June 4, 2023

CF EMS review of Medication Furosemide.

All right class welcome back and today we’re going to figure out why the phrase peeing like a racehorse uh comes into play and the drug we’re going to be talking about of course is furosemide now to answer that question about the horse racing they give this drug actually to horses to prevent uh the turbinates from bleeding uh and they’re in the big nostrils um but

It but of course it causes the horse to pee some more so but that’s why they give it but that’s why we give it to us humans is to remove water and so let’s get dive into what it is what it does is again a potent diuretic that inhibits sodium and chlorine reabsorption in the kidneys so it’s kind of a good thing in one respect the one thing it doesn’t do though is

It lets you pee out the potassium we kind of talked about that in the video with the with all the potassium so usually if they’re on lasik they’re probably going to be on some sort of potassium supplement but again it works in the loop of henle so it’s a potent loop diuretic and it helps us balance out again and usually take the water off we like this a lot for

Uh congestive heart failure patients okay and again it decreases the preload by vasodilating in about five minutes it has that effect but um the other thing that it does though is it causes an excretion of additional water through that loop of henle so the diuretic effect kicks in about five to thirty minutes now this kind of poses an interesting thing and i will

Tell you this that if you give a patient’s lasix or that matter bumx while you’re on the way to the hospital hopefully you’ve got something either a checkup underneath them or a hopefully something where you can catch the urine because they’re going to need to start collecting the urine and making sure that um that we watch our fluid balance with this but uh yeah

When i say that they’re going to pee i assure you they’re going to pee and they’re going to be a lot so again usually the diuretic effect it’s about five to f uh 15 to 20 minutes uh but it vasodilates and that’s why we like it when we have a really bad congestive heart failure patient is that it drains it it gives the fluid somewhere else to go the other problem

With that is though is then it starts going out the urethra because they start peeing a bunch and then again the duration of action is usually around four to six hours so yeah uh people on lasik you can tell they’re on it because buddy they’re headed to the bathroom every 15 minutes to make you feel better um again we use it in pulmonary edema we again it’s to

Take the fluid out of the lungs and put it somewhere else again and hopefully to to pee it out so that it doesn’t cause a fluid overload uh if they actually have cerebral edema we’ll give it for that if the patient has hypertension we give this to help dilate out the vessels reduce the preload and then have them pee it out more so in a kind of a roundabout way it

Lowers the blood pressure for these patients uh if you give it too rapidly you’re gonna get ringing in the ears uh definitely dizziness headache comes into play they can blur the vision uh again if they have any type of arrhythmias they can drop their blood pressure really bad those are the big ones that happen and again it also nausea diarrhea vomiting this can

Also happen with your with your lasix administration the other things that are kind of big is it drops your sodium levels it will drop your potassium levels uh it will cause your blood sugar to go up uh it can cause actually metabolic aciditosis uh pureitis is is the itchy skin uh involved with that so it can cause a little bit of a rash again but again it dries

Out everything so obviously it’s going to lead to that nice big wonderful fancy word that i’m probably going to put in there somewhere all right so back to it when do we not give this again you got to watch out in the emi setting you got to watch out in cardiogenic shock uh copders again it can cause some problems there they they’re hypersensitive and sulfurs

Or thiazides this probably is not gonna be your drugs um you can actually give it in pregnancy but it’s gotta clearly outweigh the risk and there’s way too many uh lists on that list uh most of the time you’re not gonna see docs given that again relative if they got a low hype low potassium renal insufficiency hypotension uh probably better to stay away from it

Especially they got a low blood pressure again remember this is going to dilate the patient out it’s going to cause some problems uh if they are on digitalis and they now have a low you get there and you put the monitor on them and they got a really nice slow heart rate with a really wide qrs you’re probably going to be going and this is a bad idea because again

It’s probably going to make that situation even worse again other diuretics can you can really quickly volume deplete it so don’t give them lasix and bumx unless there’s a clear fluid overload on that patient and again if you have sodium deflection if they’re on any type of lithium drug again they can become toxic from that again we usually protect it from light

And if you give it too fast you can actually cause them to go deaf so please give this slow all right and they patient should be catheterized if the transport is going to be more than 15 minutes again have a collection point for these folks i would say catheterization nowadays guys is kind of a out of vogue thing it’s definitely out of vogue for us here in the

Ems world uh again just remember it can really if they start peeing a lot they can lead the hypotension and they can actually have a a thromboembolism form inside the blood starts to clot and it’s been dosed to cause feasible abnormalities so with a pregnant patient stay away from it and pre-hospital administration is often overdosed they usually give too much and

The reason is because usually the patient’s in the severe amount of distress um be judicious when you’re given this a lot of places nowadays have actually taken these the lasix off the truck for these reasons all right uh usually the the ones that i’ve worked with is 40 milligrams and the four mls or the 200 milligrams of 10 ml those are the big ones that i’ve

Worked with uh it’s usually 40 to 80 milligrams uh 0.5 to 1 milligram over one to two minutes a really slow push if the patients already on lasix we would double the dose so if they’re on 40 lasiks we probably give them 80. if they’re on 206 we probably give them 40 okay and the max dose of that by the way is 2 milligrams per kilogram uh child it’s again very rare

I don’t think in 30 years i’ve given it to a child so again uh but the dosing is the same for them uh i know that it says pregnancy category c it causes fetal abnormalities gang i would not use it in a pregnant patient okay i would definitely not want to do it in a pregnant patient all right that’s going to end it for lasix and i’ll see you guys on the next one

Transcribed from video
MMG to Furosemide By The Mad Medic Learning Network