Common Treatment Orders

COMMON TREATMENT ORDERS (for fresh graduates) 1. Unclassied ward co!laints

. Res!irator$

-

Raised BP

-

0ough "edications

-

Decreased BP

-

0hest in(ection / pneu"onia

-

Decreased / no urine output

-

#ntu&ation

-

Decreased SaO2

-

'entilator settings

-

Pain

-

0O%D drugs  3

-

Headache

-

%nti-4B drugs

-

Fever

-

Hae"optsis

-

Nasal allerg

-

Drug allerg

5. Cardiac

-

Sore throat

-

Fast %F

-

S!in rash

-

0hest disco"(ort *%0S+

-

Nocturnal leg cra"p

-

#nso"nia

6. %astrointestinal

-

Di$$iness

-

0o7ee ground vo"iting

-

%&nor"al %&nor"al &ehaviour

-

0onspitaion

-

'iolent patients

-

Dspepsia

-

Pruritis

-

%&do"inal pain *anti-

-

Red ee / ee disco"(ort

spas"otics+

-

Drug )ithdra)al s"pto"s s"pto"s

-

'o"iting

*drug addicts+

-

Diarrhoea

-

Nocturnal irrita&ilit

-

Hae"orrhoid

-

Oral ulcer

-

Palpitation

2. "a#orator$ results

8. Ner&ous s$ste -

Stro!e / 0'%

-

9pileps

-

Decreased hae"oglo&in

-

Sei$ure attac!

-

Decreased platelet count *plus

-

0NS tu"our / hae"orrhage

(ul,ll indication (or trans(usion+

)ith "ass e7ect

-

Raised #NR

-

pH.1

. Endocrine

-

Hpo!alae"ia

-

-

Hper!alae"ia

patients+

-

Hpernatrae"ia

-

Hpoglcae"ia *H;sti3 .6+

-

Hponatrae"ia

-

#ncreased H;sti3

D:# drip *(asting o( D

1

-

Sliding scale o( %ctrapid H

- 4hro3ine 4hro3ine

replace"ent

-

Hperglce"ia Hperglce"ia *poor D

-

=out

control+

-

0ellulitis

- 4hroto3icosis 4hroto3icosis

-

D'4

<. Miscellaneous

-

enorrhagia

-

0ontrast allerg

-

>nit conversion

-

Drug overdose

-

0reatinine clearance

2

-

Sliding scale o( %ctrapid H

- 4hro3ine 4hro3ine

replace"ent

-

Hperglce"ia Hperglce"ia *poor D

-

=out

control+

-

0ellulitis

- 4hroto3icosis 4hroto3icosis

-

D'4

<. Miscellaneous

-

enorrhagia

-

0ontrast allerg

-

>nit conversion

-

Drug overdose

-

0reatinine clearance

2

' UNC"ASS*ED +ARD COM,"ANTS Raised BP (if SBP >180 or DBP >90) -

0hec! the stress level? previous record

-

@oo! (or chest pain? SOB? headache? &lurred vision? (undi changes

-

%dalat Retard 2A"g PO stat 3 1 or BD

-

0aptopril 8.26"g po 5H prn i( SBP C21A or DBP C11A

-

Betaloc 26"g BD

#( eating not allo)ed  patient conscious? %dalat 6"g su&lingual 3 1 #( eating not allo)ed  patient unconscious? la&etalol 6"g #' stat * up to 2A"g #' over 2 "in+ Decreased BP (esp: SBP<90) -

Shoc!? di7erentiate &et)een cardiogenic and non-cardiogenic? and

(urther identi( the underling causeE treat accordingl -

ithhold anti-H4 drugs

-

Fluid resuscitation *v cautious in 0RF or HF+

-

=elo(usine 6AA"l FR 31 Or NS 6AA"l FR 31

#notropes 救命三寶 -

Dopa"ine

-

1g in 6AA"l NSG give 1A-5A"l/hr or 5G1? 1-2A"l/hr Dol&uta"ine dripG

- 26A"g in 6A"l D6? 6"g/"l? 1"l/hr -

%drenaline %drenaline drip * )e )ould give dopa"ine ,rst+

-

A"g in 6AA"l NSG give 6-2A"l/hr or 8"g in 1AA"l NS 1-2A"l/hr

* ard G "g in 5"l NS? give 6 "l/hr + Decreased or no urine output -

0hec! BP/P? #/O? te"perature? hdration status? 0'P  drain

outputs *i( an+ -

Di7erentiate Di7erentiate &et)een causes o( Post-renal:

-

(eel (or &ladder /- &edside &ladder scan? chec! Fole patenc Renal:

-

creatinine level Pre-renal:

-

(eel peripheries?

-

chec! hdration status? I'P? ede"a? crep? 3

-

PR e3a" *i( indicated+?

-

0JR *i( indicated+ For pre-renal causes

-

i( non-cardiogenic? treat )ith Kuid challenge? e.g.NS 6AA"l FR or

1H or 2H 31 -

=elo(usine 6AA"l FR or 1H 31

-

NS 26A"l 1H 31

-

i( cardiogenic? according to BP

-

consider inotropes *e.g. dopa"ine+ / lasi3 *e.g.lasi3 2A or 5A"g iv stat 31+

- Set up 0'P Decreased SaO2 -

So"e causes to consider *and "an "ore+G

-

0ardiacG 0HF? %#? arrhth"ia? etc

-

0hestG pneu"othora3? pneu"onia? pul"onar e"&olis"? "ucus?

 90=

心

0O%D? %PO etc0JR -

0hec! vitals? I'P? oede"a? listen to chest? heart sound

-

0JR *>P+ / %strup / R@F4E /- cardiac en$"es/90= *i( cardiac

causes+ -

=ive O2 6/6A/1AAL *not to e3ceed N/0 2@/"in in 0O%D+

-

Suction (or sputu"

-'enturi "as! -

#ntu&ation / %"&u &ag

- 4reat

underling causes

Pain 痛 -

Panadol 6AA"g #D prn PO/PR

-

Dologesic ta& 1 #D PO prn

-

Dolo3ene 0o 2"g Mid po prn

-

Dolo3ene 0o 6A"g ## M8h prn

-'oltaren 6-16A"g PO dail 服他靈 4ra"adol 6A"g ## 8H prn *&e)are o( resp distress  nausea+

*cp. Pethidine-tra"adol )ea!er? slo)er onset et longer duration + Higher doses 6/1AA"g? FreMuent 5H ? #' (or" (aster onset &ut need "onitoring 4

-

Pethidine 6A/6/1AA"g ## M8h prn *&e)are o( resp distress+

"ocal a!!lication -

%nalgesic &al" @% tds prn

-

Ru&esal 26g @% tds prn

-

'oltaren gel @% tds good (or post-trau"atic inKa""ation

-

orphine 5/
-

Hirudoid @% tds prn good (or drip site )ound 喜療妥

-

Naprosn 26A"g BD PO

Headace -

Docu"ent =0S? &rie( H3 and P/9 to r/o sinister causes

-

Panadol 6AA"g #D PO prn

!e"er Post-op fever: -

ithin 5< hoursG usuall atelectasis

-

5< hours to 6 dasG chest in(ection? >4#? drip sites? etc

-

%(ter 6 dasG )ound in(ection? intra-a&do"inal a&scess? D'4

0o""on causesG -

post-op causes *as descri&ed+ resp *pneu"onia? >R4#+? >4#? drip sites? )ounds? gnae *in (e"ale+? =#? 9N4? drug-induced? tu"our? etc

-

Revie) "edications * on %/B+? la& results *e.g. on %/B alread 

00 on decreasing trend+ For atelectasis : -

chest phsio

-

encourage deep &reathing

-

o&serve trend o( (ever

For other causes: -

Septic )or!up i( not doneG

-

Bld 3 0BP/D0? 0/S4

-

Sputu" 3 0/S4/R

-

S> 3 0/S4/R

-

0JR

-

#( indicated? start e"pirical anti&iotics 5

-

Panadol 6AA"g #D PO prn i( te"p C<.6 degrees

*For neutropenic (ever? can give Fortu" 1g #' 
#asa$ a$$er%& 're$ief of s&ptos of a$$er%ic rinitis -

Phenergan 26"g 4DS PO

-

0laritne ta& 1 4DS PO 佳力天

Dru% a$$er%& -

Hdrocortisone 1AA"g #' 8H

-

Piriton 1A"g #' 
Sore troat -

0epacol/DeMuadin/Strepsils ta& 1 #D PO prn 得果定/ 使立消

-

A.2L 0hlorhe3idine / 1A"l @% 4DS

- 4h"ol

gargle / 1A"l @% 4DS

Sin ras -

93clude allergic reactions

-

Snalar 0r A.A26L or A.A6L @%

健

4DS - - Diprogenta 0r @% BD 帝普 *&eta"ethasone dipropionate + #octurna$ $e% crap -

Baclo(en 6"g tds PO *"uscle rela3ant+

*nsonia -

Piriton ta& 1 po 3 1

-

%tivan A.6-1.A"g Nocte PO 3 1

-

#"ovane .6"g Nocte PO 3 1 * $opiclone+

Di++iness 暈 If sudden onset and severe -

H3 and P/9 to e3clude sinister causes *e.g. stro!e+ 0p tone  po)er

&oth sides -SO@ Non speci,c  'ertigo * Hallpi!es "aneuver + -

Hsti3 stat? BP erect and supine

-Bld 3 0BP -

Ste"etil ta& 1 tds prn

-

Ste"etil 12.6"g ## M8h prn 6

-

Ser 0 *erislon+ ta& 1 tds po prn

,oitin%- #ausea 嘔 -

@oo! (or underling cause *e.g. S/9 o( "edications+

-

a3olon 1A"g tds po

-

a3olon 1A"g #/#' 8h prn

./nora$ /ea"iour -

For those )ith pschi histor? not (or drug overdose

-

Haloperidol 2-1A"g 5H-
usuall 6"g ## 8H prnE hal( dose (or elderl ,io$ent patients -

Haloperidol 2.6"g ## 3 1

-

Pulse o3i"etr? cardiac "onitor? BP/P 1H 3 5

Pruritis 癢 -

%(ter e3cluding allergic reactionsG

-

%Mueous crea" @% tds prn

-

9ura3 crea" @% tds prn 力!

-

0ala"ine 0r /lotion @% #D

-

Piriton ta& 1 tds po prn

Red e&e or e&e discofort -

Do e3clude sinister causes ,rstQ *e.g. loo! (or ciliar Kush+

-

=utt Hpro"ellose 2 drops @% B9 tds

-

ethlcellulose eedrop 2 drops @% BD B9

Dru% itdraa$ s&ptos (Dru% addicts) -

Phseptone *"ethadone+ 1A or 16"g tds po prn

-

Phseptone 1A"g or 1"l iv 8H prn

-

orphine 1A"g iv 8H prn

#octurna$ irrita/i$it& -

#"ipra"ine 1A or 26"g Nocte

Ora$ u$cer -

%cclovir 0r @% 4DS 7

Pa$pitation -

#nderal 1A"g 4DS PO prn * propranolol+

*onl (or s"pto"atic R3E al)as loo! (or underling cause? e.g. arrhth"ia? %#..+ Hiccup 1. Paper &ag (or sel( re-&reathing *"#$+ 2. largactil 26"g #' 3 1

- "A.ORATOR/ RESU"TS Decreased H/ -

0hec! vitals

Look for underlying cause: -

PR e3a" * e3clude PR &leeding surgicall o&ligation

-

Bld 3 iron pro,le? 4S */- 0BP? clotting pro,le? H& pattern+

-

Stool 3 occult &lood 3  * i( no o&vious PR &leeding+

- 4rans(use

i( H& 
*9ach unit o( pac!ed cells raise H& (or a&out 1g/dl+ * No)adas seldo" ust give 1 unit pac!ed cells + -

0an consider giving lasi3 2A"g iv a(ter each pint o( trans(usion i(

still conscious -

0hec! post trans(usion H& */- RF4+

-

For DS anae"ia? treat onl i( s"pto"atic

#( an pro&le"s related to &lood trans(usion e.g. Patient )ith =roup % Rh ve ? onl =roup % Rh ve &lood a/v ? consult hae"atologist Decreased p$ate$et count (p$us fu$$$ indication for transfusion) -

5 or 8 units platelet conc FR 3 1

Raised *#R - 4rans(use

5 units FFP FR 3 1? then re-chec! #NR

Platelet C A  #NR  1. can tolerate procedures. e.g. 4%09? 9R0P? %&scess drainage? P4BD insertion  P0N NoteG FFP cannot sta long in the circulation? onl give it an hour 8

&e(ore an procedure. #( not? ust )aste FFP pH < 31 -

6A"l <.5L NaH0O over 1 hour * even 1AA"l is ,ne 1AA"l per

&ottle + -

Re-chec! Bld 3 %B= a(ter)ards

H&poa$aeia -

@oo! (or co""on causes? e.g. diuretics? vo"iting? etc

If cause not obvious, or persistent hypoK, or severe hypoK (K!"#$: -

chec! spot seru" : and os"olarit? urine :? &aseline 90=

-

S&rup 45$ 2g PO 2-H 3 2- doses

-

Or s$o 4 *<""ol :/8AA"g ta&s+ ta& 1 D/BD/4DS PO

-

#ntravenous : supple"ent i( severe or NPO *: 2.6""ol/l+

-

=ive 5A-12A""ol/dG Dont e3ceed 5A""ol/hr? use large vein

-

onitor :? 90=? urine output? consult #0>

-

%void de3trose *lead to (urther drop in seru" : level+

-

=ive separatel or add to original #'F? e.g.G 

2A""ol :0l in 26A"l NS? 2H 3 1



NS 6AA"l 8H/pint  16""ol :0l/pint *i.e. 8A""ol :0l/da+

-

>suall )ill re-chec! Bld 3 : a(ter supple"ent i( original :.A

-

0onsider hpog (or persistent hpo:

-

ard has preparation o( NS 6AA"l  1A ""ol :0l /pint or

-

NS 6AA "l  2A ""ol :0@ /pint

-

#( ordered 16 ""ol :0@ /pint ? ard needs to get it (ro" Phar"ac

-

H&pera$aeia K %& -

90=? cardiac "onitoring

-

1A "l 1AL ca$ciu %$uconate iv stat )ith cardiac "onitor *over 

"in+ -

D* dripG 6A"l D6A  <-1Au %ctrapid H #' over A "in

-

Repeat 90= in 6 "in *i( original 90= sho)ed hper : changes+

-

Repeat Bld 3 Na and :? Hsti3

K not very high (&$ 9

-

Resoniu" 0 16g" 8H/4DS PO/PR

-

Resoniu" % *)atch-out Na and H2O overload+ 16g" 8H/4DS

PO/PR -%&'() ! $ -

Rechec! Bld 3 Na/: a(ter)ards

H&pernatraeia -

Rechec! &lood? clinical sign *palpitation+

-

6AA"l D6 over 5 hr *+

H&ponatraeia -

0hec! seru" os"ol? cortisol? 4SH? urine os"al? Na * al)as

re"e"&er adrenal insuTcienc+ -

0hec! drug *lasi3+? RF4

- 4reat -

according to underling causes

Re. House"an Hand&oo!

#( 1A-15  reduce diuretic dose #( 126-12U  Stop diuretics  Kuid restriction inta!e to 1.6 @/da #( 126

 Stop

diuretics  Kuid restriction to 1 @/da

0 RES,RATOR/ 5ou% edications -

ucolticsG Kui"ucil 2AA"g tds * "ore e3pensive+ ? ,-./0

acetlcsterine - &isolvon <"g tds * cheaper+ 12/ -

93pectorantsG 9S 1A"l tds 34

-

0ough suppressantsG ethnine or phensedl 1A"l tds? pro"ethasine

co"pund 1A"l &d -

OthersG 9li3ir Benadrl? 0o3illana

5est infection - pneuonia -

Bld 3 0BP *0BP/D0 i( (e&rile+? @/RF4? 0/S4 *i( (e&rile+

-

Sputu" 3 0/S4/R? %FB s"ear? 0/S4

-

Septic )or!up i( (e&rile

-

0JR

.nti/iotics: -

%ug"entin 6"g tds po or %ug"entin 1.2g iv 
-

>nasn 6"g BD po or >nasn 6A"g iv 
-

:lacid 26A"g or 6AA"g BD po * 0larithro"cin+

-

Vinace( 6A"g #' 
-

Flagl 6AA"g #' 
-

Sulpera$one 1g iv 
- 4a$ocin

--

5.6g #' 
-0iproKo3acin 2AA"g iv 12H or 0iproKo3acin 26A"g po BD -@evoKo3acin *0ravit + a. 0o""unit acMuired pneu"oniaG 6AA"g dail PO/#' 3 1-2 )ee!s &. 0o"plicated >4# G 26A"g #'/PO Dail 3 1A das c. >nco"plicated >4# G 26A"g Dail 3  das >nco"plicated a&do. O4 Pre-op 1 dose and then post op 2 doses 0op"plicated a&do O4 e.g. appendicitis )ith rupture 1 )ee! course o( anti&iotics * single does o( prophla3is anti&iotics is e7ective in "ost clinical situation * should &e given ust prior to the O4 or at the ti"e o( O4. % (urther dose us given in prolonged operation lasting C 5 hours. #n co"plicated O4? a (ull course o( anti&iotics should &e given + For aspiration pneu'onia: -

Re"e"&er to as! cho!ing H3

-

occup 3 s)allo)ing assess"ent

-

Flagl 6AA"g iv 
-

Vinace( 6A"g iv 
-

Vinnat 26A"g or 6AA"g BD po

-

0iproKo3acin 2AA"g iv 12H

-

0iproKo3acin 26A"g po BD

*ntu/ation ( 2 dru%s ou$d /e %i"en) - 4hiopenton

16A"g iv

-

Su3a"ethoniu" 6A"g iv

-

9ndotracheal tu&e "ar!ed at 22-25c" help )ith cricoid pressure

-"a!e sure suction read -

%ir 9ntr* Rt  @t + 6 points auscultation ? See chest e3pansion

-

SaO2 1AAL

-

0hec! 0JR e3clude an pneu"othora3/ chec! position post-

intu&ation ,enti$ator settin%s 11

#nitial settingsG -

S#' "ode *i( spontaneous &reathing+

-

0' "ode *i( resp "uscle paralsed+

-

4idal volu"e *4'+G A.6@ *6AA"l/6A!g+

-

Pressure supportG <-1A""Hg

-

SensitivitG /- 2""Hg

-

FiO2G 1AAL

-

RRG 12-16/"in *i( raised #0P? need hperventilationE RRG 1<2A/"in+

-

PFRG 5A

-

#9 ratioG 1 to 2 or 1 to  *(or o&structive air)a disease+E 1 to 1 (or restrictive air)a disease+

-

P99P *positive end e3pirator pressure+G 5-6 c"H2A

If need sedation: Fight 5 -

Dor"icu"  or 6"g #' stat 3 1? then A"g in 6A"l NS in(use 2"l/hr

If the folloings occurred hile on ventilator: Decreased SaO2 -

0hec! )hether pneu"othora3

-

#ncrease FiO2 *!eep "a3 8AL+

-

#ncrease P99P *increase recruit alveoli? decrease dead space+

-

#ncreased 0O2

-

#ncrease RR

-

#ncrease tidal volu"e *)ash out 0O2+

-

Sedation *"ore snchroni$ed &reathing+

-

%lar" *high pressureE s"all 4'+

-

Fighting vs "achine C sedate

-

Pneu"othora3 / pleural e7usion

-

Bloc! tu&e C suction

-

%lar" *high 4'E lo) pressure+

-

@ea!ing air C chec!

-

BP lo)

-

ust chec! )hether pneu"othora3

5O.D dru%s 6 7 -

'entolin 2.6 or 6"g ne& *no longer used a(ter S%RS+ 12

-

%trovent A.26 or A.6"g ne& *no longer used a(ter S%RS+

-

'entolin 2 or 5 pu7 5h or #D

-

%trovent 2 or 5pu7 5h or #D

-

Bisolvon 1 ta& 4DS PO or Flui"ucil 2AA"g 4DS PO

-

9S 1A "l 4DS PO

-

Prednisolone A"g D PO or Hdrocortisone 1AA-2AA"g #' 8H or


Bricanl A.26/A.6"g S0 M12h or Bricanl durule 6"g BD PO

- 4heodur

1AA or 2AA"g BD PO

-

%"inophlline drip 26A"g in 6AA"l NS over 2A"in M12h

-

0hest phsio  PFR BD

.nti'B dru%s -

Ri(a"picin 56A"g D

-

#sonia$id AA"g D

-

Pra$ina"ide 1.6g D

-

9tha"&utol
-

'it B8 1A"g D

Haeopt&sis ( 5. $un% tu/ercu$osis 6 /ronciectasis -

Bld 3 %B=

-

Sputu" 3 %FB 3? ctolog? 0/S4? R/

-

4-2 test i( 4B suspectede

- 4ransa"ine -

6AA"g #' stat then 8H or #D PO

#n(or" i( increased hae"optsis

Three air#orn transitted dis1 T.2 easles2 &aricella 3oster 4 CARDAC !ast .! -

0ardiac "onitoring? EC% 12 leads * note the rhth"- sinus

tachcardia + -

>rgent consult "edical

-

Digo3in *o"it i( %R 8A+

-

@oading doseG A.26"g iv stat? then 
-

aintenanceG A.126-A.26 "g D po *A.A826"g (or elderl+ %"iodarone drip @oadingG 16A"g in 1AA"l D6 over A "in 13

-

aintenanceG 8AA"g in 6AA"l D6G 2A"l/hr

#arro cop$e tac&cardia : 0on,r" it is the case )ith 90= 1. 'agal "aneuvers  contradicted in patient )ith carotid &ruit 2. %4P 1A"g rapid #' push *short hal( li(e+ )ait (or at least 2 "inutes &e(ore ne3t dose %4P 2A"g rapid #' push

)arn

patient

o( transient Kushing  chest disco"(ort . 'erapa"il *isoptin+ 2.6"g #' 16 "inutes i( tachcardia persists  BP sta&le 5. #( BP not sta&le? then snchroni$ed D0 cardioversion Brad&acardia: 1. Reall &radacardia  %ssess the rhth" oursel( 2. 0linicall sta&le 0onscious state? BP? SOB congestive heart (ailureneed o( atropine? 40P or inotrope as stated in house"an hand&oo! . 0auses o( &radacardia  12 leads - 90= a. drugs- &eta-&loc!er revie) drug chart &. PhsiologicalG hpother"ia c. PathologicalG rhth" sinus node disease * sic! sinus sndro"e+  %trioventricular &loc!  degrees? hpothroidis" 5est discofort (.5S) -

Blood 3 0:? @DH *cardiac en$"es+ ? 4roponin 4 
then 
#n(or" O /- urgent consult "edical *i( li!el %0S? e.g. raised 4n4+

-

%spirin 18A"g che)ed stat

-

NitratesG 4N= ta& 1 S@ prn

If chest pain at rest regardless of )*+: -

#so!et in(usion 6A"g in 1AA"l NS? at 5"l/hr *"a3 2A"l/hr+

-

Nitrocine 26"g in 1AA"l NS? at 5"l/hr

If chest pain subsided -

#sordil 1A"g tds po

-

Nitroder" 1A"g @% D

-

%spirin 18A"g che)ed stat? then D *)ith triact+ 14

-

0artia 1AA"g D PO

-

Beta-&loc!ers *i( no contraindications? and not in HF+ -

-

Betaloc 26"g BD PO

@ heparin *i( pain not controlled or high ris! (eatures present+ -

9no3aparin A.1"g/!g S0 12H

-

Fra3iparine S0G



A.5"l BD i( B 6A!g



A.6"l BD i( B 6A-6U!g



A.8"l BD i( B C8A!g

-

Others i( indicatedG %09-#? 0a &loc!er

D, : %. Reall D'P  0linicall unilateral leg s)elling? )ar"th? redness? dilated veins *s"pto"s+ Ho"ans sign ? an SOB? BP/Pulse *sign+ Ris! (actorsG old age ? "alignanc? O4 esp. pelvic surger? O0 pills >rgent >S Doppler to con,r" B %(ter con,r"ation 1. 0o"plete &ed rest 2. 90=loo! (or S14? right ventricular heart strain . 0JRG an linear atalectasis 5. onitor BP/P/SaO2 1H 3 8 ? i( sta&le then 5H 6. 9no3aparin A.5"l S0 12 H * (or B  5A!g+ 8 .0onsult "edical (or )ar(arin dosage

5 %ASTRONTESTNA" 5o;ee %round "oitin% -

0hec! BP/P? >/O? do a&do"inal? PR e3a"? /- 0JR *(ree gas+

-

Stop aspirin or )ar(arin 15

-

Special alert i( H3 o( cirrhosis * &leeding esophageal varices+G -

urgent consult surgical

-

NPO e3cept "ed? give #'F? BP/P? >/O 1H-5H * #' angiocatheter+

-

R6T to BSB? aspirate 1H-5H *ole$ insertion i( in shoc!

-

.lood 3 0BP *For ne)l ad"itted >=#B? need to )or!up (or underling cause? e.g. & Bld 3 0BP? @/RF4? clotting? hepatitis status? aFP? 4pe and

Screen+ -

Vantac 6A"g iv 
-

%nti-encephalopathG lactulose 1A-2A"l 5-
-

0onsult surgical 3 O=D

If 'assive  vo'iting fresh blood: -

'itals 1H

-

Hae"ocue statE Bld 3 0BP? clotting pro,le? 4pe and Screen

-

@osec 5A"g iv 25H *o"epra$ole+

-

>rgent consult surgical 3 assess"ent /- urgent O=D *0all (or

senior (or help Q + - 4rans(use

pac!ed cells / FFP according to &ld results

5onstipation -

Dulcola3 ta& 1 PR 31 stat

-

Fleet ene"a PR 3 1 stat

-

Seno!ot .6 or 16"g Nocte po prn

-

@actulose 1A"l &d/tds po prn

-eta"ucil 1A"l BD/4DS PO * orange in color+ D&spepsia -

g4ri 1A"l tds po

- 4riact

or lanta ta& 1 tds po

-

=elusil ta& 1 tds po

-

=asteel ta& 1 tds po prn :;1

./doina$ pain (anti'spasotics) -

93clude surgical causes ,rst & e3a"ining the patient

-

Holopon ta& 1 tds po prn 16

-

Buscopan ta& 1 tds po prn or Buscopan 2A or A or 5A"g #/#' 8H

prn Dont use it in #.O.asthenia =ravis? urinar retention due to prostate hpertroph Diarroea -

0hart #/O? /- #'F supple"ent

-

@oo! (or underling causes? prescri&e the (ollo)ings onl i(

indicatedG -

:aopectate 1A"l Mid po prn

-

@o"otil ta& 1 Mid po prn * to overco"e the side e7ect o( neotig"ine

in =+ -

#"odiu" ta& 1 Mid po prn

Haeorroid -

Fa!tu supp ta& 1 BD or oint"ent @% tds

-

Jlocaine ell @% tds prn

-

eta"ucil 1 sachet tds po

7%nusil 1 ta& Dail PR

17

8 NER9OUS S/STEM Stroe - 5,. -

NPO e3cept "ed? #'F

-

BP/P/SaO2 5H

-

Neuro O&s 1H 3 1/ *=0S+

-

Bld 3 0BP? @/RF4? clotting? glucose? (asting lipid? (asting glucose

-

0JR? 90=

-

>rgent 04 &rain *plain+

-

>rgent consult "edical 3 assess"ent

-

O7 anti-H4 drugsE treat onl i( reall high? e.g. BPC2AA/1AA

-

O7 aspirin? anti-platalets until hae"orrhagic stro!e e3cluded & 04

&rain -

@i"& and chest phsio

-

0onsult occupation 3 s)allo)ing assess"ent

pi$eps& -

%B0? O2? glucose? Hsti3? electroltes

-

=ive D6A 6A"l iv? thia"ine 1AA"g iv

-

#' dia$epa" 1A"g &olus

-

Repeat dose in 6 "in

-

Phentoin 18-1<"g/!g iv over A"in? then AA"g po/iv

-

0onsult anaesthetist? #0>

-

onitor BP/P? RR? 90=? te"p

-

r/o in(ection? poisoning? anti-convulsant )ithdra)al

Sei+ure attacs -

0onvulsion chart? /- neuro-o&s

-

#( not spontaneousl su&side in 1A"in? can considerG

-

'aliu" 6"g iv stat 3 1

5#S tuour or aeorra%e it ass e;ect -

De3a"ethasone 1A"g #' 3 1 then 5"g 8H #'

-

Dilantin 6AA"g #' 3 1 or 6AA"g in 1AA"l NS over A"in 3 1E then

1AA"g 
Pepcidine 2A"g iv 12H

-

annitol 26A"l iv over 2A"in? then 
- 4ransa"ine

1g #' 3 1 then 6AA"g 8H iv

: ENDOCRNE D4* drip (for fastin% of D7 patient) -

./ #//'l 0&-12, plus the folloings: Hsti3

%ctrapid H

:0@

5-

A

A

-11

6

6

11-1

1A

1A

1-22

16

16

C22

2A

2A

*e.g. D1A 6AA"l  1Au %ctrapid H  1A""ol :0l 
6A"l D6A iv stat 31 * &etter to give either 5A"l or 8A"l as the

pac!age li"itation+ /- D1A M8h or M
16-2AG %ctrapid H 5> S0 31

-

2A-25G %ctrapid H 8> S0 31

-

C25G %ctrapid H <> S0 31 / &etter in(or"

S$idin% sca$e of .ctrapid H7 .$a&s ec$ude infection /efore %i"in% insu$in A -

0hec! Hsti3 5H or 8H? then %ctrapid H according to the

(ollo)ing scalesG -

'ersion 1G

1-16

5

Hsti3

%ctrapid H

16-2A

8

1

A

2A-26

<

19

C26 -

#n(or"

'ersion 2G Hsti3

%ctrapid H

11

A

11-15

2

15-1

5

1-21

8

21-2<

<

C2<

1A  #n(or"

20

-

Or ust order single strength according to Hsti3 reading? e.g.

-

%ctrapid H 8u sc tds prn i( Hsti3 C18 *or o"it i( Hsti3 1A+

H&per%$&ceia (poor D7 contro$) -

0hec! H&%1c? glucose? %B= i( D:% suspected

-

>rine (or !etone? sugar? al&u"in

&rotoicosis -

Propranolol 2A"g BD PO Or #nderal 2A"g 4DS PO

-

Proplthiouracil 1AA"g 4DS PO

-

0ar&i"a$ole 1A"g 4DS PO

21

; MSCE""ANEOUS 5ontrast a$$er%& -

Hdrocortisone 2AA"g #' on call to radiolog depart"ent

Dru% o"erdose -

NPO? give #'F

-

BP/P/SaO2 5HE Neuro-o&s 1H (or 1/E 0ardiac "onitor

-

Suicidal precaution

-

>rgent &ld 3 0BP/D0? clotting? %B=? @/RF4? glucose? 0aPO5? a"lase? to3icolog *paraceta"ol? saliclate? &en$odia$epa"? ethanol+

-

>rine (or to3icolog

-

=astric lavage (or to3icolog

&roine rep$aceent -

Start at A.A26"g DE chec! 4F4 to "onitor the dose

out -

0olchicine 1"g stat?

then A.6"g 2H until pain su&side/diarrhoea/"a3 dose o( 8"g reached -

Naprosn 26A"g BD PO

5e$$u$itis -

On e3a"? note an Kuctuation *)hich indicate underling a&scess+? i( ve? &edside needle aspiration to loo! (or pus aspirates *usuall done & O+

-

Note DE &ld 3 0BP? @/RF4? 0/S4E )ound s)a& 3 0/S4

-

J-ra o( the a7ected partG to e3clude underling osteo"elitis / septic arthritis

-

a"picillin and clo3acillin 6AA"g iv 8H

-

#( "ild? a"picillin and clo3acillin 6AA"g #D PO 3 1/62

D, -

ar(arinG -

#NR 1.6 G 5"g

-

#NR 1.6-2G 2.6"g

-

#NR 2-2.6G 1.6"g

-

#NR 2.6-G 1"g

-

#NR C G o"it 22

OrderG -0o"plete &ed rest -BP/P 1H 3 5 -#NR ->rgent 0JR? 90= -9no3aparin A.5"l 12H S.0. - >rgent consult "edical 3 D'4 7enorra%ia - 4ransa"ine

6AA"g #D PO

Cnit con"ersion -

""Hg 3 A.12  !Pa

5reatinine c$earance *15A-age+ 3 B*in !g+ --------------------------- J 1.A2 *(e"ale+ or 1.2 *"ale+ seru" 0r Or 0r0l  *25 hr 0r / seru" 0r+ 3 A. < END <

23

Common Clinical /Emergency case 1. GI: a. Barim Enema: ! "li# #ie$ ! %B ! Consen$ & allergic %' ! (lean )re) 2* +, ' 1 -. Colonosco)y: ! "li# #ie$ ! %B ! Consen$ & allergic %' ! (lean +re) 2* +, ' 2  oc$e m  oi#e# in close# loo) I., c. +++ ' emicolec$omy !" i$ I" 21 /#ay !Consen$ !Bl# CB+ /*"; CE& < ma$c !C< & ECG !%B ' +ro)ylas$ic n$i-io$ics I =inace> & I >la gyl !"oley & yle?s $-e on call $o ,; !(lean +re) 2* +, ' 2 2. %B+  >ollo )ro$ocol : a. ;CE: !" i$ I >li# !Bl#: CB+ *."; I/+;; "+ BG !Consen$ & allergic ' !%B )ro)ylac$ic an$i-io$ics e.g. agmen$in 1.2gm on call $o < ray !Cis)la$in 20mg I 3. @rology: a. ,@: ! "eel >or -la##er/ -la##er scan ! ; ! CB+ */"; Ca+o4 Glcose ! C@ ' C/; ! (@B !"oley $o BB -. %aema$ria : ! ; ! Encorage >li# in$aAe ! CB+ */"; Ca+,4 Gl I/+;; ! ae rine ' ins)ec$ion ! @ ' C/; 24

! E@ ' "+ ' 3 ! @rine ' cy$ology ' 3 ! (@B ! +yri#im 1 $a- $#s ' 1/52 ! i$ro>ran$oin 50mg I ' 1 /52 i> >e-rile c. *oin )ain: ! ; ! C+ */"; Ca+,4  Gl ! @ ' C/; ! (@B ! ologesic 1 $a- I / o$aren 25mg $#s )rn 4. asclar a. + : ! " i$ I >li# !CB+ */"; I/+;; !%B !consen$ & allergic %' 5. +re!o) care: Boel )re)ara$ion >or colon $eroi# >or #rg allergy I e)arin >or oral ar>arin 6. +os$!o) care: +os$ o) ay  +ain: +C )ain a>>ec$s -rea$ing  $s eas y $o ae )nemonia +os$!o) >eer: cases accor#ing $o $e )os$!o) #ays @rine o$)$ Don# care

25

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nTV^RTm aZ]XWX[cm bXTSSQRTm YZ[^WXUTWXZ[

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o_URSWR[^XZ[

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nRUQSZWZpXYXW_

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B[YSRT^Rb YTdYXV] T[b hdZZb ^VcTS dRaRd^

ke
26

@[R Z` WQR X]]V[Z^VUUSR^^XaR bSVcê BW TYW^ h_ X[QXhXWX[c
nTV^RTm aZ]XWX[cm bXTSSQRT

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oRTbTYQR^m ^fRTWX[c

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o_URSWR[^XZ[

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nRUQSZWZpXYXW_

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27

C_YZUQR[ZdTWR ]Z`RWXd QT^ hRR[ V^Rb `ZS WQR WSRTW]R[W Z` TYVWR SRiRYWXZ[ T[b `ZS USRaR[WXZ[ Z` SRiRYWXZ[e BW YZVdb hR V^Rb X[ YZ[iV[YWXZ[ fXWQ ZWQRS X]]V[Z^VUUSR^^T[Wê qJK ]c URS YTU^VdR •

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ARVgZUR[XTm

B[`RYWXZ[

28

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oXcQ hdZZb USR^^VSR `SZ] `dVXb SRWR[WXZ[

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•

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29

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Common Treatment Orders

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