SUMMARY. The three fundamental physical quantities of mechanics are length, mass, and time, which in the SI system have the units meters (m), kilograms (kg), and sec- onds (s), respectively. Prefixes indicating various powers of ten are used with the
SUMMARY. The three fundamental physical quantities of mechanics are length, mass, and time, which in the SI system have the units meters (m), kilograms (kg), and sec- onds (s), respectively. Prefixes indicating various powers of ten are used with the
SUMMARY. The three fundamental physical quantities of mechanics are length, mass, and time, which in the SI system have the units meters (m), kilograms (kg), and sec- onds (s), respectively. Prefixes indicating various powers of ten are used with the
of c, which is why it's nice to measure distances in terms of the speed of light) .... This means the muon travels a distance vγτ, or .... in the particle's rest frame before the decay. Note that the photon has zero rest mass, that is, the square of
We may have all come on different ships, but we're in the same boat now. M.L.King
Idea Transcript
EPIDURAL ANALGESIA Troubleshooting Potential Problems Potential Problem Modified Ramsey Sedation Scale “Sedation 4-5” and/or RR10.**Page APS STAT
Numbness
Dosage (rate or concentration) too higher than necessary for analgesia. Catheter displacement. Hematoma
Notify APS. ↓ in rate will usually resolve numbness in ≈ 2 – 3 hours. Call APS if numbness not resolving. DO NOT ambulate patient if Bromage Scale ≥ 2.
Pain
Dosage (rate or concentration) too low. Catheter Displacement. Pump malfunction. Tubing occlusion Hematoma. Catheter displaced. Opioid side effect. Cutaneous reaction.
↑ rate and/or medicate for breakthrough pain as ordered. Check pump and tubing. Teach and encourage use of PCEA dose, if ordered. * Notify APS is unresolved and patient at maximum ordered dose.
↓ rate if pain controlled, as ordered. Give Droperidol (Inapsine) 0.625 – 1.25mg IVP q 4-6 hr PRN. Elevate HOB to prevent aspiration.
Anaphylaxis
Opioid side effect. Suppression of vomiting center inhibitory fibers. Opioid and/or local anesthetic effect on spinal nerves Dural puncture R/T catheter insertion or migration. Opioid side effect. Disorientation R/T dose, hypoxia, hypercapnia Intravascular migration of catheter Catheter to neural tissue contact. Spinal cord compression Medication related
Infection
Contaminated line
Disconnected Catheter
Inadequately tightened adapter. Not securely taped @ connection port. Catheter displacement (too shallow) Rate to high
Give 0.9% NS 500 ml IV over 30 minutes. Give Ephedrine 5-10mg IVP; repeat x 3 q 2 minutes PRN. (Dilute 50mg in 9ml of NS and give ½ to 1 ml) Avoid Trendelenburg position. * Notify APS
STOP infusion. * Notify APS immediately. ↓ rate if pain controlled, as ordered. Give Benadryl 10-25 mg IVP q 4-6hr PRN. If itching persists, Narcan 0.05 -0.1mg IVP q 6hr PRN(dilute 0.4mg in 9ml NS)
Assess for distention. Straight cath q 6-8hr. PRN. Notify APS if straight cath done x 2. Give Narcan 0.05 -1 mg IVP q 6h PRN (dilute0.4mg in 9 ml NS). Bed rest with HOB ↓ if not contraindicated. * Notify APS √ Baseline; was pt confused prior to epidural infusion? If not, STOP infusion. * Notify APS STOP infusion, initiate rapid response measures PRN. Bedrest. * Notify APS STOP infusion. * Notify APS STAT STOP infusion. Initiate emergency procedure. * Notify APS Assess insertion site per protocol (q 8hr) for redness, swelling and drainage. * Notify APS. Cover with a sterile 4 x 4. * Notify APS If the patient is comfortable reinforce the dressing and monitor the amount of leakage. High pressure alarm may occur. If the patient is in pain, Notify APS.