ER-101...Route/Meds/Terms - page 2

Hi, Just a tid-bit of info to those who are planning to work in an ER, or would just like to understand terms and what certain meds are for and what their uses are and why they are used. Correction... Read More

  1. by   anne74
    Man - someone adds a helpful reference and people start tearing it apart!

    Everyone at this site is at different levels, so can those of you "experts" tolerate seeing some basic stuff? I don't think any of this insulting. Everyone can use a refresher.

    And as for the QD stuff, etc., - my hospital isn't using those either, but many hospitals -and doctors - around the country still are, so it's helps to at least be able to recognize them if they happen to show up. In nursing school, we knew those terms were becoming obsolete, but we still learned them anyway so we'd be familiar with them. Relax people! And to the OP - thanks for sharing. I know many people found this helpful!
  2. by   West_Coast_Ken
    Thanks, Shill, for the starter. I'm going to do a 100 hour preceptorship next semester in the ED and I'm looking for any useful ED information so I won't look like I should be in the bed rather than beside it! :chuckle
  3. by   parrotmom
    Just a reminder ACLS is recommending no drugs down the ET instead IO's are to be used when IV access is not immediately available and meds are critical, i.e. code situation and of course pt is unconscious, course some of the new IO's (EZ-IO) have been used on conscious adults and it is said about as painful as having ones ears pierced. Corrected the typos keyboard is sticking
  4. by   Rio
    Quote from parrotmom
    Just a reminder ACLS is recommending no drugs down the ET instead IO's are to be used when IV access is not immediately available and meds are critical, i.e. code situation and of course pt is unconscious, course some of the new IO's (EZ-IO) have been used on conscious adults and it is said about as painful as having ones ears pierced. Corrected the typos keyboard is sticking
    Absolutely correct ! But from experience, the EZ-IO insertion while not as painful as one might expect, the infusion is horribly painful. We premedicate with 20 to 50 mg of lidocaine IV prior to infusion. Also it is only approved for adults in the anterior tibial plateau and humoral head. There is a FAST-IO that is placed in the sternum, but we have switched to the EZ-IO.
  5. by   Larry77
    Very good basics...is so much to learn because "emergency nursing" is not really taught in nursing school. I'd like to add a few more meds (nitro, Dilaudid, Lovenox and some other ABO families) but is a great start

    I vote sticky worthy!!!
  6. by   mysticalwaters1
    Quote from parrotmom
    Just a reminder ACLS is recommending no drugs down the ET instead IO's are to be used when IV access is not immediately available and meds are critical, i.e. code situation and of course pt is unconscious, course some of the new IO's (EZ-IO) have been used on conscious adults and it is said about as painful as having ones ears pierced. Corrected the typos keyboard is sticking
    What is IO? Is that intra osseous into bone?

    I found OP's info great! I started orientation in the ED several months ago, just finished, and the educator left 95% of my orientation without one so I really only had a cardiac dysrhythmia course online, me looking stuff up, and my coworkers. I've been on med surg but no critical care. I just ask lots of ?s but this post would have been helpful in the beginning just to have an idea what is even given in ther ER. Like ketamine, and various antiseizure meds, even iv cardizem I never had to give before. And it's a nice little review. Because I've noticed some stuff you don't see for a long time or do it rarely. Ex haven't had to give any seizure medications yet haven't had those pt's.

    I haven't had to give medicine down the ET tube yet. Maybe because it's not really reccomended anymore? Every pt I've delt with intubated had iv access. However my concern is as protocol with codes on nonmonitored floors an ER nurse goes up with intubation medications and the ed nurse administers the drugs since those floors do not require acls. I haven't had to work on any cardiac arrest pts as an ER nurse now. Only pts brought in via ambulance after everything already done. But how do you insert the medication down an ET tube? Maybe a stupid ? but I never had to do it. I usually write my ?s down and ask coworkers but this one just really never was around it so it never came up. But lots of times on the floor I know sometime iv access can't be obtained. After intubation do you just disconnect the ambu bag and poor the medication right down the tube? Because there's a little peice by the ET for injecting air into the tube to inflate the balloon. I don't remember seeing another peice to insert medication. And I can't imagine putting medicine in that peice b/c I'll expand the tube more and break something wow...

    But anyway I'm finding great info on this site that helps and thank you everyone for all the great advice and conversations!
  7. by   Jennifer, RN
    During a code, if IV access has not been established for whatever reason, emergency medications (narcan, atropine, valium, epi, and lidocaine) can be given directly down the ET tube itself (after disconnecting the ambu bag from the tube) and followed with ~10 ml of NS. Then hyperventilate the pt to circulate the meds. Some pts come in by EMS without iv access if pt is difficult stick. Very rare that we are unable to get some kind of IV access though. I took ACLS last year and have not heard anything about new guidelines about IO access (yes, that is intraosseous into the bone) with emergency meds in adults. I will have to look into it. Seems that meds down the ET are quicker still. Especially if the pt is obese and even IO access difficult to obtain.
    Also heard from some paramedics that they have given dextrose and valium rectally. They say they just shoot the med up in the rectum and the rectum is so vascular that it is absorbed that way. Any one else ever hear of this?
  8. by   DoubleblessedRN
    Quote from Jennifer, RN
    Also heard from some paramedics that they have given dextrose and valium rectally.
    Yes. Our protocols state that we may give Valium 10 mg rectally if we cannot obtain IV access, but I've never heard of rectal dextrose.
  9. by   mysticalwaters1
    Quote from Jennifer, RN
    During a code, if IV access has not been established for whatever reason, emergency medications (narcan, atropine, valium, epi, and lidocaine) can be given directly down the ET tube itself (after disconnecting the ambu bag from the tube) and followed with ~10 ml of NS. Then hyperventilate the pt to circulate the meds. Some pts come in by EMS without iv access if pt is difficult stick. Very rare that we are unable to get some kind of IV access though. I took ACLS last year and have not heard anything about new guidelines about IO access (yes, that is intraosseous into the bone) with emergency meds in adults. I will have to look into it. Seems that meds down the ET are quicker still. Especially if the pt is obese and even IO access difficult to obtain.
    Thanks!!!
  10. by   mmutk
    There needs to be an ERFAQs.com
  11. by   marybethm
    How about the term "train wreck". Does any other ER nurse use this term? Very technical.
  12. by   Verna127
    I am a brand new RN so any more tips and information that anyone has is very welcome. Thanks for the information and the link.
    Last edit by EricJRN on Oct 10, '06 : Reason: email removed per TOS
  13. by   rhp123
    This is very helpful for a nursing student!

    I like it.


    Quote from shill
    Hi,
    Just a tid-bit of info to those who are planning to work in an ER, or would just like to understand terms and what certain meds are for and what their uses are and why they are used.
    Correction of any mistakes are appreciated and by-all means,inputs are more then welcomed.
    How about some of the vintage ER Nurses, pick a topic and lets see if we can help educate our future ER Nurses, so when they step into the "ER" they won't be totally "Green" behind the ears.:wink2:

    Next Topic-ER-102-More Meds and "The Gallbladder":uhoh21:
    I hope you find this interesting and educational. Let me know!
    See Ya,
    Sherry


    Routes of administration

    IV
    Intravenous administration is when the drug is given in liquid form directly into a vein. This is often done by placing a venous catheter to allow easy administration.

    IM
    Direct injection into the muscle. Often a painful mode of administration, and provides a slow route of absorption.

    PO
    By mouth (Per Orum). Typically intermediate between IM and IV in speed of absorption. (is this true?)

    PR
    Rectal administration (Per Rectum). The rectum is actually a very quick method of drug administration as the rectum is highly vascular. This route is often used in children.

    ET
    Certain drugs can be given down an endotracheal tube. The drugs are given at 2-2.5 times normal IV dose. Drugs are followed with a saline bolus of ~10ml. The acronym for drugs that can go down an ET tube is ALONE:
    * A - Atropine
    * L - Lidocaine
    * O - Oxygen
    * N - Naloxone (Narcan)
    * E - Epinephrine

    Drug List

    Lidocaine
    Lidocaine has 2 uses: It is a local anesthetic when injected subcutaneously (and it can be used for a nerve block). It is also an antidysrhythmic drug when injected IV (used to treat cardiac dysrhythmias). Anesthetic preparations come in 2 forms: with and without epinephrine. The epinephrine is added to reduce absorption and prolong the effect. A classic question by the resident/attending is: What is the toxic dose when used as a local anesthetic (Answer: 5mg/kg for lidocaine without epi, and 7mg/kg with epi.)

    Epinephrine
    Epinephrine is a natural substance produced by the adrenal gland (a.k.a. adrenaline). Epinephrine is used in emergencies to stimulate the heart or to dilate the bronchial tree. Its use is limited by cardiac side effects. It is also mixed with lidocaine to prolong lidocaine's effect and to control bleeding.

    Furosemide (Lasix)
    Lasix is a diuretic, which is given IV or PO, which causes the patient to produce more urine. This is often given to reduce the fluid overload in patients with congestive heart failure (a.k.a. CHF) or hypertension.

    Diazepam (Valium)
    Diazepam is a benzodiazepine that is used both as a powerful sedative and as an anticonvulsant for patients with seizures. You will see it used for alcohol withdrawal, cocaine toxicity, and status epilepticus (i.e. uncontrolled seizures). Diazepam may produce respiratory depression.

    Midazolam (Versed)
    Versed is a very powerful short acting benzodiazepine type of sedative and is used to sedate patients for painful procedures. Excessive dosing may produce respiration depression (when given i.v.) or coma.

    Haloperidol (Haldol)
    Haldol is a antipsychotic with powerful sedative properties. It is often used for patients who are acting in a psychotic manner. It should not be used to treat alcohol withdrawal or cocaince toxicity. In sufficient quantities it will render the patient unconscious.

    Succinylcholine
    Often called "sux" (pronounced sucks), it is a paralytic, resulting in total muscular paralysis. It will most often be used for "rapid-sequence-intubation" to make tracheal intubation easier and to allow the patient to be mechanically ventilated. It has no analgesic properities and paralyzed patients see, hear and feel everything - like a zombie! - thus it is never used without sedation.

    Atropine
    Atropine is used for several purposes, including inducing the heart to beat faster (i.e. chronotropy) as well as an antidote for certain
    organophosphate poisonings. It is sometimes used as a drug for patients with severe asthma. It can also be dripped into the eyes to produce
    dilation of the pupil (although this is a different formulation). Can also be used to dry up respiratory secretions during procedures.

    Heparin
    Heparin is an anticoagulant used to prevent blood from clotting. It is used in patients suspected of having a myocardial infarction and to prep the syringe for an arterial-blood-gas for the same reason.

    Valproic Acid
    Valproic Acid is used as an anticonvulsant medication. It is not typically used in the emergency treatment of seizures, but toxicity can often be seen with seizure patients who have taken too much.

    Phenobarbital
    Phenobarbital is a barbiturate which is used either as a sedative and/or anticonvulsant medication.

    Pentobarbital
    Similar to phenobarbital but much faster acting and with a duration of effect. It is used as an anticonvulsant medication and to treat severe alcohol withdrawal. Often used in a continuous drip for patients who continue to seize.

    Methylprednisolone (Solumedrol)
    Solu-medrol is a long acting corticosteroid. It is often used to prevent the recurrence of anaphylaxis after the epinephrine has worn off and for patients with asthma. It has a half-life of around 6 hours.

    Albuterol (Proventil)
    Albuterol is a bronchodilator, used in a nebulizer for asthma patients. Typically a drop (0.5 mg) of albuterol is suspended in saline and nebulized with oxygen. Often referred to as "how many nebs the patient got".

    Ampicillin/Sulbactam (Unasyn)
    This is an antibiotic (ampicillin) with the second compound added to prevent bacterial lactamases from working (which interfere with penicillins). This over comes the antibiotic resistance acquired by many bacteria.

    Flouroscein
    This is a fluorescent dye used to stain the cornea to look for scratches or ulcers. Scratches and ulcers will selectively retain the dye, making them glow under the cobalt-blue light of an
    opthalmoscope.

    Ketorolac (Toradol)
    Ketorolac is a powerful NSAID, used for severe headaches, musculo-skeletal pain, kidney stones and inflammation.

    Morphine Sulfate
    Morphine is a powerful opiate (derived from opium and similar to heroin) that is used as a pain killer (i.e. analgesic). However, as a side effect it can suppress respirations.

    Narcan is the antidote to opioids such as heroin or morphine. It is very rapidly acting and competes with the opioid for the opioid receptor. Be careful when administering this drug, as it may cause withdrawal in opioid tolerant patients.

    Prednisone
    Prednisone is a corticosteroid that is given for asthma and as an anti-inflammatory. A side effect of prolonged use is Cushing's syndrome and often you may see tremors.

    Rocuronium
    Often called "rock", it is a paralytic. Administration produces total muscular paralysis. It is most often used for "rapid-sequence-intubation" to make tracheal intubation easier and to allow the patient to be mechanically ventilated. It has no analgesic properities and paralyzed patients see, hear and feel everything and should never used without sedation.

    Pilocarpine
    Pilocarpine is dripped into the eyes to produce constriction of the pupil in patients with glaucoma.

    Dopamine
    Dopamine is a mild pressor agent, which is administered IV to produce vasoconstriction and raise a patient's blood pressure.

    Phenytoin (Dilantin)
    Dilantin is an anticonvulsant. As a side effect, when administered too fast, it can induce
    hypotension.

    N-Acetylcysteine (Mucomyst)
    Mucomyst is given in cases of acetaminophen toxicity (e.g. Tylenol).

    tPA
    Tissue plasminogen activator is a thrombolytic agent, used to lyse blood clots in patients with myocardial infarction (a.k.a. heart attacks), non-hemorrhagic CVA's (a.k.a. strokes) and PE's (a.k.a. pulmonary emboli). Thrombolytics can cause hemorrhage and should be used with care.

    Streptokinase
    Streptokinase is a thrombolytic (note: discovered here at NYU) made by Streptococcus bacteria which dissolves clots, similar to tPA (although through a different mechanism)

    Diltiazem(Cardizem)
    Diltiazem is a calcium channel blocker used to slow the heart down in patients with certain types of tachycardias such as atrial fibrillation.

    Metoprolol is a beta-blocker which is used to slow down the heart and lower blood-pressure. These drugs are not typically used in asthmatics, as they can induce bronchoconstriction.

    Atenolol
    Atenolol is a beta-blocker similar to metoprolol.

    Adenosine
    Adenosine (the A of ATP fame) is used as an antidysrhythmic to break certain cardiac dysrhythmias; it is often used in patients with
    supraventricular tachycardia. The half life of the drug is only a few seconds, and can often induce non-pathologic asystole (flat line on an EKG) for a few seconds.

    Digoxin
    Digoxin (a derivative of the Foxglove plant) is a cardiac drug used to slow conduction through the heart, especially in cases of atrial-fibrillation. As a side effect it can produce various dysrhythmias including ventricular fibrillation and aystole.

    Metronidazole (Flagyl)
    Flagyl is an antibiotic used against anaerobic bacteria and certain parasites. As a side effect
    patients can become violently ill to their stomachs from consuming alcohol with Flagyl (similar to Antabuse)

    Vancomycin
    Vancomycin is the "last ditch" antibiotic, used for highly resistant bacteria. It is fairly toxic to the patient, and often is a hobson's choice to administer to a septic, shocky patient.

    Trimethoprim/sulfamethoxazole (Bactrim)
    Bactrim is a "sulfa" class antibiotic and is often used in urinary tract infections.

    Ketamine
    A sedative often used in conjuction with other sedatives (such as midazolam or diazepam).

    Pepcid
    Pepcid is a systemic antacid (H2 blocker) which takes 30-45 minutes to take effect, but lasts for several hours. Similar to ranitidine (Zantac) and cimetidine (Tagamet).

    NS
    NS stands for Normal Saline, which is 0.9% Sodium Chloride, and is the usual fluid given to a
    patient who needs fluid due to dehydration. It is approximately isotonic.

    LR
    LR stands for Lactated Ringers, which is Normal Saline with other electrolytes. Due to the presence of the other electrolytes, there is a limit to how much can be administered within a specific period of time.

    D5, D10, D25 and D50
    The D stands for Dextrose, which is a stable form of glucose. This solution is given IV to give the patient glucose. This is never given IM, as high concentrations of glucose cause tissue death outside the vasculature.

    Other useful terms

    QD-Once per Day
    BID-Twice per day
    TID-Three times per day
    QID-Four times per day
    QHS-At the hour of sleep
    NPO-Nothing by mouth

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