ER-101...Route/Meds/Terms

[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.

---

Next Topic-ER-102-More Meds and "The Gallbladder"

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. It's 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 ßlactamases 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

[TazziRN, RN]

Um.....the med list is good because non-critical care nurses going into the ER wouldn't know some of them. The terms, however......I think it's pretty insulting. Yes, we have a few non-medical people who puruse the site, but even nursing students and CNA's know what those terms mean.

[weirdRN, RN]

Thank you for the info.

[Markthemalenurse]

good information, thanks.

[CoolhandHutch, MSN, RN]

UH oh....QD? The JCAHO folks are going to get you!

[nuangel1, BSN, RN]

jcaho doesnot like QD it wants daily

[labcat01, BSN, RN]

Well...I like it! More please :)

[fgoff]

I like it too. Simple ER 101! Thanks for sharing!

[Arkansas RN]

Our hospital recently made it illegal to use qd, qid, tid, bid or the other terms we have all used for years. Even when we are typing in the computer system we use for documentation we have to write 2x/day, etc. Maybe there are a lot of errors due to poor penmanship (mostly by MDs) but when you are typing it there should be no problems figuring it out. What a total pain!!!!!

[Princess74]

Great Post. Thank You!!

[npmaui]

thx...great stuff!

[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!