thrombolytics + ICP backup Flashcards
simple explanation of Tenecteplase role
accelerates the breakdown of clots
Heparin role simple explanation
short acting anticoagulant
enoxaparin basic role
long acting anticoagulant
clopidogrel basic role
antiplatelet
tenecteplase preparation
Glass ampoule containing 50 mg of tenecteplase, in powder form with a pre-filled syringe containing 10 ml of sterile water.
what is tenecteplase
fibrinolytic that accelerates the breakdown of blood clots
Tenecteplase MOA
Tenecteplase accelerates the breakdown of clots by stimulating TPA (tissue plasminogen activator, an enzyme) to facilitate the increased conversion of plasminogen to plasmin, resulting in a breakdown of fibrin ( the mesh casing of vessels).
ILS indcation of tenectplase
STEMI when following the fibrinolytic pathway.
contradictions of tenectplase
allergy
cautions of tenectaplse
Clinically significant bleeding.
More than ten minutes of CPR.
Non-compressible vascular puncture within the last 24 hours.
Internal bleeding within the last six weeks.
Lumbar puncture or epidural insertion within the last six weeks.
TIA within the last three months.
Known bleeding disorder.
Taking an anticoagulant. If the patient is taking warfarin document their last known INR result if possible.
Systolic BP greater than 180 mmHg or diastolic BP greater than 110 mmHg.
Known to be pregnant or less than two weeks postpartum.
Time of onset of symptoms was greater than 12 hours ago.
Dependent on others for activities of daily living.
Another disease significantly shortens their life expectancy.
Very frail.
Suspected aortic dissection.
Major surgery, major trauma or severe brain injury within the last six weeks.
Intracranial surgery within the last six months.
Ischaemic stroke within the last six months.
Previous intracerebral haemorrhage.
Known cerebral aneurysm, arteriovenous malformation or tumour.
tenectaplase and pregency?
seek clinical advise
administration of tenectplase
Follow weight based medication chart
Dissolve the powder using the syringe within the kit.
Carefully discard unwanted drug from the syringe, preferably into the ampoule before administration, ensuring the correct dose remains in the syringe.
If an error is made in discarding unwanted drug and the correct dose cannot be drawn up, administer the remaining drug, document this well, and notify the receiving clinician.
Administer undiluted as an IV bolus, preferably into a running IV line.
advese effects of tenectaplase
Bleeding. Tenecteplase commonly causes superficial bleeding, including epistaxis, bruising and bleeding from IV sites.
Dysrhythmia. It is common for dysrhythmia to occur if the coronary artery reperfuses. Most commonly the rhythm is accelerated idioventricular rhythm (AIVR) which does not require specific treatment. Other dysrhythmias should be treated using the appropriate section.
onset of tenectplase
5-10 minutes
duration of tenectplasse
2-6 hours
interactions of tenectplase
nil
enoxaparin preparation
Pre-filled syringe containing 100 mg in 1 ml.
what is enoxaparin
low molecular weight heparin (LMWH) anticoagulant.
enoxaparin mechanism
Enoxaparin increases the activity of antithrombin lll (a naturally occurring anticoagulant, inhibits clotting ) causing inhibition of multiple coagulation factors including clotting factor II (thrombin) and factor 10 Xa (which makes fibrin). thrombin is unable to convert fibrinogen to fibrin and form a clot.
ILS enoxaparin indication
STEMI in conjunction with fibrinolytic therapy.
contraindction of enoxaparin
allergy
cautions of enoxaparin
Clinically significant bleeding. Enoxaparin will increase bleeding.
At risk of bleeding. If there are any cautions present within the fibrinolytic therapy checklist, personnel must seek clinical advice or discuss with the STEMI coordinator prior to administration.
Pregnancy.
admin of eneoxaparin
Administer subcutaneously into the abdominal wall.
There is no need to sterilise the skin at the site of injection unless the skin is visibly contaminated.
Discard unwanted drug from the syringe before administration.
If an error is made in discarding unwanted drug volume and the dose remaining in the syringe is less than planned, administer the remaining dose.
adverse effects of eneoxparin
increased bleeding
onset of enoxoparin
10-30 minutes
duration of enoxaparin
12-24 hours
common interactions of eneoxoparin
risk of bleeding increases if the patient is taking an anticoagulant
preparation of clopidogrel
75 mg tablets
what is clopeidegrel
an antiplatlet
mechanism of clopidogrel
platelet inhibitor that irreversibly bind to ADP receptors on platelets, imparting their function thus decreasing aggregation
indication for clopedigerl
STEMI in conjunction with fibrinolytic therapy.
contridicaitons of clopidogrel
KSA
cautions of clopidogrel
Clinically significant bleeding. Clopidogrel will increase bleeding.
At risk of bleeding. If there are any cautions present within the fibrinolytic therapy checklist, personnel must seek clinical advice.
Pregnancy.
dosage and admin of clopidogrel
administer PO:
300 mg if the patient is aged less than 75 years.
75 mg if the patient is aged greater than or equal to 75 years
adverse effects of clopidogrel
increased bleeding
clopidogrel onset
30-60 mins
clopidogrel duration
3-5 days- full life of that platelet
clopidogrel common interactions
risk of bleeding if anticoagulanted
heparin prepration
Ampoule containing 5000 units.
what is heparin
Heparin is an anticoagulant.
heparin mech
Inhibits antithrombin III, which prevents the activation of thrombin altering the clotting cascade by preventing the conversion of fibrinogen to fibrin thus slowing and or preventing the formation of clots.
Heparin dose not contribute to lysis or breakdown of clots
heparin IND
STEMI in conjunction with fibrinolytic therapy.
heparin contras
KSA
Aged greater than or equal to 75 years. When heparin is administered in combination with fibrinolytic therapy in patients aged greater than or equal to 75 years, there is an increased risk of intracerebral haemorrhage.
heparin cautions
Clinically significant bleeding. Heparin will increase bleeding.
At risk of bleeding. If there are any cautions present within the fibrinolytic therapy checklist, personnel must seek clinical advice prior to administration.
Pregnancy.
admin and dosage of heparin
→5000 units.Dilute to a total volume of 10 ml using 0.9% sodium chloride.Administer IV over 1-2 minutes.
adverse effects of heparin
increased bleeding
onset of heparin
5-15 minutes
duration of heparin
2-4 hours
common interactions of heparin
The risk of bleeding will be increased if the patient is taking an anticoagulant.
criteria for RSI
✅A GCS less than or equal to 10, and
✅Clinically significant compromise of airway or ventilation.
why do we RSI
The primary goal of performing RSI is to improve patient outcomes by securing the airway, treating hypoxia and controlling ventilation to prevent hypercarbia. This is particularly important in patients who are unconscious post cardiac arrest or have severe TBI, because secondary brain injury worsens long-term outcomes.
timeframe consideration for RSI
Personnel calling for backup from an ICP endorsed to perform RSI must take into account how long it will take for backup to arrive. In order to be appropriately utilised, such backup must arrive at least 15 minutes faster than the patient can be transported to an appropriate hospital.
role of sodium bicarb
normalisation of extracellular and intracellular pH, raising serum pH to combat clinical manifestations of acidosis/hyperkalemia/electrolyte imbalances
indications to call ICP for sodium bicarb
✅Release syndrome following crush injury in an adult.
✅Known or suspected hyperkalaemia with severe ECG changes.
✅Cardiac arrest secondary to hyperkalaemia.
✅Suspected cyclic antidepressant poisoning with QRS prolongation.
IND to call ICP for Ropivacaine
Indications:
✅Severe pain associated with clinically obvious fractured neck of femur or fractured proximal shaft of femur, where pain has not been adequately controlled with an opiate and transport time (including extrication time) to hospital is greater than 30 minutes. (Fascia iliaca blocks)
✅Moderate to severe pain associated with isolated injuries to digits when transport time is greater than 60 minutes. (e.g. digit)
meteraminol indications
✅Hypotension in the setting of septic shock, post cardiac arrest, cardiogenic shock, severe traumatic brain injury, neurogenic shock, rapid sequence intubation and post intubation.
adenosine indications
✅Patients aged greater than or equal to 12 years with SVT and a ventricular rate greater than or equal to 150/minute, and
The patient is not severely compromised, and
The rhythm fails to revert following two Valsalva manoeuvres.
labetalol indications
✅Control of hypertension prior to fibrinolytic therapy for STEMI.
✅Control of hypertension during inter-hospital transfer for STEMI.
✅Control of hypertension during inter-hospital transfer for stroke clot retrieval.
✅Control of hypertension associated with autonomic dysreflexia.
ICP ketamine indications
✅Inducing dissociation.
✅Acute behavioural disturbance causing a severe to ✅immediately life-threatening risk to safety.
✅Rapid sequence intubation (RSI).
✅Significant movement during CPR that is interfering with resuscitation.
✅Asthma with severe agitation that is impairing the ability to safely provide treatment or transport.
calcium chloride indications
✅Release syndrome following crush injury in adults.
✅Suspected hyperkalaemia with severe ECG changes.
✅Cardiac arrest secondary to suspected hyperkalaemia.
what can you consult for hydrocortisone out of scope
adrenal crisis
severe asthma unable to take prednisone
out of scope ketamine consult indications
ABD
dissociation for cardioversion
movement in CPR
out of scope magnesium inds
severe COPD of asthma
torards de point
ecampsia
pre eclampsia
what is the preferred sedation for a patient who has not responded or n/a droperidol, if under the influence of meth
midazolam over ketamine
what is primary hemostasis
It is caused when bleeding ceases or gets reduced by contraction of the blood vessels, and thrombin signals for platelet assembly and forms a loose platelet plug
what is secondary hemostasis
It includes the action of blood proteins and coagulation factors in a sequence to reinforce the platelet plug and marks the onset of the healing process. Blood coagulation is provoked by the extrinsic pathway i.e. tissue damage, but the intrinsic pathway (internal messengers) intensifies the coagulation.
Coagulation of blood is a lengthy process occurring within a few minutes where numerous coagulation factors come into play.
