MRI/LP Drugs
Drugs for LP
Try not to, but if you must you can use one of these on the floor without ICU team.
| DRUG | DOSE AND ROUTE | USE FOR |
| Lido with epi | Needle-site pain, especially if anticipate you will try multiple levels as the bottle in LP kits has a very small volume adequate for only one level. Order this and ask nurse to get it ready on every single patient but don't open unless needed | |
| Fentanyl | 25 mg IV for normal sized adult can go up to 50 mg IV for large people (>100kg) If no access, same doses intranasally will work | |
| Ativan (Lorazepam) | 0.5mg-1mg PO or 0.5mg-1.0mg IV | |
| Ketamine | 0.3 mg/kg max of 35 mg over 15 minutes in an NS bag | only use if in the ICU; key is to push it slow to not cause laryngospasm! This rate is slow and likely will be ok on the floor. |
Drugs for MRI
MRI will frequently page you that a patient is freaking out/ in too much pain to sit still for an MRI.
Return the call immediately and dose one of the following drugs.
Remember rules for conscious sedation at PUH only allow you to dose 1 at a time w/o ICU presence and certainly with just an MRI nurse (see below).
TIP: if you know a pt is likely to freak out or be in too much pain to stay still, order one of the drugs below PRN and specify in comments to use in MRI if needed (save yourself a page).
NOTE: when ordering any of these drugs which may depress respiration, there is no harm in playing it safe and just putting the patient on a cardiac monitor with pulse ox. This is something that can easily go into the scanner with the patient, no reason not to do it.
| DRUG | DOSE AND ROUTE | USE FOR |
| Valium | 5mg PO, 2.5mg IV | Anxiety / Agitation / claustrophobia |
| Dilaudid | 0.2mg IV (0.5 if large / non-opioid ideally, naive only if "<65") | Pain |
| Ativan | 0.5mg-1mg PO or 0.5mg-1.0mg IV | Anxiety / Agitation / claustrophobia |
| Zyprexa (olanzapine) | start w/ 2.5 P.O. if geriatric / small / TBI up 5.0mg ODT/IM if excessive agitation / large up to 10mg max | Agitation |