Medic 16

What function do the nasal turbinates serve?
Warming and humidifying inhaled air
Patient who is experiencing an allergic reaction states that his tongue feels thick and speaks at a low volume. You should immediately evaluate for:
angioedema
Oropharynx and nasopharynx meet in the back of the throat at the:
hypopharynx
Common effects of gag reflex stimulation include all of the following, EXCEPT:
tachycardia
Most obvious external landmark of the larynx is the:
thyroid cartilage.
Either side of the glottis, tissue forms a pocket called the:
piriform fossae.
_________ cartilage forms a complete ring and maintains the trachea in an open position.
cricoid
Cricothyroid membrane:
is relatively avascular ( having few or no blood vessels) and is covered by skin and minimal subcutaneous tissue.
Which of the following statements regarding anatomic dead space is correct?
Anatomic dead space is about 1 mL per pound of body weight.
Mainstem bronchus ends at the level of the:
bronchioles
________ cells are found in the lining of the airways and produce a blanket of mucus that covers the entire lining of the conducting airways.
Goblet
What type of medication dries secretions in the airway and prevents the cilia from removing them effectively?
Antihistamine
Wheezing is resolved with medications that
relax the smooth muscle of the bronchiole
Pulmonary surfactant is decreased:
alveolar surface tension increases.
Person who is not bedridden, most pulmonary infections occur in the:
bases of the lungs.
Polycthemia is a condition in which:
excess red blood cells are produced in response to chronic hypoxia.
Cor pulmonale is defined as:
right heart failure secondary to chronic lung disease.
Patent airway:
does not equate to adequate ventilation.
Hyproventilating patients:
become hypercapnic and acidotic.
Hyperpnea and tachypnea:
cause an increase in minute volume.
Contrast to negative-pressure ventilation, positive-pressure ventilation:
is the forcing of air into the lungs.
Difficulty with exhalation is MOST characteristic of:
obstructive lung disease.
Apneustic breathing is characterized by:
short, brisk inhalations with a long pause before exhalation.
_______ respirations are characterized by a grossly irregular pattern of breathing that may be accompanied by lengthy periods of apnea.
Biot
Unresponsive patient who overdosed on a central nervous system depressant drug would be expected to have __________ respirations.
bradypneic
Stretch receptors in the lungs are responsible for the _______ reflex, which causes you to cough if you take too deep a breath.
Hering-Breuer
The By-product of cellular respiration is:
carbon dioxide.
Respiratory alkalosis is the result of:Â
excess carbon dioxide elimination.Â
Patient’s hemoglobin level is only 10 g/dL, ___ % would have to be desaturated before he or she would appear cyanotic.
50
Patient with orthopnea:
seeks a sitting position when short of breath.
Polycythemia is a condition in which
excess red blood cells are produced in response to chronic hypoxia.
Barrel-chest appearance classically seen in emphysemic patients is secondary to:
air trapping in the lungs.
Patient’s initial presentation makes you suspicious about a particular respiratory condition, you must:
confirm your suspicions with a thorough assessment.
Patient with respiratory distress who is willing to lie flat:
may be acutely deteriorating.
Retractions of the sternum or ribs during inhalation:
are especially common in infants and small children.
Paradoxical respiratory movement is characterized by:
the epigastrium and thorax moving in opposite directions.
Patient with quiet tachypnea is MOST likely experiencing:
shock
Contrast to decreased PO2 levels, increased PCO2 levels typically manifest as: .
sedation or sleepiness.
Otherwise healthy adult whose normal hemoglobin level is 12 to 14 g/dL typically will begin to exhibit cyanosis when:
about 5 g/dL of hemoglobin is desaturated.
MOST clinically significant finding when questioning a patient with a chronic Respiratory disease is:
prior intubation for the same problem.
Which of the following conditions would LEAST likely present with an acute onset of respiratory distress?
Pneumonia
Hepatojugular reflux occurs when:
mild pressure placed on the patient’s liver further engorges the jugular veins.
Hepatomegaly and jugular venous distention are MOST suggestive of:
right heart failure.
Digital clubbing is MOST indicative of:
chronic hypoxia.
Diaphragm of the stethoscope is designed to auscultate:
high-pitched sounds.
Abnormal breath sounds associated with pneumonia and congestive heart failure are MOST often heard in the:
bases of the lungs.
_______ breath sounds are the MOST commonly heard breath sounds, and have a much more obvious inspiratory component.Â
Vesicular
Inspiratory and expiratory _______ sounds are both loud, but the inspiratory sounds are shorter than the expiratory sounds.
bronchial
Presence of diffuse rhonchi (low-pitched crackles) in the lungs indicates:
thick secretions in the large airways.
Patient who is coughing up purulent sputum is MOST likely experiencing:
An infection.
Frothy sputum that has a pink tinge to it is MOST suggestive of:
congestive heart failure.
Patient’s hemoglobin level is 8 g/dL due to hemorrhage and all of the hemoglobin molecules are attached to oxygen, the patient’s oxygen saturation would MOST likely read:
above 95%.
Pulse oximetry reading would be LEAST accurate in a patient:
with poor peripheral perfusion.
When present at low levels, oxygen binds easily to hemoglobin molecules, resulting in:
large changes in oxygen saturation when small changes in PaO2 occur.
With regard to pulse oximetry, the more hypoxic a patient becomes:
the faster he or she will desaturate.
Colorimetric ETCO2 detector turns purple during the exhalation phase through an ET tube, approximately how much carbon dioxide is being exhaled?
Less than 0.5%
Sudden increase in end-tidal CO 2 may be the earliest indicator of:
return of spontaneous circulation.
Why are children more prone to croup when they acquire a viral infection than adults infected with the same virus?
A child’s airway is narrower than an adult’s, and even minor swelling can result in obstruction.
Which of the following statements regarding epiglottitis is correct?
Epiglottitis has become relatively rare in children due to vaccinations against the Haemophilus influenzae type b bacterium.
Pneumonitis is especially common in older patients with:
chronic food aspiration.
COPD is characterized by:
changes in pulmonary structure and function that are progressive and irreversible.
Common clinical findings in patients with obstructive lung disease include all of the following, EXCEPT:
a decreased expiratory phase.
Reactive airway disease is characterized by:
bronchospasm, edema, and mucus production.
Primary treatment of bronchospasm is:
bronchodilator therapy.
Unlike bronchodilator therapy, corticosteroid therapy:
takes a few hours to reduce bronchial edema.
Patient with status asthmaticus commonly presents with:
physical exhaustion and inaudible breath sounds.
Patient with a history of asthma is at GREATEST risk for respiratory arrest if HE or SHE
was previously intubated for the condition.
Emphysema is caused by:
chronic destruction of the alveolar walls.
Classic presentation of chronic bronchitis is:
excessive mucus production and a chronic or recurrent productive cough.
Which of the following clinical findings is MOST suggestive of pneumonia in a patient with COPD?
Fever and localized crackles
Patients with COPD typically experience an acute exacerbation of their condition because of:
environmental changes such as weather or the inhalation of trigger substances.
Hypoxic drive is a phenomenon in which:
bicarbonate ions migrate into the cerebrospinal fluid of a chronically hypoventilating patient, making the brain think that acid and base are in balance.
Patients with decompensated asthma or COPD who require positive-pressure ventilation:
may develop a pneumothorax or experience a decrease in venous return to the heart if they are ventilated too rapidly.
Increase in the number of EMS calls for patients with chronic respiratory problems MOST commonly occurs:
during sudden weather changes.
Patient who is coughing up thick pulmonary secretions should NOT take:
an antitussive
Intrapulmonary shunting occurs when:
nonfunctional alveoli inhibit pulmonary gas exchange.
Bedridden patients with excessive pulmonary secretions are MOST prone to developing:
pneumonia.
Patients with pneumonia often experience a coughing fit when they roll from one side to the other because:
pneumonia often occurs in the lung bases, typically on only one side.
Uncontrollable coughing and hemoptysis in a cigarette smoker are clinical findings MOST consistent with:
lung cancer.
When auscultating the lungs of a patient with early pulmonary edema, you will MOST likely hear:
crackles in the bases of the lungs at the end of inspiration.
Person who experiences sharp chest pain followed by increasing dyspnea after he or she coughs MOST likely has:
a pneumothorax.
One of the hallmarks of a pulmonary embolism is:
cyanosis that does not resolve with oxygen therapy.
Pickwickian syndrome is a condition in which respiratory compromise results from:
extreme obesity.
MOST likely observe a grossly low respiratory rate and volume in a patient who overdosed on:
heroin
Hyperventilating patient:
may be acidotic and is trying to decrease his or her pH level.
Patients with obvious respiratory failure require immediate:
ventilation support
Intubation of a patient with severe asthma:
“is often a last resort, because asthmatics are difficult to ventilate and are prone to Pneumothoraces
Spacer device in conjunction with a metered-dose inhaler:
collects medication as it is released from the canister, allowing more to be delivered to the lungs and less to be lost to the environment.
When administering a nebulized bronchodilator, the oxygen flow rate should be set to at least _______ liters per minute.
6
Which of the following medications is a parasympathetic bronchodilator?
Ipratropium
CPAP in the emergency setting is used to treat patients with certain obstructive airway diseases by:
improving patency of the lower airway through the use of positive-end expiratory pressure.
Critical step when using a CPAP unit to treat a patient with severe respiratory distress is:
ensuring an adequate mask seal with minimal leakage.
Automated transport ventilator is NOT appropriate for patients who are:
breathing spontaneously.
76-year-old woman with emphysema presents with respiratory distress that has worsened progressively over the past 2 days. She is breathing through pursed lips and has a prolonged expiratory phase and an oxygen saturation of 76%. She is on home oxygen at 2 L/min. Your initial action should be to:
place her in a position that facilitates breathing.
Dispatched to a residence for a 59-year-old man with difficulty breathing. The patient, who has a history of COPD, is conscious and alert. During your assessment, he tells you that he developed chills, fever, and a productive cough 2 days ago. Auscultation of his lungs reveals rhonchi to the left lower lobe. This patient is MOST likely experiencing:
pneumonia
66-year-old man with chronic bronchitis presents with severe respiratory distress. The patient’s wife tells you that he takes medications for high blood pressure and bronchitis, is on home oxygen therapy, and has recently been taking an over-the-counter antitussive. She further tells you that he has not been compliant with his oxygen therapy. Auscultation of his lungs reveals diffuse rhonchi. What is the MOST likely cause of this patient’s respiratory distress?
Recent antitussive use
29-year-old woman is experiencing a severe asthma attack. Her husband reports that she was admitted to an intensive care unit about 6 months ago, and had a breathing tube in place. Prior to your arrival, the patient took 3 puffs of her rescue inhaler without effect. She is anxious and restless, is tachypneic, and has audible wheezing. You should:
apply a CPAP unit, transport immediately, and attempt to establish vascular access en route to the hospital.
Morbidly obese man called 9-1-1 because of difficulty breathing. When you arrive, you find the 39-year-old patient lying supine in his bed. He is in marked respiratory distress and is only able to speak in two-word sentences. He has a history of hypertension, but denies any respiratory conditions. What should you do FIRST?
Sit him up or place him on his side.
21-year-old man experienced an acute onset of pleuritic chest pain and dyspnea while playing softball. He is noticeably dyspneic, has an oxygen saturation of 93% on room air, and has diminished breath sounds to the upper right lobe. The MOST appropriate treatment for this patient involves:
administering high-flow supplemental oxygen and transporting at once.
Transporting a patient with a long history of emphysema. The patient called 9-1-1 because his shortness of breath has worsened progressively over the past few days. He is on high-flow oxygen via nonrebreathing mask and has an IV of normal saline in place. The cardiac monitor shows sinus tachycardia and the pulse oximeter reads 89%. When you reassess the patient, you note that his respiratory rate and depth have decreased. You should:
begin assisting his ventilations with a bag-mask and 100% oxygen.
Elderly woman with COPD presents with peripheral edema. The patient is conscious but agitated. She is breathing with slight difficulty but has adequate tidal volume. During your assessment, you note that her jugular veins engorge when you apply pressure to her right upper abdominal quadrant. She tells you that she takes a “water pill†and Vasotec for high blood pressure. You should:
suspect acute right heart failure and administer oxygen.
36-year-old man with a history of asthma presents with severe respiratory distress. You attempt to administer a nebulized beta-2 agonist, but his poor respiratory effort is inhibiting effective drug delivery via the nebulizer and his mental status is deteriorating. You should:
assist his ventilations and establish vascular access.
Transporting a middle-aged man on a CPAP unit for severe pulmonary edema. An IV line of normal saline is in place. Prior to applying the CPAP device, the patient was tachypneic and had an oxygen saturation of 90%. When you reassess him, you note that his respirations have increased and his oxygen saturation has dropped to 84%. You should:
remove the CPAP unit, assist his ventilations with a bag-mask device, and prepare to intubate him.
Known heroin abuser is found unconscious on a park bench. Your assessment reveals that his respirations are slow and shallow, and his pulse is slow and weak. You should:
assist ventilations with a bag-mask device, administer naloxone, and reassess his ventilatory status.
Dispatched to a residence for a young woman with difficulty breathing. When you arrive, you find the patient sitting in a tripod position, noticeably dyspneic and tachypneic. She tells you that she experienced a sudden sharp pain to the left side of her chest and then started having trouble breathing. She denies any past medical history and states that she only takes birth control pills. Based on this patient’s clinical presentation, you should be MOST suspicious for:
acute pulmonary embolism
Respond to the residence of an elderly man with severe COPD. You recognize the address because you have responded there numerous times in the recent past. You find the patient, who is clearly emaciated, seated in his recliner. He is on oxygen via nasal cannula, is semiconscious, and is breathing inadequately. The patient’s daughter tells you that her father has an out-of-hospital DNR order, for which she is frantically looking. You should:
recognize that he is experiencing end-stage COPD, begin assisting his ventilations, and contact medical control as needed.
Albueterol (Proventil, Ventolin) – RESPIRATORY DRUG
Adult Dose: Adult 2.5mg in 2-3 mL NS via nebulizer

Class: sympathomimetic dilator

MOA: Beta-2 agonist that causes bronchodilation. Relaxes the smooth muscles of the bronchial tree.

Indications: bronchospasms, asthma, COPD, emphysema chronic bronchitis,allergic reaction involving the airway. (Wheezing)

Contraindications: hypersensitivity (allergic), precaution : heart rate greater than 150 HR>150

Side effects: tachycardia, palpitations, lightheadedness, tremors, mucous production.

Pediatric Dose: <20 kg: 1.25 mg/dose via hand nebulizer over20 minutes. >20 kg 2.5 mg/dose via hand nebulizer over 20 minutes.

Benzocaine spray (Hurricane) – RESPIRATORY DRUG
Adult Dose: 0.5-1.0 second spray, repeat as needed. Repeat as needed.

Class: topical anesthetic

MOA: suppresses the pharyngeal and tracheal gag reflex

Indications: intact gag reflex

Contraindications: allergy, suppressed gag reflex

Adverse reaction: methemoglobinemia (causes an inability of oxygen to bind to hemoglobin and prevents oxygen that is already bound to hemoglobin to be released at the cellular level, can cause cellular hypoxia)

Pediatric Dose: 0.25-0.5 second spray. Repeat as needed.

Bumetanide (Bumex) – RESPIRATORY DRUG
Adult Dose: 0.5-1.0mg IV over 1-2 minutes. IM 2-2.5 times stronger than Lasix.

Class: Loop diuretic

MOA: a potent loop diuretic with a rapid onset and short duration. Blocks the reabsorption of sodium and chloride at the Loop of Henle.

Indications: CHF, pulmonary edema. Won’t be used for hypertensive crisis.

Contraindications: allergic, hypovelemic, hypotension, suspect electrolyte imbalance.

Side effects: orthostatic hypotension

Pediatric Dose: Safety and effectiveness in pediatric patients is not established.

Dexamethasone (Decadron) – RESPIRATORY DRUG
Adult Dose: 1mg/kg slow IV (typical dose 10-100mg).

Class: corticosteroid, Antiimflammatory

MOA: suppresses acute and chronic inflammation

Indications: anaphylaxis, asthma, croup, spinal cord injury

Contraindications: allergy, suspected sepsis

Pediatric Dose: 0.25 -1.0 mg/kg (IV/IM/IO)

Diazepam (Valium) – SEDATIVE
Adult Dose: seizure activity, anxiety, agitation, cocaine induced SVT’s, acute alcohol withdrawal: 5-10mg slow IV/IM every 10-15 minutes as needed (PRN)
Premedication for RSI, Cardioversion: 5-15mg slow IV

On Set: 1-5 minutes
Peak: 15 minutes
Duration: 20-50 Minutes

Class: benzodiazepine sedative/ hypnotic, anticonvulsant

MOA: Long acting sedative / hypnotic, controls seizure threshold

Indications: Extreme anxiety, agitation, acute alcohol withdrawal, seizure activity, sedation for medical procedures (RSI, Cardioversion), cocaine induced SVT

Contraindications: allergic, acute narrow angle glaucoma, respiratory depression, hypotension

Side effects: respiratory depression, hypotension a

Pediatric Dose: Not recommended in prehospital setting.

Diphenhydramine (Benadryl) – RESPIRATORY DRUG
Dose: 25-50 mg IV, IM

Class: Antihistamine, Anticholinergic

MOA: Blocks cellular histamine receptors

Indications: Allergic reactions, acute days tonic reactions
Contraindications: hypersensitivity

Epinephrine (adrenaline) – RESPIRATORY DRUG ETC.
Class: Sympathomimetic

MOA: Alpha-1 vasoconstriction, Beta-1 Inotropic, Chronotropic and Dromotropic effects, Beta-2 bronchial smooth muscle relaxation.

Indications: Initial drugs used in cardiac arrest (asystole, PEA, V-fib, V-tach) an alternative to Dopamine, allergic reaction (anaphylaxis), and severe asthma.

Contraindications: hypertension, hypothermic, hypovelemic shock.

Adult Dose: cardiac arrest – 1.0mg (1:10,000 solution) IV/IO every 3-5 minutes, follow each dose with 20mL flush and elevate extremity.
Alternative to Dopamine – add 1.0mg of Epi 1:1,000 solution into 500mL NS bag (yields 2mcg/mL), administer and infusion rate of 1-10mcg/min, titrate to effect.
Mild allergic reaction and severe asthma – 0.3-0.5mg (0.3-0.5mL 1:1,000 solution) SC/IM
Anaphylaxis- 0.1mg (1mL of 1:10,000 solution) IV
*supplied 1mg in 10mL of solution.

Epi Racemic (Micronefrin) – RESPIRATORY DRUG
Adult Dose: mix 0.5 mg of Epi 1:1000 in 5 mL of NS by nebulizer. One time dose only.

Class: sympathomimetic

MOA: stimulates beta-2 receptors in the lungs causing bronchodilation, reduces airway resistance, reduces laryngeal edema.

Indications: asthma, Croup (laryngotrachealbronchitis), laryngeal edema

Contraindications: hypertension, cardiovascular disease, epiglotitis, allergy

Side effects: tachycardia, nausea, vomiting, anxious, palpitations

Furosemide (Lasix) – RESPIRATORY DRUG ETC.
Adult Dose: 0.5 – 1.0 mg/kg over 1-2 minutes. Typical dose is 40-120 mg for test purposes street dosage typically 30-40 mg

*lung sounds rales/crackles
*orange vial or syringe

Class: Loop Diuretic

MOA: inhibits the absorption of sodium (Na+) or chloride at the loop of Henle causing increased urine output.

Indications: CHF, pulmonary edema, hypertensive crisis, *They have to have had a diagnosis of CHF

Contraindications: allergic, hypovelemia, hypotension, suspect electrolyte imbalance, fever

Side effects: orthostatic hypotension (vital signs change with a change in body position.

Ipratropium (Atrovent) – RESPIRATORY DRUG
DULT/PED Dose Same: 500 mcg in 2-3 mL NS via nebulizer, 0.5 mg in 2.3 mL NS via nebulizer, 1 time dose (usually given in conjunction with Albueterol.)

Class: Anticholinergic bronchodilator

MOA: Dries secretions and causes bronchodilation

Indications: bronchospasms, asthma, COPD, emphysema chronic bronchitis, allergic reaction involving the airway. (Wheezing)

Contraindications: hypersensitivity (allergic), peanuts

Isoetherine (Bronchosol) – RESPIRATORY DRUG
Dosage: 2.5-5.0mg in 3mL of NS by nebulizer.

Class: sympathomimetic

MOA: beta-2 agonist, relaxes bronchioles

Indications: asthma, bronchospasms especially in COPD

Contraindications: allergy, cardiovascular disease. *use caution in patients with diabetes

Side effects: tachycardia, palpitations, nausea, vomiting

Levalbueterol (Xoponex) – RESPIRATORY DRUG
Adult Dose: 1.25-2.5mg in 3mL NS by nebulizer up to 3 doses.

Class: Sympathomimetic bronchodilators

MOA: stimulates beta-2 receptors resulting in smooth muscle relaxation of the bronchial tree and peripheral vasculature.

Indications: Acute bronchospasms in patients with COPD and asthma.

Contraindications: allergy, Tachycardia 160>

Lorazepam (Ativan)
Dose: 2-4mg

Benzo, Schedule IV Drug

On Set: 1-5 Minutes
Peak: 6-8 Hours
Duration: Varies

Contra: Drug OD, Glaucoma

Magnesium Sulfate – RESPIRATORY DRUG ETC.
Adult Dose: syringe (Eclampsia 1-4g IV over 3 minutes); cardiac (refractory to Amiodarone) 1-2g IV,IO; Torsades 1-2g IV,IO; infusion (respiratory) 1-2g in 100mL NS 5-10 minutes 10 gtts/mL set

Pink top, supplied 1g/ 2mL

Class: Electrolyte, Anti Inflammatory

MOA: anti Inflammatory, relaxes muscles

Indications: Asthma, Emphysema, COPD, Chronic Bronchitis, Eclampsia (seizures of pregnancy), Torsades De Pointes (issue in v-tach), Hypomagnasemia, cardiac arrest (v-fib, v-tach) refractory to amiodarone

Contraindication: allergy, heart block

Side effects: hypotensive, CNS depression

Metaproterenal (Alupent) – RESPIRATORY DRUG
Adult Dose: 0.2-0.3mL of a 5% solution in 2.5mL of NS

Class: beta-2 agonist, bronchodilator

MOA: relax smooth muscles of bronchial tree

Indications: asthma, bronchospasms, chronic bronchitis, COPD

Contraindications: allergy, tachycardia

Side effects: tachycardia, palpitations, nausea, vomiting.

Methylprednisone (Solu-medrol)
Dose: Adult 1-2 mg/kg given IV/IM/IO. Typical dosage is 125 mg given IV/IM/IO.

*has to be mixed prior to use

Class: Corticosteroid, anti inflammatory, smooth muscle relaxer, Synthetic

MOA: Antiimflammatory

Indications: asthma, COPD, emphysema,chronic bronchitis, allergic reaction involving the airway. Acute spinal cord injury to help reduce swelling

Contraindications: Allergic

Side effects: negligible

Midazolam
Dose: 2-2.5mg Max 1mg/KG IV

Benzo Class IV

On Set: 1-3 Minutes
Peak: Varies
Duration: 2-6 Hours

May cause severe breathing problems (eg, respiratory depression, respiratory arrest).

Works in the central nervous system (brain) to cause sleepiness, muscle relaxation, and short-term memory loss, and to reduce anxiety.

Morphine Sulfate (MSO4)
Adult Dose: acute MI (STEMI) , CHF, pulmonary edema: 2-4mg slow IV every 5-15 minutes to max 10 mg
Moderate/ severe pain: 2-10mg slow IV

Class: Opiod analgesic (schedule II narcotic)

MOA: alleviates pain through CNS action, increases peripheral vasodilation and decreases preload.

Indications: severe CHF, pulmonary edema, chest pain associated with an acute MI, moderate to severe pain.

Contraindications: allergic, significant head injury, depressed respiratory drive, hypotension, undiagnosed abdominal pain, decreased Loc

Side effects: sedation, CNS depression, respiratory depression, hypotension, nausea and vomiting.

Nitroglycerin (NTG, Nitrostat, Nitrobid)
Adult Dose: tablet or spray (1 spray) 0.4mg SL to max of 3 doses every 5 minutes
Paste:0.5-2.0 inches topical ug/kg/min IV, IO titrated by 1 ug/kg/min (max dose: 5 ug/kg/min).

Class: vasodilator

MOA: dilation of arteriol and peripheral veins, reduce preload and after load, decrease the workload of the heart and reduce myocardial oxygen demand

Indications: acute angina, ischemic chest pain, hypertension, CHF/ pulmonary edema

Contraindications: allergic, hypotension (<100 systolic), intracranial bleeding and head injury, erectile dysfunction medications used within 24-72 hours. Side effects: hypotension, headache Supplied: tablets, spray, paste form Pediatric Dose: Not Recommended. IVinfusion: 0.25 -0.5 *note: if 12 lead reveals inferior infarction (II,III, AVF), perform right sided 12 lead (move v4 lead under right nipple) now called v4r to rule out right sided MI. Prior to NTG administration. Don't give nitro (NTG) prior to performing 12 lead Nitro decomposes when it is exposed to light and heat

Pancuronium (Pavulon)
Adult Dose: 0.06-0.1mg/kg slow IV/IO

On Set: 30 Seconds
Peak: 3.5 Minutes
Duration: 45-60 Minutes

Binds with Acetylchoine

Class: non depolarizing neuromuscular blocking agent

MOA: fast acting long lasting

Indications: paralytic for RSI

Contraindications: Allergy, acute narrow-angle glaucoma, penetrating eye injury, inability to control airway with positive pressure ventilation

Pediatric Dose: 0.04 to 0.1 mg/kg slow IV/IO

Terbutaline (Brethine)
Adult Dose: .25mg SC, may repeat in 30 minutes. Administered to the abdominal cavity.

Class: beta-2 agonist, bronchodilator

MOA: relaxes the smooth muscles of the bronchial tree and peripheral vasculature with minimal cardiac affects

Indications: asthma, bronchospasms, COPD, emphysema, chronic bronchitis

Contraindications: allergic, tachycardia

Pediatric Dose: not recommended for children younger than 12 years of age. 0.25 mg SC may repeat in 15-30 minutes to a maximum of 0.5 mg in a 4 hour period.

Levalbuterol (Xoponex)
Adult Dose: 1.25mg -2.5mg in 3ml Route Nebulizer

Sympathomimetic Bronchodilator, It can treat or prevent brochospasm.

Indications: Treatment for acute bronchospasms, COPD, Asthma

Contra: Hypersensitivity to the drug, Angioedema, Severe Cardiac Arrest

Adverse Effects: Headaches, Anxiety, dizziness, tachycardia, angina, nausea, vomiting and tremors.

Etomidate (Amidate)
Adult Dose: 0.2-0.6 mg/kg IV/IO over 30-60 seconds (typical dose 20mg)

Class: nonbarbituate hypnotic, sedative

MOA: short acting hypnotic

Indications: medication for RSI Cardioversion

Contraindications: allergic, labor delivery

Side effects: respiratory depression, hypotension

Fentanyl (Sublimaze)
Adult Dose: 1mcg/kg slow IV/IM/IO (max single dose of 100mcg)

Class: Opiod analgesic (schedule II narcotic)

MOA: pain relief with less cardiovascular effects.

Indication: moderate to severe pain

Contraindications: allergic, head injury, hypotension

Side effects: CNS depression, hypotension, respiratory depression.

Note: may cause chest wall rigidity when pushed rapidly.

Flumazenil (Romazicon)
Dose: 0.2 mg IV/IO over 15 seconds. Second dose: 0.3 mg over 30 seconds.

Class: Benzodiazepine antagonist, antidote

MOA: Reverses the action of benzodiazepines on the central nervous system.

Indication: Respiratory depression from benzodiazepine overdose

Midozolam (Versed)
Adult Dose: 2-2.5mg IV/IM/IO up to 10mg
*2-2 1/2 times stronger than Valium.

Class: Benzodiazepine sedative, anticonvulsant

MOA: short/ intermediate sedative/hypnotic

Indications: seizure, extreme anxiety and agitation, sedation for medical procedures (RSI, Cardioversion)

Contraindications: allergic, acute narrow angle glaucoma, shock, alcohol intoxication, overdose affecting CNS, depressed vital signs (respiration RR, hypotensive)

Side effects: respiratory depression, hypotension

Naloxone (Narcan)
Adult Dose: 0.4-2.0 mg IM/SQ/IV/IO, may repeat every 5 minutes up to a total of 10 mg

Class: opioid antagonist, antidote

MOA: Blocks narcotic receptors, reverses respiratory depression secondary to opiate drugs

Contraindications: use with caution in narcotic dependent patients

*Prevent patients from having to be intubated.

Odansetron (Zofran)
Dose: 4 mg IV/IM may repeat in 10 minutes

Classification: Antiemetic

MOA: Blocks action of serotonin, which is a natural substance that causes nausea & vomiting

Indications: Nausea/ Vomiting

Contraindications: allergic

Promethezine (Phenegran)
Dose: 12.5-25.0 mg IV

Classification:Antiemetic

Indications: Nausea/ vomiting, motion sickness

Contraindications: Allergic, CNS depression from alcohol, barbiturates or narcotics

Side Effect: Sedation

Rocuronium (Zemuron)
Dose: 1.0meq/kg slow IV/IO, repeat every 10 minutes at 0.5meq/kg

On Set: 1-2 Minutes
Peak: Varies
Duration: 45-120

ANTAGONIZES ACETYLCHOLINE

Class: alkalizing agent

MOA: hydrogen ion buffer, buffers metabolic acidosis and lactic acid build up in the body caused by anaerobic metabolism.

Indications: cardiac arrest, hyperkalemic, tricyclic antidepressant and aspirin overdose, crushing injury.

Contraindications: metabolic or respiratory alkalosis, hypokalemia.

*note: repeat in tricyclic antidepressant overdose as needed until the QRS narrows. Always flush IV/IO well after administering.

Succinylcholine (Anactine)
Adult Dose: 1-1.5 mg/kg rapid IV/IO, repeat as needed.

On Set: 1 Minute
Peak: 1-3
Duration: 5-10

Class: DEPOLARIZING neuromuscular blocking agent

MOA: ultra short acting and short lasting

Acetylcholine Binds with Cholinergic Receptors.

Indication: RSI use

Contraindications: acute narrow angle glaucoma, malignant, hypothermia, inability of responder to control airway or support ventilation with oxygen and positive pressure ventilation system,penetrating eye injury.

Side effects: increased intraocular pressure

Note: a sedative such as Etomidate, Valium, or Versed should be used in any conscious patient before undergoing a neuromuscular blocking agent.

Vecuronium (Norcuron)
Adult Dose: 0.1-0.2mg/kg IV/IO

On Set: 1-3 Minute
Peak: Varies
Duration: 45-90 minutes

Class: Nondepoarizing neuromuscular blocking agent

MOA: fast acting, long lasting

Indications: RSI

Contraindications: acute narrow angle glaucoma, penetrating eye injury, renal failure, an inability to control the airway and support ventilation system with O2 and positive pressure

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