This document discusses drugs commonly used in critical care settings such as the ICU, CCU, operating theater and emergency department. It provides lists of life-saving drugs used in emergencies including adrenaline, atropine and calcium gluconate. It also lists common drugs used for conditions like opioid poisoning, cardiac arrest, myocardial infarction, angina, and congestive cardiac failure. Specific drugs like xylocard, propofol and amiodarone are also discussed in detail including their mechanisms of action, uses, dosages, side effects and nursing considerations.
Any environment in which a patient may unexpectedly experience a medical emergency needs to have the equipment to deal with that emergency efficiently. That’s the job of a crash cart emergency drugs. A crash cart contains the equipment and medications that would be required to treat a patient in the first thirty minutes or so of a medical emergency. Although crash carts drugs and equipment can differ somewhat depending upon their location. Drug dilutions may also vary according to hospital policy. It's important to know these life-saving drugs to all Nurses to handle the medical emergency scenarios.
Any environment in which a patient may unexpectedly experience a medical emergency needs to have the equipment to deal with that emergency efficiently. That’s the job of a crash cart emergency drugs. A crash cart contains the equipment and medications that would be required to treat a patient in the first thirty minutes or so of a medical emergency. Although crash carts drugs and equipment can differ somewhat depending upon their location. Drug dilutions may also vary according to hospital policy. It's important to know these life-saving drugs to all Nurses to handle the medical emergency scenarios.
The CVP catheter is an important tool used to assess right ventricular function and systemic fluid status. Normal CVP is 2-6 mm Hg. CVP is elevated by : overhydration which increases venous return.
Advanced Cardiovascular Life Support (ACLS) is the pre-eminent resuscitation course for the recognition and intervention of cardiopulmonary arrest or other cardiovascular emergencies.
A "bundle" is a
group of evidence-based care components
for a given disease that, when executed together, may result in better outcomes than if implemented individually.
I just wanted to share some of my Clinical Instructors lecture materials. I don't own this document, I wish to help you guys with the summary of Commonly asked emergency drugs.
A cardiac event monitor is a device that you control to record the electrical activity of your heart (ECG). This device is about the size of a pager. It records your heart rate and rhythm. Cardiac event monitors are used when you need long-term monitoring of symptoms that occur less than daily
The CVP catheter is an important tool used to assess right ventricular function and systemic fluid status. Normal CVP is 2-6 mm Hg. CVP is elevated by : overhydration which increases venous return.
Advanced Cardiovascular Life Support (ACLS) is the pre-eminent resuscitation course for the recognition and intervention of cardiopulmonary arrest or other cardiovascular emergencies.
A "bundle" is a
group of evidence-based care components
for a given disease that, when executed together, may result in better outcomes than if implemented individually.
I just wanted to share some of my Clinical Instructors lecture materials. I don't own this document, I wish to help you guys with the summary of Commonly asked emergency drugs.
A cardiac event monitor is a device that you control to record the electrical activity of your heart (ECG). This device is about the size of a pager. It records your heart rate and rhythm. Cardiac event monitors are used when you need long-term monitoring of symptoms that occur less than daily
RSI is a method of intubating patients who have a gag reflex who would otherwise be difficult to intubate. Intubation is accomplished by sedating and paralyzing the patient, allowing for easier intubation.
This presentation is brief literature over view to guide the management to taper off Glucocorticosteroids in patient in whom suppression of HPA axis's can be suspected.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
2. COMMON DRUGS USED IN
EMERGENCY
Life Saving Drugs:
• Adrenaline
• Atropine
• Xylocard
• Calcium Gluconate
• Sodabicarbonate
Other Emergency Drugs are:
•Midazolam
Common drugs used for OP
poisoning.
•Atropine
•PAM
•Diazepam.
2Prof. Dr. RS Mehta, BPKIHS
3. Common drugs used for cardiac arrest:
• Epinephrine
• Vasopressors
• Antiarrythmic- amiodarone, lidocaine.
• Other drugs- atropine, calcium, sodium
bicarbonate, thrombolytic Agents (STK, tPA)
3Prof. Dr. RS Mehta, BPKIHS
4. COMMONLY USED DRUGS IN ICU AND CCU
The main groups of drugs used in ICU are as follows:
OPOIDS:
• Morphine
• Fentanyl
• Pethidine
• Naloxone
BENZODIAZEPINES:
• Diazepam
• Midazolam
• Lorazepam
• Flumazenil
SEDATIVES:
Propofol.
The main groups of drugs used in
CCU are as follows:
Lignocaine
Propanolol
Amiodarone
Digoxin
Verapamil
Adenosine
Aspirin
Atrovastin
GTN
Streptokinase
Isosorbide di-nitrate
Sodium bicarbonate
Nicorandil
4Prof. Dr. RS Mehta, BPKIHS
5. Common drugs used in MI:
• Pain relief : Morphine
• Vasodilators: Nitroglycerine
• Anticoagulant: heparin
• Antiplatelet: aspirin
• Stool softner: cremaffin
• Vasopressor: dopamine, dobutamine
5Prof. Dr. RS Mehta, BPKIHS
6. Drugs used in Angina
• Glyceryl trinitrate(GTN)
• Isosrbide dinitrate
• Propanolol
• Verapamil
• Amlodipine.
6Prof. Dr. RS Mehta, BPKIHS
7. Drugs used in CCF:
• Diuretics
• ACE inhibitors: captopril, enalapril
• ARBS: losartan. Candesartan
• Digoxin
• Beta blockers
• vasodilators
7Prof. Dr. RS Mehta, BPKIHS
8. NARCOTIC DRUG LAW:
• The law was authenticated and published for the first time in
2033 B.S. under Narcotic Drug Control Act.
• In this act the narcotic drug means
(1) Cannabis/ marijuana
(2) Medicinal cannabis/ marijuana
(3) Opium
(4) Processed opium
(5) Medicinal opium
(6) Plants and leaves of coca, and
(6A) Any substances to be prepared by mixing opium
and extract coca, including mixture or salt.
(7) Any natural or synthetic narcotic drug or psychotropic
substances and their salts,
8Prof. Dr. RS Mehta, BPKIHS
9. • Chemical substance to be used for preparation of narcotic drugs
may be exported, imported, stored, sold, distributed and used
only in the quantity as prescribed by the Chief Narcotic Drugs
Control Officer.
• For such procedures one must have license.
• Consumption of narcotic drugs by persons falling under the
following categories in the following circumstances shall not
be deemed to have been prohibited:-
(a) Purchase and consumption of narcotic drug by any person in
the recommended dose from any licensed shop on the
recommendation of any recognized medical practitioner for the
purpose of medical treatment.
(b) Consumption of narcotic drugs by persons belonging to
the prescribed categories in prescribed doses.
9Prof. Dr. RS Mehta, BPKIHS
10. Responsibility of the Medical Practitioner:
While prescribing narcotic drugs,
• the medical practitioner shall not prescribe it to those who do
not need it.
OR
• prescribe more than what the requirement is even to those to
whom it is required.
10Prof. Dr. RS Mehta, BPKIHS
14. Mechanism of action:
It decreases the automaticity, and excitability in the
ventricles during the diastolic phase by a direct action
on the tissues, especially the Purkinje network.
Produces local anesthesia by reducing sodium
permeability of sensory nerves, which blocks impulse
generation and conduction
Uses:
ventricular arrythmias resulting from MI, digitalis
toxicity, cardiac surgery or cardiac cathterization, general
anesthesia in susceptible patients.
14Prof. Dr. RS Mehta, BPKIHS
15. Doses:
Arrythmia
– Dosing should be individualized.
– Treatment for ventricular arrhythmias begins with an
intravenous injection followed by an intravenous infusion
Pre-infusion:
– initially, 50-100 mg iv bolus given at rate of 25-50 mg/min. if
desired response doesn’t occur , give repeat dose at 25-50
mg/min; max dose is 300 mg given over hour
15Prof. Dr. RS Mehta, BPKIHS
16. Infusion:
– A drip rate of 2-4mg/min is recommended
– Infusion duration is normally 2 or more days (at least 24 hours
after the last signs of ventricular arrhythmia is evident).
Anesthetic Uses
Adult: Infiltration 0.5–1% solution, Nerve Block 1–2%
solution, Epidural 1–2% solution, Caudal 1–1.5% solution,
Spinal 5% with glucose, Saddle Block 1.5% with dextrose
Topical 2.5–5% jelly, ointment, cream, or solution
16Prof. Dr. RS Mehta, BPKIHS
17. Side effects:
• CNS: light headedness, euphoria, confusion,
dizziness, drowsiness, tinnitus, blurred vision,
vomiting, tremors, twitching.
• Cardiovascular: bradycardia, hypotension,
cardiovascular collapse which may lead to cardiac
arrest.
• Integumentary: cutaneous lesions, urticaria, edema.
Contraindication: hypersensitivity, severe degree of
sino-atrial, atrio-ventricular or intra-ventricular block,
Adams-stokes syndrome.
Precaution: pregnancy, breastfeeding, pediatric,
geriatric.
17Prof. Dr. RS Mehta, BPKIHS
18. Nursing consideration:
When it is administered as an antiarrhythmic the nurse should
monitor the ECG continuously.
Blood pressure and respiratory status should be monitored
frequently during the drug administration.
When administered as an anesthetic, the numbness of the
affected part should be assessed.
Serum Lidocaine levels should be monitored frequently during
prolonged use. Therapeutic serum lidocaine levels range from
1.5 to 5 mcg/ml.
If signs of overdose occur, stop the infusion immediately and
monitor the patient closely
18Prof. Dr. RS Mehta, BPKIHS
19. For throat sprays, make sure that the patient’s
gag reflex is intact before allowing the patient
to eat or drink.
When IM injections are used, the medication
should be administered in the deltoid muscle.
For direct IV injection only 1% and 2%
solutions are used.
Donot breast feed while taking this drug
without physicians consultation
19Prof. Dr. RS Mehta, BPKIHS
21. • Functional class: general anesthetic
• Generic name: propofol
• Trade name: diprivan, propoven, fresenius
MECHANISM OF ACTION:
It produces dose dependent CNS depression by
activation of GABA receptors.
21Prof. Dr. RS Mehta, BPKIHS
22. USES:
induction or maintenance of anesthesia, sedation in mechanically
ventilated patients, status epilepticus, migraine
DOSES:
Induction of Anesthesia
• Adult: IV 2–2.5 mg/kg q10sec until induction onset
• Geriatric: IV 1–1.5 mg/kg q10sec until induction onset.
22Prof. Dr. RS Mehta, BPKIHS
23. Maintenance of Anesthesia
• Adult: IV 100–200 mcg/kg/min
• Geriatric: IV 50–100 mcg/kg/min
Sedation
• Adult: IV 5 mcg/kg/min for at least 5 min, may
increase by 5–10 mcg/kg/min q5–10 min until desired
level of sedation is achieved (may need maintenance
rate of 5–50 mcg/kg/min
23Prof. Dr. RS Mehta, BPKIHS
24. AVAILABLE FORMS:
Inj 10 mg/ml in 20 ml ampoule, 50 ml and 100 ml vials.
SIDE EFFECTS:
CNS= involuntary movement, headache, somnolence,
paresthesia, increased ICP, impaired cerebral flow, seizures.
CV= bradycardia, bradydysrhythmia, asystole, ST segment
depression.
EENT= blurred vision, tinnitus, eye pain, diplopia
24Prof. Dr. RS Mehta, BPKIHS
25. GI= nausea, vomiting, abdominal cramp, pancreatitis, hyper
salivation.
GU= urine retention, green urine, cloudy urine, oliguria.
INTEG= flushing, phlebitis, hives burning/ stinging at inj site,
rash.
RESP= apnea, cough, hypoventilation, wheezing, hypoxia,
respiratory acidosis.
SYS= propofol infusion syndrome
CONTRAINDICATION:
hypersensitivity to the product or soyabean oil, egg, benzyl
alcohol.
25Prof. Dr. RS Mehta, BPKIHS
26. PRECAUTION:
pregnancy (B), brest feeding, children, geriatric, respiratory
depression, cardiac dysrhythmias
NURSING CONSIDERATION:
Patient must be Intubated and ventilated
Monitor: HR, ECG, oxygen saturation, BP
Abrupt discontinuation of infusion may result in rapid
awakening with agitation, anxiety.
26Prof. Dr. RS Mehta, BPKIHS
27. .
Discard tubing/bottle after 12 hours (contains
lipids)
Do not use if emulsion appears separated.
If hypotension or bradycardia occurs, decrease
or stop and monitor BP & HR, notify to doctor.
Document neuro assessment on awakening.
27Prof. Dr. RS Mehta, BPKIHS
29. AMIODARONE
Functional class: antidysrrhythmic
Chemical class: iodinated benzofuran derivative.
Generic name: Amiodarone hydrochloride
Trade name: pacerone, cordarone, nexterone.
MECHANISM OF ACTION:
It works on cardiac cell membranes . It relaxes the
smooth muscles, the myocardial blood flow is also
ensured to be at its height of function.
29Prof. Dr. RS Mehta, BPKIHS
30. USES:
hemodynamically unstable ventricular tachycardia,
supraventricular tachycardia, ventricular fibrillation.
UNLABELED USES:
cardiac arrest, cardiac surgery, CPR, heart failure, artial flutter.
DOSES:
Adult:
• Oral Loading dose is between 800 to 1,600 mg for 1-3 weeks.
Maintenance dosage may range between 600 to 800 mg per
day. It is advised to use the possible lowest dose in reaching
cardiac stability.
30Prof. Dr. RS Mehta, BPKIHS
31. • I.V. Infusion: A 150 mg loading dose must be given
with 10 minutes slowly. For maintenance dose, a 540
mg amiodarone must be run with 18 hours. The rate
on the first day of therapy can be increased depending
on the situation.
Child:
• PO Loading Dose 10–15 mg/kg/d in 1–2 divided
doses for 4–14 d cycle or until adequate control of
arrhythmia
• PO Maintenance Dose 5 mg/kg/d once daily, may be
able to reduce to 2–5 mg/kg/d 5 d per week
31Prof. Dr. RS Mehta, BPKIHS
33. RESP: pulmonary fibrosis/toxicity, pulmonary inflammation,
ARDS; gasping syndrome if used in neontes.
MS: weakness, pain in extrimities.
CONTRAINDICATION
hypersensitivity, pregnancy(D), breastfeeding, neonates, infants,
severe sinus node dysfunction, cardiogenic shock, bradycardia,
2nd and 3rd degree AV block.
PRECAUTION
children, goiter, hashimoto’s thyroiditis, respiratory disease.
33Prof. Dr. RS Mehta, BPKIHS
34. NURSING CONSIDERATION:
Before the therapy, assess the patient’s vital signs and put more
focus on the cardiac activity.
For patients with cardiac device implants, check its condition
and if it works properly before during and after administration.
Monitor also the pulmonary, liver and thyroid function tests as
it may infer with the expected results.
Watch out for adverse drug interactions such as: peripheral
neuropathy, abnormal gait, ataxia, dizziness, headache, fatigue.
34Prof. Dr. RS Mehta, BPKIHS
35. Check pulse daily once stabilized, or as prescribed.
Report a pulse <60.
Take oral drug consistently with respect to meals.
Become familiar with potential adverse reactions and
report those that are bothersome to the physician.
Use dark glasses to ease photophobia; some patients
may not be able to go outdoors in the daytime.
35Prof. Dr. RS Mehta, BPKIHS
36. Wear protective clothing and a barrier-type sunscreen
that physically blocks penetration of skin by
ultraviolet light (e.g., titanium oxide or zinc
formulations) to prevent a photosensitivity reaction
(erythema, pruritus); avoid exposure to sun and
sunlamps.
Do not breast feed while taking this drug without
consulting physician.
36Prof. Dr. RS Mehta, BPKIHS
38. STREPTOKINASE
Classification:
therapeutic= thrombolytics.
pharmacologic= plasminogen activator.
Generic name: Streptokinase
Trade name: straptase
MECHANISM OF ACTION:
Combines with plasminogen to form activator complexes, then
converts plasminogen to plasmin, which is then able to degrade clot-
bound fibrin.
Therapeutic Effects:
Lysis of thrombi in coronary arteries, with preservation of
ventricular function. Lysis of pulmonary emboli and subsequent
restoration of blood flow. Restoration of cannula patency and
function.
38Prof. Dr. RS Mehta, BPKIHS
39. USES:
acute myocardial infarction (MI), pulmonary embolism (PE).
deep vein thrombosis(DVT), acute peripheral arterial thrombosis,
occluded arterio-venous cannula.
DOSES:
Myocardial Infarction:
• IV (Adults): 1.5 million IU given as a continuous infusion over up
to 60 minutes.
• Intracoronary (Adults): 20,000 IU bolus followed by 2000 IU/min
infusion for 60 min.
DVT, Pulmonary Emboli, Arterial Emboli, or Other Thrombosis:
• IV (Adults): 250,000 IU loading dose, followed by 100,000 IU/hr
for 24 hr for pulmonary emboli, 72 hr for recurrent pulmonary
emboli or deep vein thrombosis.
39Prof. Dr. RS Mehta, BPKIHS
40. Occluded Arterio-venous Cannula:
• IV (Adults): 250,000 IU/2 mL instilled into occluded catheter.
SIDE EFFECTS:
CNS: intracranial hemorrhage.
EENT: epistaxis, gingival bleeding.
RESP: bronchospasm, hemoptysis.
CV: reperfusion arrhythmias, hypotension, recurrent
ischemia/ thromboembolism.
GI: GI bleeding, hepatotoxicity, nausea,
retroperitonial bleeding, vomiting.
40Prof. Dr. RS Mehta, BPKIHS
41. GU: GU tract bleeding.
INTEG: ecchymoses, flushing, urticaria.
HEMAT: bleeding,
LOCAL: hemorrhage at injection site, phlebitis at
injection site.
MS: musculoskeletal pain.
MISC: allergic reactions including anaphylaxis, fever.
CONTRAINDICATION:
active internal bleeding; history of cerebrovascular accident;
recent (within 2 mo) intracranial or intra-spinal injury or trauma;
Intracranial neoplasm, severe uncontrolled hypertension, known
bleeding tendencies; hypersensitivity.
41Prof. Dr. RS Mehta, BPKIHS
42. PRECAUTION:
recent (within 10 days) major surgery, trauma, GI or GU
bleeding; severe hepatic or renal disease; recent
streptococcal infection or previous therapy with
anistreplase or streptokinase (within 5 days– 6 mo);
geriatric patients (75 yr; increased risk of intracranial
bleeding); pregnancy, lactation, or children (safety not
established).
Extreme Caution: patients receiving warfarin therapy;
early postpartum period.
42Prof. Dr. RS Mehta, BPKIHS
43. NURSING CONSIDERATION:
• Monitor vital signs, continuously for myocardial infarction.
• Do not use lower extremities to monitor BP. Notify health care
professional if systolic BP 180 mm Hg or diastolic BP 110 mm
Hg. Thrombolytic therapy should not be given if hypertension
is uncontrolled. Inform health care professional
if hypotension occurs.
• Assess patient carefully for bleeding every 15 min during the
1st hr of therapy, every 15– 30 min during the next 8 hr, and at
least every 4 hr for the duration of therapy. Frank bleeding
may occur from sites of invasive procedures or from body
orifices.
43Prof. Dr. RS Mehta, BPKIHS
44. • If uncontrolled bleeding occurs, stop medication and
notify health care professional immediately. Inquire
about previous reaction to streptokinase therapy.
• Assess patient for hypersensitivity reaction (rash,
dyspnea, fever, changes in facial color, swelling
around the eyes, wheezing). If these occur, inform
health care professional promptly. Keep
epinephrine, an antihistamine, and resuscitation
equipment close by in the event of an anaphylactic
reaction.
• Inquire about recent streptococcal infection.
Streptokinase may be less effective if administered
between 5 days and 12 mo of a streptococcal infection.
44Prof. Dr. RS Mehta, BPKIHS
45. • Assess neurologic status throughout therapy. Altered
sensorium or neurologic changes may be indicative of
intracranial bleeding.
• Myocardial Infarction: Monitor ECG continuously. Notify
doctor if significant arrhythmias occur. Monitor cardiac
enzymes.Myocardial scanning and/or coronary angiography
may be ordered 7– 10 days after therapy to monitor
effectiveness of therapy.
• Assess intensity, character, location, and radiation of chest
pain. Note presence of associated symptoms (nausea,
vomiting, diaphoresis). Administer analgesics as directed.
Notify doctors if chest pain is unrelieved or recurs.
• Monitor heart sounds and breath sounds frequently. Inform
doctor if signs of HF occur (rales/crackles, dyspnea, S3 heart
sound, jugular venous distention).
45Prof. Dr. RS Mehta, BPKIHS
46. • Deep Vein Thrombosis: Observe extremities and
palpate pulses of affected extremities every hour.
• Teach patient and family:
Explain purpose of medication and the need for close monitoring
to patient and family.
Instruct patient to report hypersensitivity reactions (rash,
dyspnea) and bleeding or bruising.
Explain need for bed rest and minimal handling during therapy to
avoid injury. Avoid all unnecessary procedures such as shaving
and vigorous tooth brushing
46Prof. Dr. RS Mehta, BPKIHS
48. SUCCINYLCHOLINE
Functional class: depolarizing skeletal muscle relaxant.
Generic name: Succinylcholine
Trade name: Anectine, Sucostrin, Quelicin
MECHANISM OF ACTION:
Prevents neuromuscular transmission by blocking the
effect of acetylcholine at the myoneural junction.
Therapeutic Effects: Skeletal muscle paralysis.
48Prof. Dr. RS Mehta, BPKIHS
49. USES:
to produce skeletal muscle relaxation as adjunct to anesthesia or
during orthopedic manipulation; to facilitate intubation and
endoscopy, to increase pulmonary compliance in assisted or
controlled respiration.
DOSES:
Surgical and Anesthetic Procedures.
Adult: IV 0.3–1.1 mg/kg administered over 10–30 sec, may
give additional doses .IM 2.5–4 mg/kg up to 150 mg
Child: IV 1–2 mg/kg administered over 10–30 sec, may give
additional doses. IM 2.5–4 mg/kg up to 150 mg
Prolonged Muscle Relaxation.
Adult: IV 0.5–10 mg/min by continuous infusion.
49Prof. Dr. RS Mehta, BPKIHS
50. SIDE EFFECTS:
MS: muscle fasciculations, profound and prolonged
muscle relaxation, muscle pain, rhabdomyolysis.
CV: bradycardia, tachycardia, hypotension,
hypertension, arrhythmias, sinus arrest.
RESP: respiratory depression, bronchospasm, hypoxia,
apnea.
META: myoglobinemia, hyperkalemia.
GI: decreased tone and motility of GI tract (large doses).
SYST: angioedema, anaphylaxis.
50Prof. Dr. RS Mehta, BPKIHS
52. NURSING CONSIDERATION:
Obtain baseline serum electrolytes. Electrolyte imbalance
(particularly potassium, calcium, magnesium) can potentiate
effects of neuromuscular blocking agents.
Be aware that transient apnea usually occurs at time of
maximal drug effect (1–2 min); spontaneous respiration should
return in a few seconds or, at most, 3 or 4 min.
Have immediately available: Facilities for emergency
endotracheal intubation, artificial respiration, and assisted or
controlled respiration with oxygen.
Monitor vital signs and keep airway clear of secretions.
.
52Prof. Dr. RS Mehta, BPKIHS
53. Patient & Family Education
• Patient may experience post-procedural muscle
stiffness and pain (caused by initial
fasciculations following injection) for as long
as 24–30 hr.
• To be aware that hoarseness and sore throat are
common even when pharyngeal airway has not
been used.
• To report if muscle weakness to physician.
53Prof. Dr. RS Mehta, BPKIHS