Sedation IV Flashcards
IV drug administration types needles
Hollow Metal Needles
Scalp Vein Infusion Needles
Indwelling Catheters
Needle Gauge
The # of needles that can be placed into a 1 in circle
Needle gauges to use
18 - GA
20-23 Sedation, IM injections
25-27 LA
30 Accupuncture
Fluids used for IV drugs
LR lactated ringers
NS sodium chloride
5% dextrose in water
Sterile water for injection
Infusion rate for adults
10 drops = 1 ml
Infusion rate for pediatric
60 drops = 1 ml
Precaution to take with rigid IV needles
Immobilize the elbow
Complications: Venospasm
Vein disappear or collapses
Heat may help vein reappear
Complications: Hematoma
Extravasation of blood into surrounding tissues
Painless bluish discoloration
If happens: remove tourniquet, apply firm pressure, and then ice
Complications: Embolism
Pt can tolerate up to 1ml/kg of air
Eliminate air bubbles from tubing to prevent
Have pt head down and lying on left side
Complications: Over-hydration
Significant for CHF pts and children
Can cause pulmonary edema, tachycardia, inc BP
Prevent by calculated fluid deficit
Complications: Extravasation of drugs
Will have pain, delayed drug absoprtion, possibly tissue damage
Mgmt: remove needle, apply pressure
If gave > 2mL, inject 1% procaine
Complications: Intra-arterial Injection
Respond aggressively!!
Chemical insult–> spasm that compromises distal circulation
Best way to avoid is prevention
Assess blood color- bright cherry red vs dark red
Complications: Intra-arterial injection - MGMT:
Leave needle in place, give 1% procaine Hospitalize pt Surgical endareterctomy Heparinzation Amputation of gangrenous limb is txt fails
Complications: Phlebitis and Thromboplebitis
Pain, edema, delayed onset
Mgmt: sling to limit limb activity
Elevate and heat limb
NSAIDs
Complications: Nausea
Tx w/ O2 and IV antiemetic
Complications: Vomiting
Stop txt immediately and put pt on RIGHT side
IV antiemetic
Suction
Complications: Emergence Delirium
Treat w/ scopolamine
Emergency Scenarios: Airway Obstruction
Most common cause: Prolapsed tongue
MGMT: Head tilt chin lift if from prolapsed tongue
Remove debris if not from tongue
If pt is not breathing - THEN you have to breath for them
Airways to fix airway obstruction
Laryngeal Mask Airway Combitube King tube Tracheal intubation Surgical airway cricothyroidotomy
LMA Indication
Alternative airway, difficult airway,
Can’t ventilate
Failed intubation
No laryngoscope
LMA Advantages
Minimal training
Can use in peds
Least amount of tissue trauma
Can use to intubate
Laryngospasm
Partial or complete closure of vocal cords due to irritation by foreign matter
Crowing noise
Laryngospasm
Laryngospasm mgmt
Stop procedure Deliver 100% O2 Position head Protrude tongue and suction oro, naso, and hypo pharynx Push on chest, listen for rush of air Positive pressure O2 Succinylcholine if still unsuccessful
Hypoglycemia
at 50-70 mg/dl –> CNS becomes excitable, nervousness, sweating, trembling
at 20-50 mg/dl –> convulsions, loss of consciousness, shock
Hypoglycemia mgmt
If conscious- oral carbs, monitor, IV 50% dextrose if no response to oral carbs
If unconscious - get help, BLS, O2, administer carb, 50% dectros IV and Glucagon 1mg IM
Allergy
Heightened response of the immune system
Broad range of onset
Affects multiple organ systes
If hypotension is involved– anaphylactic shock
Commonly used drugs w/ allergic potential
Antibiotics
Antianxiety meds
Analgesics
LA
Allergy: Clinical manifestations
CVS - pallor, lightheadedness, hypotension, tachycardia, loss of consciousness
GI - nausea, vomiting, severe abdominal cramping, diarrhea
Skin- urticaria, erythema, angioedema
Respiratory - follow skin but precedes CVS- Bronchospasm, angioedema of the larynx
Progressive respiratory and circulatory failure Itching of nose and hands Flushing of face Labored breathing Sudden hypotension Cyanosis Swelling of tongue, lips
Anaphylactic Shock
Anaphylactic Shock mgmt
Epinephrine 0.1 mg IV
Antihistamine and steroid IM/IV
Transfer to hospital
Asthma mgmt
position pt, administer bronchodilator
100% O2 by facemask
If not responsive, epi
Opioid overdose mgmt
Naloxone - 0.4 mg/ml add 3 ml of saline = 0.1 mg/ml initial dose - fast acting but short lasting
Benzodiazepine overdose mgmt
Flumazenil - 0.1 mg/ml- give initial dose of 0.2 mg
Angina during procedure - mgmt
Terminate procedure
Position pt
supplemental O2
Administer nitroglycerine
Myocardial Infarction mgmt
Terminate procedure Initiate EMS Establish IV access MONA Be ready to do CPR
MONA
Morphine for pain (nitrous can work too)
Oxygen
Nitroglycerine
Aspirin
