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IV Therapy (week 7): Emergencies


from quiz:

angina
etio: vasospasm of cardio aa
tx: nitro, reestablish fluid and electrolyte balance, address stress, homeop, bot

asthma
mbdt exposure to cold, anxiety is trigger, dz of pulm obstrx
sx: expiratory wheeze
tx: IV Mg+ works in many cases

shock
bp decr, hr incr

anaphylaxis
type I immune rxn occuring within 1-10 mins of exposure
early sx: hives, itching, flush
rare rxn to iron dextran, thiamine, herbs
tx: if progressed to airway obstruction administer epi 1/1000, .1 to .5mL depending on body wt
tx: and benadryl

CHF
chronic condition mb agg by iv therapy
fluid overload is sx
tx: dig, diuretics, o2
*calcium CI for pts on dig

air embolism
tx: pt in L lateral decubitus position with head down
very rare with gravity feed IV system, more with pumps not well attended
takes 50-80mL of air to cause sig probs

inserting IV: don't forget to release tourniquette
before removing stylette

arnica montana
wounsd, contusions, bruises
< cold, motion, touch
> lying down

catheter embolism
avoid re-inserting stylet/needle into catheter to avoid

B6 B12 and folate essential for HCYS metabolism
give these IV x6wks if high hcys
methyltetrahydrofolate not available for IV

circ overload
excess fluid in vasc sys
cardiac arrest
absent or inadequate ventribulc contxns resulting in systemic circ failure

vasovagal
onset from fright, pain or trauma
(reflex inhibition of sympathetic activity)

aconitum napellus
sudden violent onset, fear & anxiety, restlessness
may have incr hr

speed shock
variable hr
drip rate of 120 is 6mL/min = very high!

hypoglycemia
often pale and sweaty
syncope possible
may see personality changes, unsteady gait, diplopia
high dose vitamin c therapy may induce hypoglycemia, often given to cancer pts
vit C will cause false + high glucose reading for 8 hours or so after infusion

calcium gluconate
antidote to Mg+ overdose

ports
legal for NDs to access ports installed by MDs
as long as you are adequately trained

EMERGENCY DRUGS
locate and review this handout!! stuff that's in bold italics is life threatening
child and adult doses for epi, iv is 1/10,000, sq or im is 1/1000
*1/1000 contains 1mg/ml of epi (know for final)
CI for benadryl: hypersensitivity
apis for hives, quercetin to prevent mast cell degranuulation
calcium gluconate dosing for resp arrest
keep calcium and minerals at room temp to prevent precipitation, or warm it up to dissolve crystals
vitamins are stored in fridge

SAMPLE EMERGENCY PROTOCOL FORM
Dr Osborne's form
use this as template to devise our own

INCIDENT REPORT FORM
used in hospitals

EMERGENCY EQUIPMENT LISTS
fairly standard

FIRST AID KIT IN IV PREP ROOM
plastic toolbox with good selection of emergency gear

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