Muscle Rigidity after Rapid Fentanyl Administration

From Susan's patient case presentation:

Fentanyl, 50-100 x's more potent than morphine, may produce muscle rigidity in particular chest wall rigidity. High doses and/or too rapid administration have been implicated as causal factors. This has also been seen with morphine.

Reversal with naloxone has shown to be effective....but use caution with cardiac patients b/c naloxone can cause changes in cardiovascular hemodynamics. Also, giving too much naloxone or giving it too fast can cause pulmonary edema.

Usual rate of administration of fentanyl IV push is over 5 minutes, diluted 1:1 with normal saline.

All this snow really succs

According to Hospira (Kim Vanvervoog at 800-615-0187 2/16/10 @1455)and the insert, precipitation in the succinylcholine vials should be returned for credit. We had several vials in a flat that looked like those cute-little snow globes you see in the dime store. White fluffy critters floating around and wouldn't go back into solution when warmed in the hand.

Here is something I learned from Matt and Nick:

-Calcium gluconate is more stable than calcium chloride in TPNs.

-One way to decrease risk of precipitation of calcium and phosphorus is to increase the amount of amino acids in the TPN.

-Calcium chloride is usually given via central vein because it is alot more concentrated than calcium gluconate and is therefore more irritating to the veins.

Synagis (palivizumab)

Just a reminder -- Synagis is only approved for children under 2 y/o. Also, for IM injection, if the volume is >1ml it needs to be in 2 syringes for kids.

Calculating Iron IV dose and LBW

I found out this morning when calculating an iron dextran iv dose using the formula in lexi {Dose (mL) = 0.0442 (desired Hgb - observed Hgb) x LBW + (0.26 x LBW)} that LBW is the same as IBW. There is also a calculator for iron dosing in GlobalRph.com that is easier and very helpful.