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Resuscitation Medication Routes

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1. Review of Routes to Administer Medication During Prolonged Neonatal Resuscitation. (PubMed)

Review of Routes to Administer Medication During Prolonged Neonatal Resuscitation. During neonatal cardiopulmonary resuscitation, early establishment of vascular access is crucial. We aimed to review current evidence regarding different routes for the administration of medications during neonatal resuscitation.We reviewed PubMed, EMBASE, and Google Scholar using MeSH terms "catheterization," "umbilical cord," "delivery room," "catecholamine," "resuscitation," "simulation," "newborn," "infant (...) . Umbilical venous catheter: European resuscitation guidelines propose the placement of a centrally positioned umbilical venous catheter during neonatal cardiopulmonary resuscitation; intraosseous access: case series reported successful and quick intraosseous access placement in newborn infants. Peripheral intravascular access: median time for peripheral intravascular access insertion was 4-5 minutes in previous studies.Based on animal studies, endotracheal tube administration of medications requires

2018 Pediatric Critical Care Medicine

2. Resuscitation Medication Routes

Resuscitation Medication Routes Resuscitation Medication Routes Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Resuscitation (...) Medication Routes Resuscitation Medication Routes Aka: Resuscitation Medication Routes , Emergency Medication Delivery II. Type: Intravenous Administration (Preferred) Follow drugs with 5 ml flush III. Type: Intraosseous Administration Equivalent to IV dosing Preferable to ET dosing IV. Type: Endotracheal route administered medications Medications (Mnemonic: LEAN) Dosages Larger than conventional IV doses Standard IV dose should be minimum ET dose Administration Deliver beyond into tracheobronchial tree

2018 FP Notebook

3. Medications or Fluids for the Resuscitation of the Newborn Infant

medication or fluids. 1. Routes of Administration 1.1. Umbilical vein An umbilical vein catheter (UVC) is the most rapidly accessible intravascular route for adrenaline (epinephrine) and it can also be used for fluid administration. It can also be used for continued vascular access until an alternative route is established after admission to a neonatal unit. Blood gases obtained from the UVC during resuscitation are sometimes useful in guiding treatment decisions. UVC, 3-way stopcock & syringe prepared (...) , particularly in a premature infant. However, depending on operator training and experience, this route can be used as an alternative, especially if umbilical or direct venous access is not available [Class B, LOE IV 6,7 ]. 1.5 Umbilical artery The umbilical artery is not recommended for administration of resuscitation drugs. There are serious concerns that complications may result if hypertonic or vasoactive drugs (e.g. adrenaline (epinephrine)) are given into an artery. 2. Types and Doses of Medications

2016 Australian Resuscitation Council

4. Standards for Neonatal Resuscitation

Significance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Identification of Newborns at Risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Neonatal Resuscitation Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Documentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Availability and Maintenance of Equipment, Supplies and Medications . . . . 14 5. Administration (...) . . . . . . . . . . . . . . . . . . . . . . . . . 26 Appendix 6: ACoRN Respiratory Score . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Appendix 7: British Columbia Newborn Resuscitation Record . . . . . . . . . . . 282 Perinatal Services BC Approximately 90% of newborns make a smooth transition from intrauterine to extrauterine life. The remaining will require assistance to establish effective ventilation. Chest compressions and medications are rarely required (less than 1%). 1 To facilitate neonatal transition, anticipation

2017 British Columbia Perinatal Health Program

5. Cardiopulmonary Resuscitation in Infants and Children With Cardiac Disease

arrest. 13 Cardiac arrest requiring resuscitation occurs in ˜7 per 1000 hospitalizations of children with cardiovascular disease, a rate >10-fold higher than that observed in children hospitalized without cardiovascular disease. 13 The frequency of cardiac arrest is also reported to be higher in dedicated cardiac intensive care units (ICUs) (4% to 6% of admissions) than in medical-surgical pe- diatric ICUs (2% to 4% of admissions). 3,4,14–16 Since 2005, there have been substantial efforts to improve (...) Cardiopulmonary Resuscitation in Infants and Children With Cardiac Disease Circulation. 2018;137:e691–e782. DOI: 10.1161/CIR.0000000000000524 May 29, 2018 e691 ABSTRACT: Cardiac arrest occurs at a higher rate in children with heart disease than in healthy children. Pediatric basic life support and advanced life support guidelines focus on delivering high- quality resuscitation in children with normal hearts. The complexity and variability in pediatric heart disease pose unique challenges during

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2018 American Heart Association

6. Resuscitation - neonatal

hypothermia Temperature between 35.5 °C and 35.9 °C Moderate hypothermia Temperature between 32.0 °C and 35.4°C Queensland Clinical Guideline: Neonatal resuscitation Refer to online version, destroy printed copies after use Page 5 of 38 Table of Contents 1 Introduction 7 1.1 Clinical standards 7 1.2 Clinicians 8 2 Risk factors for neonatal resuscitation 9 3 Preparation: staff, equipment, medications and environment 10 3.1 Communication and information sharing 11 4 Assessment and management of baby 12 4.1 (...) Initial assessment and management 12 4.2 Subsequent assessment and management 13 4.3 Oxygen saturation monitoring 14 4.3.1 Care of baby during resuscitation 15 5 Airway management 16 5.1 General principles 16 5.2 Airway and delivery devices 17 5.2.1 Delivery devices 18 5.3 Supplemental Oxygen 19 5.4 Oxygen/air mix 19 5.5 Positive pressure ventilation 20 5.6 Intubation 21 5.6.1 ETT size and length 21 5.6.2 Endotracheal intubation 22 6 Chest compressions 23 7 Medication and fluids 24 7.1 Adrenaline

2018 Queensland Health

7. Guideline supplement: Neonatal resuscitation

as effectiveness of ETT adrenaline (epinephrine) has not been established.” Replaces MN16.5-V3-R21 July 2018 MN16.5-V5-R21 · Alignment with ANZCOR. Appendix A: Equipment and medications for neonatal resuscitation updated: From: Intraosseous needles 50 mm length 18/G To: Intraosseous needles · Oxygen saturation target ranges updated to align with QNSAG recommendations (Section 4.3 Oxygen saturation monitoring) From: After 10 minutes of age the target differs for example: For term babies the target is 94%– 99 (...) from: http://www.health.qld.gov.au/qcg/ The guideline supplement can be cited as: Queensland Clinical Guidelines. [Supplement: Neonatal resuscitation Guideline No. MN16.5-V5-R21. Queensland Health. 2016. Available from: http://www.health.qld.gov.au/qcg/ Queensland Clinical Guideline Supplement: Neonatal resuscitation Refer to online version, destroy printed copies after use Page 8 of 18 3 Levels of evidence The levels of evidence identified [in the National Health and Medical Research Council

2016 Queensland Health

8. CRACKCast E011 – Neonatal Resuscitation

. provodine drapes PPE equipment scalpel, hemostats suture 2) List 5 questions to ask the mother during an imminent delivery What is the estimated gestational age? Is this a multiple gestation? Is meconium present? Is there a history of vaginal bleeding? Were medications given during delivery or drugs taken intrapartum? 3) Describe the components of the initial assessment of the newborn (APGAR) In the acute resuscitation phase we really only care about the HR and respiratory effort APGAR = Appearance (...) if it’s thought to be a cardiac cause then the 15:2 ratio can be used. use the encircling hands technique compress ⅓ the AP depth reassess every 30-60 seconds Step 4: resuscitative medications medications are indicated: bradycardia/asystole hemorrhage Suitable medications: Oxygen use for persistent bradycardia use for respiratory distress lasting 90 seconds (after all the other measures have been attempted (controversial) Epinephrine indications: i) asystole ii) HR < 60 despite effective ventilations

2016 CandiEM

9. Neonatal resuscitation

hypothermia Temperature between 35.5 °C and 35.9 °C Moderate hypothermia Temperature between 32.0 °C and 35.4°C Queensland Clinical Guideline: Neonatal resuscitation Refer to online version, destroy printed copies after use Page 5 of 38 Table of Contents 1 Introduction 7 1.1 Clinical standards 7 1.2 Clinicians 8 2 Risk factors for neonatal resuscitation 9 3 Preparation: staff, equipment, medications and environment 10 3.1 Communication and information sharing 11 4 Assessment and management of baby 12 4.1 (...) Initial assessment and management 12 4.2 Subsequent assessment and management 13 4.3 Oxygen saturation monitoring 14 4.3.1 Care of baby during resuscitation 15 5 Airway management 16 5.1 General principles 16 5.2 Airway and delivery devices 17 5.2.1 Delivery devices 18 5.3 Supplemental Oxygen 19 5.4 Oxygen/air mix 19 5.5 Positive pressure ventilation 20 5.6 Intubation 21 5.6.1 ETT size and length 21 5.6.2 Endotracheal intubation 22 6 Chest compressions 23 7 Medication and fluids 24 7.1 Adrenaline

2016 Clinical Practice Guidelines Portal

10. Neonatal resuscitation

hypothermia Temperature between 35.5 °C and 35.9 °C Moderate hypothermia Temperature between 32.0 °C and 35.4°C Queensland Clinical Guideline: Neonatal resuscitation Refer to online version, destroy printed copies after use Page 5 of 38 Table of Contents 1 Introduction 7 1.1 Clinical standards 7 1.2 Clinicians 8 2 Risk factors for neonatal resuscitation 9 3 Preparation: staff, equipment, medications and environment 10 3.1 Communication and information sharing 11 4 Assessment and management of baby 12 4.1 (...) Initial assessment and management 12 4.2 Subsequent assessment and management 13 4.3 Oxygen saturation monitoring 14 4.3.1 Care of baby during resuscitation 15 5 Airway management 16 5.1 General principles 16 5.2 Airway and delivery devices 17 5.2.1 Delivery devices 18 5.3 Supplemental Oxygen 19 5.4 Oxygen/air mix 19 5.5 Positive pressure ventilation 20 5.6 Intubation 21 5.6.1 ETT size and length 21 5.6.2 Endotracheal intubation 22 6 Chest compressions 23 7 Medication and fluids 24 7.1 Adrenaline

2016 Clinical Practice Guidelines Portal

11. Increasing Cardiopulmonary Resuscitation Provision in Communities With Low Bystander Cardiopulmonary Resuscitation Rates

(or the equivalent universal access number) promptly. Third, the call is routed to a dispatcher, who must identify that a cardiac arrest event has occurred and dispatch an appropriate EMS response. The dispatcher may provide “just-in-time” CPR instruction that guides the rescuer in performing CPR. Finally, the rescuer starts and continues CPR on the OHCA victim until help arrives. Figure 1. Four critical steps to the performance of cardiopulmonary resuscitation (CPR) by a bystander. OHCA indicates out (...) English as a second language Medium Living below poverty line Medium With no access to car Medium CPR indicates cardiopulmonary resuscitation; EMS, emergency medical services; and OHCA, out-of-hospital cardiac arrest. * Number of unworked and worked OHCA events per population at risk. † Number of worked OHCA events with an arrest before EMS arrival and that did not occur at a medical facility. ‡ Number of OHCA survivors discharged from hospital per total number of worked OHCA events. § Defined

2013 American Heart Association

12. Resuscitation Medication Routes

Resuscitation Medication Routes Resuscitation Medication Routes Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Resuscitation (...) Medication Routes Resuscitation Medication Routes Aka: Resuscitation Medication Routes , Emergency Medication Delivery II. Type: Intravenous Administration (Preferred) Follow drugs with 5 ml flush III. Type: Intraosseous Administration Equivalent to IV dosing Preferable to ET dosing IV. Type: Endotracheal route administered medications Medications (Mnemonic: LEAN) Dosages Larger than conventional IV doses Standard IV dose should be minimum ET dose Administration Deliver beyond into tracheobronchial tree

2015 FP Notebook

13. Management of Cancer Medication-Related Infusion Reactions

medications. Results were limited to English publications from January 1990 to current. Search terms included hypersensitivity, chemotherapy, monoclonal antibodies (and specific names of chemotherapy and monoclonal antibodies), grading or severity, chemotherapy or oncology, risk factors, infusion rate or route of administration or formulation, common terminology criteria for adverse events and clinical severity scale. A grey literature search was also conducted through focused and targeted internet (...) medicationsRoute of administration • Drug formulation • Patient factors Additional Considerations • Consider a non-sedating H1-receptor antagonist (e.g. cetirizine 10 mg) in patients with comorbidities where diphenhydramine may be contraindicated. 12,13 Key prophylactic recommendations by medication 1.2 Taxanes: Anticancer Medication Prevention Strategy Paclitaxel every 3 weeks 7,14–24 (Recommendation 1.1) • Dexamethasone 20 mg PO 12- and 6- hours prior to paclitaxel OR Dexamethasone 20 mg IV 30-60

2019 Cancer Care Ontario

14. Intraosseous versus Intravenous access in Patients with Out-of-Hospital Cardiac Arrest: Insights from the Resuscitation Outcomes Consortium Continuous Chest Compression Trial. (PubMed)

Intraosseous versus Intravenous access in Patients with Out-of-Hospital Cardiac Arrest: Insights from the Resuscitation Outcomes Consortium Continuous Chest Compression Trial. To examine outcomes associated with intraosseous access route attempt for delivery of medications during out-of-hospital cardiac arrest (OHCA) resuscitation.Using data from the Continuous Chest Compression trial, we examined rates of survival to hospital discharge, sustained return of spontaneous circulation (ROSC (...) ), and survival with favorable neurological function among patients with intraosseous and intravenous access attempts after adjusting for age, sex, initial rhythm, bystander cardiopulmonary resuscitation, public location, witnessed status, EMS response and trial randomization cluster.Among 19,731 patients, intraosseous access was attempted in 3068 patients and intravenous access in 16,663 patients respectively. Patients in whom intraosseous access was attempted were younger, more often female, and had

2018 Resuscitation Controlled trial quality: uncertain

15. Safe Medication Use in the ICU

Safe Medication Use in the ICU Clinical Practice Guideline: Safe Medication Use in the ICU : Critical Care Medicine You may be trying to access this site from a secured browser on the server. Please enable scripts and reload this page. Login No user account? Lippincott Journals Subscribers , use your username or email along with your password to log in. Remember me on this computer Register for a free account Registered users can save articles, searches, and manage email alerts. All (...) Practice Guideline: Safe Medication Use in the ICU Email to a Colleague Colleague's E-mail is Invalid Your Name: (optional) Your Email: Colleague's Email: Separate multiple e-mails with a (;). Message: Thought you might appreciate this item(s) I saw at Critical Care Medicine. Send a copy to your email Your message has been successfully sent to your colleague. Some error has occurred while processing your request. Please try after some time. Article Tools Share this article on: Email to a Colleague

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2017 Society of Critical Care Medicine

16. Intraosseous Compared to Intravenous Drug Resuscitation in Out-of-Hospital Cardiac Arrest. (PubMed)

Intraosseous Compared to Intravenous Drug Resuscitation in Out-of-Hospital Cardiac Arrest. Although the intraosseous (IO) route is increasingly used for vascular access in out-of-hospital cardiac arrest (OHCA), little is known about its comparative effectiveness relative to intravenous (IV) access. We evaluated clinical outcomes following OHCA comparing drug administration via IO versus IV routes.This retrospective cohort study evaluated Emergency Medical Services (EMS)-treated adults (...) with atraumatic OHCA in a large metropolitan EMS system between 9/1/2012-12/31/2014. Access was classified as IO or IV based on the route of first EMS drug administration. Study endpoints were survival to hospital discharge, return of spontaneous circulation (ROSC) and survival to hospital admission.Among 2164 adults with OHCA, 1800 met eligibility criteria, 1525 of whom were treated via IV and 275 principally via tibial-IO routes. Compared to IV, IO-treated patients were younger, more often women, had

2017 Resuscitation

17. Medications in Adult Advanced Life Support

on Resuscitation (ANZCOR) make the following recommendations: 1. Intravenous (IV) administration is the preferred means of administering medications to patients during or after cardiac arrest, followed by intraosseous (IO) access. 2. Given the observed benefit on short-term outcomes, standard dose adrenaline (epinephrine) is administered to adult patients in cardiac arrest. 3. Vasopressin is not be added to standard dose adrenaline (epinephrine) during cardiac arrest. 4. Given the observed benefit on short (...) 11.5 August 2016 Page 2 of 13 Guideline While the listed drugs have theoretical benefits in selected situations, no medication has been shown to improve long-term survival in humans after cardiac arrest. Priorities are defibrillation, oxygenation and ventilation together with external cardiac compression. 1 Administration 1.1 Intravenous (IV) route Intravenous (IV) drug administration is preferable and IV access is quickly and most easily achieved via a peripheral cannula inserted into a large

2016 Australian Resuscitation Council

18. Resuscitation in Special Circumstances

] Electrolyte disorders See Guideline 11.5 Medications in Adult Cardiac Arrest. Percutaneous Coronary Interventions There is evidence of underlying ischemic heart disease in the majority of patients who have cardiac arrests. Recommendations for the use of angiography and percutaneous coronary intervention (PCI) in the setting of cardiac arrest are included in Guideline 11.7 Post- Resuscitation Therapy in Adult Advanced Life Support. See also Guideline 14.3 Acute Coronary Syndromes: Reperfusion Strategy (...) for at least an additional 30 min before termination of resuscitation attempts. [Class A; Expert consensus opinion] Consideration should be given to performing CPR for at least 60–90 min. [Class B; Expert consensus opinion]. See also Guideline 11.5 Medications in Adult Cardiac Arrest. Three stacked shocks There are some situations where the patient with a perfusing rhythm, develops a shockable rhythm in a witnessed and monitored setting and the defibrillator is immediately available (eg. first shock able

2011 Australian Resuscitation Council

19. Medical Concepts: Acute Pancreatitis – A Pain in the Back

Medical Concepts: Acute Pancreatitis – A Pain in the Back Medical Concepts: Acute Pancreatitis - A Pain in the Back - CanadiEM Medical Concepts: Acute Pancreatitis – A Pain in the Back In by Doran Drew June 28, 2016 The trauma bay is swamped, rooms are a scarce commodity and inpatient beds are in even more dubious supply. You set your coffee down and prepare to go see your newest patient, a 65-year-old male complaining of abdominal pain. Flipping through his chart, you note that he (...) is tachycardic at 113 bpm and febrile with a temperature of 38.1 °C. En route to the patient’s bed, your nursing colleague stops to tell you that the patient looks terrible. Your patient is a portly man of ruddy complexion. His face is flushed and sweat beads his brow. The history is non-contributory and physical exam reveals only epigastric tenderness without peritoneal signs. You add acute pancreatitis to your lengthy differential. Acute Pancreatitis Patients with acute pancreatitis fall somewhere

2016 CandiEM

20. Smartphone Apps for Pediatric Resuscitation

, at the page of 15 kg, it is written that the dosage of epinephrin is 1.5 cc of 1: 10 000. Outcome Measures Go to Primary Outcome Measures : Medication error [ Time Frame: During resuscitation ] The primary outcome is the presence of a medication error. An error will be defined as a drug dose varying by more than 20% from the recommended dose or by incorrect route. Secondary Outcome Measures : Proportion of tenfold error [ Time Frame: During resuscitation ] A tenfold error will be defined as a drug dose (...) to decrease dosage error has never been evaluated in resuscitation setting. The aim of the study is to evaluate whether the use of a smartphone application designed to calculate medication doses decreases prescribing errors among residents during pediatric simulated resuscitations. This will be a crossover-randomized trial using high fidelity simulation among 40 residents rotating in the pediatric emergency department. Condition or disease Intervention/treatment Phase Status Epilepticus Anaphylaxis Device

2016 Clinical Trials

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