGLE JEOPARDY
    3. 3. Appropriate alternative locale anesthetic for patient with reported allergy to procaine? Topic I 100 Question
    4. 4. What is any Amide local anesthetic?
    5. 5. Amides Esters • Lidocaine • Mepivacaine • Bupivacaine • Prilocaine • Procaine • Benzocaine • Tetracaine Topic I 100 Answer Go To Single Jeopardy
    6. 6. DOUBLE JEOPARDY 2 local anesthetics which can cause methemoglobinemia Topic I 200 Question
    7. 7. What are: Topic I 200 Answer Go To Single Jeopardy Benzocaine and Prilocaine
    8. 8. A one year old boy, 10 kg, has just been bitten by a cockapoo... Topic I 300 Question
    9. 9. No, of course not, it was a pit bull...
    10. 10. He will require extensive laceration repair. Calculate the maximum doses of lidocaine 1 % with and without epinephrine? PRIZE !!
    11. 11. What are: 4.5 cc plain, 7 cc with epi?
    12. 12. % 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 Answer Go To Single Jeopardy
    13. 13. 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:
    14. 14. What are: CNS Toxicity (seizures, coma) and Cardiovascular Toxicity (dysrhythmias, myocardial depression)
    15. 15. 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 Answer Go To Single Jeopardy
    16. 16. 5 ways to decrease the pain of infiltration of local anesthetics? Topic I 500 Question
    17. 17. What are: 1. Inject slowly 2. Buffer with sodium bicarbonate 3. Inject through open margins of wound 4. Use warm anesthetic 5. Use small needle 6. Reassure patient/distraction Topic I 500 Answer Go To Single Jeopardy
    18. 18. Safe and appropriate oral analgesic choice for patient reporting an allergic reaction of vomiting to codeine Topic II 100 Question
    19. 19. What is: Anything except codeine
    20. 20. Analgesic Classes • Phenanthrenes: Morphine, Hydromorphone, Codeine, Hydrocodone, Oxycodone, mixed agonists/antagonists • Phenylpiperidines: Fentanyl, Meperidine • Diphenylheptanes: Methadone Topic II 100 Answer Go To Single Jeopardy
    21. 21. Analgesic just removed from US market on 11/19/2010 Topic II 200 Question PRIZE !!
    22. 22. What is propoxyphene? Topic II 200 Answer Go To Single Jeopardy (darvon, darvocet)
    23. 23. The correct increasing order of potency for the following ORAL analgesics • oxycodone • hydromorphone • codeine • morphine • hydrocodone Topic II 300 Question
    24. 24. What are: • codeine 200 mg • hydrocodone 30 mg • morphine 30 mg • oxycodone 20 mg • hydromorphone 7.5 mg Topic II 300 Answer Go To Single Jeopardy
    25. 25. This relative of clonidine has sedative and analgesic properties and reportedly very little respiratory depression Topic II 400 Question PRIZE !!
    26. 26. What is dexmedetomidine? Topic II 400 Answer Go To Single Jeopardy
    27. 27. Leave blank Topic III 100 Question
    28. 28. Leave blank Topic III 100 Answer Go To Single Jeopardy
    29. 29. ASA physical status classification for patient with well controlled asthma requiring procedural sedation Topic III 200 Question
    30. 30. What is II?
    31. 31. Topic III 200 Answer Go To Single Jeopardy
    32. 32. Amount of time recommended by ASA to wait before sedation after patient has drank clear liquids Topic III 300 Question
    33. 33. What is 2 hours?
    34. 34. ASA guidelines • 2 hrs for clear liquids • 4 hrs for breast milk • 6 hrs for other milk or a light meal Topic III 300 Answer Go To Single Jeopardy
    35. 35. Medication used for procedural sedation which is associated with adrenal insufficiency and myoclonus Topic III 400 Question
    36. 36. What is Etomidate?
    37. 37. 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 Answer Go To Single Jeopardy
    38. 38. An increasingly popular mixture of two procedural medications has this name and contains this common ratio of the medications Topic III 500 Question
    39. 39. 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 Answer Go To Single Jeopardy
    40. 40. The reason not to use Ketamine in small children with active URIs Topic IV 100 Question PRIZE !!
    41. 41. What is Laryngospasm? Topic IV 100 Answer Go To Single Jeopardy
    42. 42. 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
    43. 43. What is Ketamine? (would also accept Midazolam) Topic IV 200 Answer Go To Single Jeopardy
    44. 44. Contraindication to use of Nitrous Oxide Topic IV 300 Question PRIZE !!
    45. 45. Topic IV 300 Answer Go To Single Jeopardy What is/are: pneumothorax, SBO, middle ear effusion, balloon tip catheter use? Also head injuries, psych, intoxication
    46. 46. Patient responding to verbal/light touch with adequate spontaneous ventilation after etomidate sedation is at this sedation level Topic IV 400 Question
    47. 47. What is Moderate Sedation?
    48. 48. 1. Anxiolysis/Minimal Sedation 2. Moderate Sedation 3. Deep Sedation 4. General Anesthesia Topic IV 400 Answer Go To Single Jeopardy
    49. 49. Three requirements prior to the safe discharge of a patient from the ED after procedural sedation Topic IV 500 Question
    50. 50. What are: 1. Stable Vital Signs 2. No respiratory distress 3. Has ride home with responsible adult 4. No significant N/V, able to take po 5. Awake, at neuro baseline, ambulatory, following instructions Topic IV 500 Answer Go To Single Jeopardy
    51. 51. Alternative method of delivery for Fentanyl besides IV and Transdermal and Intranasal Topic V 100 Question
    52. 52. 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 Answer Go To Single Jeopardy
    53. 53. These two drugs are used in the treatment of Complex Regional Pain Type I (reflex sympathetic dystrophy) Topic V 200 Question
    54. 54. What are corticosteroids and calcitonin?
    55. 55. 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
    56. 56. Topic V 200 Answer Go To Single Jeopardy
    57. 57. What the abbreviation EMLA stands for Topic V 300 Question PRIZE !!
    58. 58. What is:What is: Eutectic Mixture ofEutectic Mixture of Local AnestheticsLocal Anesthetics (prilocaine and lidocaine)
    59. 59. • 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 Answer Go To Single Jeopardy
    60. 60. This high potency ultra-short acting opioid is on the horizon as a sedative/analgesic Topic V 400 Question
    61. 61. Topic V 400 Answer Go To Single Jeopardy What is remifentanil?
    62. 62. FINAL JEOPARDY Analgesia
    63. 63. Ketamine can be used in this dosing regimen as a sub-dissociative drip for pain control (recently discussed on EM- RAP for trauma patients).
    64. 64. FINAL JEOPARDY What is 0.3 mg/kg IV bolus then drip of 0.3 mg/kg/hour IV?
    65. 65. Credits Software Template Design by David L. Shenson Use of this software is free. Please maintain the credits so credit Can be given where it is due. Comments and suggestions can be made by e-mail to dshenson@concentric.net

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