Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Sedation
| Question | Answer |
|---|---|
| Universal opening statement (say first for any emergency) | “I’m going to ensure that the airway is patent, free of foreign body risk, and suctioned well while I place oxygen and continue to sweep all of the other vital signs.” |
| -Wheezing on auscultation -Increased work of breathing -Patient history of asthma, COPD, aspiration, or anaphylaxis -Drop in oxygen saturation compared to baseline -Blood pressure cycling shows stress response -Chest tightness or difficulty exhaling | bronchospasm |
| Moderate Bronchospasm Steps | Administer supplemental oxygen via facemask @ 6 L/min Administer 2–4 puffs of albuterol via inhaler In 2–5 minutes, auscultate lung fields and check oxygen saturation a) O2 down weezing up - severe b) O2 and weezing same repeat albuterol |
| Severe Bronchospasm Initial Steps | Halt surgery Call 911 and verify Administer supplemental oxygen via facemask @ 6 L/min Administer 2–4 puffs of albuterol In 2–5 minutes, auscultate lung fields and check oxygen saturation |
| When and how do you give epinephrine in severe bronchospasm? | If oxygen saturation or wheezing worsens: Administer epinephrine 0.3–0.5 mg IM Pediatric dose: 0.15–0.3 mg IM Recheck oxygen saturation and wheezing after 5 minutes |
| What if severe bronchospasm does not improve? | Re-administer epinephrine 0.3–0.5 mg IM Pediatric dose: 0.15–0.3 mg IM Maintain oxygenation with supplemental oxygen Continue to await emergency services |
| Sudden inability to ventilate No chest rise with attempted ventilation High-pitched stridor or silence Oxygen saturation dropping rapidly Occurs during stimulation, secretions, blood, or foreign material in airway Patient may be biting down or rigid | laryngospasm |
| What are the first steps in suspected laryngospasm? | Suction with a tonsil suction tip to remove all blood, saliva, and foreign material Administer 100% oxygen with constant positive pressure ventilation via the Ambu bag Hold positive pressure until laryngospasm breaks |
| When is laryngospasm considered refractory | Oxygen saturation becomes critical for greater than 60 seconds Positive pressure ventilation is unsuccessful |
| What drugs can be used to break a refractory laryngospasm | (ADMA LIST — ANY ONE): Lidocaine 1.5 mg/kg IV Propofol 20 mg IV Succinylcholine 20 mg IV |
| What do you do after the laryngospasm breaks | Provide appropriate ventilation and oxygenation with 100% oxygen via the Ambu bag As respiratory drive and ventilation normalize, assist each breath with additional positive pressure ventilation Continue when the patient ventilates themselves |
| Vomiting or regurgitation during sedation Gurgling sounds in airway Sudden coughing or choking Drop in oxygen saturation Presence of gastric contents or foreign material in the oropharynx Respiratory distress following emesis | emesis and aspiration |
| How do you position the patient during emesis/aspiration | Place the patient in the Trendelenburg position Head down at least 15 degrees Roll the patient onto their right side |
| What are the immediate airway management steps? | Clear any vomitus in the oropharynx using finger sweeps Use large-bore suction to remove all material |
| What do you do if the patient does not improve during emesis and aspiration? | Place the patient in the supine position Intubate the patient Muscle relaxants may be necessary prior to intubation |
| How do you manage solid particles in the airway | Position the airway and remove the foreign body under direct visualization. Consider repositioning the patient to use their intact airway to expel the foreign object. Consider using the laryngoscope to directly visualize the foreign body. Magil |
| Sudden respiratory distress Inability to ventilate adequately Choking or gagging Absent or diminished breath sounds History of dental materials or instruments in the mouth Abrupt drop in oxygen saturation | airway blockage by a foreign body |
| What is the first step in airway blockage by foreign body | Position the airway and remove the foreign body under direct visualization |
| What should you consider before instrumenting the airway | Consider repositioning the patient to use their intact airway to expel the foreign object |
| What instrument may be used to visualize the foreign body | Consider using the laryngoscope to directly visualize the foreign body |
| What must be done after removal of the foreign body | Listen to both lung fields for residual bronchospasm |
| Chest pain or pressure Patient is conscious and responsive Known history of this Symptoms similar to prior angina episodes Pain may radiate to arm, neck, or jaw Vital signs may be stable | angina pectoris |
| What is the first step when angina pectoris is suspected | Call 911 and discontinue surgery |
| How do you treat a patient with a known history of angina pectoris | Treat with the patient’s usual dose of nitroglycerin |
| What if the patient does not report a history of angina pectoris | Begin the myocardial infarction protocol |
| Chest pain or pressure not relieved by rest Pain may radiate to arm, neck, jaw, or back Shortness of breath Diaphoresis, nausea, or anxiety No known history of angina OR pain does not respond to nitroglycerin Vital signs may become unstable | myocardial infarction |
| What are the first steps when MI is suspected | Call 911 and verify Terminate surgery and all stimulation of the patient Administer oxygen at 6 L/min via non-rebreather face mask |
| What monitoring and access steps are required during MI | 4. Ensure full monitoring, specifically including the ECG 5. Set the blood pressure cuff to cycle every 1 minute 6. Verify the integrity of IV access |
| What aspirin dose is given during MI | Administer 325 mg aspirin Ask the patient to chew and swallow |
| How is nitroglycerin administered during MI | Administer one 0.4 mg (440 mcg) nitroglycerin tablet sublingually every 5 minutes Only if systolic BP is greater than 90 mmHg Continue while chest pain persists |
| What medications are used for pain control in MI | BACK: 9. Administer morphine 1–3 mg IV OR fentanyl 25–50 mcg IV May repeat every 5 minutes Only if systolic BP > 90 mmHg Monitor closely for respiratory depression |
| What must you be prepared for during MI | 10. Verify the AED is placed and on standby 11. Monitor vital signs closely 12. Watch for new onset arrhythmias or cardiac arrest |
| Systolic blood pressure between 175–200 mmHg Diastolic blood pressure between 95–110 mmHg Patient is asymptomatic No signs of end-organ damage No chest pain, neurologic symptoms, or shortness of breath | non-emergent hypertension |
| How do you define non-emergent hypertension per ADMA | Systolic BP 175–200 → use non-emergent hypertension protocol Diastolic BP 95–110 → use non-emergent hypertension protocol Systolic BP >200 → hypertensive emergency protocol Diastolic BP >110 → hypertensive emergency protocol |
| What is the first management step in non-emergent hypertension | Define the blood pressure |
| What causes must be evaluated in non-emergent hypertension? | Check for optimal local anesthetic conditions Ensure the patient does not need to void Check the patient’s positioning Check the patient’s level of sedation |
| What do you do if evaluating non=emergent HTN causes does not reduce BP? | Temporarily pause surgery for 5–10 minutes Re-evaluate blood pressure |
| When should surgery be rescheduled? | If blood pressure does not normalize after pausing If hypertension persists despite correction of reversible causes |
| Why are antihypertensives avoided in non-emergent hypertension? | Antihypertensives are dangerous intra-operatively When surgery ends, the medication can drive blood pressure to dangerously low levels |
| Systolic BP > 200 mmHg Diastolic BP > 110 mmHg May be symptomatic or asymptomatic Blood pressure exceeds non-emergent range Requires pharmacologic intervention | hypertensive crisis / emergency |
| What findings suggest a hypertensive crisis / emergency? | Systolic BP > 200 mmHg Diastolic BP > 110 mmHg May be symptomatic or asymptomatic Blood pressure exceeds non-emergent range Requires pharmacologic intervention |
| How do you define a hypertensive emergency per ADMA | Diastolic BP > 120 OR Systolic BP > 200 |
| How/when do you administer esmolol for immediate control? | In a Hypertensive Crisis-Emergency Administer 80 mg IV (approximately 1 mg/kg) over 30 seconds Follow with infusion at 150 mcg/kg/min Adjust infusion as needed Maximum infusion: 300 mcg/kg/min |
| What is the gradual control dosing for esmolol? | Administer loading dose 500 mcg/kg/min for 1 minute Follow with 50 mcg/kg/min infusion over 4 minutes If inadequate after 5 minutes: Repeat loading dose 500 mcg/kg/min for 1 minute Increase infusion to 100 mcg/kg/min |
| How is labetalol administered in hypertensive emergency | Initial adult dose: 5–20 mg IV over 2 minutes Follow with infusion 2 mg/min Maximum total dose: 300 mg Onset: 5 minutes Duration: 3–6 hours |
| When and how is hydralazine used? | Used in patients who can tolerate increased heart rate and cardiac output Especially useful in patients with history of asthma Initial dose: 5 mg IV May titrate up to 25 mg IV Onset: 5 minutes Duration: 2 hours |
| What is the therapeutic goal in hypertensive emergency? | Directed at producing vasodilation Or altering cardiac output via beta-adrenergic blockers Common agents: esmolol, labetalol, hydralazine |
| Blood pressure significantly below baseline Dizziness, lightheadedness, or altered mental status Pale, clammy skin Tachycardia may be present Decreased perfusion | hypotension |
| What findings suggest hypotension? | Blood pressure significantly below baseline Dizziness, lightheadedness, or altered mental status Pale, clammy skin Tachycardia may be present Decreased perfusion |
| What are the first steps when hypotension is identified? | Stop the procedure Place the patient in the supine position with legs elevated Administer 100% oxygen via mask or Ambu bag |
| What reassessments are required during hypotension? | 4. Re-evaluate blood pressure, heart rate, and rhythm 5. Treat any arrhythmias if present |
| What is the role of fluids in hypotension? | Administer a bolus of isotonic IV fluid |
| Which vasopressor is typically used first in hypotension? | Ephedrine is generally used Phenylephrine may be preferred if tachycardia with hypotension is present |
| How do you prepare and administer ephedrine? | Dilute a 50 mg/mL vial in 9 mL saline → 5 mg/mL solution Administer 2.5–5 mg IV May repeat until blood pressure stabilizes Onset: ~1 minute Peak: 15 minutes Duration: ~1 hour |
| How do you prepare and administer phenylephrine? | Dilute 10 mg/mL vial in 9 mL saline Discard 9 mL Dilute again with 9 mL saline → 0.1 mg/mL solution Administer 0.1 mg IV increments Onset: ~1 minute Duration: ~20 minutes |
| Urticaria (hives), flushing, itching Swelling of lips, tongue, or face Wheezing or bronchospasm Hypotension Tachycardia Gastrointestinal symptoms nausea, vomiting Anxiety or sense of impending doom | allergic reaction or anaphylaxis |
| What findings suggest an allergic reaction or anaphylaxis | Urticaria (hives), flushing, itching Swelling of lips, tongue, or face Wheezing or bronchospasm Hypotension Tachycardia Gastrointestinal symptoms nausea, vomiting Anxiety or sense of impending doom |
| How do you distinguish mild allergic reaction from anaphylaxis? | Mild Allergic Reaction: -Skin findings only (urticaria, itching, flushing) -No respiratory compromise -No hypotension Anaphylaxis: -Airway compromise, bronchospasm, hypotension, or cardiovascular instability -Multisystem involvement |
| What are the first steps in suspected anaphylaxis? | Stop the procedure Call 911 and stop administering antigen Administer facemask oxygen 6 L/min while maintaining airway |
| What is the first-line medication for anaphylaxis? | Epinephrine 0.3–0.5 mg IM (adult) Pediatric dose: 0.15–0.3 mg IM |
| What adjunctive medications are used in anaphylaxis? | Diphenhydramine 25–50 mg IV Albuterol inhaler 4-6 puffs Dexamethasone 4–12 mg IV |
| Seizures Altered level of consciousness Cardiac arrhythmias Hypotension Cardiac arrest | severe local anesthetic toxicity |
| severe local anesthetic toxicity? | Seizures Altered level of consciousness Cardiac arrhythmias Hypotension Cardiac arrest |
| Metallic taste Perioral numbness or tingling Tinnitus or auditory changes Dizziness or lightheadedness Slurred speech Anxiety or agitation | early local anesthetic toxicity |
| What findings suggest early local anesthetic toxicity? | Metallic taste Perioral numbness or tingling Tinnitus or auditory changes Dizziness or lightheadedness Slurred speech Anxiety or agitation |
| What is the first step in suspected local anesthetic toxicity? | Immediately discontinue any further administration of the local anesthetic. |
| How do you position the patient in local anesthetic toxicity? | Place the patient in the supine position. |
| What airway and breathing steps are required? | 4. Administer oxygen. 5. Maintain airway and initiate CPR if indicated. |
| What is required regarding IV access? | 6. Confirm or establish IV access. |
| What medications are used for seizure control in local anesthetic toxicity? | IV midazolam 2.5 mg over one minute, titrated to effect or 7. Administer IV diazepam 5 mg over one minute, titrated to effect |
| Sudden loss of consciousness Tonic-clonic muscle activity Jaw clenching Possible apnea or irregular breathing May occur during sedation or following drug administration | seizure |
| What findings suggest a seizure? | Sudden loss of consciousness Tonic-clonic muscle activity Jaw clenching Possible apnea or irregular breathing May occur during sedation or following drug administration |
| What is the first step when a seizure occurs? | Prevent injury to the uncontrolled unconscious patient. |
| How do you position and protect the patient? | -Loosen clothing about the neck. -Place pillow under the head. -Place padded tongue bade between teeth if evidence that the tongue is being traumatized |
| What airway and breathing steps are required for siezure? | -Continue to monitor vitals -Place 100% oxygen -Check BSL |
| When are medications are used to terminate a seizure? | If it doesn't resolve itself in 3-5 min OR If patient becomes hypoxic |
| What medications are used to terminate a seizure? | Administer IV midazolam 5 mg over one minute |
| What emergency is characterized by transient loss of consciousness due to decreased cerebral perfusion? | Syncope |
| What is the first steps in managing syncope? | 1. Immediately discontinue the stimulation 2. Position them legs up 3. Monitor HR and BP |
| When do you administer atropine in syncope? | If the heart rate is below 50 bpm and the blood pressure remains 20% lower |
| Dosing of Atropine in Syncope? | atropine 0.4 mg Iv x 1. |
| What do you do if atropine has no effect in syncope? | call 911 and consider epinephrine 0.1 mg IV x 1 |
| What condition involves inflammation of a vein, often related to IV placement? | Phlebitis |
| How do you treat phlebitis if there is no infection? | Warm compresses Anti-inflammatory medications, such as ibuprofen Compression stockings may be helpful |
| How do you manage phlebitis when infection is present? | Refer to the MD for antibiotic treatment |
| What findings suggest infection is present with phlebitis? | Redness Fever Pain Swelling Breakdown of the skin |
| What findings suggest an intra-arterial injection? | Severe pain on injection Blanching of the skin Immediate signs of vascular spasm |
| What is the first action if intra-arterial injection is suspected? | Cease injection immediately Stop administering the medication as soon as intra-arterial injection is suspected Carefully and promptly remove the needle |
| How do you manage the injection site immediately after needle removal? | Apply gentle but firm pressure Maintain pressure for at least 5–10 minutes Reduce bleeding and risk of hematoma formation |
| What adjunctive local treatment is applied? | Apply a warm compress Promote vasodilation and improve blood flow |
| What local medication may be administered during in intra-arterial injection if available? | Inject 1% plain lidocaine (without epinephrine) around the site for vasodilation Helps relieve pain and reduce vascular spasm |
| How should the affected limb be positioned during intra arterial injection? | Elevate the affected limb Promote venous return and reduce swelling |
| What complications must be monitored for intra-arterial injection? | Signs of ischemia Compartment syndrome Embolic events Monitor pulse oximetry Monitor distal pulse to ensure adequate circulation |
| When should the patient be transferred to a hospital following intra-arteriole injection? | If signs of tissue ischemia, severe vascular spasm, or other complications develop Transfer to a higher level of care for further management |
| What documentation and follow-up are required? | Record: Suspected drug injected Volume Location of injection site Interventions performed Schedule follow-up appointments Monitor for delayed complications such as tissue necrosis or vascular damage |
| Rapid, deep breathing Patient is conscious and responsive Tingling of fingers or around mouth Lightheadedness Anxiety or panic Normal oxygen saturation | hyperventilation |
| What finding helps distinguish hyperventilation from hypoxia or bronchospasm? | Normal or elevated SpO₂ |
| What is the first step when hyperventilation is suspected? | Maintain adequate oxygen while reducing carbon dioxide elimination |
| How do you manage hyperventilation? | position patient Upright or semi-upright position Reassure the patient Coach slow, controlled breathing Continue to monitor vital signs and oxygen saturation |
| What should you avoid in hyperventilation? | No emergency drugs No epinephrine No benzodiazepines No oxygen if SpO₂ is normal No escalation unless symptoms persist or worsen |
| What condition is characterized by inadequate ventilation during sedation? | Hypoventilation |
| What is the first rule regarding medications during hypoventilation? | Do not administer any sedation medication during hypoventilation. |
| How is oxygen administered during hypoventilation? | Place O₂ nasal cannula at 2 L/min. |
| What must be ensured regarding the airway? | 3. Ensure the patient’s airway positioning is optimized. |
| How do you assess the patient’s depth of sedation? | Assess the patient’s depth of sedation by talking to them and stimulating them. |
| What do you do if the patient is in a deep state of sedation? | 4a. Control the airway with the Ambu bag and mask ventilate until O₂ saturations normalize. |
| What do you do if the patient is in a moderate level of sedation? | 4b. Continue O₂ therapy and stimulation to maintain O₂ saturation. |
| What is the first step in managing cardiac arrest? | Call 911 and verify |
| What is the next immediate action after calling 911? | . Begin high-quality CPR and call for the AED. |
| What is the adult CPR sequence? | 30 chest compressions followed by 2 breaths Breaths delivered with Ambu Bag @ 15 L/min |
| When and how is the AED used? | Place AED as soon as possible, evaluate with the AED, and follow AED instructions. |
| What do you do if the AED verifies a non-shockable rhythm? | Resume high-quality CPR and concurrently call for epinephrine. |
| What is the epinephrine dose in cardiac arrest? | . Administer epinephrine 1 mg IV push followed by 10 cc fluid flush. Pediatric dose: 0.01 mg/kg |
| How long do you circulate epinephrine? | Circulate epinephrine with CPR for 2–3 minutes (about 6 cycles). |
| What do you check after circulating epinephrine? | Check for a pulse, blood pressure, and rhythm. |
| When does the ADMA bradycardia protocol apply? | Heart rate < 50 bpm Patient is symptomatic with hypotension |
| What is the first fluid intervention in symptomatic bradycardia? | 1a. Administer 250–300 cc IV fluid. |
| How is oxygen administered in symptomatic bradycardia? | Administer 100% O2 @ 6L/min |
| How should the patient be positioned during bradycardia? | Adjust the patient to a Trendelenburg position. |
| What cardiac assessment must be performed? | Thoroughly investigate the possibility of an arrhythmia by examining the rhythm strip. |
| When and how is atropine administered? | If still symptomatic, administer atropine 0.3 mg IV. |
| How often may atropine be repeated? | May repeat every 10 minutes, up to 3 total doses. |
| What is the limitation of pre-filled atropine syringes? | The supplied 1 mg pre-filled syringes are not effective for AV blocks. |
| What precautions must be taken when treating bradycardia? | Take precautions in the presence of myocardial infarction and hypoxia Due to increased oxygen demand |
| When does the ADMA tachycardia protocol apply | Narrow complex tachycardia Regular rhythm Heart rate > 150 bpm Patient is symptomatic |
| What medication is administered for symptomatic narrow complex tachycardia? | Administer adenosine. Adults: 6 mg rapid IV push May repeat up to 12 mg IV |
| Dosing for Adenosine for tachycardia | Adults: 6 mg rapid IV push May repeat up to 12 mg IV |
| Why is adenosine effective in narrow complex tachycardia? | Effective in terminating rhythms due to re-entry involving the SA or AV node. |
| What are the side effects of adenosine? | Flushing Chest pain Asystole |
| What condition is managed under the New Onset Cardiac Arrhythmia protocol? | New onset cardiac arrhythmia |
| What is the are the steps in managing a new onset cardiac arrhythmia? | Call 911. Place 100% Oxygen at 10 L/min via facemask. Cycle BP cuff every minute and evaluate the rhythm. Place the AED and evaluate. |
| When is amiodarone used in cardiac arrest? | Persistent V-Fib or pulseless V-Tach After defibrillation and epinephrine |
| What is the adult amiodarone dose in cardiac arrest? | 300 mg IV push May repeat once at 150 mg IV |
| First Steps in VFib and FTach are the same | Call 911 and verify. Start high-quality CPR and call for the AED. Adults: 30 compressions : 2 breaths with Ambu bag @ 15 L/min 100% O₂ Place AED ASAP and analyze rhythm. If shockable: follow AED prompts. CPR and 2 shocks |
| What is the epinephrine dose in ventricular fibrillation and pulses V-Tach? | Administer epinephrine 1 mg IV push followed by 10 mL flush. |
| What is important during epinephrine administration? | Do not interrupt CPR during administration if possible. |
| How long do you circulate epinephrine? | Circulate epinephrine with CPR for 2–3 minutes (about 6 cycles). |
| What is assessed after circulating epinephrine? | Check for a pulse, blood pressure, and rhythm. |
| What procedures do you not want to say the starting script for? | Aspiration and cardiac arrest |
Created by:
user-2015162