M1 Medical

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Author:
stan5155
ID:
97351
Filename:
M1 Medical
Updated:
2011-08-17 21:01:17
Tags:
Medical
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Description:
General medical protocols
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  1. Abdominal Aortic Aneurysm
    Establish 2 large bore IVs of Normal Saline or Lactated Ringers as necessary, to maintain a blood pressure greater than 90 mm/Hg systolic.

    Interfacility

    If systolic BP greater than 120, initiate antihypertensive

    • Labetalol IV bolus dose is 0.25 mg/kg. This may be doubled in 10 minutes and then doubled again in 10 minutes with repeat doubling until a desired effect is reached or until cumulative dose of 300 mg has been given.
    • Cardene 5mg/hr (50 ml/hr) may increase q 15 min by 2.5 mg/hr. No more than 15 mg/hr
    • o If systolic BP is < 90, only initiate vasopressors if evidence of altered mental status or imminent cardiac arrest.

    Fentanyl
    1-2 mcg/kg IV every 10 minutes as needed for pain management. Hold if systolic BP <90.
  2. Acute Aortic Dissection
    Confirm dissection with CT of Chest/Abdomen, If unable to confirm dissection via CT do not follow this protocol

    • Target systolic BP of < 120
    • If systolic BP greater than 120, initiate Cardene 5mg/hr (50 ml/hr) may increase q 15 min by 2.5 mg/hr. No more than 15 mg/hr

    If noted tachycardia or HR > 100 may administer 5mg of IV Lopressor, may repeat every 5 minutes; hold if systolic blood pressure is <90 or a heart rate <60 bpm

    If systolic BP is < 90, Only Initiate Vasopressors if evidence of altered mental status or imminent cardiac arrest

    May use Fentanyl 1-2 mcg/kg IV every 10 minutes as needed for pain management. Hold if systolic BP <90.
  3. Adult Sepsis
    • Criteria for suspected sepsis and 2 or more of the following:
    • Fever >100.5
    • HR > 100
    • RR >20 or PaCO2 < 32
    • WBC <4000 or > 12000

    • Fluid bolus 20 mg/kg in the first 2 hrs
    • Repeat 500 ml boluses and reassess

    Dopamine or Levophed 5-30 mcg/min
  4. Combative patient
    Blood glucose

    Versed 1-2 mg IV repeat as necessary.

    or

    Ativan 2 mg IV/IM and 50 mg IV/IM Benadryl
  5. Diabetic Emergencies
    Glucose > 250 mg/dL

    Insulin 0.1 unit/kg IV followed by infusion of 0.1 unit/kg/hr

    Mix 25 units in 250 ml NS= 1 unit/10 ml
  6. Heat Stroke
    Temp

    Ice packs

    Valium 2.5-5 mg IV for shivering

    Cool NS 125 ml/hr unless hypotensive
  7. Hyperkalemia
    lab value present > 6.0 or clinical suspicion

    fluid replacement as needed

    • 10 units insulin IV with 1 amp D50
    • hold D50 if glucose > 250 mg/dL

    Albuterol 10-20 mg in 4 ml inhalation

    1 amp Sodium Bicarb, may repeat if QRS > 120 or absent p wave

    1 gram Calcium Gluconate IV over 3 minutes with QRS > 120 or loss of P wave. May repeat every 5 min x 3 until ECG resolves....first line in unstable pts.
  8. Hypotension of undetermined origin
    10-20 ml/kg LR or NS WO, repeat to maintain BP > 90.

    In the setting of pulmonary edema consider vasopressors, refrain from fluid

    Dopamine 5-30 mcg/kg/min

    Levophed 2-30 mcg/min
  9. Continued Sedation
    ETCO2, monitor, SpO2, definitive airway

    Normotensive BP >90

    • Zemuron 1 mg/kg, IV x 1
    • Fentanyl 1 mcg/kg IV every 10 as needed
    • Versed 1-2 mg IV every 5, max 8mg in 1 hr

    Hypotensive BP < 90

    • Zemuron 1 mg/kg IV x 1
    • Fentanyl 1 mcg/kg every 10 unless decrease in BP > 6 mmHg
    • Ketamine 1 mg/kg every 10 as needed

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