five rights med admins
- Right patient
- Right Time
- Right drug
- Right dose
- Right route
3 types of drug calculations
- Prepared strength doses
- Doses from solutions with concentration expressed as a percentage
- IV dose calculations
When are the 3 checks for the right drug?
- When getting the med
- Before admin
- Before putting away
4 drug routes
- Inhaled
- Instilled
- Intravenous
- Injection (intradermal, subq, intramscular)
Unit conversion: how many mls are in 1 teaspoon
- 1mL = 1000uL
- 1g = 1000mg
- 1mg = 1000mcg
- 1 measuring teaspoon = 5 mL
Unit conversion: how many uL in 1 mL?
- 1mL = 1000uL
- 1g = 1000mg
- 1mg = 1000mcg
- 1 measuring teaspoon = 5 mL
What does the percentage in a drug refer to in terms of active drug available?
- I.E 4% lidocaine
Percentage refers to the amount of active ingredient (solute) in a preparation containing 100 parts of the total preparation (solute and solvent)
- Weight to weight: grams per 100 g of mix
- Weight to volume: grams per 100 ml of mix
- Volume to volume: ml per 100 ml of mix
How do you drug amount by percentage strength?
Move the decimal 1 place to the right and it becomes the drug amount in mg/ml…Example below:
- (10% = 100 mg/ml, 1% = 10 mg/ml)
- for the first example above, there is 100mg/ml of active ingrediant
main uses of aerosol therapy (3)
- Humidification of dry inspired gases
- Improved mobilization and clearance of respiratory secretions (using bland aersols, hyper/hypotonic saline)
- Delivery of aerosolized rugs to the respiratory tract
Particle size that deposits in mouth and nose?
10-15 um
Particle size that deposits into large airways, first 6 generations?
5-10 um
Particle size that deposits into the small airways, last 6 generations?
1-5 um
Particle size that deposits into the alveoli?
0.8-0.3 um
What is Mass Median Aerodynamic Diameter (MMAD)
Where the mass of drug is centered in a distribution of particle sizes
- 50% of the mass of particles will be above this size, 50% will be below this size
Why is Mass Median Aerodynamic Diameter (MMAD) important?
Determines which nebulizer to use to deliver medication to target area
When would Ultrasonic nebulizers be used?
In PF labs for sputum induction treatments
When are SPAG units used?
For RSV, used to give Ribavirin…not as common anymore
What are ultrasonic nebulizers?
Electrically powered devices operating on the piezoelectric principle
- high output with small particle sizes
What kind of aerosol device is a small particle aerosol generator (SPAG)?
Device is a large reservoir nebulizer
- large amounts of solution and very small particle sizes
What are Small Volume Nebulizers (SVN)
Either pneumatic (gas powered) that utilize a jet shearing principle for creation of aerosol
Factors that effect SVN efficiency?
- Dead volume:
- min vol required in the reservoir to aerosolize the drug 0.5-1 ml…only 35-65% of drug sol’n is delivered from SVN before sputter
- Filling volume and Treatment Time:
- Ideal is 3-5 ml at 6-8lpm for 10 minutes
How long do SVN need to disperse drug solutions
Approximately 10 minutes
- Ideal = 3-5ml@6-8lpm
Why is dead volume an issue for SVN?
Min volume required in the reservoir to aersolize drug, only 35-60% of drug sol’n is delivered before sputter
Factors that affect MDI performance?
- MDI should be shaken before use to properly mix drug and propellant (med dependent)
- Loss of prime or propellant from the metering valve
- Loss of dose in the first discharge in the meter valve-no longer an issue with HFA
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Mod 2 Difficult Airway Management93
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Airway Devices40
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Mod 2 Difficult airways 229
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Trach Devices26
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Extubation and Decannulation Weaning29
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APRV stuff27
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Adult Pt getting sicker Vent Strategies (Mod 4)78
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Pt getting sicker NEOS (mod 4)54
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Pt getting better strats (Mod 4)44
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Weaning (Mod 4)0
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Patient-Vent Asynchrony (Mod4)38
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IV Insertion46
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Med admin (Mod 6)39
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Specialty Gases (Mod 6)59
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Arterial Puncture (Mod 8...)52
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Procedural Sedation (Mod 7)1
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Patient transport4
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Bronchoscope (mod8)36
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Thoracic drainage4
