Amiodarone: Infusion or Bolus ?

You’re dispatched for a 55 y/o male complaining of palpitations. You find him in a-fib at a rate of 150 but otherwise stable. You load the patient and get a line, but soon after, you note a change to VT with no major change in patient condition. Your partner draws up 150 mg of amio, but without cross-checking, pushes it IV. The patient goes unresponsive and experiences a brief PEA arrest that, luckily, is remedied with a few compressions and some epi. Oops 🫣

Based on a true story. 

Amio is an antiarrhythmic that affects sodium, potassium and calcium channels. It prolongs action potential and depolarization, and suppresses sinus node function and AV conduction. Whew 🥵

This drug is a source of confusion among students & new providers, as it has multiple different modes of administration. Let’s break it down. 

🙂STABLE PATIENTS:

•Amio suppresses cardiac function and is dissolved in a solvent that can also precipitate hypotension - give SLOWLY 🐢 

•Via: s l o w infusion. 150 mg bolus ✨over 10 minutes✨

•Not ideal to try to push 3 mLs over 10 mins (typical concentration: 50 mg/mL), so we mix it in something. 

•If you have a pump, mix it in a small bag (if not prepackaged) and run the bolus over 10.

•No pumps? Put it in a 100 mL bag and run it in over 10(ish) mins with a macroset. Other size bags are acceptable based on IV access and fluid tolerance. 

•Can be mixed in D5W or NS (yes, NS)

•It worked!? Maintenance drip💧 (after finishing bolus)

☠️DEAD PATIENTS:

•Since perfusion sucks and we’re mechanically controlling cardiac output (compressions), just push it. 

•300 mg for refractory vf/VT, then 150 mg if it’s still happening. 

•It worked!? Maintenance drip💧 

🥳IT WORKED:

•For patients who convert with an amio bolus, we can MAINTAIN the bolus’ effects and keep the bad juju away with a maintenance drip

•1 mg/min

•No pump? Put 100 mg (usually 2mL) in a 100 mL bag. That’s 1mg/mL. Spike with a 60 gtt set, run at one drop a second (aka 1 mL/min) and voilà. 

⚠️: Amio is not to be used with Torsades, as it prolongs QT further and can cause deterioration into vfib. 

🤓: If using lidocaine instead, same concept of bolus before maintenance drip applies.

Testicular Torsion

 Testicular torsion occurs when the spermatic cord twists, cutting off blood supply to the testis. 

 SYMPTOMS: 

Pain and swelling of the scrotal sac are usually the main symptoms of testicular torsion. 

Most people, in general, do not understand the difference between testicular torsion and infection, and when they have pain, they assume it is due to infection and they start themselves on analgesics and antibiotics. 

 CAUSES: 

Torsion could occur while people are asleep. Torsion tends to occur early in the morning when testosterone levels are at their peak, and the cremasteric reflex is strongest. Occasionally, a tumor or prior trauma may be present and risk factor includes a congenital malformation known as a “bell-clapper deformity” wherein the testis is attached to the epididymis vertically instead of longitudinally allowing it to move freely and thus potentially twist. Cold temperatures may also be a risk factor. 

 Torsion of the testes is a medical emergency, but many adolescent males are hesitant to say they are having pains on their testes or seek treatment right away. You should never ignore sharp testicular pain. It’s possible for some men to experience what is known as intermittent torsion.

 This causes a man to have a testicle twist and untwist. Due to the fact that the condition is likely to recur, it is important to seek treatment. Seek to consult with a urologist, even if the pain becomes sharp and then subsides

VAGINA APPRECIATION DAY

Despite centuries of stigmatization, the vagina is truly incredible. 💗

Among many other things, it’s the structural connection between the outside world and the female body’s most powerful reproductive organs. 💪

So it makes sense that the vaginal microbiome — defined as the complex ecosystem of microorganisms, including bacteria and fungi, that lives inside the vagina — has biologically evolved to help protect that reproductive system. 🔬

Every day, the vaginal microbiome performs the equivalent of modern health miracles. ⚡️

It can fight off yeast infections and bacterial vaginosis (BV), protect a pregnancy, and possibly even defend against cancer, as well as play a crucial role in your overall health.

🔑 This #VaginaAppreciationDay, we’re celebrating vaginas (and vulvas and the vaginal microbiome!) because it’s time we started to recognize them as superpowers and not liabilities, as sources of pride and not shame, and as beautiful, complex, powerful parts of our bodies.

Leave a 💗 if you agree!

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#destigmatizevaginalhealth #NurseOtienoWrites

Dapivirine Vaginal Ring Prevents HIV

The first topical HIV prevention method to be submitted for regulatory approval, it is an intravaginal silicone ring, developed by the International Partnership for Microbicides (IPM) for HIV prevention.

Also read: Campus Mafisi

The ring delivers an antiretroviral drug called dapivirine. It’s released slowly over the course of one month directly to vaginal tissue to help protect against HIV at the site of potential infection. Little of the drug is absorbed elsewhere in the body resulting in low systemic uptake.

Also read :Crash Cart

This means that the drug is unlikely to be found in high concentrations in the bloodstream and other body tissues, which may reduce side effects as well the risk of development of HIV resistance. Data from Phase III studies of the ring show no evidence that the ring increased resistance to NNRTIs, the class of ARV drug to which dapivirine belongs and which is also used in some treatment regimens.

The Dapivirine Vaginal Ring reduces the risk of HIV-infection, and offers a discreet and long-acting alternative to daily oral PrEP.

Although access to daily oral PrEP is increasing around the world, a daily pill is not a suitable or desirable prevention method for everyone. Today, women account for more than half of all people living with HIV globally, and face persistently high HIV-infection rates. Experience introducing oral PrEP in many countries has revealed that women face unique challenges when it comes to adhering to a daily pill due to gender inequity, social norms and other structural barriers.

Efficacy data shows that the ring reduces HIV risk by 35 percent, with recent data from open label extension studies suggesting a greater reduction in HIV risk by about half. Modelling has shown that even a partially effective prevention option can have an important protective impact for women and their communities as part of a comprehensive HIV prevention strategy.

Like oral PrEP, the Dapivirine Vaginal Ring does not protect against other STIs or unwanted pregnancy.

The ring does not reduce risk of chlamydia, gonorrhea, syphilis or herpes, or unwanted pregnancy. There are studies underway examining the safety of a combined dapivirine-levonorgestrel ring that would protect against both HIV infection and unwanted pregnancy, as well as different vaginal rings that combine antiretrovirals and other medications to prevent STIs.

For more information read Dapivirine

Top Nursing Jobs Away from the bedside

“Tired of the Bedside??"

(Save this post)

1️⃣ Flight Nurse: A RN trained to care for patients arriving at a medical facility via an emergency Aircraft 🚁. Trained to manage a number of conditions in-flight.

2️⃣ Forensic Nurse: Provides care to victims of violent crimes and collects evidence and DNA.

3️⃣ Aesthetic Nurse: This nurse administers non-invasive cosmetic procedures including dermal fillers, chemical peels and anti-wrinkle injections. 

4️⃣ Nurse Consultant: The Nurse uses their experience and expertise to provide medical information to those otherwise not know. A “legal” nurse consultant can provide this expertise on criminal cases. 

5️⃣ Nurse Educator: These Nurses teach the nurses. Nurse educators are strong communicators and are responsible for developing and teaching nursing curriculum.

Also read : Code Blue

6️⃣ Mental Health Nurse (NP): A mental health NP works with a team of psychiatric professionals to service patients suffering from mental health issues and disorders. This involves diagnosing and treating a variety of psychiatric conditions.

  Which position is for you?

The beauty of Nursing is being able to change the trajectory of your career when needed. Take an opportunity to see what field fits you best. Your career is in your hands!

 Also read : My Challenging Night Shift

Other off-bedside specialties:

-Travel NP- 

-Telehealth

-School Nurse

-Pharmaceutical sales

-Nursing Informatics

-Public Health Nurse

-Cruise Ship Nurse

-Research Nurse

-Nutritionalist Nurse

-Correctional Nurse

-etc

The Code Cart Or "Crash Cart."

This is the heart of every unit. It’s the last weapon in the arsenal( get to know the meaning of arsenal not the football club); the final measure standing between this life and the next. Its function and its contents are universally known by nurses across the continuum. 

Also read: Team Mafisi

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You should certify it every 2 years to ensure that you are up to date with the latest evidence for optimal outcomes. You should run “mock codes” to train for the many scenarios that require precision and sound judgement. You should check it daily to ensure that it is properly functioning and equipped with the tools and medications designed for the single purpose of prolonging life and preventing death. Any missing item, oversight or misstep can mean the difference between success or failure. 

 Also read : Nurse Are Rude

No matter what is happening around us, when the Crash Cart is activated, nothing else in the nurse’s world matters in that moment. We form one team. We assume one role. We speak one language. And we unite together with one mission- to save a life. 

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When was the last time you familiarized yourself with the crash cart?

When was the last time your crash card was updated?