medication
naproxen is to (blank) ibuprofen is to (blank)
aleve and motrin
what are the s/s of LAST?
metallic taste in the mouth
ringing in the ears
hemodynamic instability (EKG irreg, bp laible)
disorientation , seizure
name a s/s that would make you suspect a patient is having a vasovagal reaction?
I feel hot and sweaty (diaphoretic)
i feel dizzy , tunnel vision
heart rate decreasing
feeling nauseas
pale
nasuea
zofran (4mg, iv or po)
I just had an ESI 2 days ago, now i have returned to clinic i have a horrible head ache and cant look at the light.. i feel nauseas ... what do you suspect i have and WWYD?
lay me down, does my head ache go away? suspect a dura tear and need for a blood patch
if severe enough to proceed to a blood patch start gathering supplies for BP (iv supplies, 20 cc syringe, sterile towels, large chloroprep), spinal tray , iv fluids and tubing
treatments- caffeine drip, laying down flat all day (if known in proc) blood patch
what does succinylcholine do and where is it stored?
Paralytic used for intubation, in the fridge
all caines block which channel
NA aka Sodium -- which promotes nerve conduction (we inhibit nerve conduction)
why does lifting the legs/pumping the legs help decrease a v/v response ?
the blood vessels in the legs dilate during a v/v response and blood pools in the dilated vessels draining from important organs. so this helps return the blood to the brain and heart increasing HR and improving altered mentation
caine toxicity
LIPIDS !
i open a nerve tray and the lidocaine vial seems to have broken.. WWYD?
open a new and not prep patient with this kit, let leslie know
what are the max doses of lidocaine and ropi/bupi?
5mg/kg and ropi/bupi 2-3mg/kg
which is more likely to cause lido toxicity bupi, ropi or lido and why?
BUPI (BAD) Lasts longer than lidocaine, but at higher doses it can stop the heart and cause arrythmias, so in large volumes it is not as safe ** sodium channel blocker
vasovagal involves the (blank) system and when not addressed quickly can lead to a loss in (blank)
nervous , consciousness
will also cause decrease bp and HR
seizing
midazolam (ativan first line)
i sit the patient up after a procedure, and they look extremely pale and sweaty but they say they are fine ! WWYD
lay them down for another minute or so with their leg raised if needed until their color improves.. don't move the patient until they are HDS
which is more potent dexamethasone or solumedrol ?
dexamethasone kenalog and depomedrol (solutes in them - white in color)
if you suspect last what should should you do ?
get vs, put on monitor alert Leslie and provider, get the emulsion kit and make not of the LAST protocol signs on the wall .. start IV have crash cart in close proximity have suction available , make note of oxygen
ephedrine can be administed how ?
IV or IM
(5-10mg iv) , 25mg im
stick is 5mg per ml
low hr and bp
ephedrine
glyco (HR)
atropine symptomatic brady
epinephrine (adrenalin) ACLS, code
your patient in recovery has a significant v/v and appears to seiz while losing consciousness WWYD?
call for help.
lay flat and turn patient on side
get patient on monitor and get VS
apply O, ask some one to grab you suction. when able leg raise .. may need IV fluids or meds
if patient remains unconscious get provider.
this measurement tells us how long a medication lasts in the body for and helps the provider determine how long we should wait to do a procedure if taken by the patient
half life
how does lipid emulsion work on bupivicaine ?
prevents bupi from binding by sucking it up in the blood stream as bupi is lipo-phyllic (loves lipids)
if you suspect a patient may be having a v/v what should you do ?
ice, Trendelenburg, remain calm (dont want to make patient more nervous or stressed) , bp cuff, stop procedure per provider, ask provider if want to admin medication (usually will if hypotens) consider iv start. monitor
if nausea and emesis suction *
if LOC can apply oxygen , sternal rub, leg raise.. may twitch while v/s
if seizure have midazolam
high bp
clonidine
hydrazaline
lopressor
esmolol
my patients first set of VS at end of SGB is 140/89 WWYD? then at 30 min their VS are 165/112 WWYD?
check their baseline bp which was 138/85
second set.. keep patient , let provider know, reassess bp again in 10 min or so or per provider request. keep patient in recovery longer.. we do not want to d/c patient if HTN past baseline may need to give medication