Chapter 25 – Emergency Drugs, IV Fluids, Blood Products

4 types of life-threatening emergencies that require prompt drug intervention
-cardiac or respiratory arrest
-shock from trauma or infection
-anaphylaxis
-drug overdose

Effects life-threatening emergencies will have on the body unless corrected within minutes
-oxygen levels in the blood decrease
-carbon dioxide and lactic acid levels in the blood increase
-the blood pH becomes acidic
-cellular metabolism in the vital organs stop working
-patient dies

Cardiopulmonary resuscitation (CPR)
Basic life support that mechanically circulates the blood and inflates the lungs with air

Routes of administration for emergency drugs
-Intravenous (IV) line, IV push, bolus
-Endotracheal route
-Intracardiac route

Intravenous route
Provides maximum drug effect in shortest period of time

Endotracheal route
Drugs placed in the endotracheal tube; as lungs are mechanically ventilated, drug solution is propelled into the lungs and abosrbed by lung tissue and enters the blood

Intracardiac route
Not used frequeuntly, but can be used when other routes failed to produce therapeutic effect

What does NAVEL stand for
N – naloxone (Narcan)
A – atropine
V – vasopressin
E – epinephrine (Adrenalin)
L – lidocaine (Xylocaine)

Emergency drugs are used to
-correct a life-threatening cardiac arrythmia in which the heart is > beating extremely fast, slow or has stopped (asystole)
-also used to increase extremely low blood pressure

Drug for ventricular fibrillation
lidocain (Xylocaine)
Drug of choice which inhibits flow of sodium into myocardial cells, slows electrical impulses that cause the heart to fibrillate, and has no therapeutic effect when the heart has stopped (asystole)

Drug for bradycardia
atropine
Blocks the action of acetylcholine released from the vegas nerve (when acetylcholine is released, the heart rate slows)

Drug for asystole
epinephrine (Adrenalin)
-acts as a neurotransmitter released in response to pain, danger, or stress
-makes the myocardium more responsive to the use of defibrillator that can restore normal rhythm
-helps stimulate the contractions of the myocardium
-stimulates the heart to beat
-helps to maintain blood pressure and blood flow to the heart and brain

Vasopressor drugs
(definition)
-stimulate beta1 receptors to increase heart rate
-stimulate alpha receptors in the blood vessels to produce vasoconstriction and raise blood pressure
-maintain blood flow to the kidneys

Vasopressor drugs
(names)
-dopamine
-epinephrine (Adrenaline)
-isoproterenal (Isuprel)
-norepinephrine (Levophed)
-phenylephrine (Neo-Synephrine)

Drugs for metabolic acidosis
sodium bicarbonate
-controversial and last resort
tromethamine (Tham)
-corrects acidosis, returns blood pH within a normal range

Metabolic acidosis
(definition)
During cardiac/respiratory arrest:
-the pH of the blood decreases rapidly
-carbon dioxide and waste products accumulate in the blood
-effectiveness of any emergency drug is diminished

Anti-anxiety antagonist drug
Benzodiazepine type such as flumenazil (Romazicon)

Anti-depressant antagonist drug
Tricyclic type such as physostigmine (Antilirium)

Anaphylaxis
(definition)
Massive amounts of histamine are released causing life-threatening conditions

Anaphylaxis
(2 conditions is causes)
-Severe vasodilation > drop in blood pressure and shock
-bronchoconstricion > limits air flow in and out of lungs

What IV fluids do in an emergency
-administer drugs
-correct decreased volume of body fluids
-correct decreased level of electrolytes or glucose
-administer blood or plasma products
-maintain venous access between drug doses

Crystalloid
Refers to any IV fluid that provides dextrose and sodium chloride alone or in combination with other electrolytes

Total parenteral nutrition (TPN)
>AKA hyperalimentation solution<
-contains specific amounts of proteins, electrolytes, vitamins, minerals
-supplies calories for those unable to meet long-term nutritional needs

Intravenous lipids
-used to meet a patients dietary fat requirement
-contains fat, water, glycerin, egg yolk
-given to patients unable to take oral feedings

Intravenous vitamins
-formulated combination of 12 vitamins for IV administration

Blood for transfusion is available in 3 kinds
-units of whole blood
-packed red blood cells
-platelets

Units of whole blood for transfusion contain
-citrated: anti-coagulant that preserves the blood and prolongs its refrigerated shelf life
-provides complete correction of blood loss
-blood cells and plasma in correct proportions
-contains all cellular components (rbc, wbc, platelets)
-contains plasma and its constituents (albumin, globulins, clotting factors, electrolytes)

Before whole blood can be given as a transfusion:
-patient and unit of blood must be typed for blood type and cross-matched to eachother
-assure compatibility
-avoid transfusion reaction (hemolysis of rbc due to incompatibility)

Packed red blood cells (PRBC) contain
-concentrated prepartaion of rbc’s in a small amount of plasma which have an advantage over whole blood
-DO NOT contain plasma proteins and clotting factors
-must be type and cross-matched before administered

Platelets contain
-extracted from whole blood
-suspended in a small amount of plasma
-given to patients with thrombocytopenia, leukemia, suppressed bone marrow
-cross-matched for best results
****unmatched MAY be given in an emergency****
-does not provoke transfusion reaction
-body’s antibodies quickly destroy them
-less effective than matched platelets

Plasma and plasma volume expanders contain
*Plasma
-advantage over blood
-does not need to be type or cross-matched
-given to hemophiliacs or severe burn victims
*Fresh frozen plasma
-consist of plasma that contain all the plasma proteins, clotting factors
-frozen to prolong shelf life
-thawed to room temperature before given through IV
*Plasma protein fraction
-derived from plasma
-contains no clotting factors
*Albumin
-derived from plasma
-contains no clotting factors

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