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33 Cards in this Set
- Front
- Back
How do patient's tolerate fecal aspiration? |
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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1. airway obstruction
2. atelectasis -bronchial lavage can be helpful |
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What is mendelson's syndrome? What are CXR findings?
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aspiration of gastric acid with development of:
1. pulm edema, 2. pulm htn, 3. cyanosis 4. decreased pulmonary compliance, 5. hypoxemia secondary to right to left intrapulmonary shunt -CXR is mottled |
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What are the results of gastric acid aspiration? What is the most consistent manifestation?
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destruction of surfactant producing cells and damage to pulmonary capillary endothelium resulting in:
1. atelectasis, 2. pneumonitis 3. ARDS -arterial hypoxemia is the most consistent manifestation |
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What is the typical pH and volume of gastric aspiration?
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at least 25 mL (or > 0.4 cc/kg) and pH <2.5
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What are symptoms of aspiration? When does radiograph evidence begin to show?
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1. bronchospasm,
2. wheezing, 3. tachypnea, 4. coughing, 5. dyspnea, 6. cor pulmonale secondary to pulm htn, 7. arterial hypoxemia is often not relieved by oxygen therapy, 8. pink frothy pulmonary exudate is characteristic of aspiration, 9. PCWP is often decreased secondary to loss of fluid through the pulmonary capillaries, -radiograph may not show evidence until after 6-12hrs - evidence most often seen in RLL |
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What are the physiologic effects of reglan?
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1. increases LES pressure,
2. decreases pyloric pressure, 3. speeds gastric emptying 4. 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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1. patients who have eaten
2. trauma 3. obese 4. pregnant 5. outpatients |
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When should you not use reglan?
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patients with or are on:
1. phenothiazines, 2. butyrophenones, 3. TCAs, 4. MAOIs, 5. patients with SBO, 6. patients with pheochromocytoma (can release catecholamines from the tumor) |
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What are the side effects of cimetidine by system?
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1. Heart - bradycardia, heart block, cardiac arrest
2. Lungs - increased airway resistance (blocks H2 receptors leaving H1 receptors unopposed), 3. CNS - confusion, agitation, hallucinations, seizures, 4. Liver - retard metabolism and excretion of several drugs (drugs that are highly metabolized on first pass through liver: digitalis, propranolol, meperidine, pentazocine, aminophylline, verapamil, lidocaine) |
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What is the onset, duration, and dose of cimetidine?
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onset - 45min,
duration - 4 hrs dose - 300 mg IV Q4-6hrs |
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What is the onset and duration of reglan?
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PO 30-60 min,
IV 1-3 min Duration 1-2 hrs |
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How does ranitidine compare to cimetidine? What are doses of each?
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5x more potent, longer acting (8 hrs compared to 4 hrs)
ranitidine 150 mg PO, cimetidine 300 mg IV |
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What are some complications of ranitidine?
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Has fewer side effects than cimetidine.
Mainly CV - 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 20-40 mg BID,
IV 20 mg Q12H |
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What is the half life of zofran?
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3 hrs
-shorter in children and longer in the elderly |
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What are side effects of zofran?
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1. headache,
2. constipation, 3. diarrhea, 4. mild elevations in LFTs, 5. rarely associated with EPS (drug is still considered safe in parkinsons), 6. 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:
1. myalgias, 2. angioedema, 3. anaphylaxis, 4. dermatologic manifistations; 5. 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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1. QT prolongation,
2. prolonged PR and JT intervals, 3. widened QRS |
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What are some common misconceptions for treating aspiration?
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1. pulmonary irrigation - with NS can aggravate the damage caused by aspiration,
2. effectiveness of steroids - has not been demonstrated, 3. antibiotics - should not be given prophylactically - only administer based on positive cultures |
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How do you treat meconium aspiration in a newborn with APGAR of 0-3?
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1. establish an airway - apply suction removing as much meconium as possible, ventilation with 100% O2,
2. start chest compressions in those pulseless or severely bradycardic (30:2 compression (100/min)/ventilation (1 sec/breath) ratio), 3. Check the EKG and defibrillate if necessary (2 Joules/kg), 4. umbilical artery catheterization - umbilical vein is easier but run the risk of liver damage 5. drugs management |
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What are the ASA NPO guidelines? What type of liquid falls in each category?
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1. Clear liquids (carbonated or non, non alcoholic liquids such as fruit juices without pulp, clear tea, coffee, or water) - 2 hrs
2. Breast milk - 4 hrs 3. Infant formula/non-human milk - 6 hrs 4. Full liquids (liquids other than clear, non human milk, infant formula, juices with pulp) - 6 hrs 5. Light meals (non fatty, non fried ie toast) - 6 hrs 6. Heavy meals (fried foods, fatty foods, meat) - 8 hrs |
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What is the treatmenf of aspiration?
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1. Head down
2. Suction 3. Intubation 4. Mechanical ventilation |
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Reglan dose and onset
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5-10 mg PO/IV
Onset 30-60 min for PO 1-3 min for IV/IM |
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What does Reglan not reliably do?
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It does not alter gastric pH
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Cimetidine MOA
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a competitive inhibitor of H2 receptors which block histamine induced secretion of H+ ions by gastric parietal cells
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What is the chief advantage of Sodium Citrate?
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Effectively raises gastric pH and is non-particulate, especially desirable in the setting of aspiration
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Zofran MOA
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a 5-HT3 receptor (serotonin) antagonist - both central and peripheral receptors are blocked and they appear to play an important role in the vomiting reflex
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Omeprazole MOA
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Proton pump inhibitor which binds to the H+ ion pump in gastric parietal cells and inhibits secretion of H+ ions
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Drug management in pediatric CPR
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Narcan 10 mcg/kg,
Atropine 20 mcg/kg, Epi (1:10,000 ie 100 mcg/cc) 0.1 cc/kg, Na Bicarb 1-2 mEq/kg in 10 cc D5W Consider Ca and glucose |
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Pts at increased risk for aspiration
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1. Delayed gastric emptying - diabetics, pain, bowel obstruction, prior opioids
2. Increased gastric volume - obesity, pregnancy, trauma 3. Disorders of GE sphincter - hiatal hernia, achalasia, esophageal tumors 4. Pts in PACU - airway reflexes are decreased secondary to opioids, NM block, and inh agents |