Answer: Bradycardia & hypotension are the hallmark signs of neurogenic shock. This type of shock falls under the distributive umbrella.
Remember that the reversal agent for benzodiazepines (Xanax, Ativan, Valium)=Romazicon (flumazenil) 👇🏽👇🏽👇🏽 Narcan-CAN reverse NARCOTICS (morphine, heroin etc.). 👇🏽👇🏽👇🏽
Always have the reversal agents on hand for every drug that you are using, especially when performing a moderate sedation or any other type of procedure.
In addition, have an Ambu bag, & an
NP/OPA handy. Airway adjuncts are appropriate in the event the patient suffers from unanticipated respiratory issues, which are the most known side effect of the majority of these drugs. 👇🏽👇🏽👇🏽
Use your nasal cannula w/ETCO2 monitoring so you can ensure your patients oxygenation & ventilation status.
Maintain 35-45 and watch the waveform. 👇🏽👇🏽👇🏽
Senior RN tip: I usually bring the crash cart in the room and then I feel more prepared for any potential complications.
Ceftriaxone (Rocephin) is an intravenous/intramuscular third generation cephalosporin that provides decent aerobic gram positive coverage (ie, pneumococcus although bacterial resistance is growing) but wonderful gram negative coverage against organisms like E. coli, Klebsiella, H. flu, and Proteus. Anaerobic bacteria and Pseudomonas are NOT covered by ceftriaxone. 🤓💉
As an intensivist, I use this antibiotic in a myriad of clinical situations ranging from spontaneous bacterial peritonitis (SBP) prophylaxis and community acquired pneumonia to genitourinary infections and meningitis (even late Lyme disease involving the central nervous system as ceftriaxone as penetrates the cerebrospinal fluid very well). 😷🧠
Similar to cefepime, ceftriaxone can also cause encephalopathy and altered mentation. Additionally, one must be aware of possible hepatobiliary impairment due to biliary sludging and cholecystitis. 👨🏽⚕️🏥
My favorite aspect of using ceftriaxone is that it can usually be dosed once-a-day (a key exception being meningeal dosing which is twice daily). 😊
Levetiracetam (Keppra) is an oral and intravenous antiepileptic drug (AED) indicated as adjunctive therapy for partial onset seizures, myoclonic seizures, and generalized tonic-clonic (“grand mal”) seizures in adults. The medication is used in the pediatric population as well for various reasons beyond my scope of practice. Most AEDs either enhance the release or limit the uptake of GABA – the primary inhibitory neurotransmitter in the central nervous system. Levetiracetam’s activity is thought to center around SV2A, a ubiquitous synaptic vesicle protein involved in regulating the exocytosis of neurotransmitters from vesicles. 💉🤓
Post-traumatic seizures (PTSs) are fairly common in patients who sustain traumatic brain injuries (TBIs), and the early initiation of AEDs like phenytoin help decrease early PTS in severe TBI; however NO AED prophylaxis I’m aware of helps prevent late TBIs. Lower levels of data suggest that newer AEDs like levetiracetam may be a safer alternative to phenytoin for early PTS prophylaxis. 👍🏥
As an anesthesiologist, I can’t remember when I last administered levetiracetam intraoperatively (general anesthesia tends to be a pretty good antiepileptic itself), but as an intensivist, I’ve written for this many times at the recommendation of my colleagues in neurology. Interestingly, the oral formulation of levetiracetam is ~100% bioavailable, and its renally-excreted metabolites have no activity. 😷
Regardless of why it’s given, levetiracetam can increase the risk of suicidal ideations (even within a week), so providers must remain vigilant about any unusual changes in mood or behavior in patients initiated on therapy. 👨🏽⚕️
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#drugoftheday Diltiazem (Cardizem)-drug class: calcium channel blocker (CCB) Diltiazem (Cardizem) is a Class IV antiarrhythmic and one of the most common pharmacological agents used for treatment of AFib w/RVR (rapid ventricular response). Class IV antiarrhythmics are Calcium Channel Blockers (CCBs), which inhibit intracellular calcium influx via calcium channel antagonism.🖤💙 Although dosages may vary based on physician orders, protocols and age, a standard initial dose is 0.25 mg/kg, ranging between 10-20 mg over 2 minutes, with a second dose of 0.35 mg/kg, ranging between 20-25 mg over 2 minutes, often followed by a 5-10 mg/hr infusion. 💉 Typically, patients are given a bolus, followed by a gtt (drip). Treatment of hemodynamically unstable patients in narrow QRS complex AFib w/RVR requires synchronized cardioversion at 120-200 J initially, and should not be delayed for administration of an anti-arrhythmic agent.
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