Medications/Treatments

Question 1

PUSH DOSE PRESSORS

(clinical indications)

Answer 1

Clinical Indications:

 To migate short-lived hypotension in the case of intubation in high risk patients.

 Transient hypotension (To serve as a bridge while other interventions, which the clinician anticipates will result in improved blood pressure, are being implemented)

Question 2

PUSH DOSE PRESSORS

(Epi)

Answer 2

Procedure: Epinephrine:

Epinephrine is an inopressor that has Alpha 1and 2, and Beta 1 and 2 effects.

The onset of effects are seen in < 1 min and the duration of effects may last 5-10 min

Mixing:

Take a 10ml syringe with 9ml of normal saline. Draw up 1ml (0.1mg) of 1:10,000 Epinephrine from a pre-mixed vial.

The resulting concentration is 10 mcg/ml of Epinephrine (1:100,000) concentration. -

Alternatively, take 1ml of 1:1,000 Epinephrine and mix into a 100ml bag of normal saline. The resulting concentration is also 10 mcg/ml of Epinephrine (1:100,000) concentration.

Label the syringe as 10 mcg/ml to prevent errors.

Dose: 0.5-2ml (50-200mcg) every 2-5min, with a 5-10 min duration.

Question 3

PUSH DOSE PRESSORS

(Phenylephrine)

Answer 3

Phenylephrine is a pure Alpha agent and is the preferred push dose pressor in the presence of tachycardia.

The onset of effects is seen in < 1 min and the duration of effects may last 10-20 min.

Mixing:

Take a 3ml syringe and draw up 1ml of Phenylephrine with a 10mg/ml concentration. Inject this into a 100ml bag of normal saline. The resulting concentration is 100 mcg/ml of Phenylephrine.

Draw up into a syringe and label as 100 mcg/ml to prevent errors.

Alternatively, take 1ml of 1:1,000 Epinephrine and mix into a 100ml bag of normal saline. The resulting concentration is also 10 mcg/ml of Epinephrine (1:100,000) concentration.

Dose: 0.5-2ml (50-200mcg) every 2-5min, with a 10-20 min duration.

Question 4

CONSCIOUS SEDATION

(clinical indications/contraindications)

Answer 4

Clinical Indications:

 Conscious patients that require conscious sedation for procedures, such as, but not limited to: o Cardioversion

o Pacing

Contraindications:

 This order is not intended to replace or circumvent the Airway: Rapid Sequence Intubation Procedure. If the patient meets the criteria for RSI, follow RSI procedures.

 This order is not intended for pain management.

 This order is not intended for the sedation of unruly behavioral patients.

Question 5

CONSCIOUS SEDATION

(procedure)

Answer 5

1. Administer one of the following medications:
   a. Adults:
   i. Lorazepam (Ativan) 1 – 2 mg IM/IO/IV/IN repeated up to 4 mg max OR
   ii. Midazolam (Versed) 1 – 2 mg IM/IO/IV/IN repeated up to 5 mg max
   iii. Diazepam (Valium) 5-10 mg IO/IV or 0.2 mg/kg rectal up to 20 mg max
   b. Pediatrics:
   i. Lorazepam (Ativan) 0.05 – 0.1 mg/kg IM/IO/IV/IN repeated up to 4 mg max OR
   ii. Midazolam (Versed) 0.1 mg/kg IM/IO/IV/IN up to 2mg max initial dose repeated up to 5 mg.
   iii. Diazepam (Valium) 0.1 mg IO/IV up to 5 mg or 0.5 mg/kg rectal up to 5 mg max
2. Monitor patient’s airway/breathing and vital signs carefully.
3. It is required the airway be monitored continuously through waveform capnography and pulse oximetry.
4. If benzodiazepine overdose is suspected, adult administer Romazicon (Flumazenil) 0.2 mg IO/IV, may be repeated every minute to a max dose of 1 mg. Pediatric, 0.01 mg/kg up to 0.2mg IO/IV may be repeated every 5 minutes up to a max dose of 1mg.