Sedation IV

Question 1

IV drug administration types needles

Answer 1

Hollow Metal Needles
Scalp Vein Infusion Needles
Indwelling Catheters

Question 2

Needle Gauge

Answer 2

The # of needles that can be placed into a 1 in circle

Question 3

Needle gauges to use

Answer 3

18 - GA
20-23 Sedation, IM injections
25-27 LA
30 Accupuncture

Question 4

Fluids used for IV drugs

Answer 4

LR lactated ringers
NS sodium chloride
5% dextrose in water
Sterile water for injection

Question 5

Infusion rate for adults

Answer 5

10 drops = 1 ml

Question 6

Infusion rate for pediatric

Answer 6

60 drops = 1 ml

Question 7

Precaution to take with rigid IV needles

Answer 7

Immobilize the elbow

Question 8

Complications: Venospasm

Answer 8

Vein disappear or collapses

Heat may help vein reappear

Question 9

Complications: Hematoma

Answer 9

Extravasation of blood into surrounding tissues
Painless bluish discoloration
If happens: remove tourniquet, apply firm pressure, and then ice

Question 10

Complications: Embolism

Answer 10

Pt can tolerate up to 1ml/kg of air
Eliminate air bubbles from tubing to prevent
Have pt head down and lying on left side

Question 11

Complications: Over-hydration

Answer 11

Significant for CHF pts and children
Can cause pulmonary edema, tachycardia, inc BP
Prevent by calculated fluid deficit

Question 12

Complications: Extravasation of drugs

Answer 12

Will have pain, delayed drug absoprtion, possibly tissue damage
Mgmt: remove needle, apply pressure
If gave > 2mL, inject 1% procaine

Question 13

Complications: Intra-arterial Injection

Answer 13

Respond aggressively!!
Chemical insult–> spasm that compromises distal circulation
Best way to avoid is prevention
Assess blood color- bright cherry red vs dark red

Question 14

Complications: Intra-arterial injection - MGMT:

Answer 14

Leave needle in place, give 1% procaine
Hospitalize pt
Surgical endareterctomy
Heparinzation
Amputation of gangrenous limb is txt fails

Question 15

Complications: Phlebitis and Thromboplebitis

Answer 15

Pain, edema, delayed onset
Mgmt: sling to limit limb activity
Elevate and heat limb
NSAIDs

Question 16

Complications: Nausea

Answer 16

Tx w/ O2 and IV antiemetic

Question 17

Complications: Vomiting

Answer 17

Stop txt immediately and put pt on RIGHT side
IV antiemetic
Suction

Question 18

Complications: Emergence Delirium

Answer 18

Treat w/ scopolamine

Question 19

Emergency Scenarios: Airway Obstruction

Answer 19

Most common cause: Prolapsed tongue
MGMT: Head tilt chin lift if from prolapsed tongue
Remove debris if not from tongue
If pt is not breathing - THEN you have to breath for them

Question 20

Airways to fix airway obstruction

Answer 20

Laryngeal Mask Airway
Combitube
King tube
Tracheal intubation
Surgical airway cricothyroidotomy

Question 21

LMA Indication

Answer 21

Alternative airway, difficult airway,
Can’t ventilate
Failed intubation
No laryngoscope

Question 22

LMA Advantages

Answer 22

Minimal training
Can use in peds
Least amount of tissue trauma
Can use to intubate

Question 23

Laryngospasm

Answer 23

Partial or complete closure of vocal cords due to irritation by foreign matter

Question 24

Crowing noise

Answer 24

Laryngospasm

Question 25

Laryngospasm mgmt

Answer 25

``` Stop procedure Deliver 100% O2 Position head Protrude tongue and suction oro, naso, and hypo pharynx Push on chest, listen for rush of air Positive pressure O2 Succinylcholine if still unsuccessful ```

Question 26

Hypoglycemia

Answer 26

at 50-70 mg/dl --> CNS becomes excitable, nervousness, sweating, trembling at 20-50 mg/dl --> convulsions, loss of consciousness, shock

Question 27

Hypoglycemia mgmt

Answer 27

If conscious- oral carbs, monitor, IV 50% dextrose if no response to oral carbs If unconscious - get help, BLS, O2, administer carb, 50% dectros IV and Glucagon 1mg IM

Question 28

Allergy

Answer 28

Heightened response of the immune system Broad range of onset Affects multiple organ systes If hypotension is involved-- anaphylactic shock

Question 29

Commonly used drugs w/ allergic potential

Answer 29

Antibiotics Antianxiety meds Analgesics LA

Question 30

Allergy: Clinical manifestations

Answer 30

CVS - pallor, lightheadedness, hypotension, tachycardia, loss of consciousness GI - nausea, vomiting, severe abdominal cramping, diarrhea Skin- urticaria, erythema, angioedema Respiratory - follow skin but precedes CVS- Bronchospasm, angioedema of the larynx

Question 31

``` Progressive respiratory and circulatory failure Itching of nose and hands Flushing of face Labored breathing Sudden hypotension Cyanosis Swelling of tongue, lips ```

Answer 31

Anaphylactic Shock

Question 32

Anaphylactic Shock mgmt

Answer 32

Epinephrine 0.1 mg IV Antihistamine and steroid IM/IV Transfer to hospital

Question 33

Asthma mgmt

Answer 33

position pt, administer bronchodilator 100% O2 by facemask If not responsive, epi

Question 34

Opioid overdose mgmt

Answer 34

Naloxone - 0.4 mg/ml add 3 ml of saline = 0.1 mg/ml initial dose - fast acting but short lasting

Question 35

Benzodiazepine overdose mgmt

Answer 35

Flumazenil - 0.1 mg/ml- give initial dose of 0.2 mg

Question 36

Angina during procedure - mgmt

Answer 36

Terminate procedure Position pt supplemental O2 Administer nitroglycerine

Question 37

Myocardial Infarction mgmt

Answer 37

``` Terminate procedure Initiate EMS Establish IV access MONA Be ready to do CPR ```

Question 38

MONA

Answer 38

Morphine for pain (nitrous can work too) Oxygen Nitroglycerine Aspirin