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25 Cards in this Set
- Front
- Back
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How do patient's tolerate fecal aspiration?
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mortality is high from fecal aspiration secondary to pna and septic shock and often in spite of treatment, includes steroids and antibiotics
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What are the chief features of particulate aspiration?
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airway obstruction and atelectasis, bronchial lavage can be helpful
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What is mendelson's syndrome?
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aspiration of gastric acid with development of pulm edema, pulm htn, cyanosis, and decreased pulmonary compliance, CXR is mottled and patient is prone to develop hypoxemia secondary to right to left intrapulmonary shunt
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What are the results of gastric acid aspiration?
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destruction of surfactant producing cells and damage to pulmonary capillary endothelium resulting in atelectasis, pneumonitis, and ARDS
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What is the typical pH and volume of gastric aspiration?
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at least 25mL and pH <2.5
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What are symptoms of aspiration?
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bronchospasm, wheezing, tachypnea, coughing, dyspnea, cor pulmonale secondary to pulm htn, arterial hypoxemia is often no relieved by oxygen therapy, pink frothy pulmonary exudate is characteristic of aspiration, PCWP is often decreased secondary to loss of fluid through the pulmonary capillaries, radiograph may not show evidence until after 6-12hrs
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What are the physiologic effects of reglan?
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increases LES pressure, decreases pyloric pressure, speeds gastric emptying(can also antagonize dopamine leading to EPS)
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In what patients have the gastric emptying effects of reglan proven to be beneficial?
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patients who have eaten, trauma, obese, pregnant, outpatients
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When shouldy you not use reglan?
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patients on phenothiazines, butyrophenones, TCAs, MAOIs, patients with SBO, patients with pheochromocytoma(can release catecholamines from the tumor)
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What are the side effects of cimetidine?
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bradycardia, heart block, airway resistance(blocks H2 receptors leaving H1 receptors unopposed), confusion agitation, hallucinations, seizures, retard metabolisma of several drugs at the liver(drugs that are highly metabolized on first pass through liver: digitalis, propranolol, meperidine, pentazocine, aminoophylline, verapamil, lidocaine)
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What is the onset and duration of cimetidine?
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onset-45min, duration 4 hrs
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What is the onset of reglan?
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PO 30-60min, IV 1-3min
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How does ranitidine compare to cimetidine?
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5x more potent, longer acting(8hrs) ranitidine 150mg PO, cimetidine 300mg IV
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What are some complications of ranitidine?
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cardiovascular complications(hypotension, arrhythmias, bradycardias, cardiac arrest)
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What is the benefit of using famotidine compared to other H2 blockers?
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not associated with cardiovascular complications
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What is the typical dose of famotidine(pepcid)?
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PO 20-40mg BID, IV 20mg Q12H
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What is the half life of zofran?
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3hrs
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What are side effects of zofran?
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headache, constipation, diarrhea, mild elevations in LFTs, rarely associated with EPS(drug is still considered safe in parkinsons), can also cause QT prolongation in very high doses
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What is the most effective way to give zofran?
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more effective alone than in combination with other drugs(in patients on cisplatin effect is enhanced with decadron)
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What are complications of PPI?
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all very rare: myalgias, angioedema, anaphylaxis, dermatologic manifistations; can interfere with hepatic enzymes, dose should be decreased in liver failure
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What are side effects of dolasetron?
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QT prolongation, prolonged PR and JT intervals, widened QRS
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What are some common misconceptions for treating aspiration?
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pulmonary irrigation with NS can aggravate the damage caused by aspiration, effectiveness of steroids should has not been demonstrated, antibiotics should not be given prophylactically
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How do you treat meconium aspiration in a newborn with APGAR of 0-3?
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establish an airway, apply suction removing as much meconium as possible, ventilation with 100% O2, start chest compressions in those pulseless or severe bradycardia(30:2 compression/ventilation ratio), defibrillate if necessary(2J/kg), umbilical artery catheterization, drugs(narcan 0.01mg/kg, atropine 20mcg/kg, epi, Na Bicarb 2mEq/kg)
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What are the NPO guidelines for breast feeding and infant formula?
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breast feeding-4hrs, formula-6hrs
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What is the treatmenf of aspiration?
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intubation with mechanical ventilation
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