UNIT 1 - Emergency Medications Flashcards
Gracia is experiencing an episode of cardiac arrest. How much adrenaline will you administer for 1:10,00?
1.0 mg in 9ml of normal saline
How much ml of adrenaline do you give for 1:1,000?
Only 1 ml without normal saline
Barbara is given adrenaline for cardiac arrest. She was already given 1 mg of Adrenaline. She weighs 200 Ibs. How much mcg do you need to maintain the patient at until desired blood pressure is obtained?
Convert: 200 Ibs/ 2.2 = 90 kg
Maintain at 0.5 mcg/kg/min
Therefore = 90 kg x 0.5 mcg = 45 mcg per min
How many mg IM to you give Adrenaline for anaphylaxis and how many minutes?
0.3 - 0.5 mg IM every 5 minutes
Susie is experiencing an episode of symptomatic bradycardia/shock. What would you administer?
2 - 10 mcg of Adrenaline every minute
MOA of Adrenaline
Gives a flight-or-fight response by acting alpha 1 receptors
Atropine was unable to be given to the patient IV, what route can you use instead and what dose?
Intraosseous 1 mg
What are the three (3) intraosseous routes?
Proximal tibia - anteromedial surface, 2 -3 cm below the tibial tuberosity
Distal tibia - proximal to the medial malleolus
Distal femur - midline, 2 - 3 cm above the external condyle
The patient is experiencing lots of secretions during symptomatic bradycardia. What medication will you administer and the dose?
Atropine 1 mg IV every 3 - 5 minutes
Brandon was given 10 mg of Atropine. What is your next method of action and why?
Administer Cogentin because the max dose of Atropine is 3 mg.
MOA of atropine
Inhibits acetylcholine and gives a “fight or flight” response.
On the ECG of Tim, it is noted that there are multiple rapid, chaotic QRS complexes with a HR of 250 bpm. For Jim, it was noted that his ECG has wide complexes with a HR of 167 bpm. What are their rhythms and what medication would be administered?
Tim has ventricular fibrillation and Jim has ventricular tachycardia.
Amiodarone can be administered.
Tim was given an initial dose of Amiodarone, 150 mg. What did the nurse do incorrectly and what is the correct dose?
Amiodarone should be given as 300 mg in 20 - 30 ml
Jim’s initial dose of 300 mg in 25 ml of Amiodarone was administered but his VF was unresolved. What can be done?
Repeat 150 mg in 3 - 5 mins
MOA amiodarone
Blocks K+ ion channels, Na+ channels, and alpha/beta receptors
After handover, it was noted that the patient has an irregular QRS, what should the patient not be given?
Adenosine
Makayla’s ECG was noted to have regular, narrow QRS complexes with a HR of 250 bpm. What medication will be administered and why?
Adenosine because it is narrow paroxysmal supraventricular tachycardia.
The doctor orders 8 mg IV bolus of Adenosine for a patient as their initial dose. Will you administer this and why?
No. A bolus of Adenosine is 6 mg IV for the initial dose.
The bolus of 6 mg IV Adenosine was ineffective. What should be the repeat dose?
12 mg in 1-2 mins.
Before administering dopamine what should occur first?
Fluid resuscitation
Kezia was noted to have symptomatic bradycardia. She has a history of CHF and Shock. What medication would be administered?
Dopamine
Kezia weighs 155 Ibs and has CHF/ shock with an episode of symptomatic bradycardia. The doctor orders 1.4 mg per min? Is this a safe dose for Dopamine?
Convert= 155 / 2.2 = 70.4 kg
Ordered dose = 1.4 mg x 1000 = 1,400 mcg
Dopamine dose = 2 - 20 mcg/kg/min
Safe dose = 70.4 x 2 = 140 mcg/min
= 70.4 x 20= 1,408 mcg/min
Yes, the dose is safe as it falls within the safe dose range of 140 mcg - 1,408 mcg/min
Jessyka is noted to have twisting QRS complexes with a HR of 300 bpm. What rhythm is this and what medication would be administered?
Hint: This rhythm can also be pulseless
Torsades de pointes
Magnesium sulphate
Jessyka who has a torsades de pointes rhythm, is in cardiac arrest. How much MgSO4 would be administered?
1 - 2 g in 10 ml D5W IV push
Relisha has torsades de pointes but isn’t in cardiac arrest. How much MgSO4 would be administered?
1 - 2 g IV over 5 - 60 min
How do you maintain MgSO4 sulphate?
0.5 - 1 g/hr IV
A patient with a wide QRS tachycardia or VT with pulse cannot use Amiodarone. What can they be given?
Procainamide
Your patient has a wide QRS tachycardia or VT with pulse. As the RN, you reviewed the patient’s ECG and have concluded the patient can be taken off of procainamide. What indications would provide this evaluation?
i) Rhythm improved
ii) B/P of 80/55 mmHg
iii) HR 156 bpm
iv) QRS widens by 50%
A) i & iv
B) i, iv & iii
C) i, ii, iv
D) All of the above
C
The doctor orders 38 mg/min of procainamide as an initial dose for a patient with a wide QRS tachycardia. Is this a safe dose and why?
Part 2, the patient’s weight is 98 kg, what would be their max dose.
Yes, falls between the range of 2 - 50 mg/min
Max dose = 17 mg x 98 = 1,666 mg = 1.7 g
How should you dilute procainamide and what rate to put the drip?
1 - 2 g in 250/500 ml
Drip @ 1 - 4 mg/min
The doctor orders procainamide for a prolonged QT. The patient has CHF, do you administer?
No, you do not use procainamide for these conditions.
Jill was resuscitated from cardiac arrest and complains of involuntary muscle contractions and leg cramps. What medication and how much would you administer?
10 ml of 10% Calcium Gluconate
In an emergency setting, a patient is experiencing a swollen tongue with difficulty breathing, urticaria and pruritis. What medication would be given after epinephrine as a second line treatment?
Chlorpheniramine/ pirton 10 mg/ml
What is a major sign of digoxin toxicity and what is the antidote?
Vision changes
Digoxin specific antibody antigen binding fragments (DSFab)
Which patient should you hold Digoxin?
a) Middled aged woman with a HR of 56 bpm
b) A child’s ECG showing an irregular heart rhythm
c) Elderly gentlemen with a HR of 200 bpm
d) Patient with confusion and delirium.
A
Antidote for Dilantin?
Valium, hynoval
Patient has a NA+ level of 158, 3+ pitting edema and ascites. What is the best diuretic to give and why?
Furosemide (Lasix) because it is a loop diuretic which means it inhibits the reabsorption of sodium.
Part 1) Marcia has an ECG of ventricular tachycardia. She goes into cardiac arrest on MICU and no amiodarone is available. The doctor orders Lidocaine 142 mg IV. She weighs 230 Ibs. Is this dose safe and why?
Part 2) He orders a second dose of 71 mg IV in 5 mins. Is this dose safe and why?
Part 1) Convert = 230 / 2.2 = 104 .5 kg
Dose for Cardiac Arrest (VT/VF) = 1 - 1.5 mg/kg IV
Safe dose = 104.5 x 1 = 104.5 mg IV
= 104 x 1.5 = 156 mg IV
Patient’s dose is safe because it falls in the range of 104 - 156 mg IV
Part 3) Safe dose is 1/2 of first dose in 5 - 10 minutes. 142/2 = 71 mg IV so the dose is safe.
Part 1) Kate has a wide complex tachycardia with pulse. No amiodarone is available. The doctor orders Lidocaine 98 mg IV. She weighs 68 kg. Is this dose safe and why?
Part 2) He orders a second dose of 49 mg IV in 10 mins. Is this dose safe and why?
Part 1) Dose for Wide Complex Tachycardia =
0.5 - 1.5 mg/ kg IV
Safe dose = 68 kg x 0.5 = 34 mg
= 68 kg x 1.5 = 102 mg
Patient’s dose as in falls in the range of 34 - 102 mg IV
Part 2) Safe dose is 1/2 of first dose in 5-10 minutes. 98/2 = 49 mg IV so the dose is safe.
A patient whilst going through cardiac arrest, has a potassium level of 2.5, what is your next action.
a) This is a normal potassium
b) Inform doctor and administer KCL
c) Inform doctor and administer CaCl2
d) Monitor ABG analysis
B
The doctors puts the patient on Cefazolin and 10 days later, she has a K+ of 2.5? Why did this occur?
antibiotics in the gut may reduce or inhibit synthesis of Vitamin K
During a resuscitation, a toxic amount of morphine was given. What is the antidote that can be used for opioids?
Narcan/ Naloxone Hydrochloride
What should you administer for a bronchospasm?
Aminophylline
What is verapamil and what is it used for?
Calcium channel blocker
Prevent premature ventricular contract
& atrial dysrhytmias
Maintain sinus rhythm after cardioversion
V Fib/ V tach medications
Adrenaline/Epinephrine
Amiodarone
Lidocaine
Magnesium
Vasopressin
Asystole/ PEA medications
Epinephrine
Atropine
Vasopressin
Bradycardia
Atropine
Epinephrine
Dopamine
Tachycardia
adenosine
Diltiazem
Beta-blockers
amiodarone
Digoxin
Verapamil
Magnesium
Acute Coronary Syndrome
Oxygen
Aspirin
Nitroglycerin
Morphine
Fibrinolytic therapy
Heparin
Beta-Blockers
Acute stroke
tPA-tissue
plasminogen
activator
Glucose (D50)
Labetalol
Nitroprusside
Nicardipine
Aspirin
