Emergency Drugs Flashcards
oxygen is essential to life– without it, brain death begins within ___ min
6
inadequate O2 in the blood
hypoxemia
ambient room air contains approximately ___% O2
21%
fraction of inspired oxygen (FiO2) 21% of the total volume of gas taken in
cardiac arrest initially require supplemental O2 in high concentrations (FiO2 close to 100%)
The initial emergency oxygen delivery devices of choice for these conditions include a ____ mask w/ an O2 reservoir
what flow rate?
nonrebreather (10-15 L/min)
What pt may lose their hypoxic respiratory drive when given high oxygen concentrations?
COPD
what should normal SpO2 read?
94-99%
rate for nasal cannula
1-6 L/min
emergency drugs used for an MI
1) Aspirin
2) Nitro
3) Morphine
4) Atropine
(MOANA)
first-line emergency drug used to decrease platelet aggregation in the management of acute coronary syndromes and MI
aspirin
to speed absorption chew instead of swallowing whole
dilates coronary arteries and improves blood flow to an ischemic myocardium
treatment choice for angina pectoris and MI
nitroglycerin
SL
repeat q5min (3 tabs/15 min) as long as BP > 90 mmHg
relieves pain and anxiety, dilates venous vessels, and reduces the workload on the heart
Morphine sulfate
resp depression and hypotension are common adverse side effects
dose 0.4 - 2 mg every 2 min
narcotic antagonist to reverse the side effects of morphine
naloxone
primary drug indicated for the treatment of hemodynamically significant bradycardia and some types of heart block
increase HR by inhibiting the action of the vagus nerve
atropine sulfate
also used to reverse toxic effects of organophosphate pesticide and nerve agent exposure
0.04 mg/kg q3-5min (max 3mg)
considered a first-line agent in ALS algorithms for the treatment of life-threatening ventricular dysrhythmias and cardiac arrest
indication in pulseless v-tach and v-fib
amiodarone
alternative to amiodarone used to treat significant ventricular dysrhythmias such as PVCs, v-tach, and v-fib
exerts a local anesthetic effect on the heart, thus decreasing myocardial irritability
lidocaine
1-1.5 mg/kg bolus, then 0.5 - 0.75 mg/kg q5-10min until dysrhythmia is controlled or a total dose of 3 mg/kg has been administered via the IV or IO route
metabolized in liver (hepatic impairment = HR toxicity); other risks heart failure, shock, advanced age >70yrs
need continuous cardiac monitoring and assessment for signs of toxicity
catecholamine with alpha and beta adrenergic effects
emergency cardiac indications for admin IV/IO are bradycardia and hypotension, asystole, pulseless v-tach, and v-fib
epinephrine
prescribed to treat severe metabolic acidosis (DKA) as well as the hyperkalemia and acidotic states related to specific drug overdose situations
sodium bicarbonate
IV dose 1 mEq/kg
careful monitoring of ABG
opiate antagonist; competitively binding to opiate receptor sites in the body
naloxone
0.4-2mg/2min
IV, IO, IM, SubQ, IN
monitor the pt closely for signs and symptoms of recurrent opiate effects such as resp depression and hypotension
may be prescribed for poisoning as a means to prevent absorption of toxins into the body
activated charcoal
contact poison control
1-2g/kg/dose
a sympathomimetic agent often used to treat hypotension in shock state; increase HR in bradycardic rhythms
dopamine
dose 5-10mcg/kg/min
increases HR and vasoconstricts
watch for extravasation (phentolamine mesylate 5-10mg in 10-15mL of NS)
a synthetic catecholamine; sympathomimetic drug with beta-adrenergic activities
enhance the force of myocardial contraction (positive inotropic) and increasing HR (positive chronotropic)
blood pressure is only elevated through the increase in cardiac output
dobutamine
IV 2-20mcg/kg/min
adverse effects: myocardial ischemia, tachycardia, dysrhythmias, HA, nausea, and tremors
a catecholamine with extremely potent vasoconstrictor actions (alpha-adrenergic effect)
when drugs such as dopamine and dobutamine have failed to produce adequate BP or as first-line alternative to dopamine
Norepinephrine
tapered slowly to avoid hypotension
monitor IV site for extravasation
the drug of choice in the treatment of anaphylactic shock, an allergic response of the most serious type, brought about by antibody-antigen reaction
causes bronchodilation, enhanced cardiac performance, and vasoconstriction to increase BP
epinephrine
IM 0.3-0.5mg (1:1000)
an antihistamine, is administered with epi to treat anaphylactic shock
effective for treating the histamine-induced tissue swelling and pruritus common to a severe allergic reaction
diphenhydramine HCl
adult dose: 25-50mg IV or IM
adverse reactions: hypotension, sedation, confusion, dry mouth
generally defined as a systolic BP that exceeds 180-200mmHg, a diastolic BP that exceeds 120mmHg, and pulmonary edema
hypertensive crisis
an alpha and beta adrenergic blocker that acts by inhibiting the effects of the sympathetic nervous system
labetalol
initially 20mg IV push over 2min, can be repeated or doubled q10min until desired response max dose of 300mg
contraindicated in asthma or COPD (bronchospasm), severe bradycardia or apparent heart failure AB BEAM <– cardioselective
IV agent used to reduce arterial BP in hypertensive emergencies
MOA is immediate, direct arterial and venous vasodilation
nitroprusside sodium
50mg mixed in 250mL D5W; 0.25-0.3mcg/kg/min, max 10mcg/kg/min
on cardiac monitoring and BP increases with drug is stopped
when should nitroprusside be discarded
1) inactivated by light (wrapped in aluminum foil or another opaque material to protect the solution from degradation)
2) a faint brown tint is typical, blue or brown discoloration of the solution indicated degradation and needs to be discarded
