Medications and Syringes
Syringe Prep- Labeling
Nine classes of drugs commonly used in the practice of anesthesiology have standard background/text colors established for user-applied syringe labels by ASTM D4774-11, Standard Specifications for User Applied Drug Labels in Anesthesiology and ISO 26825:2008
Syringe Prep- Safety
Never reuse a needle, or needleless access device even on the same patient. Once a needle or access device has been used, it is considered contaminated and must be discarded in an appropriately identified sharps container. Access devices are single-use devices.
Never refill a syringe once it has been used, even for the same patient. Syringes are single-use devices. Once the plunger of a syringe has been completely depressed in order to expel the syringe contents (i.e., intravenous medication), the internal barrel of the syringe is considered contaminated and must be discarded in an appropriate fashion. A syringe must only be used once to draw up medication, and must not be used again even to draw up the same medication from the same vial for the same patient. CRNAs should weigh the risks of possible syringe contamination (e.g., from anesthesia workspace contamination) that may occur when repeatedly connecting and disconnecting a medication-filled syringe from an intravenous infusion set or other administration systems.
Pressor Mixing
Ephedrine
Mixing Instructions:
Take a 10 ml syringe with 9 ml of normal saline
Into this syringe, draw up 1 ml of ephedrine from the vial (vial contains Ephedrine 50 mg/ml)
Now you have 10 mls of Ephedrine 5 mg/ml
Phenylephrine
Pure alpha, so no intrinsic inotropy; it may increase coronary perfusion which can improve cardiac output.
Mixing Instructions:
Take a syringe and draw up 1 ml of phenylephrine from the vial (vial concentration must be 10 mg/ml)
Inject this into a 100 ml bag of NS
Now you have 100 mls of phenylephrine 100 mcg/ml
Draw up some into a syringe; each ml in the syringe is 100 mcg
Epinephrine
Do not give cardiac arrest doses (1 mg) to patients with a pulse
Has alpha and beta-1/2 effects so it is an inopressor
Mixing Instructions:
Take a 10 ml syringe with 9 ml of normal saline
Into this syringe, draw up 1 ml of epinephrine from the cardiac amp (amp contains Epinephrine 100 mcg/ml)
Now you have 10 mls of Epinephrine 10 mcg/ml
Infusion Pumps
Effect on Syringe Size vs Expected Dose with Common Syringe Pumps
Recommended Concentrations
Continuous Infusion Concentration Recommendations
CV Medications
http://pie.med.utoronto.ca/CVmanual/CVManual_content/CardiacDiseasesAndTherapies.html
Advanced Cardiac Life Support (ACLS) Guidlines
Drugs for Treatment of Hypertensive Crisis
Acute Coronary Syndromes
Antiplatelet Therapy Switching- Clinician Guide
Antithrombotic Management of Acute Coronary Syndromes (Unstable Angina and Non-ST Elevation MI)
Fondaparinux Clinician Summary
Prasugrel (Effient) Clinician Summary
ST Segment Elevation Myocardial Infarction (STEMI) - Alogorithm for Management
Tricagrelor (Brilinta) Clinician Summary
Atrial Fibrilation
Emergency Department EFib/Aflutter Management Pathway
Idarucizumab Clinician Summary
Endocarditis
Antibiotic Prophylaxis - Cardiovascular Surgery
Antibiotic Prophylaxis - Prevention of Bacterial Endocarditis
Heart Failure
Digoxin Immune Fab (DigiFab) Management of Digoxin Toxicity
Hypertension
Guideline for Hypertensive Emergency Treatment
Drugs for Treatment of Hypertensive Crisis
Thrombosis
Alteplase for Treatment of Pulmonary Embolism - Clinician Summary
Oral Antiplatelet Comparison Chart
Beta-Adrenergic Receptor Blocking Agents
Calcium Channel Blocking Agents
Anticoagulants
Oral Anticoagulant Comparison Chart
Anticoagulant Antidotes
Idarucizumab Clinician Summary