IV/Monitor?

[Veneficus]

Exactly which chest injuries appear as an ECG abnormality? (excluding cardiac tamponade)

Blunt cardiac injuries can appear with EKG changes.

Yes I would be worried about internal bleeding (ruptured liver, perforated bowel etc) but an ECG monitor won't help there.

I'll go with this.

We give IM adrenaline first then if that doesn't work hang up a drip of 1mg adrenaline to one litre of fluid run at 2gtt/s titrated.

Sub Q injection of Epi is highly suspect. It has been used in surgery for ages to slow absorbtion by vasoconstriction.

As we all know in shock, circulation to the dermis is compromised as well.

IM is more than likely a superior administration route compared to Sub Q. All 3 of the academic medical centers i am affiliated with have replaced sub Q with IM.

You guys down on the other side of the world sure do like your drips.

I would like to point out that when people are or report allergy to radiological dye and the test absolutely must be performed, or a medication with a reported allergy must be administered, prophylactic epi can be given. Certainly it is not ideal, nor should it be common, but sometimes the situation calls for extraordinary measures.

 

[MrBrown]

Blunt cardiac injuries can appear with EKG changes.

Thats what I kind of figured

Sub Q injection of Epi is highly suspect. It has been used in surgery for ages to slow absorbtion by vasoconstriction.

Yes, well most of my practice is highly suspect to begin with ....

You guys down on the other side of the world sure do like your drips.

We have adrenaline infusions for anaphylaxis, severe asthma and bradycardia.

Although our previous guideline stated we were able to mix 1mg of adrenaline into ont litre of fluid and give 10cc boluses (0.01mg) the new guideline says that an infusion is preferred.

It is so much easier than dopamine

 

[Veneficus]

It is so much easier than dopamine

No Way

take weight in Kilos, drop last number, multiply by 4 and you have your dose ranges.

example:

86Kg pt. drop the ones column, you have 8 multiply by 4 = 32.

8gtts/min = 5mcg/kilo/min

32gtts/min=20mcg/kilo/min

up or down they trade 1gtts/min for 1 mcg/kilo/min

accurate up to 0.10 mcg damn fine precision.

second quick exmple:

120 kg patient, = 12 x 4 = 48

12-48 gtts/min for 5-20 mcg/kilo/min respectively.

 

[MrBrown]

No Way

take weight in Kilos, drop last number, multiply by 4 and you have your dose ranges.

example:

86Kg pt. drop the ones column, you have 8 multiply by 4 = 32.

8gtts/min = 5mcg/kilo/min

32gtts/min=20mcg/kilo/min

up or down they trade 1gtts/min for 1 mcg/kilo/min

accurate up to 0.10 mcg damn fine precision.

second quick exmple:

120 kg patient, = 12 x 4 = 48

12-48 gtts/min for 5-20 mcg/kilo/min respectively.

1. Take out vial of adrenaline
2. Pull cap off medication port on IV bag
3. Inject adrenaline into bag of fluid
4. Shake well and slap on an "adrenaline" sticker

Heaps easier mate

 

[Veneficus]

1. Take out vial of adrenaline
2. Pull cap off medication port on IV bag
3. Inject adrenaline into bag of fluid
4. Shake well and slap on an "adrenaline" sticker

Heaps easier mate

we have premixed bags of dopamine.

spike bag with 60 gtts set, count the drops.

 

[Shishkabob]

OR... Take weight in pounds,

If it's above 209, drop the last number and subtract 2 from it, and that's your 5mcg

If it's below 209, drop the last number and subtract 3, and that's your 5mcg.



IE, if they weigh 210, it becomes 21, then you subtract 2 so it's 19

19 gtts/min for 5mcg/kg


(Works for my concentration bags)




Wont help you much though Brown... you and your weird metric system

 

[Aidey]

No Way

take weight in Kilos, drop last number, multiply by 4 and you have your dose ranges.

example:

86Kg pt. drop the ones column, you have 8 multiply by 4 = 32.

8gtts/min = 5mcg/kilo/min

32gtts/min=20mcg/kilo/min

up or down they trade 1gtts/min for 1 mcg/kilo/min

accurate up to 0.10 mcg damn fine precision.

second quick exmple:

120 kg patient, = 12 x 4 = 48

12-48 gtts/min for 5-20 mcg/kilo/min respectively.

That. Is. Awesome. I'm assuming it is for the standard 1600mcg/ml concentration?

Any other good ones?

 

[18G]

Myocardial contusion can show as PVC's on the monitor.

Epinephrine in my opinion is a little easier than dopamine.

Just add 1mg of Epi to a 250mL bag = 4mcg/mL.

Then just use the clock method:

1mcg/min = 15gtts
2mcg/min = 30gtts
3mcg/min = 45gtts
4mcg/min = 60gtts

Want a higher concentration per mL? Add 2mg of Epi to a 250mL bag which yields 8mcg/mL.

Simple.

 

[MrBrown]

I hear (and this is only what I hear) that we don't have dopamine because an adrenaline infusion is "better".

"Better" how I don't know but it seems that all of the Australasian services use adrenaline 1mg/1,000ml and North America uses dopamine.

 

[Hellsbells]

...To the OP

The thought process of your preceptor seems to be a little suspect. The numbness and tingling are just from hyperventilation? Perhaps, but until spinal injuy is ruled out, it stays in the differential.

One could argue for or against a cardiac monitor in this case, I'd put it on, there is a long transport time and its a simple method for continous monitoring of the pts heart rate.

I think an IV would be a must for this pt. Even if you don't anticipate the need for fluid replacement or analgesics, the pt may need an antiemetic. THe last thing you want is the pt vomiting while strapped to a backboard.

 

[i5adam8]

I'm going to agree with everyone and say absolutely put him on the monitor and start an IV. Their are very few patients who I don't put on the monitor,and the anxious behavior could quite possibly be early signs of shock.

 

[Veneficus]

That. Is. Awesome. I'm assuming it is for the standard 1600mcg/ml concentration?

Any other good ones?

You covered the epi.

If I am not mistaken it is 800mcg in 500ml. But I would have to look and I am at home

 

[Veneficus]

I hear (and this is only what I hear) that we don't have dopamine because an adrenaline infusion is "better".

"Better" how I don't know but it seems that all of the Australasian services use adrenaline 1mg/1,000ml and North America uses dopamine.

"better" may be relative to the pathology being treated. They both work from different receptors.