Podcast Beta
Questions and Answers
What is the primary purpose of using vasopressors like Dopamine and Norepinephrine?
Which of the following is a side effect specifically associated with Dopamine extravasation?
What should the titration goal be for an insulin drip management?
Which monitoring method is essential when administering Heparin?
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What complication can arise from administering Magnesium sulfate?
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What is the initial step in case of hypoglycemia in a conscious patient under insulin treatment?
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What electrolyte replacement is administered to maintain cardiac function at a normal level of 3.5-4.5 mEq/L?
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What is the primary indication for the use of Amiodarone?
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Which medication is contraindicated in patients with renal issues?
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What is a significant side effect of benzodiazepines used for sedations?
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Which of the following agents requires an IV filter tubing and must be changed every 12 hours?
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What should be monitored closely when administering nitroglycerin?
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What agent is commonly used for reversal of benzodiazepines?
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What is a serious risk associated with succinylcholine?
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What is the ideal order for administering neuromuscular blocking agents?
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Which medication can be administered during a code blue if no pulse is present?
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Study Notes
Sedation & Pain Medications
- Etomidate (IVP) - uses: Rapid Sequence Intubation (RSI) and sedation.
- Ketamine (IVP or drip) - uses: sedation and pain management.
- Midazolam (Versed) (IVP or drip) - uses: sedation, amnesia effect.
- Fentanyl (IVP or drip) - uses: pain management; short-acting narcotic; typically ordered every 1-2 hours.
- Propofol (Diprivan) (drip) - uses: sedation; milky-white color due to lipid base.
- Dexmedetomidine (Precedex) (drip) - uses: sedation and pain management; does not cause respiratory depression to the same extent as other sedatives.
- Benzodiazepines (IVP or drip) - uses: RSI and maintenance sedation.
- Reversal Agents - Narcotics: naloxone; Benzodiazepines: flumazenil.
- Propofol - requires an IV filter tubing and must be changed every 12 hours. Monitor lipid levels. Monitor the Richmond Agitation-Sedation Scale (RASS) for effectiveness of sedation. Goal parameters for sedation will be an ordered RASS score (e.g., RASS -2). Drips: monitor dose (e.g., mcg/min, mg/hr, etc.) in addition to rate (e.g., ml/hr).
Neuromuscular Blocking Agents (NMBAs) (Paralytics)
- Succinylcholine (IVP) - short half-life; short-acting; contraindicated in patients with renal issues.
- Rocuronium (IVP) - typically used when succinylcholine is contraindicated; lasts longer - approximately 1 hour.
- Vecuronium (IVP).
- Cisatracurium (drip).
- Uses: RSI; general anesthesia.
- Side Effects: paralysis, hypotension.
- Important Note: NMBA's do not cause sedation, decrease level of consciousness, or influence pain!
- Succinylcholine - risk of malignant hyperthermia (medical emergency). Treatment: dantrolene.
- Rocuronium, Vecuronium, and Cisatracurium - reversal agent: neostigmine.
- Titrate drips using peripheral nerve stimuli (TRAIN-of-Four).
- Drips: monitor dose (e.g., mcg/min, mg/hr, etc.) in addition to rate (e.g., ml/hr).
- Safety Consideration - must have an airway! And maintain a patent airway.
- Always sedate first, then give paralytic.
- Two Registered Nurse (RN) verification during administration.
Vasodilators
- Nitroglycerin (IV drip) - uses: chest pain or hypertension.
- Side Effects: headache, hypotension, orthostatic hypotension.
- Drips: monitor dose (e.g., mcg/min, mg/hr, etc.) in addition to rate (e.g., ml/hr).
- Titrate per order parameters (e.g., maintain systolic blood pressure for 3 days) to prevent cyanide poisoning.
- Signs and Symptoms of Cyanide Poisoning: lethargy, headache, drowsiness, cardiac arrest.
- Monitor blood pressure closely and electrocardiogram (ECG). Monitor neuro status. Monitor for toxicity - draw serum levels if used >3 days.
Vasopressors
- Epinephrine (drip or IVP) - epinephrine is given IVP only if no pulse during a code blue!
- Dopamine (drip).
- Norepinephrine (drip).
- Neosynephrine (drip).
- Vasopressin (drip) - synthetic antidiuretic hormone (ADH) and increases blood volume (vs vasoconstriction).
- Side Effects: hypertension, tachycardia (in some types).
- Dopamine - causes necrosis if extravasation occurs; treatment is Phentolamine.
Vasopressors: General Considerations
- Drips: monitor dose (e.g., mcg/min, mg/hr, etc.) in addition to rate (e.g., ml/hr).
- Continuous ECG.
- Frequent or continuous blood pressure monitoring via arterial line.
- Titrate per order parameters ( e.g., maintain systolic blood pressure >90 or mean arterial pressure (MAP) of 65).
- Discontinue as soon as possible due to the risk of complications.
Dobutamine (drip)
- Improves stroke volume and cardiac output without immediate increase in blood pressure.
- Helps "the squeeze" or contractility of the heart.
Insulin
- Insulin Regular (IVP or drip).
- Insulin lispro (subcutaneous) - short-acting.
- Insulin Glargine (subcutaneous) - long-acting.
- Uses: blood glucose control.
- Side Effects: hypoglycemia!
- Reversal Agent: glucose, glucagon.
- Hypoglycemic Protocol - addresses intervention for a conscious versus unconscious or NPO patient.
Insulin Drip Management
- Dose: units/kg/hr or units/hr.
- Titration Goal: Keep glucose level between 140-180 mg/dL.
- Hourly glucose monitoring.
- Two Registered Nurse (RN) verification.
- No Delegation to Licensed Practical Nurse (LPN).
Subcutaneous Insulin Regimens
- Glucose monitoring varies (e.g., every 4-6 hours, before meals and at bedtime).
- Okay to delegate to Licensed Practical Nurse (LPN) to administer.
Heparin
- Routes: subcutaneous or IV drip.
- Use: prevention of deep vein thrombosis (DVTs) and pulmonary embolisms (PEs).
- Side Effects: bleeding, thrombocytopenia.
- Reversal Agent: protamine sulfate.
Heparin Drip Management
- Dose: units/kg/hr - weight-based dosing.
- Titration Goal: Based on activated partial thromboplastin time (aPTT). Drawn every 6 hours.
- Two RN verification.
- Monitor Signs and Symptoms of Bleeding: internal (non-visible) versus external (visible).
- Monitor other labs: hemoglobin/hematocrit (H/H) and platelets.
Magnesium Sulfate (intravenous piggyback)
- Electrolyte Replacement.
- Normal Level: 1.3-2.1 mEq/L.
- Maintain Level ( >2 mEq/L) to Optimize Cardiac Function.
- Side Effects: hypermagnesemia: decreased/absent deep tendon reflexes, respiratory depression, hypotension.
- Reversal Agent: calcium gluconate.
- Monitor deep tendon reflexes. Monitor serum magnesium levels. Antidote for Magnesium toxicity: Calcium gluconate.
Potassium Chloride (i.e., PO or IVPB)
- Electrolyte Replacement.
- Normal Level: 3.5-4.5.
- Maintain Level >4 mEq/L to Optimize Cardiac Function.
- Side Effects: hyperkalemia.
- Peaked T waves can indicate high potassium levels. Monitor ECG.
- Cardiac dysrhythmias or ectopy can indicate low levels of potassium.
- For high concentrations of IV potassium, it must be given via a central venous access device (CVAD).
Amiodarone (Continuous drip or oral medication)
- Anti-dysrhythmic; drip.
- Use: Ventricular dysrhythmias, supraventricular tachycardia (SVT) (atrial fibrillation, atrial flutter...).
- Side Effects: bradycardia, hypotension; hypothyroidism with long-term use.
- Reversal Agent: lidocaine (for ventricular dysrhythmias).
- Monitor ECG frequently.
- Monitor thyroid function if used for extended periods.
- Monitor for signs of hypothyroidism: fatigue, weight gain, bradycardia, cold intolerance.
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Description
This quiz covers key sedation and pain medications used in medical settings, focusing on their administration, uses, and monitoring requirements. Learn about various agents such as Etomidate, Ketamine, and Fentanyl, along with crucial information on reversal agents and safety measures. Test your knowledge on the essential aspects of sedation in patient care.
