Premedications Flashcards
Fentanyl Classification
Narcotic analgesic
Fentanyl action
Potent Analgesic, sedative, euphoric
Fentanyl 1. Onset 2.Duration
- 1 min IV, 7-8 min IM
2. 30-60 min IV, 1-2 hrs IM
Fentanyl indication
- severe pain
- back pain with muscles spasm
- premedication for RSI?
Fentanyl contraindication
- Head trauma with ICP
- ALOC
- severe liver or renal insufficiency
Fentanyl use with caution
- bradycardia
2. respiratory depression
Fentanyl dosage and administration
Adults:
Traumatic emergencies - 50mcg IV/IO or 50-100mcg IN, every 5-10 min to max dose 200mcg if SBP>100
Cardiac emergencies - 25mcg IV/IO or 50mcg IN every 2-3 min up to 100mcg if SBP>100
Pediatric: 1-2mcg/kg IV/IO/IN/IM
Fentanyl adverse reaction
- hypotension
- bradycardia
- CNS depression
- nausea and vomiting
- respiratory depression
- chest wall rigidity
Fentanyl References
Traumatic (musculoskeletal trauma, amputated parts, Burns, crush injury)
Cardiac (chest discomfort and ACS)
Lidocane classification
Antiarrhythmic
Lidocane action
- suppresses ventricular arrhythmias
2. local aesthetic
Lidocane 1. Onset 2. Duration
- Immediate
2. 10-20 min
Lidocane indication
- cardiac arrest from VF/VT
2. Stable VT, wide complex tachycardia of uncertain type, wide complex PSVT
Lidocane contraindication
Heart blocks
Lidocane use with caution
- liver disease
- CHF
- respiratory depression
- hypovolemia
- shock
- heartblock
Lidocane Dosage and Administration
Cardiac arrest from VF/ VT:
a. 1-1.5mg/kg IV/IO bolus
b. for refractory VF, additional .5-.75 mg/kg IV/IO, repeat in 5-10 min; max dose 3mg/kg
c. ET dose: 2-3mg/kg in 10 ml NS
2. Perfusing arrhythmia stable VT
a. .5-.75mg/kg up to 1.5mg/kg IV/IO
b. Repeat every 5-10 min to total of 3mg/kg
3. Maintenance Infusion mix 1g/250ml NS 2-4mg/min
4. RSI for ICP 1.5mg/kg I/V
5. IO anesthesia adult only: 20-50mg prior to infusion
Pediatric: 1mg/kg IV/IO or 2-3mg/kg IN in 5ml NS
Lidocane adverse reaction
- CNS: dizzy, somnolence, confusion, Paresthesias, muscle twitching, seizure, slurred speech
- CV: hypotension, bradycardia
- EENT: tinnitus, blurred vision
Lidocane reference
- cardiac
- RSI
- pediatric arrest
Atropine Classification
Parasympathetic blocker, anticholinergic
Atropine Action
Cardiac:
1. Chronotropic effect of Increase SA node rate by blocking vagus nerve
2. Positive dromotropic effect in AV Node
Non-Cardiac:
1. decrease body secretions
2. dilate pupils and eye paralysis
3. Decrease bladder tone and increase urinary retention
4. CNS Stimulant
Atropine 1.Onset 2.Duration
- Immediate IV
2. 4 Hrs
Atropine Indication
- Bradycardia with HYPOTN, AMS, PVC, Cpx,
- 2nd, 3rd heart block, asystole but not very effective
- Organophosphate, Nerve agent poisoning
- Pre-medication for pediatric intubation
Atropine Contraindication
- Afib/flutter
- HR>60
- Bradycardia due to ICP (stroke/trauma)
Atropine Use with Caution
- Do not mix with sodium bicarb
2. Be certain bradycardia not due to hypoxia or ICP
Atropine Dosage and Administration
- Bradycardia
Adult: .5mg IV every 3-5 min as needed, not to exceed .04mg/kg, ET 1mg diluted in 10ml NS
Ped: .02mg/kg, min = 0.1mg, max single dose = 0.5mg, max total dose = 1mg
Adolescent single dose = 1mg, max total = 2mg
ET = .05mg/kg in 5ml NS - Poisoning
Adult: 1mg every 1 min until Sy clear, up to 10mg, If using MARK1 kit give up to 3 sets of meds
Ped: <12yo .5mg IV/IO every 1 min. until Sy clear, max total 10mg.
RSI = .02mg/kg, min dose = .1mg, max dose = .5mg
Atropine Adverse Reaction
Cardiac: tachy, palpitations, V-Fib
Non Cardiac: Dry mouth, diplopia, restless, irritability, AMS, injection site px
Atropine Reference
Cardiac
Environmental
RSI
Pediatric Cardiac Arrest Guide
