EMCrit Podcast Podcast 103 – Avoiding Resuscitation Medication Errors – Part II
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Jul 21, 2013 Bryan Hayes, a clinical pharmacist specializing in emergency medicine and toxicology, shares vital insights on avoiding medication errors during resuscitations. He discusses the importance of properly priming insulin IV infusion lines and advocates for low-dose titrated naloxone to minimize withdrawal effects. Bryan highlights the issues with hydralazine and recommends nicardipine for better blood pressure control. Plus, he emphasizes the significance of syringe labeling and the retention of empty vials to enhance medication safety during critical moments.
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Insulin Adsorbs To IV Tubing
- Insulin binds to IV tubing and can be sequestered, delaying effective dosing.
- Recent data suggest priming with ~20 mL of infusion is usually sufficient instead of 30–50 mL.
Australian Nurses Question Insulin Priming
- Australian ICU nurses told Bryan Hayes they often don't prime insulin lines and sometimes don't believe the adsorption issue.
- Hayes and others still reference literature and practice priming variably across institutions.
Titrate Naloxone With Small Incremental Doses
- Dilute 0.4 mg naloxone in 9 mL saline to create 0.04 mg/mL and titrate 1–2 mL boluses.
- Use small incremental doses to find the minimal wake-up dose and avoid precipitating severe withdrawal or agitation.