Intravenous Fluids Flashcards
Types of shock
- Hypovolemic
- Cardiogenic
- Distributive (septic)
- Obstructive (massive pulmonary embolism)
Issues with intravenous bags
- Leaching: tacrolimus, temsirolimus, teniposide, cabazitaxel, docetaxel, ixabepilone, paclitaxel ( tic tac toe craving delicious irresistible pho)
- Sorption: amiodarone for infusions greater than two hours, carmustine, lorazepam, sufentanil, REGULAR HUMAN INSULIN AND NITROGLYCERIN (ACLS TIN)
Hypovolemic
Typically treated with fluids
Cardiogenic shock
Often requires the use of a vasopressor and/or Inotropic agent
Septic shock
Administer crystalloids or Holroyd fluids, vasopressors, and/or inotropic drugs
HIS PATIENTS OBVIOUSLY ALSO NEED ANTIBIOTICS AND SOMETIMES ARE GIVEN CORTICOSTEROIDS
Inotropes and vasopressors
Inotropes:
- Dobutamine: beta agonist and increases heart rate which increases cardiac output
- Milrinone is a selective phosphodiesterase inhibitor and cardiac and vascular tissue which causes vasodilation and inotropic effects (must be does reduced for renal dysfunction)
Vasopressors: cause vasoconstriction which increases systemic vascular resistance
- Dopamine
- Epinephrine (adrenalin)
- Norepinephrine (levophed)
- Phenylephrine (neo-synephrine)
- Vasopressin (pitressin)
Note: extravastation can cause tissue damage and necrosis (phentolamine is used if this occurs as it antagonizes vasopressors)
Neuromuscular blockers
These agents do not provide sedation or analgesia. Therefore, patient should receive adequate sedation and in eulogies of prior to starting an NMBA
Two types:
- Depolarizing: succinylcholine the only available agent is reserved for intubation
- Nondepolarizing agents: vecuronium, atrcurium, cisatracurium (Nimbex), pancuronium, rocuronium (Zemuron)
Side effects of nondepolarizing NMBAs: Flushing, bradycardia, hypertension, tachyphylaxis
Monitoring: peripheral nerve stimulator to assess his depth of paralysis, vital signs
Injectable anesthetics
- Bupivacaine ( Marcaine, Sensorcaine)
- Lidocaine (Xylocaine)
- Ropivacaine (Norapin)
EPIDURALS CONTAINING BUPIVACAINE CAN QUICKLY BE FATAL IF GIVEN VIA THE INTRAVENOUS ROUTE. DO NOT GET BUPIVACAINE EPIDURAL THE IV INFUSION
Photosensitive drugs
Amiodarone, amphotericin, ceftriaxone, cefepime, ciprofloxacin, dopamine, Dr. C cycling, epinephrine, Fentonville, Verizon line, hydrocortisone, hydromorphone, levofloxacin, levothyroxin, Linezolid, methylprednisolone, metronidazole, micafungin, norepinephrine, ondansetron, phytonadione, Bactrim, sodium nitroprusside
IV medications that require filtration
About a set, abciximab, albumin, amiodarone, amphotericin, diazepam, digoxin immune fab, infliximab, lipids, Lorazepam, mannitol, phenytoin, parenteral nutrition
IV agents that should not be refrigerated
Metronidazole (Flagyl), Bactrim, phenylephrine (Neo-Synephrine), hydralazine, moxifloxacin (Avelox), acetaminophen (ofirmev), esomeprazole (Nexium)
Poisoning
Gastric decontamination is no longer recommended: such as activated charcoal or syrup of ipecac
Insecticide poisoning: most occur from organophosphates which inhibit acetylcholinesterase leading to a buildup of acetylcholine and presenting with cholinergic side effects
Cholinergic side effects (MUDDLES): miosis, urination, diarrhea, diaphoresis, lacrimation, excitation and salivation
Antidotes for select toxicities
- Acetaminophen: N acetylcysteine
- Anti-cholinesterase insecticides organophosphates: atropine
- Anticholinergic compounds: physostigmine (antilirium)
- Arsenic, Lead: succimer
- Benzodiazepines: flumazenil (romazicon)
- Beta blockers: glucagon (GlucaGen)
- Botulism: botulism antitoxin
- Black widow spider bites: anti-venin (Latrodectus mactans)
- Calcium channel blockers: calcium chloride 10%, glucagon
- Carbon monoxide: oxygen
- Cyanide: sodium nitrate, sodium thiosulfate, hydroxyocobalamin (cyano kit)
- Digoxin: digoxin immune fab (digifab)
- Ethylene guaiacol, methanol: ethanol or fomepizole (Antizol)
- Heavy metals: dimercaprol
- Heparin: protamine
- Iron: deferoxamine (Desferal)
- Isoniazid: pyridoxine or vitamin B6
- Methemoglobinemia: methylene blue
- Opioids: naloxone (Narcan)
- Salicylate: sodium bicarbonate
- Methotrexate: leucovorin
- Snakebites: crotalidae polyvalent
- Scorpion stings: anascorp
- TCAs: sodium bicarbonate
- Warfarin, rat poison: phytonadione (AquaMEPHYTON, mephyton)
- Vasopressors: phentolamine
Acid-base: metabolic acidosis
PH less than 7.35 and bicarb less than 22
Anion gap= sodium- (Cl+HCO3)
Mud piles: methanol, uremia, diabetic ketoacidosis, purpling glycol, isoniazid, lactic acidosis, ethylene glycol, salicylates. (others: alcoholic ketoacidosis, ethanol, cyanide, toluene)
