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Resp ....................................................................................................................................................... 3
Asthma .............................................................................................................................................. 7
COAD .................................................................................................................................................. 8
Suspected bronchiectasis .............................................................................................................. 8
Bronchopneumonia ........................................................................................................................ 8
Pulmonary Embolism ..................................................................................................................... 9
Drugs.................................................................................................................................................. 9
Cardiology ............................................................................................................................................... 3
Stable Angina ................................................................................................................................... 3
AMI ..................................................................................................................................................... 4
APO..................................................................................................................................................... 4
Arrhythmia ....................................................................................................................................... 4
New Onset AF ............................................................................................................................... 4
SVT ................................................................................................................................................. 4
Infective Endocarditis .................................................................................................................... 5
CCF...................................................................................................................................................... 5
Uncontrolled Hypertension .......................................................................................................... 5
Hypertension ................................................................................................................................... 5
CRHD- tooth extraction .................................................................................................................. 5
Drugs.................................................................................................................................................. 3
Renal .................................................................................................................................................... 10
Acute Renal Failure....................................................................................................................... 10
Chronic Renal Failure ................................................................................................................... 11
Nephrotic Syndrome..................................................................................................................... 11
Electrolyte Disturbances ............................................................................................................. 11
Hypokalaemia ............................................................................................................................ 11
Hyperkalemia ............................................................................................................................ 11
Na.................................................................................................................................................. 12
Hypocalcemia ............................................................................................................................. 12
Infectious Ds.......................................................................................................................................... 12
Suspected Dengue ............................................................................................................................ 12
TB ...................................................................................................................................................... 15
Neuro .................................................................................................................................................... 15
Stroke ................................................................................................................................................ 15
Fits ..................................................................................................................................................... 15
Status Epilepticus .............................................................................................................................. 16
Acute psychosis ................................................................................................................................. 17
Endrocrine ............................................................................................................................................. 17
Hypoglycemia .................................................................................................................................... 17
Diabetes ............................................................................................................................................ 17
DKA................................................................................................................................................ 18
HONK ............................................................................................................................................. 18
Thyroid .............................................................................................................................................. 19
Hyperthyroid ................................................................................................................................. 19
Thyroid Storm ............................................................................................................................... 19
Hypothyroid ...................................................................................................................................... 19
Myxoedematous Coma ................................................................................................................. 19
Hypothyroidism................................................................................................................................. 19
Serious Metabolic Acidosis: pH<7.1, HCO3<10 mmol/L ....................................................................... 19
Hematology ........................................................................................................................................... 20
Warfarin Overdose............................................................................................................................ 20
Drug & blood reaction .......................................................................................................................... 20
Anaphylaxis ....................................................................................................................................... 20
Hypersensitivity ................................................................................................................................ 20
Ix ............................................................................................................................................................ 21
Drugs ..................................................................................................................................................... 22
ABx .................................................................................................................................................... 22
Sxmatic Relief .................................................................................................................................... 23
Procedures ............................................................................................................................................ 24
PD ..................................................................................................................................................... 24
CVP ........................................................................................................................................................ 24
Documentation ..................................................................................................................................... 24
Pronouncing Death ........................................................................................................................... 24
Cardiology
Entry criteria:UA or NSTEMII c as ischemic pain at rest within past 24H, with evidence of CAD (ST segment
deviation or +marker)
UA
Normal CE
Clexane X3/7, BD. OD if Creat
clearance<30
OR Fundaparinox X3/7
2.5mg OD
Aspirin 300 mg stat, 150mg OD
EST
Refer cardio
NSTEMI
STEMI
Incr CE
STE
Clexane X5/7 OR Fundaparinox X5/7
Plavix (clopidogrel) 300 mg stat, 75 mg OD
Aspirin 300 mg stat, 150mg OD
Streptokinase (first 12 H)
1.5 Mu in 100cc NS in 1 H
T/O CRU
Stable Angina
Dx: CE normal, no ECG changes, CP w high risk factors
1.
2.
3.
4.
Unstable Angina:
1.
2.
3.
4.
5.
6.
7.
8.
T.Aspirin 300 mg stat & 150 mg OD. T.cardiprin 100 mg OD if got gastritis.
S/C clexane 0.1mg/10 kg BD X3/7. S/C Funda 2.5 mg OD
liq paraffin 15 mls TDS
T. alprazolam 0.25 mg ON
T. Lovastatin 20 mg ON
3L NP O2
CRIB
KIV ACE inhibitor( if BUSE normal) or beta blocker (target HR 50-60, bisoprolol or metaprolol
50mg BD)
9. IX
a. Serial ECG + CE (X3)
b. Daily PT/INR/APTT
c. FBC, RP/LFT,CE, RBS, Coags. FBS, FSL
d. UFEME
e. Echo, CXR
AMI
APO
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Arrhythmia
New Onset AF
Acute Mx
IV amiodarone 300mg in 50cc NS over 1H, followed by 500mg in 1 pint D5% run over
23H WITH cardiac miotoring
IV Digoxin 0.25 mg in 50cc ND over 1H
Digoxin PO 0.5mg BD, 0.125-0.25mg OD.
Keep K>4.0
SVT
? carotid massage
IV adenosine 6mg
Infective Endocarditis
IV C-pen 4 Mu X4/52
IV Gentamicin 80mg TDS X2/52, 240mg OD
CCF
1.
2.
3.
4.
5.
6.
7.
8.
Uncontrolled Hypertension
Hypertension
Withold warfarin
IV Heparin 25000 u in 50 cc NS, run @ 2cc/H
IV Unasyn 1.5g (1H pre and 6H post etraction)
Withold IV Heparin 2H prior to extraction
Restart T warfarin/Heparin 6H post extraction if no bleeding
6. TCA 2/12
7. Ref warfarin to 1.5mg post tooth extraction
8. T Lasix 20mg OD
Drugs
ACE inhibitor
perindropril (Coversyl)
T. 2/4/ 8mg OD
Enalapril
Captopril
2.5/5/10 mg BD
6.25mg TDS
12.5 mg BD/TDS
18.75mg TDS
25mg BD/TDS
50mg TDS
2.5mg BD
10 mg OD
1/10 mg BD
Max 6mg TDS
Ranipril
Alpha blocker
ARB
Beta blocker
Prazosin
Doxazosin
Irbesartan
Losartan
(Cozaar/Hzaar)
Telmisartan (micardis)
Valsartan (diovan)
Metoprolol (betaloc)
Propanolol
1/16 mg OD
150/300 mg OD
50mg OD
100 mg OD
20/40/80 mg OD
30/50/80/160 mg OD
50/100 mg BD
200mg OD
20/40/80 320 mg/
BD
bisoprolol
Atenolol
Carvedilol (cardioselective)
Betaprolol
Labetolol
Carvedilol
CCB
Amlodipine
Nifedipine
Diltiazem
Filodipine
Centrally acting
Methyldopa
Diuretics
HCTZ
Lasix
CHF due to
mechanical
obstruction
cardioselective
Not absolutely CI in
COPD
50/100 mg OD
3.125/6.25mg BD
10/40 mg OD
100mg BD
800 mg TDS
12.5 mg OD
50mg OD
5/10 mg OD
10/30mg TDS
30/60 mg TDS
T. 5mg BD
T. 10mg OD
125/250 mg BD/TDS
Max 1g TDS
T. 25mg OD
Max 200mg OD
T. 20/40 mg OD/BD
hepatotoxic
Spiranolactone
Lovastatin
Simvastatin
Atorvastatin
Pravastatin
Gemfibrozil (brand
name- Lopid)
Lipid lowering
T. 25mg OD
T. 20/40 mg ON
T. 20/40 mg ON
T. 20/40 mg ON
T. 20/40 mg ON
T. 300mg
Inotropes
Dopamine
20 mcg/kg/min
Single strength: 200 mg in 50 cc NS
400mg in 50cc NS at 72cc/H
Dobutamine
250 mg in 50cc
500 mg in 500cc run 3cc/H
Initial: 0.5-1.0 mcg/kg/min
Maintenance 2.5-20 mcg/kg/min
Max 40 mcg/kg/min, up to 20cc/H
4mg in 50cc
8mg in 50CC
0.005-0.5 mcg/kg/min, up to 20 cc/H
Noradrenaline
Resp
VM 28 35 50%
HFM 10 15 L/min
Intubation
*if CO2 retention- max VM 28%
Asthma
1. Ix: FBC, RP, Coags, ABG, GM, RBS, Sputum C&S, CXR, ECG if >40,
a. CXR: hyperinflated lung when R>5th rib, L> 6th rib. Sulcus widened, flattened
diaphragm
2. Prop up pt
3. Neb combivent 4Hly
4. Neb Pulmicort 1mg BD/TDS
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
COAD
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Suspected bronchiectasis
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Bronchopneumonia
A/B options:
o IV Unasyn 1.5g TDS+ T.EES 820 mg QID
o IV Augmentin 1.2g TDS + T.EES 820 mg QID
o HCAP: IV Tazosin 4.5mg stat & TDS, or renal dose 2.25 mg TDS
T.PCM 1g TDS
Tepid sponging
Decongestant:
o T. Piriton 4mg TDS
CAP: strep pneumonia, moxarella
HAP: G-ve, Klebsiella, Enterobacter, Pseudomonas, ACBC ESBL. 3rd-4th line: cefipime, tienam,
imipenem
A/B choice
o 1st line: Augmentin w EES
o 2nd line: Unasyn, cefuroxime, augmentin
o 3rd line: fortum, cefobid
Pulmonary Embolism
Ix
o ABG: hypoxia, hypocapnia
o ECG: SI, Q III, T III. Sinus tachycardia, RBBB, R ventricular strain, RAD
o D dimer
o CXR
o Spiral CT
O2 supplement
Prop up pt
Heparin infusion
Drugs
Anticholinergic
Atrovent (Ipatropium)
Short acting B
agonist
Ventolin
Respolin (salbutamol)
2 puff PRN
Long acting B
agonist
Serevent (salmeterol)
2 puff TDS
Long acting
anticholinergic
steroid
Combo
Spiriva (Tiotropium)
Budesonide (inflammide)
Combivent (Ipatropium
+albuterol)
Seretide (salmaterol &
fluticasone)
2 puff TDS/PRN
Renal
Creatinine clearance Cockcroft-Gault formula
0.88 if male
Normal F95, M120
Sediment
Specific Gravity
Na
Fractional excretion of Na
U:P Urea
U:P Creatinine
U:P osmolality
Osmolality
Mx
Prerenal
N
>1.020
<20 mmol/L
<1%
>20
>40
>1.2
>500
Renal
Tubular cell/cast/granular cell
1.010-1.012
>40
>1%
<10
<20
<1.2
<400
Ix:
o FBC, RP, Ca/Alb/PO4, FBS
o ABG (acidosis)
o UFEME, Urine C&S, Urinary profile
o ECG (hyperK)
o USG KUB
o CXR TRO Pedema
Fluid restriction 800cc/day (oliguric ARF). In prerenal cause- fluid replacement
Strict IO
KIV PD if urea increase
Tx hyperkalemia
Dietary advice: low protein and postassium diet
Fluid challenge: 250 cc NS over 15 mins. If BP not improved or CVP does not increase by 2
cm, rpt fluid challenge (up to 500-1000cc)
Keep CVP 5-10 cm
Scenario
o Good BP and U/O: fluid for maintenance
o Volume restored, low BP= inotrope
o Volume restored, BP good, U/O poor- IV frusemide. If not improving w frusemide
and inotropes, fluid restriction 500cc /d
Nephrotic Syndrome
Ix:
o
o
o
Plan
o
o
o
o
o
o
o
o
o
Electrolyte Disturbances
Hypokalaemia
Fast correction
o 1g KCL in 100cc NS over 1 H
o Max 1.5g KCl in 100cc over 1H
o Repeat BUSE 1H post correction
BEWARE fast correct in ESRF pt!!
Hyperkalemia
Dx
1. Sx rare: muscle weakness, abd distension, diarrhea
2. ECG: tall T wave flatten P wave widened QRS sine wave VF/Asystole
3. Cause
a. Renal failure: dialysis
b. Drug induced: ACE inhibitor,
c. Acute adrenal insuff: long term prednisolone + stress. IV NS +IV hydrocortisone
100mg 6 Hly
Mx
1. 5-6: oral kalimate 5/10/15 g TDS. Stop when K<5.0
2. If K>7 OR K>6 AND QRS widening, give cocktail
3. Cocktail:
a. IV 50cc D50% (bolus, over 5min) +IV Actrapid 10 u
b. 10cc IV Ca Gluconate 10% (1-2 amp) over 5-10 mins w ECG monitoring
c. Repeat ABG, KIV resonium A
4. (If expected persistent hyperK-RF, crush injury), Resonium A 15g TDS
5. IV NaHCO3 1mmol/kg over 5 min (caution: fluid overload)
6. Perform dialysis
Na
Requirement: 1-2mmol/kg/d
Na maintenance= (2XBW)/ 177
Na deficit = (140-Na) X 0.6 (young) or 0.5 (old) X BW, divide by 17.7
1 pint= 150 mmol/L
Mist NaCl= 1g/5ml, 1ml=3.5 mmol
Correct < 12 mmol/24H
00
Hypocalcemia
Fast correct
o IV 20cc 20% Ca gluconate over 20 min
o IV 10cc 10% Ca gluconate over 10 mins
ECG: Prolonged QT, corrected QT =QT/square root of RR. Normal 0.38-0.42
Infectious Ds
Suspected Dengue
DF
DHF
DHF w compensated shock
DHF w decompensated shock
Thrombocytopenia + Hct
+ warning sign
Normal BP
Systolic hypotension
WHO grading
1.
2.
3.
4.
5.
Muar Med sign: fundoscopy-retinal hrage, bleeding (epistaxis, petchechiae, rash), jaundice,
arthralgia/myalgia, headache, retro-orbital pain.
Complete Dx: DHF grade x, Day x of illness, x phase, x hours of defeversence with/without
warning signs or organ impairment, with (compensated) shock
1.
2.
3.
4.
5.
6.
Fluid mx
Ix
Mx
Dengue CME question
1. Severe Dengue, D4 illness, compensated shock, with warning signs, critical phase
2. How to manage Ht 153.4 kg Wt 68 kg
a. Ideal body weight
b. Run fluid bolus 5-10cc/kg NS over 1H
c. Refer GA
d. Dengue serology
3. Why the above regime
a. Fluid resuscitation for compensated shock
4. How soon to repeat FBC
a. Right after finishing bolus
b. To decide if require further fluid resuscitation
5. HR 118 BP 100/86Hct 47
a. Inadequate fluid resuscitation
b. Repeat bolus 5-10cc/kg NS over 1H
6. Hct 38 BP 92/76. Imp and mx
a. Decompensated shock
b. Suspect bleeding tendencies
c. Blood transfusion: WB or PC
d. Further fluid bolus
7. Warning sign
8. Hct
TB
Anti TB regime
Isoniazide
Rifampicin
Pyrazinamide
Ethambutol
Streptomycin
Daily dose
Mg/kg
5-8, recom 5
10-15recom 10
20-40, recom 25
15-25, recom 20
15-20
Max (mg)
300
600
1500
1200
1000
Biweekly dose
Mg/kg
15-20
15-20
50
50
15-20
Max (mg)
1200
600
3000
2000
1000
Pyroxidine 10 mg OD
Neuro
Stroke
1.
2.
3.
4.
5.
6.
7.
8.
Ix: FBC, RP RBS, FSL, Ca/Mg/PO4/Alb, Coags, ESR, ECG, Echo (if have ht problem), KIV CT
brain, CXR (TRO aspiration pneumonia).
Withhold all antiplatelet until CTBrain
BP: keep MAP<130
NBM (depends on gag reflex), with IV ranitidine 50 mg TDS
RT (if no gag reflex)
IVD 3 pint NS/24 H
Limb/chest physio
KIV IV GTN
GCS Chart 2-4 Hly, inform if GSC drop, for urgent CT brain
4 Hly positioning
Ripple mattress (if bed bound)
Fits
Breakthrough Seizures
Causes:
o Missed dose, incorrectly timed dose, incorrect dosage
o Switching meds
o Sleep deprivation
o Stress
o Alcohol/drug use
o Menses
o Acute illness: esp vomit/diarrhea decreases drug absorption
Mx
1. IV Phenytoin loading dose: 750 mg in 100cc NS over 1H, maintenance 100mg TDS, then T.
Phenytoini 300 mg ON
2. IV Diazepam 5mg PRN
3. Fit chart
4. NBM
5. GCS chart
6. (If Focal)- KIV CT brain
7. T. Folate 5mg OD
Status Epilepticus
Dx
1. Seizures lasting >15 mins OR multiple seizure episode without regaining full consciousness in
between
Mx
1. RBS/GM, FBC, RP/LFT, Ca, Mg, Alb, ABG. KIV toxicology/drug level
2. Emergency Mx:
a. Protect airway: roll pt to lateral position.
b. Take V/S & GM, tx hypotension/arrhythmia/hyperthermia
c. IV Diazepam 5-10 mg stat, repeat every 5 min (MAX bolus 40 mg)
3. (If required): IV Diazepam infusion- 30 mg Diazepam in 500 NS or D5% run over 8H (MAX 100
mg /day)
4. IV Phenytoin loading dose 750 mg/100cc NS over 1H Followed by IV Phenytoin 100mg bolus
every 6-8H
a. (15-18 mg/kg eg. 750-1000 mg in 100cc NS over H
b. under ECG & BP monitoring: wo arrhythmia
5. If seizure persist w phenytoin loading dose,
a. IV phenobarbitone 10mg/kg eg. 600mg over 10min
b. If persist: IM Paraldehyde 5100mL OR IV Lignocaine 50 mg KIV followed by 50100mg in 250cc D5% over 1H
c. If persist: refer GA
6. KIV ventilation if spont resp inadequate (pO2 <80 mmHg, CO2 retention)
7. Find cause
a. Electrolyte, acid base imbalance
b. Hypoglycemia- IV D50% 50cc
c. Cerebral hypoxia: O2, CPR, ventilation
d. Uremic encephalopathy- dialysis
e. Hypertermia:
f. Hypertensive encephalopathy- IV Nitroprusside/labetolol/hydralazine
g. Drug overdose
h. Infection-meningitis
8.
9.
10. l
Acute psychosis
Endrocrine
Hypoglycemia
GM<2.8
50cc D50 bolus, GM 1H post dose, then 4Hly GM
IVD 2 pint D10%, adjust accordingly
Search for cause
o OFF insulin & OHA
o If no cause- do RBS
If GM high 1H post bolus
o Gh GM before cutting downDO NOT give IV actrapid
o If on IVD- cut down.
o If not on IVD- rpt GM in 1H. Allow 2-3X
Diabetes
Dx Criteria
Normal
<5.6
<6.1
Asx pt
FPG
Target:
>5.6
6.1-6.9 OGTT
> 7.0 FPG
o
o
o
o
o
Drugs
FBS
HbA1c
TG
HDL
LDL
Biguanide
: 4.4-6.1
: <6.5
: <1.7
: >1.1
: <2.6
Acarbose: 50 mg OD
MTF 500 mg OD-TDS, max 1000 mg BD
sulphonylurea
SE: hypoglycemia
DKA
Dx criteria: ketonuria, ketoacidosis(pH<7.3, HCO3<15), high GM. Usually Type I young pt
1.
2.
3.
4.
5.
6.
7.
HONK
BUSE stat, RBS
Plasma osmolality= 2 (Na + K) + urea + glucose
Thyroid
Hyperthyroid
Carbimazole
PTU
Propanolol
Initial 4-6wk
30-40 mg OD
300-450 mg OD
Maintenance
5-10 mg OD
Max 60mg OD
50-100 mg OD
30-60mg OD
Thyroid Storm
Cardinal sx: severe tachycardia, hyperthermia, GI sx (vomit, diarrhea, abdo cramp, jaundice),
delirium
Precipitating factors: stress, surgery, radio-iodine therapy in poorly prepared pt, MI
Mx
Hypothyroid
L-thyroxine
50-100 mcg OD
Maintenance
100 mcg OD
Myxoedematous Coma
Ix
o ABG: hypercapnia
o FBC, BUSE, GM, TFT
o ECG: short Q wave
L-thyroxine
Hypothyroidism
<3.0
Sx: tremor, palpitation, weakness, headache
50cc D50 bolus, then flush w NS 5mL. Rpt GM after 5 mins
Then D10% maintenance, or if GM>15 D5%
Hematology
Warfarin Overdose
Plan
o
o
o
Daily Coags,
Wo for bleeding tendencies
If bleeding:
Withhold warfarin
Vit K/FFP (d/w MO first)
Avoid green vegetables: cabbage(bunga kubis), spinach(bayam), mustard (sawi),
soya bean, peanuts, alcohol
Swelling>itchy
o IM prednisolone 40 mg stat
o IV Hydrocortisone 100 mg stat
o T. piriton 4 mg TDS
Itchy>swelling
o IM piriton 10-20 mg stat
o T. prednisolone 5 mg OD
Hypersensitivity
Ix
Anemic W/up
Lumbar Puncture
Renal w/up
Septic w/up
Stool w/up
TB w/up
HV/Hep B/Hep C
Drugs
ABx
Amoxycillin
Augmentin (Amoxycillin +
Clavulanic acid)
Azithromycin (macrolide)
Bactrim (trimethoprim&
sulfamethoxazole)
Bacampicillin (prodrug of
ampicillin)
Benzylpenicillin
C-penicillin
Cefuroxime (2nd gen)
Cefobid (Cefoperazone, 3rd gen)
Ciprobay (ciprofloxacin)
Claforan (Cefotaxime, 3rd gen)
Clarithromycin (macrolide)
Clindaymycin
Cloxacillin
Doxyxycline
EES (erythromycin
ethylsuccinate)
Flagyl (Metronidazole)
Fortum (Ceftazidine, 3rd
gen+antipseudomonal)
Imipenem
Meropenem
Rocephine (Ceftriaxone)
Sulfaperazone (Cefoperazone
+sulfabactam)
Tazosin (tazobactam
+piperacillin)
Tienam (imipenem +cilastatin)
T. 1g BD
IV 1.2g TDS
T 625mg BD, 625mg TDS for
pneumonia
IV 500mg /1g OD
T. 500 mg OD
2/2 BD
T 400 mg BD
IM 1.2/2.3 megaunit weekly in
syphilis
IV slow infusion 7.2g daily in 6
divided dose
IV 2-4 megaunit QID
IV 3.5g QID
T 125 mg QID
IV 1.5g stat, 750mg BD
T. 250mg BD
IV 500mg/1g BD
T. 200 mg BD
IV 400-800mg OD
IV 1g QID normally change
to T.Zinnat
T. 1g BD (max 12g/d)
T 500mg OD/BD/TDS
T. 400 /600 mg QID
IV 1g QID
T. 500mg QID
T. 100 mg BD
T. 800mg BD/ 400mg QID
(max 4g/d)
IV 500 mg TDS
T. 400mg BD
IV 1g TDS 2g BD 2gTDS
IV 500mg TDS/QID
IV 500 mg OD 1g TDS
IV 2g stat, 1g OD
IV 1-2g BD
IV 4.5mg TDS
IV 1g BD
Unasyn
(ampicillin+sulfabactam)
Vancomycin
Zinacef (cefuroxime)
Zinnat
H pylori eradication
o C.lansoprazole 20 mg BD, T. Amoxycillin 1 g BD, T. Clarithromycin 500 mg BD 2/52
o THEN C. lansoprazole 30 mg OD 6/52
Meningitis
Prophylaxis of meningococcal
meningitis
Pneumonia (partially tx)
Sxmatic Relief
Actifed
Decongestant
DONT give <2yo
Buscopan (hycosine)
1/1 TDS
(triprolidine 2.5mg,
pseudoephedrine 60mg)
T. 10mg TDS
Motilium (domperidone)
T. 10 mg TDS
Piriton (Clorpheniramine)
T. 4 mg TDS/QID/4 Hly
Stemetil (Prochlorperazine)
Stugeron
5/10 mg BD/TDS
T. 25mg TDS (vestibular
disorder)
50-75mg TDS (PVD)
GI spasm
N&V, vertigo
Procedures
PD
Indication
1.
2.
3.
4.
Creat>300,
Metabolic acidosis
HperK >6
Uremic encphalopathy
Documentation
PD done aseptic technique under the supervision of Dr.. Consent taken
SpO2 maintained >95% throughout procedure
Good inflow & outflow observed, no immediate complications noted. Clear PD fluid
Plan:
PF for 60 cycles
Isotonic solution in/out first 6 cycles
a. In 5-10 mins
b. Out 10-20 mins
c. No retention
Then for the 7th cycle onwards: in 10 mins, retain 20 mins, out 15 mins
Inform if PD poor flow/blood stained/ leaking/ ssx of peritonitis
Others:
(IF TURBID)Add IV Genta 8mg in each PD bag until clear
Wo for ssx peritonitis
IV Dormicum 2.5mg during PD (If pt resist, add 2.5mg)-monitor SpO2
CVP
Normal 8-12
Tip of CVP: 2nd ICS. If too deep- low reading, too peripheral- high reading.
IJVC
Placement in R atrium
Documentation
Pronouncing Death
Informed by SN
Pt put on VS monitoring & Cardiac monitor