Pharmacology and Fluid Therapy PART 2 Flashcards
Methoxyflurane (Penthrox®) -generic name-trade name-class
Generic name:-Methoxyflurane Trade name: -Penthrox® Classification Analgesic gas -
Methoxyflurane (Penthrox®) -MOA
Active ingredient is methoxyflurane, works by decreasing the CNS and making patients less responsive to pain. Research is unsure how this drug effects the CNS.
Methoxyflurane (Penthrox®) -indications-contraindications
Indications -Moderate to severe pain related to trauma Contraindications -Inadequate understanding/patient cooperation -Decreased level of consciousness -Psychosis -Pre-eclampsia -Moderate to severe renal and/or liver impairment -Hypersensitivity/ family history of malignant hyperpyrexia without negative personal test -Significant cardiovascular compromise -Raised intracranial pressure
Methoxyflurane (Penthrox®) -precautions-side effects
Precautions -Used with care in patients with underlying hepatic conditions -Previous exposure to halogenated hydrocarbon anesthetic (methoxyflurane when used as an anesthetic agent) especially if the interval is less than 3 months. -May increase the potential for hepatic injury. Side Effects -Altered level of consciousness -Cough
Methoxyflurane (Penthrox®) -route-dose-pharmacokinetics
Route -Inhalation Dose -Self-administered -One bottle containing 3 mL of Penthrox® to be vaporized is a supplied inhaler -Maximum dose is 6 mL in a 48-hour period Pharmacokinetics -Onset 1 to 3 minutes -Duration 1 hour -Half-life unavailable
Methoxyflurane (Penthrox®) -how supplied SKIP FOR NOW-special notes
How Supplied -Bottle containing 3 mL Penthrox® Special Notes -When disposing Penthrox®, the inhaler and medication is to be placed in plastic bags provided, sealed and disposed
Salbutamol -generic name-trade name-class
Generic name: -Salbutamol Trade name: -Ventolin® Classification -Bronchodilator
Salbutamol - MOA
-Beta adrenergic agonist.-Predominant Beta 2 effects: relax bronchiole smooth muscle and cause bronchodilation
Salbutamol -indications-contraindications
Indications -Bronchospasms due to exacerbation of Chronic Obstructive Pulmonary Disease (COPD) and Asthma Contraindications -Hypersensitivity, symptomatic tachycardia
Salbutamol -precautions-side effects
Precautions -Caution with cardiac patients Side Effects -Palpitations, tachycardia, increased blood pressure, anxiety -Headache, dizziness -Sweating, trembling
Salbutamol -route-dose-pharmacokinetics
Route -Inhalation Dose -Adult: 2.5–5 mg -Pediatric: 1.25–2.5 mg with 2–4 mL of NaCl Pharmacokinetics -Onset: 5–15 min -Peak effects: 30 min–2 hours -Duration: 3–4 hours
Salbutamol -how supplied SKIP FOR NOW-special considerations
How Supplied - Metered dose inhaler: 100 mcg/ metered spray -Nebules: 2.5 mg/2.5 mL Special Considerations -Monitor blood pressure, pulse and electrocardiogram (ECG)
Anti-microbial -what is it-how much of it can be given over what period of time
is an agent used to kill microbes or prevent the replication of microbes in an infected host most, if not all, can be given intravenously over 15–20 minutes
what is the procedure for PCP and anti microbial infusion
- Ask the attending MD or RN to complete the administration of the IV anti-microbial before setting out on the transfer2. A dosage sticker must be affixed to the IV mini-bag indicating: -The name of the anti-microbial. -The dose and the time of preparation. 3. The anti-microbial will be given by constant IV infusion using an infusion control device at a predetermined rate according to the local pharmacy protocol
what is the procedure for PCP and anti microbial infusion during transport
Vital signs every 15 minutes. Discontinue if any unexplained symptoms or signs of hypersensitivity develop. (If there is any doubt concerning the etiology of any new signs or symptoms during the transport, contact the referring physician.) Discontinue if any signs or symptoms of anaphylaxis develop. Treat anaphylaxis as per protocol. If the patient’s condition deteriorates, arrange for an ALS intercept.
Heparin
directed primarily towards preventing development of intravascular thrombosis and the treatment of thromboembolitic disorders such as acute myocardial infarction, pulmonary embolism, and deep venous thrombosis
2 classes of anticoagulant drugs
parenteral (administered via IV) oral agents
The patient receiving IV Heparin must meet certain criteria before being infused -what does not meet the criteria
Anyone who has a known hypersensitivity to Heparin, is actively bleeding, is in shock, is suffering from some form of severe bleeding disorder (hemophilia)
If any adverse reactions are going to occur, such as anaphylaxis, they usually begin within
the first several minutes to 1 hour of the infusion
why does a pt on heparin need to be closely monitored
This drug classification is potentially dangerous, capable of causing severe, possibly fatal hemorrhaging
Possible Complications of heparin
Localized bleeding Irritation at the IV site Hemorrhaging Hypersensitivity (chills, urticaria, fever, anaphylaxis, bronchospasm) Elevated blood pressure Chest pain Impaired renal function
Management of heparin
Observe for bleeding (GI urinary, epistaxis, etc.) and discontinue the infusion if present and significant. Vital signs are to be recorded every 15 minutes, watching for any signs and symptoms of shock. Ensure that you have an accurate baseline of all vital signs before the transport begins. A record of the patient’s vital signs over the last several hours or days will provide you with some criteria to gather your baseline data. Stop Heparin if unexplained hypotension occurs. If there is any doubt about the origin of any new signs or symptoms during transport, contact the medical control physician for further orders.
Drug Interactions with heparin
very stable medication when mixed in normal saline, D5W or Ringer’s Lactate for a period of up to 24 hourshas to be given in a separate IV site if other medications are also being infusedHeparin will interact with salicylates (ASA), nonsteroidal anti-inflammatory drugs, NSAIDs, and will interfere with platelet aggregation. Heparin will also antagonize the action of insulin.
Potassium
Potassium is an electrolyte that is frequently administered intravenously to maintain a serum level
what should the serum level of potassium be betweenwhat is considered a low serum level and symptoms what serum level is too low and what can happen
between 3.5 and 5.3 mmol/Lbelow 3.0 mmol/L may be associated with symptoms such as weakness and malaise. below 2.5 mmol/L, lethal arrhythmias may occur
what can potassium added to an iv bag be infused up to in a patient with normal renal function
up to 40 mEq/hr
Sudden boluses of potassium may cause lethal arrhythmias meaning…
the rate of infusion of a potassium drip cannot be increased rapidly if the patient develops hypotension
To prevent a rapid infusion of potassium, the following must be adhered to:
must be administered via an IV pump. ensure that a medication sticker is affixed to the IV bag which identifies potassium as the medication being infused, as well as the dose of potassium. The rate of administration must be in writing and is not to be exceeded under any circumstances. If the patient has the potential to develop hypotension enroute, a second IV line is to be established. The patient may complain of burning along the vein where potassium is infusing; however, this is a common symptom the pre-hospital care provider should ensure the infusion is not exceeding the specified rate, and should provide reassurance to the patient. Under no circumstances is the flow rate of potassium-containing solution to be increased.
Oxytocin
a naturally occurring hormone that is secreted by the posterior pituitary gland. When secreted, it causes contraction of the uterine smooth muscles and lactation.
When postpartum hemorrhage cannot be controlled with breastfeeding or fundal massage, an IV infusion containing
10 – 20 units of synthetic oxytocin (Syntocinon®) may be administered
Possible Complications of oxytocin
Hypotension Dysrhythmias Tachycardia Seizures Coma Nausea Vomiting Uterine rupture from overstimulation of uterus
Management of oxytocin
Monitor vital signs. Due to the fact that excessive oxytocin can cause overstimulation of the uterus, uterine tone must be monitored throughout transport. If there is any doubt about the origin of any new signs or symptoms during transport, contact the medical control physician for further orders.
Drug Interactions with oxytocin
Syntocinon® can cause hypertension when administered with a vasoconstrictor such as norepinephrine.
Total Parenteral Nutrition (TPN)
the most common site for administration is via a central venous catheter due to the high concentration of the solution TPN is given to patients that have a long-term need for intravenous feeding, cannot receive adequate nutrition to meet their physiologic needs, do not have a functioning gastrointestinal (GI) tract or have a condition that has them on total bowel rest
possible patients that may receive TPN:
Hypercatabolic states (burns, trauma, sepsis) Gastrointestinal diseases Renal failure Congenital GI abnormalities Short bowel syndrome due to surgery
Standard dosing for an adult of TPN
is 2 liters per day of standard solution
Adverse reactions related to TPN’s components:
Water: -Fluid overload Insulin and dextrose:-Hypoglycemia or hyperglycemia Heparin: -Hemorrhage Electrolytes: -Abnormal levels of sodiumchloride, potassium, and magnesium Vitamins: -Deficiency in vitamin D-excess of vitamin A Dextrose:-Respiratory distress-liver dysfunction Allergic reaction
TPN Administration
When administering TPN via the central line, maintain sterility to help prevent infection. The line that is used for TPN administration should not be used for any other purpose. The TPN infusion must be transported on an infusion pump, and the prescribed rate must never be exceeded.
Acetylcysteine (Mucomyst®)
is an antidote for acetaminophen poisoning.
Acetylcysteine (Mucomyst®) classification
Its classification is Antitode (Mucolytic).
Acetylcysteine (Mucomyst®) Dosage
Loading dose: Dilute 150 mg/kg in 250 mL D5W; infuse over one hour Second infusion (repeat): Dilute 50 mg/kg in 500 mL D5W, infuse over four hours Third infusion (repeat): Dilute 100 mg/kg in 1000 mL D5W; infuse over sixteen hours or as directed
EMS Contraindications for Acetylcysteine (Mucomyst®)
No contraindications when used to treat acetaminophen overdose Hypersensitivity to acetylcysteine when used for indications other than treating acetaminophen overdose
Cautions for Acetylcysteine (Mucomyst®)
Encephalopathy, due to hepatic failure Asthma, chronic pulmonary disease, or sensitivity to acetylcysteine; administer loading dose slowly and be prepared to treat anaphylactoid reactions Pregnancy/Breast Feeding: Contact pharmacy for most recent information
what is an iatrogenic response
is an adverse condition that is inadvertently induced in a patient by a treatment given.
what is an iatrogenic overdose
an overdose of medication by a medical personnel It can be a result of wrong dosing or wrong route of administration.
Blood serves the following functions:
Supplies oxygen and nutrients for energy production and for tissue maintenance, growth, and repair Transports cellular waste, including carbon dioxide, to the organs for elimination Provides a defense against infection by transporting antibodies Regulates and equalizes body temperature Helps to maintain the acid-base balance Regulates fluid and electrolyte balance
Blood is made up of 2 basic components:
Cellular or formed elementsPlasma
Plasma
is a sticky straw-coloured fluid approximately 90% water. Dissolved within the plasma are over 100 different solutes including proteins, nutrients, electrolytes, and respiratory gases. Plasma makes up about 55% of the volume of blood.
Erythrocytes
(red blood cells) constitute approximately 45% of the blood’s volumehave a dedicated role in the transportation of respiratory gases.
Leukocytes
white blood cellsmake up less than 1% of the entire blood volumeplay a major role in defense against infection and disease.
Platelets
(also less than 1% of blood volume) are necessary for the clotting process and circulate in the vasculature, inactive until a blood vessel ruptures or is damaged
Blood is group classified based
on the types of antigens present or absent on the surfaces of the red blood cell
Pre-transfusion testing includes the following
Blood typing Antibody detection (and antibody identification if antibody screen is positive) Crossmatching
ABO Group -A -B -AB -O * name antigen and the frequency in population
-A 40% -B 11% -A and B 4% -None 45%
A patient’s antibodies will do what to red blood cells that have corresponding antigen on their surface
A patient’s antibodies will hemolyze (break down or destroy red blood cells) transfused red blood cells that have the corresponding antigen on their surface.
Historically, patients whose blood group was unknown and who required an urgent transfusion were provided with
Group O Rh negative red blood cells (RBC) until the patient’s blood group was determined
In situations where the blood group is unknown:
The Transfusion Medicine Laboratory (TML) will usually issue O Rh negative RBC’s for females of child bearing potential (less than 45 years of age) until the patient’s blood group is confirmed. All males and females past child bearing potential, can receive O Rh positive RBC’s until the patient’s blood group is confirmed
Crossmatching
is the process of determining the compatibility of blood from a donor with that of the recipient before transfusion
Whole blood
contains all components of blood the clotting factors and platelets quickly lose their function during storage A unit contains approximately 450 mL of whole blood plus 63 mL of anticoagulant
Indications of whole blood
indicated in blood loss not commonly available from blood banks, and therefore red blood cells are more commonly used for treatment of anemia and acute blood loss One unit of whole blood can increase the patient’s hemoglobin by approximately 10g/L
Infusion Rate of whole blood
The initial transfusion should be slow (5 mL/min for 15 minutes) while assessing the patient for adverse reactions In the absence of any reactions, the product can be infused as quickly as the patient can tolerate it. The transfusion must be completed with the 4-hour window
whole blood Compatibility
Normal saline
whole blood Special Considerations
Whole blood must be ABO-identical to the recipient’s blood group. (Group O is not universal donor for whole blood.)
whole blood Administration Set
The administration set must be a blood tubing set that has a 170–260 micron blood filter.
whole blood Storage and Shelf Life
Whole blood cannot be left at room temperature for longer than 4 hours. As soon as collection from the donor is complete, whole blood must be stored at 1–6° C the red blood cells will retain their function for up to 21–35 days
Whole Blood – Overview -major uses-storage and shelf life-administration
Major Uses -To replace: -Fibrinogen: in patients actively bleeding who have a low fibrinogen level Storage and Expiration -Frozen -Shelf life: 1 year -Once thawed, expires after 4 hours stored at 20–24°C Administration -Blood tubing required -Transfuse as rapidly as tolerated
Red Blood Cells
along with normal saline are more commonly used than whole blood for acute blood loss A unit of red blood cells is 240–340 mL and will be more viscous than whole blood most red blood cell components today have an additive solution mixed with the red blood cells (e.g., AS-3). With an additive solution, red blood cells will have the same flow rate as whole blood Red blood cells have minimal amounts of plasma (and ABO antibodies) so you can give ABO-compatible blood rather than only ABO identical
Red Blood Cells indications
Red blood cells units are administered to patients requiring increased oxygen-carrying capacity by increasing the circulating red blood cell mass.
Infusion Rate
The initial infusion should be slow for the first 15 minutes to assess for adverse reactions, then administered as quickly as the patient tolerates A slower rate should be considered for patients at risk for overload. A unit of red blood cells must be administered within 4 hours.
red blood cells Compatibility
Normal Saline
red blood cells special considerations
In massive transfusions, if possible warm blood with approved blood warmer prior to transfusion to prevent hypothermia.
cAdministration Set
The administration set must be a blood tubing set that has a 170–260 micron blood filter. If administering at a fast rate, 16–18 gauge cathlon is required in small vein patients a 20–22 gauge may be used.
red blood cells shelf life
Depending on the anticoagulant and additive solution used, red blood cell units have a shelf life of 21–42 days.
red blood cells Storage
Red blood cells must be stored at 2–6° C. During inter-facility transfers, the blood should be stored in a Canadian Blood Services styrofoam box with ice packs.
Red Blood Cells – Overview
Major Uses-Bleeding or anemic non-bleeding patients with signs and symptoms of impaired tissue oxygen delivery: –Tachycardia –Shortness of breath –Dizziness Storage and Expiration -2–6° C in approved refrigerator only -Shelf life: Maximum 42 days Administration-Blood tubing required -Initiate transfusion slowly for first 15 minutes unless massive blood loss -Transfuse over no more than 4 hours -Typically over 1½–2 hours with slower rates for patients at risk for circulatory overload
Fresh Frozen Plasma
-Fresh frozen plasma (FFP) is separated from whole blood by centrifugation or sedimentation and must be frozen within 8 hours of collection -A unit of fresh frozen plasma (FFP) contains approximately 250 mL (minimum 100 mL) of anticoagulated plasma.
Fresh Frozen Plasma Indications
Fresh frozen plasma (FFP) is separated from whole blood by centrifugation or sedimentation and must be frozen within 8 hours of collection A unit of fresh frozen plasma (FFP) contains approximately 250 mL (minimum 100 mL) of anticoagulated plasma. Fresh frozen plasma is indicated for patients requiring plasma coagulation factors, patients on Coumadin requiring emergency invasive procedures before Vitamin K can reverse its effects, or patients with plasma protein deficiencies.
Infusion Rate Fresh Frozen Plasma
Recommended infusion time is 30 minutes to 120 minutes but must be infused within 4 hours.
Compatibility Fresh Frozen Plasma
Normal Saline
Special Considerations Fresh Frozen Plasma
FFP should be thawed in a water bath at 30–37° C (in a watertight protective plastic over wrap using gentle agitation); this may take 20–30 minutes. Once thawed, FFP must be used immediately and cannot be refrozen.
Administration Set
The administration set must be a blood tubing set that has a 170–260 micron blood filter.
Storage and Shelf Life
FFP can be stored up to 12 months at temperatures -18° C and for 24 hours at 1–6° C once thawed.
Fresh Frozen Plasma – Overview
Major Uses -Liver disease coagulopathy –Massive transfusion –Plasma exchange procedures for certain diseases (e.g., TTP/HUS*) Frozen Storage and Expiration -Shelf life: 1 year; Once thawed, expires after 5 days stored at 1–6° C Administration -Blood tubing required Initiate transfusion slowly for first 15 minutes unless massive blood loss -Transfuse over no more than 4 hours -Typically over 30 minutes–2 hours
Cryoprecipitate
produced by Canadian Blood Services from fresh frozen plasma An insoluble precipitate, cryoprecipitate, is separated from the plasma and refrozen One unit of cryoprecipitate contains 80IU of Factor VIII and 150 mg of fibrinogen in 5–15 mL of plasma.
Indications of cryoprecipitate
Cryoprecipitate is indicated in patients requiring a source of fibrinogen or Factor VIII. It can only be used as a source of Factor VIII when virally inactivated fractionation products or recombinant Factor VIII (used for Hemophilia A) are not available.
Infusion Rate of cryoprecipitate
Recommended infusion time is 10–30 minutes per dose but must be complete within 4 hours.
Compatibility of cryoprecipitate
Normal saline
Administration Set of cryoprecipitate
The administration set must be a blood tubing set that has a 170–260 micron blood filter.
Storage and Shelf Life
Cryoprecipitate can be stored up to 12 months at temperatures of -18° C and for 4 hours at 20-24° C.
Cryoprecipitate – Overview
Major Uses-To replace: -Fibrinogen: in patients actively bleeding who have a low fibrinogen level Storage and Expiration-Frozen -Shelf life: 1 year; Once thawed, expires after 5 days stored at 1–6° C Administration-Blood tubing required -Transfuse as rapidly as tolerated
4.1 Rights of Transfusion
- Patient - Is this the right patient? 2. Product - Is this the right product? Check the blood for any clots, leaks, or discolouration Check the expiry date 3. Amount - Is this the right amount? 4. Rate - Is it set at the right rate? 5. Time - Is it the right time?
monitoring of a patient receiving blood products:
Only transport those patients receiving blood products that have been stable for last 24 hours Ensure that vital sign assessment is performed 15 minutes after the initiation of transfusion Repeat vitals every 30 minutes, including a temperature Repeat vitals more often for patients who are at greater risk of overload or experienced previous reactions Ensure that a physician’s order is present specifying the infusion rate and that the rate is no faster than 2 hours per unit All infusions must be complete within 4 hours of initiation A pressure infuser cannot be utilized unless a physician is present during transport Only normal saline can be infused through the same IV line as a blood product All blood tubing must be changed every 2–4 units of blood
Steps Upon Completion of Transfusion
Disconnect blood tubing once infusion is complete, as used tubing can be a breeding ground for bacteria Dispose of used blood tubing and bags in a biohazard bag and return to the hospital Continue to assess patient for symptoms of reactions for 6 hours post transfusion
Documentation
include the following on your PCR: Start and finish time of each bag Type of product being infused Blood unit number Rate the transfusion was run at Volume transfused during transport Vital signs and assessment findings Any reactions and treatment provided
List Potential Complications of Blood and Blood Product Transfusions
Adverse effects, generally referred to as transfusion reactions, are infrequent and vary in severity. Death due to transfusion is rareAIDS has occurred following transfusion, but blood donors are now tested
Adverse reactions can be classified as one of the following:
Immediate transfusion reactions Delayed transfusion reactions
deaths from blood transfusion
The majority of deaths are due to severe intravascular hemolysis (the destruction of red blood cells) following the administration of ABO mismatched blood Viral hepatitis is the second most common cause of death related to blood transfusion; the association with transfusion may not be recognized, and the hepatitis may develop many months after the transfusion
Immediate Transfusion Reactions
Reactions that occur during or within 24 hours of the infusion of blood products They include the following: Acute hemolytic transfusion reactions Febrile reactions Allergic reactions Air embolism Overload Chills Hypothermia
Acute Hemolytic Transfusion Reactions
rare usually due to the transfusion of ABO incompatible blood following the improper identification of the recipient, either when the crossmatch specimen is taken or when the blood donor is transfused
Signs of acute intravascular hemolysis include
fever, chills, hypotension, hemoglobinuria (the presence of hemoglobin in the urine which may cause a reddish discoloration of the urine), flank pain, and shortness of breath
disseminated intravascular coagulation (DIC)
results in abnormal bleeding such as around an IV site
Febrile Reactions
during transfusion is the most common adverse reaction following a transfusion
Febrile Reactions may be due to
Destruction of transfused red blood cells Destruction of transfused white blood cells Bacterial contamination of the blood Reaction to proteins
Urticaria during blood transfusion
(hives) fairly common. Unless extremely severe or accompanied by bronchospasm or other signs of impending anaphylaxis, the development of urticaria is not serious Treatment consists of discontinuing the transfusion of the blood product and keeping the IV line open with normal saline.
Anaphylaxis
A life-threatening anaphylactic reaction (hypotension, bronchospasm, flushing, and laryngeal edema) rarely occurs during a transfusion of blood Treatment consists of discontinuing the transfusion of the blood product, keeping the IV line open with normal saline, providing high flow O2, etc.
Air Embolism
The use of closed plastic systems for the collection of whole blood and for the preparation of blood components has virtually eliminated air embolism as a complication of blood transfusion deaths have occurred when air has been deliberately introduced into the blood bag, or the administration set, to increase the rate of blood flow to the patient
Delayed Transfusion Reactions
a delayed reaction occurs after 24 hours and in some cases is not identified until much later.
Delayed Transfusion Reactions include
Hepatitis Sepsis Iron overload Delayed hemolytic reaction Post transfusion purpura Transfusion-associated graft-versus-host disease
Transfusion Associated Circulatory Overload (TACO)
The infusion of blood products can cause fluid overload and resultant pulmonary edema Circulatory overload occurs when the rate of infusion is excessive for that patient’s cardiovascular status especially in the elderly or very young
Transfusion Associated Circulatory Overload (TACO) symptom
These patients complain of shortness of breath (which can also be present with anaphylactic and acute hemolytic reactions)
Transfusion Associated Circulatory Overload (TACO) treatment
Treatment consists of discontinuing the transfusion of the blood product and keeping the IV line open with normal saline The patient should also be placed on high flow O2 and placed as high as possible in the sitting position.
Chills and treatment
Chills may occur as a result of a febrile reaction or in patients with a normal temperature In either case the transfusion should be discontinued Treatment consists of discontinuing the transfusion of the blood product and keeping the IV line open with normal saline
Hypothermia and treatment
Hypothermia may occur if cold blood is rapidly transfused Treatment consists of discontinuing the transfusion of the blood product and keeping the IV line open with normal saline
Possible Transfusion Reaction -Fever, chills, or rigors (shaking)
Bacterial contamination Acute hemolytic transfusion reaction Transfusion related acute lung injury (TRALI) Febrile non-hemolytic transfusion reaction
Possible Transfusion Reaction -Urticaria and other allergic symptoms
Anaphylaxis Minor allergic reaction
Possible Transfusion Reaction -dyspnea
Transfusion related acute lung injury (TRALI) Transfusion associated circulatory overload (TACO) Anaphylaxis Bacterial contamination Acute hemolytic transfusion reaction
Possible Transfusion Reaction -Hypotension
Transfusion associated circulatory overload (TACO)
Possible Transfusion Reaction -Hemolysis, hemoglobinuria
Acute hemolytic transfusion reaction
Possible Transfusion Reaction -Pain
Acute hemolytic transfusion reaction IV site Lumbar Transfusion associated circulatory overload (TACO) Chest
Possible Transfusion Reaction -Nausea and vomiting
Acute hemolytic transfusion reaction Acute anaphylaxis Febrile non-hemolytic transfusion reaction
Risk and Description -Minor Allergic Reaction
1 in 100 Mild allergic reaction to an allergen in the blood component/product.
Risk and Description -Anaphylaxis
1 in 40,000 Potentially fatal reaction caused by an allergen that the patient has been sensitized to.
Risk and Description-Febrile Non-Hemolytic Transfusion Reaction
1 in 300 Mild, usually self-limiting, reaction associated with donor white blood cells or cytokines in the blood component/product. Usually presents with fever and/or rigors.
Risk and Description-Bacterial Sepsis (platelet pool)
1 in 10,000 will become symptomatic 1 in 60,000 will be fatal Potentially fatal reaction caused by bacteria inadvertently introduced into the blood component/product or originating from the donor. More common in platelets due to room temperature storage.
Risk and Description-Bacterial Sepsis (red blood cells)
1 in 250,000 will become symptomatic 1 in 500,000 will be fatal More common in platelets due to room temperature storage.
Risk and Description-Acute Hemolytic Transfusion Reaction
1 in 40,000 Potentially fatal reaction caused by blood group incompatibility. Can also be caused by chemical hemolysis (e.g. incompatible solutions) or mechanical hemolysis (e.g. improper storage). Can result in renal failure, shock, and coagulopathy.
Risk and Description-Transfusion Related Acute Lung Injury (TRALI)
1 in 12,000 Acute hypoxemia with evidence of new bilateral lung infiltrates on X-ray and no evidence of circulatory overload. Patients often require ventilatory support.Usually occurs within 1–2 hours of start of transfusion and rarely after 6 hours. Usually resolves within 24–72 hours, with death occurring in 5–10%. Cause not fully understood. Postulated to be related to donor or recipient antibodies acquired through pregnancy or transfusion.
Risk and Description-Transfusion Associated Circulatory Overload (TACO)
1 in 100 Circulatory overload from excessively rapid transfusion and/or in patients at greater risk for overload (e.g. very young, elderly, impaired cardiac function). Preventative measures include slower transfusion rates and pre-emptive diuretics for patients at risk.
Risk and Description-Hypotensive Reaction
Rare Bradykinin mediated hypotension. Characterized by profound drop in blood pressure, usually seen in patients on ACE inhibitors unable to degrade bradykinin in blood component/product.
Macro
10 gtts/mL, 15 gtts/mL and 20 gtts/mL.
Micro
60 gtts/mL
TKO (to keep vein open)
is always 30 mL/hr
When performing drip rate calculations when do u round up
f the number in the tenths is above zero the number would be rounded up. For example 22.1 mL should be rounded up to 23 mL.
Calculate Drip Rate
volume x set——————- =rate time
Calculations for Intravenous Infusions
volume x set = time x rate
To Calculate Volume:
rate x time—————- =volume set
medication infusion calculation
pres. d x dripfactor————————— = rateconcentration of drug in 1 ml
1 inch is how many cm
2.54 cm
how many ml in an ounce
30ml
how many ml in 1 teaspoon
5ml
how many mg in 1 g
1000mg
how many grams in a decagram
10g
how many grams in a kilogram
1000g
Concentration refers to how many of a given item is present in something elseWhen we are dealing with medication it refers to
how much medication is in 1 mL of solutionIf the medication is stated as mg in an amount of fluid, this can be easily determined by dividing the number of mg by the number mL of fluid
Drug concentration is sometimes listed as a percentage
This refers to how many grams of drug are present in 100 mLThe concentration can be determined by converting grams to mg and dividing by 100
drug calculation formula
ml in vial x desired dose———————————- mg in vial
The ratio and proportion method
Dose on hand × Desired volume = Volume on hand × Desired dose
examples Enteral
Oral medication administration Rectal medication administration
examples Parenteral
Subcutaneous medication administration Intramuscular medication administration Intravenous (IV) medication administration including IV infusion pump use Intraosseous medication administration Endotracheal medication administration Inhalation medication administration
examples Percutaneous
Transdermal medication administration Sublingual medication administration Buccal medication administration Intranasal medication administration
Medication Preparation
begins with you checking the medication to ensure that it is the correct drug, that the drug is not cloudy or discoloured, and that the expiry date has not passed You then have to determine the correct dose and concentration for that medication
ampoule
a sterile glass container that is designed to carry a single dose of a medication. An example of a medication supplied in an ampoule is epinephrine
Medication Preparation: Vials
A vial is a glass or plastic container with a rubber-stopper top. They may be either single or multi-dose. An example of a medication supplied in a vial is Narcan®.
safe scene practices that include the following:
- If the patient is responsive or if there is another reliable source of information confirm that the patient is not allergic to the drug that has been ordered2. Read the label carefully as you take the vile or syringe from its box and again before you give the drug note the concentration printed on the label and the drugs date of expiry3. Check with your partner to ensure the correct medication is being administered4. Check the defects in the vile, preloaded syringe or ampoule and make sure the fluid inside is not cloudy discoloured or precipitated• Check whether the container itself appears to be cracked or damaged5. If more than one drug is going to be administered to make sure that the drugs are compatible6. Monitor the patient for possible adverse side effects7. Dispose of the syringe and needle safely do not try to recap the needle
If an online physician consultation is required:
- Make sure the physician understands the situation2. Make sure you understand the physician orders clearly3. Always repeat any orders Word for Word back to the physician before administering medication to confirm state in the name of the drug the dose and the route
- Enteral route of administration refers to
any route in which the medications are absorbed through the gastrointestinal tract.
oral administration
Oral medication administrations are given to the patient to take by mouth. Depending on the medication they can be either swallowed whole or chewed.
oral administration Absorption
Since medication taken orally is absorbed by the stomach and intestines, onset of action is delayed sometimes as long as 30-90 minutes.
oral administration Advantages
• Convenient• Sterility is not needed
oral administration disAdvantages
• Unpleasant taste for patient• Nausea may result due to gastric mucosa irritation• Patient must be conscious to reduce the risk of aspiration• Digestive juices may destroy medication
oral administration Example
is ASA.
Rectal Medication Administration
are inserted into the patient’s rectum. Depending on the medication it may be in liquid form or in a firm base that is designed to melt at body temperature.
Rectal Medication absorption
Since medication administered rectally is absorbed by the highly vascular rectal mucosa, onset of action is rapid.
Rectal medication Advantage and disadvantage
An option for patients that cannot tolerate the medication orallyCan be uncomfortable for the patient.
Rectal medication equipment
• Water-soluble lubricant• Syringe• NPA, ET tube, plastic sheath off IV cathlon or 1 mL syringe
Rectal medication Example
Acetaminophen
Subcutaneous Medication Administration
are given in the loose connective tissue located between the dermis and the muscle layer. Volumes up to 1 mL can be injected subcutaneously.45 degree angle
Subcutaneous Medication Absorption
- Since the subcutaneous space does not have a rich blood supply, medications injected into this space have a slower onset of action and prolonged duration of action.
