ENTRESTO

Mida-Morphine for sedation may vary from other healthcare institution. Preparation available in KKM: 1) Midazolam injection: 5mg/ml, 15mg/3ml 2) Morphine Injection: 10mg/ml Dilute: ||| Midazolam 30mg (6ml) ||| + ||| Morphine 30mg (3ml) ||| in 21ml Normal Saline (qs. 30ml) in 50cc syringe ~ ~ ~ Midoazolam 1mg/ml and Morphine 1mg/ml   1. May give loading dose of 0.05 mg/kg midazolam 2. Start at 0.06 mcg/kg/hr of midazolam 3. Dose range: 0.06 - 2 mg/kg/hr 4. May increase by 1ml/hr every 20 minutes till target RASS -2 to +1 achieved     Source: Medication Reconstitution & Medication Dilution Reference 2013 HSAJB

Shock Index: - An early bedside assessment - to quickly identify septic/ dengue patients early for resuscitation - Is HR divided by SBP - Normal range: 0.5 - 0.7 - SI > 1.0 is a/w significant poor clinical outcome with acute respiratory failure - SI value is inversely proportionate with CI, SV, & MAP. - SI value in most cases raise in proportionate with lactate. How this two correlates? - Shock state (as a response of HR > SBP) causes cellular hypoxia, increase in norepinephrine release, resulting anaerobic respiration      - increase in lactate production! (HYPERLACTATEMIA) Source of information is cited by:  Berger, T., Green, J., Horeczko, T., Hagar, Y., Garg, N., Suarez, A., … Shapiro, N. (2013). Shock index and early recognition of sepsis in the emergency department: pilot study.   The West J. of Em Med ,   14 (2), 168–174. doi:10.5811/westjem.2012.8.11546

"Staff Nurse, saya nak order Lytic Cocktail satu!" Regimen Lytic Cocktail for severe hyperkalemia (In Sequence!) (with cardiac monitoring) 1) IV (slow bolus) Ca Gluconate 10%, 10mls over 5 mins STAT 2) IV (bolus) D50%, 50mls STAT 3) IV (bolus) Insulin Regular (Actrapid) 10iu STAT IV Ca gluconate 10% a. NOT for hyperkalemia secondary to digoxin toxicity b. effect should be seen in few min (onset: 5 min) & lasts 30-60 min c. may be repeated once or twice PRN d. works as membrane stabilizer = restore normal gradient between threshold potential and resting membrane potential c. Complication to observe - hypercalcemia IV D50% a. May not require if patient severe hyperglycemia, DKA or HHS b. In conjunction with insulin to prevent hypoglycemia IV Insulin regular a, Facilitate glucose uptake into cell, resulting intracellular K+ shift b. Complication to observe - hypoglycemia (that's why give D50) Emergency treatment of hyperkalemia (other than

When to suspect high risk MRSA and S. viridans    in neutropenic fever?  Do all neutropenic fever initial treatment shall be added up with IV Vancomycin? Those are the risk factors: 1) Mucositis 2) Skin infection 3) History of colonization with MRSA 4) Recent prophylaxis using fluoroquinolones 5) Catheter-site infection Reserve the vancomycin use for institutions with high rate of MRSA or S. viridans . Source: BMJ (Oct 2018)

DILUTION PROTOCOL for mida-fentanyl may vary from other health institution. Preparation for each dosage form: 1. Inj Midazolam : 5mg/1ml and 15mg/3ml 2. Inj Fentanyl : 100mcg/2ml Dilution: |||||||  30MG MIDAZOLAM |||||| + ||||||  300MCG FENTANYL |||||| dilute in  30ML NORMAL SALINE in 50ML syringe For every 1ml/hr,  1mg/hr midazolam + 10mcg/ml fentanyl  is administered. Infusion starting dose : 3 ml/hr Titrate to the desired effect Bolus dose may be required for faster effect ( 3 - 5 mls), followed by infusion dose. Source: ETD HSAJB

Previous Entry: AMBIL TAHU 2: UBAT DAN KEHAMILAN Assalamualaikum, greetings! Sesetengah orang akan alergi atau biasa kita panggil "menjadi alah" kepada sesuatu bahan atau benda. Benda ini biasa terjadi. Namun, tidak semua orang akan mendapat tindak balas alergi kepada benda yang sama. Guys, nak tahu apa itu alergi? Alergi adalah satu tindak balas tubuh secara berlebihan kepada sesuatu benda setelah dikesan di dalam tubuh. Dalam kata lain, alergi juga adalah tindak balas sistem imun dalam badan kita terhadap benda yang sebenarnya tidak pun membahayakan kita. Alergi ini biasa dikaitkan dengan alergi makanan. Kadang kala kita mendengar seseorang drp member kita ni alah kepada seafood. Tapi bila kita makan tak ada pula tindak balas alah ke atas kita? Ianya boleh kita katakan "unpredictable". Bahan yang menjadi alah kepada seseorang biasa dipanggil dalam perkataan khusus iaitu "allergen". Allergen ini boleh menghasilkan tanda-tanda alah sekitanya i