ER-101...Route/Meds/Terms - page 4

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   parrotmom
    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.
    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?
    D50 can be given rectally but it is very necrotic so one must be careful, Glucagon is a better choice. The new guidelines are the AHA ECC 2005 guidelines that went into place mandatorily in July( to be taught not everyone must retrain though it is recommended) IO is intraosseous, very effective means of short term fluid resusc. inserted into tibia humerus or sternum depending on the device nad pre med w/idocaine prior to admin of fluid is recommended. elsevier has a new ACLS study guide out and the PALS book is due out the end of the month that are fabulous for the courses.
  2. by   TRD
    Thank you. The drug portion is VERY helpful! I'll pass this onto my fellow nursing students.
  3. by   twotrees2
    acually i believe that the QD QID BID etc are now recomended to be writen out long hand, ie: every day, four times a day , twice a day, to prevent any confusion as many are hard to read and look alike with docs writing.

    Quote from shill
    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,

    Routes of administration

    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.

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

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

    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.

    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 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 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.

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

    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.

    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

    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 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.

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

    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

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

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

    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 is a beta-blocker similar to metoprolol.

    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 (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 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.

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

    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 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 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
  4. by   ER <3 LOVE
    thank you for the info. i interned in the er before i became a cna through rop and it has been awhile. i love the emergency room and i am looking for a job in one. anyway, it was a great review. thank you.
  5. by   tddowney
    Thanks much, shill.

    I'm a nursing student with interest in the ED and this is very handy info in an easy to use form. I put the file on my PDA to browse at odd free moments.
  6. by   shill
    Hi Everyone,
    Long time no hear, and to some I wasn't missed, but through a rough upbringing, I've learned to be kind to the ones that are resistant, and to continue to help those that are interested.

    Oh gosh, where do I start? Let me start by asking you all a question. "Has anyone here, experience feeling great one minute, then get hit with a sickness that put you down for about two or three weeks, you're feeling great ready to go back to work, and then Bam!!!!!! you get hit with something else?(Sickness that is!)" Now remember, what I'm about to tell you, is not for anybody here(not that some would) to feel sorry for me by all means!!!! So here goes.......( mind you, I am a type of person that "never calls in sick and really has never had anything medically wrong, very seldom do I even get a head ache.") Well, when September 13 came around that really change my medical history. I went to work doing my usual shift 7p-7a, feeling a little "a-gi-da", (oh yeah I do have a history of Gerd). I didn't really think anything of it, just a little discomfort. The oncoming doctor, who is a really great doctor, was having some left lower quadrant pain. So joking I said, "we'll be a great working team tonight". As the night progressed, four hours into it, the doctor asked me how I was feeling, and I said it's not getting any better, and she said you look a little pale you should get checked in. So, to make a long story short, instead of my gallbladder being five to 6 cm long, it was 17 cm long.(Yeah, I even impressed Dr. Brady my surgeon)." It looked like Santa's sack, only it was filled with stones and fluid."(Ho ho ho) I did get a nice vacation of about three weeks. The week of, October 8th, I was planning on going back to work. That Sunday, I was having a garage sale, "thank God my girlfriend was there," two hours into it, she noticed me doing funny things, and I felt myself doing things out of the ordinary. I wasn't stumbling or having problems speaking. I remember waving my hands over the cash box, she stepped in and took over. At one point she asked me what her name was, and I couldn't tell her. Then she asked me how many goats were across the street, (yes, there really are goats across the street), I looked over, then up to the sky and said, "WHAT GOATS!" I remember putting my fingers to my temples, looking at her and saying, "something's not right!" The next thing I remembered was waking up in ICU. I got updated on what went on in an emergency room, by the RN and Dr. who took care of me. In short, my right side was paralyzed(stroke) for about 15 minutes in the ER while my left side was going to town, making up for my right side. Then my right side regained movement, both arm and leg, and joined my left side, and continued to seize for a total of 45 minutes. In the process I apparently bit the side of my mouth and tongue, aspirated blood. They landed up intubating me, for my own safety and protection from the sedation I had gotten, my vital signs weren't the best either. In the ICU with the sedation that I gotten, I still was fighting everything,(being filled in by my girlfriend) they had to strap my arms and legs down because I was still fighting. Not to brag, but I am one tough, B#@%*,let's settle for "Cookie"! I was transferred to the floor, to recoup and because I had developed, rhabdomyolysis and to find out exactally what was going on. To those of you who know what this is you can skip this part, and to those of you who don't know what rhabdomyolysis is... here's a short definition:
    Rhabdomyolysis occurs when muscle damage and destruction develops. The causes of my rhabdomyolysis was due to the length of seizure that I had. My rhabdo level was hitting the 1000 mark which really isn't good, so I got pumped full of fluids, sodium bicarb and potassium. And my rhabdo level came down to 450 which was a safe level they felt, so I could go home. In patients with rhabdomyolysis, the muscle destruction allows leakage of muscle components, resulting in abnormalities of electrolytes, and kidney function. If not recognized and not treated appropriately, in some cases the next step is dialysis. :bowingpurThank God recognition was early in my case.
    While on the floor, being the /patient, I did my own urine output measurements, and wrote then on the board along with the time. And only used the call light when the fluids ran empty and new ones needed to be hung. (Wasn't that nice of me). I went for a MRI five days later. Has anyone here ever had an MRI of the head? For those of you who have never had a MRI(of the head)... just imagine, putting your ear against a jackhammer, as the guy is chiseling away at cement. And for those of you who have had one, will agree with me.
    All in All, they came up with a diagnosis of Hippocampus . And the saga goes on..... but for now, I'm going to stop (gotta fix dinner)... and I'll continue later.
    But I have been on this site, reading the new posts. I've also have read the additional responses to my topic ER 101, and I appreciate the responses and comments.
    Remember, no oooo's or aaah's, or pitty felt.... because I'm back and fully CHARGED!!!! umpiron:
    See Ya...
  7. by   Brown_1057
    thank you, useful information :studyowl:
  8. by   pannie
    Is it at least OK to say "Glad you're back, Tough Cookie"!? We need more posts from you!
  9. by   Nurse_Diane
    Great information, thanks a ton!

    As a future (hopefully) ER nurse, I really appreciate it!!

  10. by   treborhon
    This really help me.Thanks a lot for the post.
  11. by   azeERNurse
    Thank you for sharing this info. Its helpful for quick reference
  12. by   shill

    you're probably all thinking that, "man that was a long dinner", i guess with all that's been happening to me, i got a little tired and have laid back a little bit. and as i reread my last post, i see that i put my diagnosis as hippocampus, which as, most of you here know that hippocampus is not a diagnosis. i should have stated that, it was at the hippocampus that my stroke (tia) took place. just a little knowledge to the new rn’s…… and to myself, which i have learned, after experiencing this event, it has given me a better knowledge and understanding, of the patients that come into the er, who has either experienced a stroke, has alzheimer's or is going through what i have gone through. it has really given me a good understanding to the old saying, ” unless you have walked in their shoes and experience what they have experienced,” can you say,” i understand what you're going through”. below is just a few interesting points, about the hippocampus and what happens at this segment of the brain….. i found it to be interesting: i hope you do ….
    hippocampus (hippo camp' us)
    **the hippocampus is a horseshoe shaped region of the subcortical brain. as part of the limbic system, located in the temporal lobe, it has a role in emotion and memory. it also contains "place" cells that construct mental maps of position, and with the parahippocampal gyrus, is implicated in the learning and remembering of space (spatial orientation).
    ** it is important for converting short term memory to more permanent memory, and for recalling spatial relationships in the world about us. it is also part of the limbic lobe. it got its name because its shape resembles that of a 'seahorse'.
    **damage to the hippocampus disrupts recent memory, but leaves remote (already learned?) memory intact.
    **it is a center for short term memory. it weighs the importance of episodic acts and decides which should be kept as memories. therefore it has an important role in learning.
    **new memories are first processed and kept in the hippocampus for several weeks, before they are transferred to the cerebral cortex for permanent storage..
    **it receives input from auditory as well as visual tracts
    **it allows for rapid learning of new items.
    **it helps construct a three dimensional "mental map" of our surroundings, and is crucial for our ability to move around in the real world.
    **this may explain why people with brain damage to their hippocampal region retain previous memories of faces and places, which are stored in the cortex, but have difficulty forming new short-term memories.
    **damage to the hippocampal region results in a failure to remember spatial layouts or landmarks.
    **stroke patients who experience navigation problems inevitably manifest brain damage in an area just below (and connected to) the hippocampus, a region called the parahippocampal gyri. this area is crucial to the storage and recall of spatial information. after stroke damage to the parahippocampus, patients develop graphical disorientation. they lose the ability to learn new routes or to travel familiar routes.
    **there may be a connection between children with navigational disabilities, stroke patients, and victims of alzheimer's disease. it may be that the blood supply to the hippocampus and parahippocampus is vulnerable, ie. more easily damaged by infarction, more prone to damage faster when oxygen (and/or nutrients) is reduced.
    **the hippocampus creates longterm memories (which are then stored in the neocortext).
    as a result of experiencing this condition, the only after effect i have, that i think i have, is a small problem remembering let's say, somebody's last name. but i had that problem before all this happened. when i mentioned this to my coworkers, they all say, hell that happens to them all the time, so maybe i'm not too crazy after all. the bad part about being in the medical field, is that we like to diagnose ourselves and sometimes we have a problem accepting medical conditions that we have been diagnosed with by the professionals. you know they're only human, and they can make mistakes too. in my opinion i think this is a freak thing that happened, i don't really know, but my neurologist himself, is still a little uncertain of what all went on, he's only going by the eeg, he'll know more when he sees the results of the mri.
    see ya,
    sherry the time i got to posting this....time has gone by and the mri result are back, spoke to my neurologist and had a 2nd mri, it was done yesterday(no results yet on that one). let me catch my breath and i'll be back....probably the results of the 2nd one will be back by then.
  13. by   d l a 666