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Extra resources for RNotes®: Nurse's Clinical Pocket Guide
Observe: If capnography tracking on hand, objective can be an EtCO2 of 30 mm Hg. ■ retain head increased to 30Њ, preserve head in impartial alignment and stay away from flexion or rotation of neck. ■ heavily computer screen VS and neurological prestige (AVPU/GCS). ■ alter IV to TKO; if hypotensive, titrate to SBP >90 mm Hg (avoid D5W). irregular Extension (decerebrate posturing) irregular Flexion (decorticate posturing) 154 2313_Tab05_133-179. qxd 12/24/09 3:31 PM web page one hundred fifty five a hundred and fifty five Overdose (OD) and Poisoning medical (Suggestive) Findings CNS depressants (opioids, sedatives): Constricted students, drowsiness, weak spot, coma, breathing melancholy, pulmonary edema, apnea, bradycardia, hypotension, hypothermia. CNS stimulants: (cocaine, amphetamines): Dilated students, anxiousness, agitation, HA, psychotic, tachypnea, tachycardia, dysrhythmias, HTN, CP, diaphoresis, hyperthermia. Carbon monoxide (CO): Cherry purple lips and/or epidermis, weak spot, fatigue, HA, dizziness, visible disturbances, ataxia, coma, dysrhythmias, respiration misery, n/v. Caustics (acids, alkalis): Chemical burns to the realm of publicity or mouth and GI tract if ingested, ache, n/v, breathing misery. Hydrocarbons (gasoline, oil): breathing misery, smell on breath if ingested, bronchospasm, pulmonary edema, seizure. Organophosphates (OPP): SLUDGEM (salivation, lacrimation, urination, defecation, gastric disillusioned, emesis, muscle twitching). Collaborative administration ■ guard yourself—either from possibly competitive Pts or poisonous exposures. ■ count on and get ready for breathing and cardiovascular compromise. ■ place Pt on left aspect and suction airway as wanted (for diminished LOC). ■ Definitive therapy calls for swift identity of poison/exposure. ■ Administer STAT antidote/reversal as ordered. warning: steer clear of use of ipecac simply because vomiting may perhaps complicate or irritate medical administration of OD or poisoning. Antidotes and Reversals Acetaminophen (APAP, Tylenol) ■ Activated charcoal: 1 gram/kg (Peds: comparable) PO, NG. ■ N-acetylcysteine: one hundred fifty mg/kg in 250 mL D5W IV, IO over 60 mins (Peds <40 kg: similar dose other than use much less D5W). PO course (if wakeful and never vomiting): a hundred and forty mg/kg (Peds: Same). Aspirin (ASA, Bayer, Excedrin) ■ Activated charcoal: 1 gram/kg (Peds: similar) PO, NG. ■ Sodium bicarbonate eight. 4%: 1 mEq/kg (Peds: similar) IV, IO. EMERG TRAUMA 2313_Tab05_133-179. qxd 12/24/09 3:31 PM web page 156 EMERG TRAUMA Beta Blockers (metoprolol, Lopressor, atenolol, Tenormin) ■ Activated charcoal: 1 gram/kg (Peds: related) PO or NG. ■ Glucagon: three mg (Peds: a hundred and fifty mcg/kg) IV, IO by means of three mg/hr (Peds: three mg/hr) infusion. Calcium Channel Blockers (Adalat, Cardizem, Isoptin) ■ Activated charcoal: 1 gram/kg (Peds: related) PO, NG. ■ Calcium chloride 10%: 1–4 grams (Peds: 20–25 mg/kg) sluggish IV, IO. Carbon Monoxide (CO) ■ See basic Hazmat Decontamination (page 177). Caustics (acids and alkalis) ■ See basic Hazmat Decontamination (page 177). Cholinergics (organophosphate, carbamates, nerve gasoline) ■ get rid of from resource and take away Pt’s garments and jewellery. ■ Decontaminate with copious NS or water.