moderate sedation emergencies Flashcards
Laryngospasm
Oxygen up to 15 L/Min Pull tongue, eval airway, suction Push chest to break spasm positive pressure O2 EMS reverse sedation if possible Compression, airway , breathing Succinylcholine 10mg 40 mg or 100mg for severity Ventilate for 10 min for succinylcholine Consider: intubation, glucagon
Bronchospasm
upright pt compression, airway, breathing remove debris from pt mouth calm pt Ventolin 2 pumps EMS Epinephrine .3 or .6 mg IM only Benadryl if reoccurs 10-50 mg over 3 hours if severe, consider atropine .5-1mg every 3 hours
Cardiac arrest
no pulse, start compressions, activate EMS
EKG
ACLS protocols
start IV
VT or V FIB:
Epi 1 mg, amiodarone 300mg epi 1 mg, amiodarone 150mg epi 1mg, then pure lidocaine 1.5 mg per kg
if asystole:
Epinephrine 1 mg, shock, epi 1 mg, shock, 1 mg epi
Hypoglycemia
50% Dextrose check glucose levels juice or glucose by mouth if severe activate EMS Start IV with largest bore needle or Glucagon IM
Syncope
Trendelenburg position oxygen ammonia under nose be ready for vomit EMS if takes greater than 15 seconds Start IV/ rehydrate pt if needed for low blood volume check glucose compression, airway, breathing
Bradycardia
Heart rate below 50 and symptoms, then treat
Trendelenburg position
EMS
CAB if needed
Atropine IV 1mg for 3mg Dmax over 5 minutes
Consider Dopamine IV 20mcg per minute to increase heart rate
If atropine fails, then epinephrine 10 mcg/ min until EMS arrives
Emesis and aspiration
Trendelenburg with head to left suction pharynx EMS Oxygen Tracheal lavage with saline, suction and oxygenate IV steroids CAB if needed consider hospital for pneumonia prevention
Respiratory depression and arrest
Airway oxygen start IV EMS nasal trumpet or bag valve mask reverse with nalaxone .4 mg flumazenil .2 mg up to 1 mg max (fill to 2 cc line)
Angina pectoris
pt upright EMS CAB if needed nitrogylcerin 2 sprays IV placed Oxygen oral nitroglycerin if first dose doesn't work
Myocardial Infarction
EMS
CAB if needed
AED if needed
if conscious:
Nitrogylcerine, apsirin, o2, then consider morphine, nitrous
Morphine is 4 mg slowly over 10 min intervals
consider fentanyl 50 mcg instead of morphine
Hypertensive crisis
BP is 200/130 or higher
if able, take oral meds with small amount of water
Labetalol 20mg( up to 80 mg) every 5min for max of 300mg
check BP often
EMS if unable to control
Hyptotensive crisis
systolic lower than 90 Oxygen EMS IV on fast drip (consider larger IV) 25 mg Ephedrine IV 5 sec push if not maintained, .5 mg epinephrine IM slowly
Allergic reaction/ Anaphylaxis
upright pt 50 mg Benadryl IV or IM nasopharyngeal airway if needed IF analphylaxis- EMS Epinephrine.3 to .6 mg 50 mg of benadryl again or 25 if child hyrdocortisone IV 100 mg
Consider cricothyrotomy as last ditch procedure
Convulsions
EMS
Oxygen
IV Benzo (anticonvulstant) 5 mg diazepam or 1 mg Midazolam
CAB if needed
If caused by local anesthetic, they need hospital
overdose can be caused by MAOI or liver issues
Bradycardia meds (3)
Atropine 1 mg up to 3 max
Dopamine 20mcg a minute
If all fails epi 10mcg per minute till ems arrives
