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1
Q

Q. What are your RSI drugs (rapid sequence intubation), what order do you give them, can you give them, or does a doctor?

A

(Optional) Lidocaine or Fentanyl, (Sedative) Ketamine or Propofol, (Paralytic) Succinylcholine or Rocuronium, (post-intubation) Propofol, midazolam or fentanyl.
Nurses can administer RSI drugs but only under a physician’s order.

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2
Q

Q. Who needs to be present during intubation? What drips will be running?

A

Physician or Advanced practice provider, Critical care nurse, RT, support staff/other nurses.
Drips that will be running will be: post-intubation sedation drips (propofol, versed, precedex), Pain control drips (fetanyl/morphine),and vasopressors if pt is unstable (Levophed, epi, vasopressin)

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3
Q

Q. What resuscitation equipment will be needed?

A

Intubation kit, suction, bag mask

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4
Q

What are your sedation drugs? (3)

A

Propofol (Diprivan)
Midazolam (Versed)
Precedex

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5
Q

What is primary action for propofol?
Notes?

A
  • Fast-acting sedation
  • Reduces brain O2 demand
  • Can cause hypotension
  • Requires secure airway
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6
Q

What is primary action for Midazolam (Versed)?
notes?

A
  • Benzo used for sedation and amnesia
  • May cause hypotension
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7
Q

What is primary action for Precedex?
notes?

A
  • Sedation w/o deep respiratory depression
  • Good for weaning off vent
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8
Q

What are your vasopressors? (3)

A

Epinephrine
Norepinephrine (Levophed)
Vasopressin

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9
Q

Primary action for Epinephrine
notes?

A
  • Increases BP & HR
    *used in Cardiac arrest/severe anaphylaxis
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10
Q

Primary action for Norepinephrine (Levophed)

notes?

A
  • Increases BP
  • 1st line hypo/shock
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11
Q

Primary action for Vasopressin

notes?

A
  • Increases BP w/o increasing HR
  • Often added to NE
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12
Q

What are your paralytic drugs? (2)

A

Cisatracurium (Nimbex)

Rocuronium (Zemuron)

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13
Q

When to use Cisatracurium (Nimbex)

A

Common in ARDS, severe resp failure, or high vent demands

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14
Q

When to use Rocuronium (Zemuron)

A

Bolus for RSI
Long-acting paralytic

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15
Q

When to use Cardizem (diltiazem)?
Monitor?
Push?

A
  • Treats rapid HR or high BP
    (Afib, Atrial flutter, SVT)
  • Monitor BP closely (hypotension), ECG monitoring (heart block, bradycardia)
  • Push over 2min/never rapid push
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16
Q

NS - what kind of fluid?
Used for?

A

NS 0.9% NaCl - ISOTONIC
General use - Fluid resuscitation, hydration
(Hypovolemic shock, trauma, sever dehydration, sepsis, hypotension, burn)
If the patient is hypotensive, a fluid bolus of 500-1000ml may be given before vasopressors

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17
Q

LR - what kind of fluid?
Used for?
Better than NS because?

A

ISOTONIC
* Trauma, burns, metabolic acidosis, electrolyte replacement
* due to rapidly expanding intravascular volume, provides electrolytes, and helps correct acidosis.
Contains lactate and helps correct lactic acidosis from blood loss or ischemia

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18
Q

D5W 0 what type of fluid?
Used for?
Never use in?

A

HYPOTONIC
* Hypoglycemia or to maintain BG, hypernatremia, severe dehydration, heat stroke
* Never use in ICP, brain injury (swelling), Stroke, hypovolemia, hyperglycemia,

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19
Q

What do isotonic fluids do?
What are the 2 isotonic fluids?

A

Expand blood volume, increase BP, maintain fluid balance
NS, LR,

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20
Q

What do hypertonic fluids do?
What are the 4 hypertonic fluids?

A
  • Fluid to shift OUT of cells into blood stream
  • Reduce swelling, cerebral edema, and severe hyponatremia
  • 3%NaCl, 5%NaCl, D51/2NS, D10W
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22
Q

What do hypotonic fluids do?
What are the 4 hypotonic fluids?

A

Fluid to shift OUT of bloodstream into CELLS
dehydration, hypernatremia, DKA,
1/2NS or 0.45%NaCl, D5W, 0.33% NS,

23
Q

How many pressors can you run at a time?

24
Q

What is max titration for levophed?

A

Levophed is titrated to effect based on bp goals (MAP 65-70 mmhg) / max dose usually up to 30 mcg/min

25
Q

What is max titration for vasopressin

A

Vasopressin is titrated to effect based on bp goals (MAP 65-70 mmhg) / max dose usually up to 0.04 units/min

26
Q

What is max titration for epinephrine

A

Epinephrine is titrated to effect based on bp goals (MAP >or = MAP 65 mmhg) / max dose, usually up to 0.2mcg/kg/min

27
Q

What is cool therapy mgmt
ROSC?
Target tempt?
How to cool?
Rewarming?
Complications?

A
  • Cool therapy mgmt aims to reduce the risk of neurological injury by cooling the brain and body
  • ROSC - Return of Spontaneous Circulation after cardiac arrest
  • 32-36C target cooling maintained for at least 24 hours
  • Cooling blankets, ice packs, internal cooling (IV chilled fluids)
  • Rewarming should be slow (0.25C/hr) to avoid hemodynamic instability and seizures
  • Infection, coagulation issues, rewarming shock (hypotenison, cardiac arrhythmias)
28
Q

What are nitro drips used for and what are contraindications?

A

Nitro drips and contradictions
Used to treat ACS, HTN, HF
Contraindications are hypotension (SBP <90, MAP <65mmhg), Severe anemia, ICP, PDE-5 inhibitors (viagra, cialis w/in last 48hours)

29
Q

What is DKA and what are symptoms?

A

Life-threatening complications of diabetes result from severe insulin deficiency, leading to hyperglycemia, ketosis, and metabolic acidosis.
* Hypeglycemia >250mg/dl, ketouria, dehydration, fruity breath, kussmaul respirations, electrolyte imbalances, particularly potassium

30
Q

What is your insulin drip rate for DKA and how often do you check BGL?

A

Insulin drip rate 0.1units/kg/hr
Check BGL q hourly until stable then q2-4hr

31
Q

What other fluids do you run for DKA?
What labs do you draw?
how often?

A

Run normal saline first 1st 1-2 hours ,switch to 0.45% NS once BG falls to 250mg/dl to avoid fluid overload, and add 5% dextrose once BG reaches around 200mg/dl to prevent hypoglycemia
Labs: BG, aretial pH and bicarb, electrolytes K+(insulin therapy will shift potassium INTO cells, which can cause hypokalemia), ketones and renal function.
check potassium q 2-4hours

32
Q

Q. Which critical meds must only run through a central line

A

Vesicants - chemo drugs, vasopressors, TPN, Milrinone

33
Q

What is the protocol for blood transfusions?

A

Blood transfusions can only be paired with NS and must be given within 4 hours; must be started within 30 min of retrieval from blood bank, double verified, run at 75ml/hr for the first 15 min and watch for transfusion reaction, some facilities will have you start it at 90ml/hr. After 15 min, increase rate based off doctor order or patient history.

34
Q

Normal range for SODIUM ?

A

Sodium 135-145

35
Q

Normal range for POTASSIUM

A

Potassium 3.5-5.0

36
Q

Normal range for Chloride

A

Chloride 98-106

37
Q

Normal range for HCO3

A

HCO3- 22-28

38
Q

Normal range for Calcium

A

Calcium 8.5-10.2

39
Q

Normal range for mag

A

Mag 1.7-2.2

40
Q

Normal range for Phosphate

42
Q

As the pH goes —-

A

So does my patient except POTASSIUM

43
Q

HypErnatermia - Causes?
S/S
HypOnatermia - causes?
S/S

A

**HypErnatermia **
(DKA, DI, HHNK)
S/S- dehydration - Dry skin, Thready pulse, Rapid HR
HypOnatermia
(SIADH)
S/S - Overlaod

44
Q

Calcium Channel blockers
Like what?
Negative ___
Treats?
S/S
Drug? ending in plus __ + __
Monitor?

A

Like valium for your heart
* Negative inotropic, dromotropic, chronotropic
Treat - A, AA, AAA
* Antihypertensive, AA - Anti-angina, AAA - Anti atrial arrhythmias
S/S Headache & hypotension
Drugs - anything ending in DIPINE + verapamil & Cardizem
Monitor BP and hold if SYS is under 100

45
Q

Kalemias -
Does –?
Hypo?
Hyper?
Never push?
Decrease fast? slow?

A

Same as prefix, except HR and Urine output
Hypo - Lethargy, Bradypnea, U wave, Ilius / constipation, Flaccidicy, Tachycardia, Increased urine / polyuria
Hyper - Agitated, Seizures, Tachypnea, Diarrhea, Spasticity/clonus , Bradycardia ,Oliguria
* NEVER PUSH IV / No more than 40mEq of K+/liter of IV fluid
* Give D5W & Insulin to decrease K+ FAST - hides K in cells
* Kayexalate - K+ exists-late SLOW - gets K out via poop

47
Q

Calemias
(Calcium)
Does?
Hypo?
Hyper?

A

Opposite as prefix
Hypo - Agitation/ Irritability, Seizure, Tachycardia, Clonus, Diarrhea, Hyperactive reflexSpasicity / clonus, Polyuria Chvosteks, Trousseau
HYPER - Lethargy, Bradycardia, U wave, Bradypnea, Ilius / Constipation.Flaccidicy / hypoactive reflexes, Oliguria

48
Q

HypErnatermia - Causes?
S/S
HypOnatermia - causes?
S/S

A

**HypErnatermia **
(DKA, DI, HHNK)
S/S- dehydration - Dry skin, Thready pulse, Rapid HR
HypOnatermia
(SIADH)
S/S - Overlaod

49
Q

S/S HYPERGLYCEMIA

A

Hyperglycemia - Polydipsia, Polyuria, Fatigue, blurred vision, headache, dry mouth, Kussmaul resp, nausea, vomit
Fruity breath,

50
Q

S/S HYPOGLYCEMIA

A

Hypoglycemia - below 70, Shakiness/tremors, sweating, hunger, anxiety, tachycardia, dizzy, headacheconfusion, seizures

51
Q

S/S SHOCK

A

Shock - Hypovolemic - low bp, tachycardia, weak pulse, cold skin, decreased urine
Cardiogenic - SOB, rapid or weak pulse, low bp, chest pain
Septic - fever, chills, warm, flushed skin, rapid hr, low bp, confusion
Anaphylactic - swelling, diff breathing, hypotension
Neurogenic - hypotension, bradycardia, warm dry skin

52
Q

What is a shockable heart rhythm?

A

Ventricular Fibrillation (VF or V-fib)
Ventricular Tachycardia (VT or V-tach)

NCLEX (4 decks)

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