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FOAMfrat Podcast

Aug 24, 2017

There is just not a whole lot of exposure to infusion mixing and administering in Paramedic school. In this episode I discuss what I think to be the four "must know" infusions in my current setting. High Dose Nitro! It doesn't make sense to break the CPAP seal every time you want to give a spray of nitro. IV nitro is the best way to care for the acute sympathetic pulmonary edema patient. You need quick reduction of afterload.. and you need it now. We do an initial bolus of 400mcg over 2 minutes while an infusion of 100mcg/min is being set up on our IV pump. This has been implemented in our protocols and is not recommended unless you have done the same. A paramedic should definitely have a plan to deliver either epi or norepi in an efficient and safe matter. Our typical concentration for norepinephrine is 4 mg in 250 bag of 0.9% or D5w. This renders a concentration of 16 mcg/ml. If I want to start it off at 5mcg/min, I set my pump to 18.7ml/hr. If I decide I need more inotropic or chronotropic response I can consider epinephrine. We typically mix this as 1000mcg in 500ml (depending on how much fluid you want to give). Ask a new paramedic how he plans to deliver his 150 mg of Amio over 10 minutes! These mental steps just be premeditated and planned before you have a patient in ventricular tachycardia sitting in front of you. We place 250 mg in a 250 bag of D5w. The initial bolus is run in by placing the IV pump at an infusion rate of 900 ml/hr and a volume to be infused of 150ml. This is nice because if you need to start a maintenance Amio drip later you can just set the pump to 60ml/hr (1mg/min). Ketamine intubations are the cats ass right now, which is good! However, it only lasts fifteen to twenty minutes. You need to immediately be thinking of starting a Ketamine drip to prevent your patient from coming down the K continuum to the "disassociated and aware" stage. We throw 500 mg in a 500 bag of 0.9%. This will be ran at whatever the patient weighs in KG's. For example a 120 kg person will receive 1mg/kg/hr or 120 ml/hr. Now go practice!