Let’s start out 2009 with an emergency response question!
Question: Explain your role in responding to a Malignant Hypertherma crisis.
Answer: Multiple tasks should take place when the anouncement of MH is heard. It is important for everyone to know who is to respond and how to respond. JDJ Consulting performs MH drills annually to all clients. If you have questions or need additional assistance please contact us at: john@jdjconsulting.net.
This completes the first year for the “Question of the Month.” We have received alot of wonderful feedback and look forward to keeping the questions coming. Patient safety is the foundation for the “Question of the Month” and I hope you are learning while enjoying it. If you have suggestions, please send them to us.
Happy New Year!
Question: Name the official “DO NOT USE” abbreviation list?
(hint: there are 5 items)
Answer: 1. U for unit
2. IU for international unit
3. QD, QOD for daily, every other day
4. trailing zero and lack of leading zero
5. MS, MSO4, MgSO4 for morphine and magnesuim sulfate.
Question: Discuss the indications and administration of Adenosine in a code?
Answer: Treatment of paroxysmal supraventricular tachycardia (PSVT) including that associated with accessory bypass tracts (Wolff-Parkinson-White syndrome); when clinically advisable, appropriate vagal maneuvers should be attempted prior to adenosine administration; not effective in atrial flutter, atrial fibrillation, or ventricular tachycardia
Paroxysmal supraventricular tachycardia (Adenocard®): I.V. (rapid - over 1-2 seconds, via peripheral line): 6 mg; if not effective within 1-2 minutes, 12 mg may be given; may repeat 12 mg bolus if needed; maximum single dose: 12 mg.
Follow each I.V. bolus of adenosine with normal saline flush.
High alert medication: The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drugs which have a heightened risk of causing significant patient harm when used in error.
QUESTION: What is the dilution and rate of administration of Magnesium Sulfate in an emergency?
ANSWER: 50% Magnesium Sulfate Injection, USP must be diluted to a concentration of 20% or less prior to I.V. infusion (typically 1-2 gm diluted in 50-100ml NSS). Rate of administration should be slow and cautious, to avoid producing hypermagnesemia. The 50% solution also should be diluted to 20% or less for intramuscular injection in infants and children. The adverse effects of parenterally administered magnesium usually are the result of magnesium intoxication. These include flushing, sweating, hypotension, depressed reflexes, flaccid paralysis, hypothermia, circulatory collapse, cardiac and central nervous system depression proceeding to respiratory paralysis. Magnesium intoxication is manifested by a sharp drop in blood pressure and respiratory paralysis. Disappearance of the patellar reflex is a useful clinical sign to detect the onset of magnesium intoxication. In the event of overdosage artificial ventilation must be provided until a calcium salt can be injected intravenously to antagonize the effects of magnesium.
For Treatment of Overdose
Artificial respiration is often required. Intravenous calcium, 10 to 20 mL of a 5% solution (diluted if desirable with isotonic sodium chloride for injection) is used to counteract effects of hypermagnesemia. Subcutaneous physostigmine, 0.5 to 1 mg may be helpful.
Question? What is USP 797?
Answer: The United States Pharmacopeia (USP) is the official public standards-setting authority for all prescription and over-the-counter medicines, dietary supplements, and other healthcare products manufactured and sold in the United States. USP sets standards for the quality of drug products and works with healthcare providers to help them meet the standards. Chapter 797 will affect anyone or any facility that handles injectables and other products that require sterility. This includes injections, aqueous bronchial and nasal inhalations, baths and soaks for live organs and tissues, irrigations for wounds and body cavities, ophthalmic drops and ointments, and tissue implants. USP 797 went through its final revision approval in December. The new standard becomes official June 1, 2008.
Please contact JDJ Consulting for assistance in meeting these standards.
Question: What drugs can trigger Malignant Hyperthermia?
Answer: All of the volatile inhalation anesthestics and one muscle relaxant, Succinycholine.
Remember, JDJ Consulting offers annual MH drills to all current clients.
Question: What is the dose of IV Amiodarone in life-threatening ventricular fibrillation/pulseless ventricular tachycardia?
Answer: Give 300 mg diluted in a volume of 20 to 30 ml of 5% dextrose in water via IV push. For recurrent ventricular fibrillation/pulseless ventricular tachycardia, a 2nd dose of 150 mg IV may be given. Do not exceed 2g total in any 24h period.
Question: Benzocaine toxicity leads to what condition?
Answer: Methemoglobinemia
Extra Credit: What is the treatment for methemoglobinemia?
Answer: Methylene Blue
Contact JDJ Consulting for dosing guidelines.
Question: How do you administer Vancomycin 1gm IV?
Answer: Reconstitute a 1gm vial and then add to 250ml NSS. Infuse over at least 60 minutes.
Extra credit: What will occur if Vancomycin is run too rapidly?
Answer:
Red man syndrome may occur if the infusion is too rapid. It is not an allergic reaction, but may be characterized by hypotension and/or a maculopapular rash appearing on the face, neck, trunk, and/or upper extremities. If this should occur, slow the infusion rate to over 11/2 to 2 hours and increase the dilution volume. Reactions are often treated with antihistamines and steroids.