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handling_of_procedure_related_complications_and_specimens [2010/07/02 00:38]
hyomul
handling_of_procedure_related_complications_and_specimens [2012/04/03 01:54] (current)
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-===== 1. URTICARIA: ===== 
- 
-==== A. Mild urticaria and prutitis ==== 
- – Observation and H-1 antihistamine (diphenhydramine- 25-50mg PO/IM/IV) 
-==== B. Severe urticaria ==== 
-  - ADD – IV fluids (normal saline, Lactated ringers) 
-  - Epinephrine (1:10,000)- 0.1mg – IV slowly 
-  - Epinephrine (1:1000) – 0.1-0.3mg – subcutaneously 
-  - H-2 antihistamine 
-  * cimetidine injectable-300mg-diluted to 20 ml-IV slowly [Pediatric-5-10mg/​kg-diluted to 20ml- IV slowly] 
-  * ranitidine injectable-50mg-diluted to 20ml-IV slowly 
-===== 2. BRONCHOSPASM (ISOLATED): ===== 
- 
-==== A. Oxygen by mask ==== 
- – 10 L/min 
-==== B. Beta-2-agonist metered dose inhaler ==== 
- – 2-3 deep inhalations (metaproterenol,​ terbutaline or abuterol) 
-Use nebulizer if available- albuterol 0.5% solution- 0.5ml in 3ml normal saline- breathe through nebulizer tube for 8-10 minutes 
-==== C. Epinephrine ==== 
-  
-=== Normal blood pressure- stable bronchospasm ​ === 
- 
-(1:​1000)-0.1-0.2mg- may give 0.3mg – subcutaneously [Pediatric- 0.01mg/kg up to 0.3mg maximum- subcutaneously] 
- 
-=== Progressive bronchospasm or decreased blood pressure === 
-(1:10,000) – 0.1mg – IV slowly [Pediatric- 0.01mg/kg – IV slowly] 
- 
-===== 3. HYPOTENSION (ISOLATED): ===== 
- 
-==== A. Elevate patient legs ==== 
- 
-==== B. Oxygen by mask – 10 L/min ==== 
- 
-==== C. IV fluids (primary therapy) ==== 
- 
-  - normal saline or lactated ringers solution-Rapidly 
-  - If hypotension unresponsive- vasopressor (epinephrine or dopamine) 
-  - get appropriate assistance – Call CODE 
-  - Epinephrine – (1:10,000)- 0.1mg- IV slowly 
-  - IV solution – 1mg in 250ml D5W- start at 4mcgm/min (1ml/min) 
- 
-===== 4. VAGAL REACTION (HYPOTENSION AND BRADYCARDIA):​ ===== 
- 
-==== A. Elevate patient legs ==== 
-==== B. Oxygen by mask (10 L/min) ==== 
- 
-==== C. IV fluids ==== 
-- normal saline or lactated ringers solution- Rapidly 
-==== D. Atropine ==== 
-0.6-1.0mg IV- repeat q 3-5 min (as needed)- 3mg total [Pediatric- 0.02mg/kg IV-starting dose- 0.1-0.6mg dose- 2mg total] 
- 
-===== 5. ANAPHYLACATOID REACTION (GENERALIZED SYSTEMIC REACTION): ===== 
- 
-==== A. Suction ==== 
- – as needed 
-==== B. Elevate patient legs ==== 
- – if hypotensive 
-==== C. Oxygen by mask ==== 
- (10 L/min) 
-==== D. IV fluids ==== 
- – normal saline or lactated ringers solution- Rapidly 
-==== E. Epinephrine ==== 
- – (1:10,000)- 0.1mg- IV slowly – incrementally over 2-5 minutes [Pediatric- 0.01mg/kg – IV slowly – 0.1mg total (Limit amount of Epinephrine in patients taking non-cardioselective beta-adrenergic blocking drugs] 
- 
-=== Alternate drug therapy for severe reaction in patients taking beta-adrenergic blocking medications === 
- 
- 
-  * Isoproterenol- (1:5000)- 0.2mg/ml- IV slowly- 0.5-1.0ml diluted to 10ml with normal saline- 1ml (20 microgram) increments 
-  * Glucagon- 1-5 mg IV bolus- followed by IV infusion of 5-15 microgram/​min (may cause hypotension) 
-==== F. Antihistamines ==== 
-  - H-1 blocker : diphenydramine 25-50mg- IV slowly- (may exacerbate or cause hypotension-may thicken bronchial secretions) 
-  - H-2 blocker 
-  * cimetidine injectable 300mg- diluted to 20 ml- IV slowly [Pediatric- 5-10mg/kg- diluted- IV slowly] 
-  * ranitidine injectable 50mg- diluted to 20 ml- IV slowly 
- 
-==== G. Beta-2-agonist metered dose inhaler ==== 
-- 2-3 deep inhalations (metaproterenol,​ terbutaline or abuterol)- Use nebulizer if availablealbuterol 
-0.5% solution- 0.5ml in 3ml normal saline- breathe through nebulizer tube for 8-10 minutes 
- 
-==== H. Corticosteroids ==== 
-- Hydrocortisone 200mg IV slowly 
-- Methylprednisolone 80mg IV slowly 
- 
-===== 6. ANGINA: ===== 
- 
-==== A. Oxygen by mask ==== 
- – 10 L/min 
-==== B. IV fluids ==== 
- – very slowly 
-==== C. Nitroglycerin ==== 
- – 0.4mg-sublingually- may repeat q 15 minutes 
-==== D. Morphine ==== 
- – 2 mg IV slowly 
- 
-===== 7. HYPERTENSION:​ ===== 
- 
-==== A. Oxygen by mask ==== 
- – 10 L/min 
-==== B. IV fluids ==== 
- – very slowly- primarily to maintain IV access 
-==== C. Nitroglycerin ==== 
- – 0.4mg-sublingually or 2% ointment topically-1-2 inch strip 
-==== D. If secondary to autonomic dysreflexia ==== 
- 
-~nifedipine 10mg capsule- punctured or chewed and swallowed 
-(nifedipine sublingually- is no longer recommended as the first line 
-drug for treatment of all hypertensive crises- due to very poor 
-sublingual absorption and reported serious adverse effects) 
- 
-==== E. If secondary to pheochromocytoma ==== 
-- phentolamine- 5mg- IV slowly 
- 
-===== 8. SEIZURES: ===== 
-==== A. Protect patient ==== 
- 
-==== B. Airway ==== 
-- suction as needed- monitor airway for tongue obstruction 
-==== C. Oxygen by mask ==== 
- – 10 L/min 
-==== D. If caused by hypotension +/- bradycardia ==== 
-- treat per protocols 
-==== E. Uncontrolled ==== 
-- consider diazepam- 5mg IV slowly 
- 
- 
-===== 9. HYPOGLYCEMIA:​ ===== 
- 
-==== A. Oxygen by mask ==== 
- – 10 L/min 
-==== B. IV fluids ==== 
- – D5W 
-==== C. IV glucose ==== 
- – Dextrose 50% solution- IV push 
-==== D. Oral glucose ==== 
- – glass of orange juice plus sugar or glass of milk 
-  
handling_of_procedure_related_complications_and_specimens.1278056324.txt.gz · Last modified: 2012/04/03 01:53 (external edit)