Trauma and Pain Control Flashcards
Fentanyl trade name?
Sublimaze
Fentanyl classification?
Opioid Analgesic
Fentanyl actions?
Combines with receptor sites in the brain to produce potent analgesic effects
Fentanyl onset/duration?
IV: 1-2 min / 30-60 min
Fentanyl indications?
Pain control, sedation for invasive airway procedures, pain control for right-sided myocardial infarction
Fentanyl Contraindications?
Respiratory depression, hypotension, head injury, cardiac dysrhythmias, myasthenia gravis, hypersensitivity
Fentanyl side effects?
Respiratory depression, bradycardia, hypotension or hypertension, nausea and vomiting, chest wall rigidity
Fentanyl Route of admission?
IV, IO, IM, IN
Fentanyl adult dose?
50-100mcg (max initial dose of 100mcg), slow over 1-2 min every 1-2 hours for pain control
Fentanyl peds dose?
1-2mcg/kg
Fentanyl supply?
100mcg/2mL
Fentanyl special consideration?
Do not mix with Amiodarone as it may cause profound bradycardia, sinus arrest, and hypotension
Hydromorphone trade name?
Dilaudid
Dilaudid classification?
Opioid Agonist, Analgesis
Dilaudid Actions?
Inhibits pain pathways altering perception and response to pain
Dilaudid onset/duration?
5 min / 3-5 hours in nondependent patients
Dilaudid indications?
Moderate to severe pain management, burns, analgesia
Dilaudid contraindications?
Hypersensitivity, head injury or head trauma, hypotension, respiratory depression, asthma, GI obstruction
Dilaudid side effects?
Respiratory depression, altered LOC, bradycardia, nausea and vomiting, constricted pupils, drowsiness, hypotension, seizures, hallucinations, agitation, and delirium
Dilaudid route of administration?
IV/IO, IM
Dilaudid adult dose?
0.015mg/kg ; max initial dose 2mg
Dilaudid peds dose?
There isn’t one
Dilaudid supply?
1mg/1ml prefilled syringe
Dilaudid special considerations?
in patients 65 years or older administer half the normal dose and titrate to their pain tolerance
Toradol generic name?
Ketorlac
Toradol classification?
NSAID
Toradol actions?
Anti-inflammatory drug that also exhibits peripherally acting nonnarcotic analgesic activity by inhibiting prostaglandin synthesis
Toradol onset/duration?
Within 10 min / 6-8 hours
Toradol indications?
Short-term pain management (<5 days) of moderate to severe pain
Toradol contraindications?
Hypersensitivity, allergies to aspirin or other NSAIDs, bleeding disorders, renal failure, active peptic ulcer disease. (may increase bleeding so think of other pain management drugs associated with kidney stones.
Toradol side effects?
Anaphylaxis, edema, sedation, bleeding disorder, rash, nausea, headache
Toradol route of admission?
IV, IM
Toradol adult dose?
IV: 15mg over 1 min
IM: 30mg
Toradol supply?
15 or 30mg in 1ml or 60mg in 2mL
Toradol special considerations?
Reduce dose when giving to a patient over 65
Morphine Sulfate trade name?
Duramorph, Astamorph
Morphine classification?
Narcotic, opioid analgesic
Morphine actions?
Powerful pain killer. It’s also an arterial and venodilator that pools blood and decreases both preload and after load of the heart. This decreases the workload on the heart that decreases myocardial oxygen demand. It is a CNS depressant which helps alleviate anxiety.
Morphine onset/duration?
5-10 min, peaks in 20 min / 4-5 hours
Morphine indications?
Chest pain unrelieved by nitro. Severe (non-cardiac) pain
Morphine contraindications?
Hypotension, head injury, abdominal injury or pain
Morphine side effects?
Respiratory depression, hypotension, nausea, and vomiting
Morphine route of administration?
IV slow push, IM (do not give IM to cardiac chest pain patients)
Morphine adult dose?
STEMI:
2-4mg IV, may give additional at 2-8mg at 5-15 min
Unstable Angina / NSTEMI:
1-5mg IV, only if pain is not reduced by nitrates
Pain:
IM- 0.1mg/kg; max dose 15mg
IV,IO- 0.1mg/kg; max dose 10mg
Morphine peds dose?
0.1-0.2mg/kg slow IVP; max dose 15mg
Morphine supply?
10mg/1ml prefilled syringes
Morphine special considerations?
May worsen bradycardia or heart block in inferior MI
Ondansetron trade name?
Zofran
Zofran classifications?
Antiemetic
Zofran Actions?
Blocks the serotonin 5-HT3 receptors found in the chemoreceptor trigger zone and peripherally at vagal nerve terminals in the intestines
Zofran onset/duration?
Within 30 min/ 3-6 hours
Zofran indications?
Nausea and vomiting
Zofran contraindications?
Hypersensitivity, GI obstruction, Liver disease, prolonged QT syndrome
Zofran side effects?
Flushing, hiccups, dizziness, constipation, headache, drowsiness, dry mouth
Zofran route of administration?
PO, IV, IM, SL
Zofran adult dose?
IV: 4mg, injected over 30 seconds
IM: 4mg
PO: 4mg tablets
Zofran supply?
4mg/2ml vials
2mg/ml vials
4mg tablets
Sodium Bicarbonate trade name?
There isn’t one
Sodium Bicarbonate classification?
Alkalinizing agent, electrolyte replacement
Sodium Bicarbonate actions?
Neutralizes excess acid in the blood and interstitial fluid. Returns blood to a normal pH by increasing the availability of the bicarbonate ion
Sodium Bicarbonate onset/duration?
Rapid/ 8-10 min
Sodium Bicarbonate indications?
Pre-exisiting metabolic acidosis associated with cardiac arrest, shock, and DKA. Hyperkalemia. To promote the excretion of some types of barbiturate and salicylate overdoses. Tricyclic antidepressant overdoses and crush injuries.
Sodium Bicarbonate contraindications?
Hypokalemia. Conditions in which a patient cannot handle an increased salt load, such as CHF to renal failure. Metabolic alkalosis.
Sodium Bicarbonate side effects?
Increases intravascular volume. Lowers serum potassium. Raises the arterial carbon dioxide levels. Inactivates catecholamines. Metabolic alkalosis. Tissue necrosis if infiltrated at the IV site.
Sodium Bicarbonate route of administration?
IV, IV infusion
Sodium Bicarbonate adult dose?
IV: 1 mEq/kg
crush injuries-
IVP: 1 mEq/kg
Sodium Bicarbonate peds dose?
IV, IO: 1 mEq/kg per dose
Sodium Bicarbonate supply?
prefilled syringes of 50 mL containing 1 mEq/mL (8.4%)
Sodium Bicarbonate special considerations?
Flush the IV line well when using Sodium Bicarbonate before and after epi or calcium chloride
Tranexamic Acid generic name?
TXA
TXA classification?
Antifibrinolytic
TXA actions?
Synthetic amino acid (lysine) that blocks plasminogen from being converted too the enzyme plasmin. Plasmin works to break down already formed blood clots in a process known as fibrinolysis
TXA onset/duration?
unknown/ 7-8 hours
TXA indications?
Major trauma with severe blood loss
TXA contraindications?
Hypersensitivity, Thromboembolic disorders
TXA side effects?
Nausea and vomiting, joint pain, headaches, hypotension, thrombus
TXA route of administration?
IV drip
TXA adult dose?
1 gram in 100 mL NS over 10 min
TXA supply?
Different concentrations, refer to your medical control