| Nitro classification | Anti-anginal / coronary vasodilator |
| indications for Nitro | Cardiac ischemia, moderate/severe respiratory distress, cardiogenic pulmonary edema |
| Contraindications for nitro | Allergy or sensitivity, use of phophodiesterase inhibitors -boner pills within 48 hours, if SBP drops 1/3 of the initial value after first dose, if 12 lead indicates RV infarct |
| What is the BP and HR parameters for nitro | normotensive - SBP >100 mmHg, 60 - 159 bpm |
| Onset and dosing interval for nitro | onset: 1-4 mins
interval - 5 mins |
| Common side effects of nitro | Headache, metallic taste, syncope, N/V |
| 5 conditions that must be present in order to administer Nitro | >18
Unaltered
HR 60 - 159
Normotensive SBP >100
Pervious use or IV access obtained |
| what is the primary mechanism by which nitro helps M.Is | Decreases preload thereby decreasing MVO2 |
| what is the effect of Nitro on myosin filaments | Inactivates it causing vasodilation |
| what are the routes Nitro can be administered | SL, Transdermal,IV |
| what are the 7 rights of nitro | right patient, Right drug, right dose, right time, right route, right to know, right to refuse |
| Classification of ASA | antiplatelet, anti-inflammatory, analgesic, antipyretic |
| Use for ASA | Headache, fever, pain relief |
| Indications for ASA | Suspected cardiac ischemia |
| Contraindications for ASA | Allergy or sensitivity to it or NSAIDS
CVA or TBI within the pervious 24 hours
Current active bleeding
Asthmatic or no prior use |
| Onset and dosing intervals for ASA | Onset : 30 mins
Dosing : 1 dose or 2 tablets ( 80-81mg each) |
| Duration of ASA | 24 - 48 hrs |
| Side effects of ASA | Overdose on 150mg/kg S&S = Tinnitis, Kussmaul breathing - caused by metabolic acidosis - , Pyrexia -fever-, altered LOA |
| 3 conditions that must be met to administer ASA | >18
Ability to chew
Unaltered |
| what is the therapeutic index for ASA | 80-1500mg |
| Classification of Oxygen | Naturally occurring atmospheric gas |
| Onset of Oxygen | Immediate |
| Precautions when administering oxygen | With COPD PT giving high O2 can cause them to stop breathing due to hypoxic drive, with neonates prolonged high PO2 may cause blindness - retrolental fibroplasia |
| Using O2 for COPD PT | start at 2 LMP - if they are not on home air - maintain flow rate if PT status improves, increase increments of 2 LMP above starting every 2-3 minutes if PTs status deteriorates or they feel worse - reasses every 10 mins |
| NRB O2 % | 60 - 90 % |
| NC - nasal cannla - O2 % | 44 % |
| SFM (simple face mask) O2 % | 40 - 60 % |
| Tank equation | Tanks pressure (gauge pressure – safe residual pressure) x tank constant
oxygen delivered in litres per minute |
| Classification of Glucagon | glucose elevating agent, insulin antagonist |
| Use for Glucagon | Hypoglycaemia , esophageal obstruction, beta blocker overdose |
| Contraindications for Glucagon | Allergy or sensitivity, phechromoctoma |
| Onset and dosing intervals for Glucagon | Onset: 5 - 10 mins
Dosing: 20 mins , max 2 doses |
| what cells secrete Glucagon | Alpha cells |
| What is the effect that Glucagon has on the heart | increases FOC |
| What does it mean if you give Glucagon then PT becomes hypertensive, tachycardia and intracranial bleed | pheochromocytoma - blood vessels in brain burst |
| Glucagon <25kg | Given : IM
Dose: 0.5mg
Max SINGLE dose: 0.5mg
Dosing interval: 20 mins
Max # of doses: 2 |
| Glucagon >25 kg | Given: IM
Dose: 1mg
Max SINGLE dose: 1 mg
Dosing interval: 20 mins
Max # of doses: 2 |
| D10 | 2 years old +
Given: IV
0.2g/kg OR 0.2cc/kg
max dose: 2
max SINGLE dose: 10g/100cc
dosing interval: 10 mins |
| Classification of Ventolin | sympathomimetic, bronchodilator |
| What is the effect of Glucagon on the renal system | Decreased renal vascular resistance |
| Indications for hypoglycaemia assessment | agitation or
altered LOA or
Seizure or
Symptoms of stroke |
| What is the main site of action for Ventolin | Lungs - lower respiratory |
| Indications for Ventolin | bronchoconstriction |
| Contraindications for Ventolin | NEB: pt's with known or suspected fever or febrile respiratory outbreak |
| Onset and Dosing intervals for Ventolin | Onset: 3- 10 minutes
Dosing: 5-15 prn |
| Max dosage for Ventolin | 3 |
| Durations of Ventolin | <4 hours |
| Adverse effects of Ventolin | Tachycardia , dysrhythmias
Restlessness
Dizziness |
| What is the effect on MVO2 of Ventolin | increases MVO2 |
| <25kg MDI -puffer- for Ventolin | Dose: 600mcg
Max SINGLE dose: 6 puffs
Dosing interval: 5-15 prn
Max # of doses: 3 |
| <25kg NEB for Ventolin | Dose: 2.5mg
Max SINGLE dose: 2.5mg
Dosing interval: 5-15prn
Max doses: 3 |
| Greater than >25kg MDI -puffer- for Ventolin | Dose: 800mcg
Max SINGLE dose: 8 puffs
Dosing interval:5-15 prn
Max # of doses: 3 |
| >25kg NEB for Ventolin | Dose: 5.0 mg
Max SINGLE dose: 5.0mg
Dosing interval: 5-15prn
Max # of doses: 3 |
| What are 3 S&S of toxicity for Ventolin | increased frequency of PVCs
Hr >150, >200 in peds pt
Severe tremors |
| what are the possible adverse effects of Ventolin when administered to PT with CHF | Worsening SOB |
| one rule of Ventolin | Always give full dosage! |
| Classification of Epinephrine | sympathomimetic - alpha 1 agonist |
| Indications for Epinephrine | Bronchorestriction , anaphylaxis , croup |
| Contraindications for Epinephrine | IF you have a PT who is 8 and you believe they have croup you cannot follow the croup protocol. |
| Onset and dosing intervals for Epinephrine | 5 - 15 IM
1 - 5 NEB
Immediate IV |
| Possible side effects with Epinephrine | Tachycardia
Palpitations
Angina
PVCs
HTN |
| Epi for Bronchoconstriction | Route: IM
Concentration: 1mg/ML= 1:1000
Max SINGLE dose: 0.5mg
Dosing interval: N/A
Max # of doses: 1 |
| Epi for Anaphylaxis | Concentration: 1mf/mL= 1:1000
Dose: 0.01mg/kg
Max SINGLE dose: 0.5mg
Dosing interval: 5 mins or less
Max # of doses: 2
**MAY BE ROUNDED TO THE NEAREST 0.05**
DIPHENHYDRAMINE SHOULD ALWAYS FOLLOW THE
ADMINISTRATION |
| Epinephrine for Croup less than 1 YEARS OLD < 5KG | Administered: NEB
Dose: 0.5mg
Max SINGLE dose: 0.5mg+ 2 cc NS
Max # of doses: 1 |
| Epi for Croup <1 YEARS OLD >5kg | Administered: NEB
Dose: 5.0mg
Max SINGLE dose: 2.5mg
Max # of doses: 1 |
| Epi for Croup >1and <8 YEARS OLD | Administered: NEB
Dose: 5.0mg
Max SINGLE dose: 5.0mg
Max # of doses: 1 |
| What are the conditions a child must meet for Epinephrine | <8 years old, HR >200bpm |
| What is the effect epinephrine on cells | decrease histamine release/ stabilize cells |
| methods of administrating Epi | NEB & IM |
| Classification for Ibuprofen | NSAID also Analgesic / antipyretic |
| Use for Ibuprofen | Limits prostaglandins and reduces inflammation, not recommended for kids under 6 |
| Indications for Ibuprofen | Pain/fever |
| Contraindications for Ibuprofen | NSAID use within 6 hours,
allergy to it, PT on anticoagulant therapy , active bleed,
hx of peptic ulcers/ GI bleed, pregnant , CVA or TBI in the last 24 hrs,
active vomiting, LOA, ischemic chest pain |
| Onset and dosage intervals of Ibuprofen | Onset :30-60 mins
Interval: only one dose |
| Side effects for Ibuprofen | Elevate BP, can cause
ulceration of
perforation in the GI
tract, fluid retention
and edema |
| Classification of Acetaminophen | Analgesic, antipyretic |
| Uses for Acetaminophen | Limits prostaglandins but does not reduce inflammation - easier on stomach, more geared toward pain relief |
| Contraindications for Acetaminophen | Acetaminophen used within 4 hours, allergy, hx of liver disease, LOA, active vomiting, ischemic chest pain |
| Onset for Acetaminophen | Onset 1 hour |
| Acetaminophen >12-17 years of age | Administration: PO
Dose: 500-650mg
Max SINGLE dose: 650mg
Dosing interval: N/A
Max # of doses: 1 |
| Acetaminophen >18 years | Administration: PO
Dose: 960-1000mg
Max SINGLE dose: 1000mg
Dosing interval: N/A
Max # of doses: 1 |
| Ibuprofen >12 years | Administration: PO
Dose: 400mg
Max SINGLE dose: 400mg
Dosing interval: N/A
Max # of doses: 1 |
| Ketorolac | Administration: IM/IV
Dose: 10-15mg
Max SINGLE dose: 15mg
Dosing interval: N/A
Max # of doses: 1 |
| Classification for Naloxone - Narcan | Narcotic antagonist |
| Use for Naloxone - Narcan | Opioid overdose |
| Indications for Naloxone - Narcan | altered LOA, respiratory depression,
suspected opioid overdose,
Inability to adequately ventilate |
| Contraindications for Naloxone - Narcan | Allergy, uncorrected hypoglycaemia |
| Onset for Naloxone - Narcan | Onset: 1 min |
| Conditions that must be met for Naloxone - Narcan | >12 years of age
Altered LOA
<10 bpm |
| What drugs have specific vital sign parameters? | Glucagon – BGL
Epi – croup HR <200
Nitro – HR and Bp
Ventolin – temperature
Ketorolac - BP |
| Which drugs can only be given once ? | ASA
Ketorolac
Acetaminophen
Ibuprofen
Dimenhydrinate
Diphenhydramine |
| Which drug can be used to treat an
obstructed airway (after a patch and with
permission) ? | Glucagon |
| Which drugs could be used with complaint of S.O.B. ? | Epi
Ventolin
Oxygen
Nitro |
| What is the first drug administered if the
patient is apneic? | Epinephrine |
| Which drugs are weight based for administration ? | Epi
Ventolin
Glucagon
Diphenhydramine
Dimenhydrinate |
