What are the 3 things you need to do to prepare patient for CPAP administration? (1)
PPE
Systolic BP over 100
Position patient in a position that will optimize ease of ventilation
What are the indications for a CPAP? (2)
Asthma
CHF
Pulmonary edema
COPD
What are the contraindications for CPAP? (3)
- unconscious, unresponsive
- over 16 y/o
- inability to sit up
- respiratory arrest/ agonal respirations
- nausea/vomiting
- systolic BP under 100
- suspect pneumothorax
- cardiogenic shock
- penetrating chest trauma
- facial abnormalities, trauma, burns
- closed head injury
- active upper GI bleed or recent surgery
What is the goal of CPAP administration?
10 cm h20, coach patient to breath normally
What are the steps in reassessing patient for desired CPAP effects?
- decreased ventilatory distress
- spo2 greater than 92%
- decreased adventitious lung sounds
- absence of reactions I.e. Barotrauma or pnemo
- record settings, readings and document appro.
What are the first 3 initial steps of IN medication administration? (1)
- assure pt. Is being ventilated adequately
- ask patient for known allergies
- clearly explain procedure to patient
What is the equipment needed for IN medication administration? (2)
- medication
- syringe, needle, MAD device
- sharps container
- alcohol swabs
- sterile gauze
When administering medication IN, what are the 6 rights of medication administration? (3)
- right patient
- right medication
- right dosage/concentration
- right time
- right route
- right documentation
What do you also need to check the medication for before administration of IN? (4)
- clarity, expiration date
- assemble syringe/needle while staying steril
- cleanse stopper, draw med., dispel air
- reaffirm medication
- dispose needle in sharps, attach MAD
- verbalized PPE
- stop ventilation of patient
- admin 1/2 medication in each nostril
- properly dispose of syringe and MAD
- resume ventilation of patient if necessary
- verbalized need to monitor patient for desired effect and side effects
What are the six rights of medication administration?
Right medication - correct medication given in standing orders, generic vs. non generic brands, check expiration
Right patient - confirm patient ID and allergies, contraindications for that patient
Right dose - check concentration, calculations, and that the correct dose has been drawn up
Right route - route is accessible and matches what standing orders and medication label list, confirm dose is correct for chosen route
Right time - medication is given over proper time duration per standing orders
Right documentation - document medication, dose, time of administration, duration of administration, route and patient response
When administering medication IN, what else do you need to check for?
- clarity
- expiration date
- maintain sterility during assembly
- reaffirm medication
- dispose of needle properly and attach MAD
- verbalized PPE
- stop ventilation of pt. to administer medication
- admin 1/2 medication up each nostril
- disposes/verbalized proper of MAD & syringe
- resume ventilation of patient
- observe pt. for desired effect and side effects
*generally takes 5 minutes, side effects can be nausea
What are the 6 rights for Aspirin administration?
- pt. over 25 y/o with cardiac chest pain/AMI
- Acetylsalicylic acid in blister pack tablets, check expiration date
- 81 mg tablets x4 (324 mg)
- chewed up
- dose can be repeated every 3-4 hours
- right documentation (324 mg ASA administered po and chewed @ time)
What are the six rights of administration for EPIPEN?
- pt. in anaphylaxis or allergic reaction
- Epi pen or Epi pen jr. autoinjector, check expiration date, should be about 18 months
- if adult is above or equal to 30 kg (66 pounds) give both adult (0.3 mg) and jr. (0.15 mg). For cardiac arrest, pt. will be given 1 mg Epi 1:10 IV or IO.
- anterolateral thigh, hold for 10 seconds
- for adults, may repeat every 10-15 minutes as needed
- right documentation
What are the six rights of administration for nitro?
- used in pt. over 25 y/o or with prescribed nitro, cardiac related chest pain, pulmonary edema with systolic BP over 100, crack/cocaine OD with chest pain.
- medication will be abbreviated as NTG, called Nitrostat. Check expiration date on bottle and proper storage.
- dose is 0.4 mg tablet given sublingually every 5 min for continued chest pain up to a total of 3 tablets.
- route is sublingually
- time is a tablet can be given every 5 min of continued chest pain up to 3 tablets
- right documentation
What are the six rights of medication administration for Mark 1 kits?
- to be used following atropine in organophosphate or nerve gas poisoning for civilians and EMS personnel
- medication is pralidoxime or 2-Pam, check for expiration date
- dose is 600 mg IM for both adult and pedi greater than 20 kg
- route is anterolateral aspect of thigh, hold for 10 seconds
- time is?
- right documentation
What are the steps for the AED station?
- perform initial assessment of pt. LOC
- begin CPR with 100% O2 while preparing defib at a rate of 30/2. 2 minutes if unwitnessed. 100 per minute with a depth of 1/3 chest depth.
- attach AED/ turn on AED
- place defib pads on patient
- stop CPR, allow AED to analyze
- clear and shock
Resume immediately and repeat shock after another 2 minutes of CPR
What are the first steps for acquiring a 12 lead that must be performed in the first two minutes?
- expose chest
- limb lead placement and placement options
- precordial lead placement with no deviation
- when to acquire according to optional standing orders
What do you do for the hospital with suspected MI in 12 lead acquisition?
- notify that you or machine suspect MI
- rapid transport
- transmit EKG
With 12 lead artifact, what could cause it and how do you correct it?
- skin prep/ make sure it is dry as possible
- electrode attachment/ make sure all electrodes are in correct place with firm adhesive
- patient movement/ tell patient to stay still and not talk while taking EKG
- cable movement/ stay still
- vehicle movement/ if possible acquire EKG before transport
- EMI/ ?
What are the indications for insertion of an LMA? (1)
- recommended as the primary pediatric airway except in extreme cases such as airway edema
- limited to patients who need an artificial airway that are apneic and pulse less
What are the correct LMA sizes? (2)
1-neonate, infant up to 11 lb/ 4 ml air 1.5-infants up to 22 lbs/ 7 ml of air 2-infants/children (44 lbs.)/ 10 ml of air 2.5-children (66 lbs.)/ 14 ml of air 3- children (110 lbs)/ 20 ml of air 4-adults (154 lbs)/ 30 ml of air 5-adults (220 lbs)/40 ml of air 6-adults (220 lbs)/50 ml of air
What are the rest of the steps for LMA placement? (3)
- check cuff by inserting air, then withdrawing
- deflate cuff so it forms a smooth “spoon” shape
- lubricate the posterior surface of the mask with a water soluble lubricant
- hold the LMA like a pen, placing index finger at the junction of the cuff and the tube
- non trauma patient: with head extended and neck flexed, carefully flatten LMA tip against the hard palate. Trauma patient: have second person maintain inline stabilization, carefully flatten LMA tip against the hard palate.
- use the index finger to push cranially, maintaining pressure on the tube with the finger
- advance the mask until definite resistance is felt at the base of the hypopharynx
- gently maintain cranial pressure with the non dominant hand while removing the index finger
- without holding the tube, inflate the cuff with just enough air to obtain a seal. Never over-inflate.
- ventilate and check for breath sounds
- confirm sufficient cuff inflation using end tidal co2. Medications can not be given via LMA
