Allergies Latex Penicillin…. Which of these antibiotics contain penicillin? –Amoxicillin? –Co amoxiclav (Augmentin)? –Co-trimoxazole (septrin)? –Tazocin? –Gentamicin?
Speedshock Rapid administration of a drug Toxic levels in the blood Floods organs rich in blood, i.e heart, liver, brain Fainting, shock and cardiac arrest
A patient is prescribed 1g of Vancomycin. You know it should be given over 2 hours but the patient has to go to scan so you run it through quickly. Shortly after it’s completion you notice that the patient has a rash and is itchy. What has happened? Red man syndrome How could this have been prevented?
Phlebitis Irritant medications Cannula too big Cannula not secured
Infiltration Leakage of fluid from the vein to the surrounding tissues. Caused by cannula piercing the vessel wall. Pain, paraesthesia, cold Prevention? Treatment?
Extravasation Leakage of a vesicant fluid into surrounding tissues. E.g. cytotoxic, sodium bicarbonate, phenytoin, dopamine, calcium chloride, potassium, amiodarone) Treatment –Stop infusion –Leave cannula in –Mark area –Seek medical advice
Errors April-June 2005 = 158 incidents –112 had an impact on the patient –3 = serious CHECK Right patient Right patient Right drug Right drug Right route Right route Right dose Right dose Right time / rate Right time / rate
Pumps Many errors are pump related Pump training If you don’t know ASK If you think you know CHECK
1902 Richet & porter –Ana = against, prophylaxis = protection –Disordered reactions of immune system –Due to Drugs Nuts Shell fish Insects latex
Major allergens causing severe anaphylaxis
Anaphylaxis and Drugs
How is it caused? Allergen causes mast cells to produce histamine and other mediators –Bronchoconstriction > Dyspnoea –Angiooedema (swelling of the head and neck) –Vasodilation > Hypotension –Skin reactions > rashes
Treatment Emergency, most serious symptom first, ABC Airway –Maintain, ? Intubate, adrenaline 0.5mg IM Breathing –100%O2 Circulation –Restore, adrenaline 0.5mg IM –Fluids…Which ones
Immediate actions Remove allergen Call for help 0.5mg adrenaline IM 100% O2 via trauma mask Fluids if needed Later chlorpheniramine (10-20mg IM)and Hydrocortisone(100-500mg IM)
Reporting of adverse events
Summary When giving a drug IV Think –Route central or peripheral –Bolus or intermittent Allergies and interactions Report adverse events of black triangle drugs
References Sivagnanam S, Deleu D (2003) Red man syndrome Critical Care 7 119- 120 RCN IV Forum (2005) Standards for IV infusion therapy Resuscitation Council UK –www.resus.org.uk